Education, Simulation & Virtual Reality

Moderated Poster Session

MP19-17 - Reduced-Size Training Boxes as a Tool for Simulation and Education in Pediatric Robotic Surgery

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 241

Introduction & Objective : Nearly all robotic surgery training modules currently are based on instruments and workspaces designed to simulate adult-sized patients. The combination of delicate cases, smaller working spaces, and adult-sized instruments have likely impeded the adoption of robotics into pediatric urology. As these complex procedures become the trend for surgical training, the importance of formalized pediatric urologic robotics simulation and training has become increasingly critical.The purpose of this study was to evaluate the effect of reduced-size training boxes on the robotic surgical skills of novice and experienced surgeons.


Methods : Fifteen surgical volunteers comprised of residents, fellows, and attending surgeons completed three surgical tasks: peg transfer, simple suturing, and rubber band transfer in both standard-size and reduced-size training boxes. The standard sized box trainer was used from standard FLS training modules. The reduced sized box was approximately a 25% reduction in volume when compared to the standard sized box. Participants were scored using a modified version of GEARS (Global Evaluative Assessment of Robotic Skills) wherein error rate and time to completion were noted.


Results : Performance on the reduced-size training boxes resulted in longer times to completion (peg transfer: 144 vs 104 sec, p <0.005; simple suturing: 134 vs 123 sec, p <0.05, rubber band transfer: 138 vs 86 sec, p <0.05), higher error rates (peg transfer: 1 vs 0, p = 0.015; simple suturing: 2 vs 1, p = 0.008; and rubber band transfer: 1 vs 0, p = 0.005), and lower GEARS scores (peg transfer: 3.0 vs 3.5, p = 0.001; simple suturing: 3.3 vs 3.7, p = 0.006, rubber band transfer: 3.0 vs 3.7, p <0.05). Similarly, expert robotic surgeons had relatively similar scores between training boxes, whereas trainees were noted to have significantly longer times to completion, committed more errors, and achieved lower GEARS scores with the reduced-size training box.


Conclusions : We propose that a reduced-size training model may be a critical component for minimally invasive surgical training curriculum for pediatric surgical specialties. Subjects utilizing the reduced-size training box scored worse on robotic skills assessment (GEARS) scores, performance times, and number of errors committed when compared to standard sized trainers. The reduced-size training box may be a valuable tool in cultivating the robotic skillsets of the next generation’s pediatric surgeons.

ARUN Rai

Resident Physician
Baylor College of Medicine

Arun Rai, MD; Baylor College of Medicine Scott Department of Urology

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    Jason Scovell

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      Chester Koh

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        Gene Huang

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          Engin Yilmaz

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            Saynur Yilmaz

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              Minki Baek

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                Kathleen Puttmann

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