Fig. 1.

The 9 da Vinci Surgical Skills Simulator (dVRSS) exercises used were as follows: (A) Pegboard level 2: to assess camera and endowrist manipulations when transferring rings from a pegboard onto 2 pegs on the floor. (B) Match board level 2: to assess clutching and endowrist manipulation when picking up objects and placing them into their corresponding places. The objective was to avoid excessive instrument strain. (C) Needle targeting: to assess endowrist manipulation and needle control when inserting needles through a pair of matching colored targets. (D) Ring and rail level 2: to assess camera control and clutching as wells endowrist manipulation when picking up 3 colored rings and guiding them along their matching colored railings. (E) Dots and needles level 1: to assess endowrist manipulation and needle control as well as needle driving technique when inserting a needle through several pairs of targets that have various spatial positions. (F) Suture sponge level 2: to assess endowrist manipulation, camera control, needle control as well as needle driving technique when inserting and extracting a needle through several pairs of targets on the edge of a sponge. (G) Energy and dissection level 1: to assess endowrist manipulation and dissection as well as energy control when cauterizing and cutting small branching blood vessels. (H) Ring walk level 3: to assess endowrist manipulation, camera control, clutching and fourth arm control when guiding a ring along a curved vessel and retracting obstacles using the fourth arm. (I) Tubes: to assess endowrist manipulation, needle control and needle driving technique when performing a tubular anastomosis. 2013 Intutitive Surgical, Inc.