Table 3.

Evidence of skill transfer from surgical skill acquired with robotic virtual reality simulators to the operating room

Reference Country	Design LOE	Simulator	No. of participants	Groups and experience	Intervention	Tasks		Outcomes	Results
						Simulator	OR
Culligan et al.30   USA	NRCT III	dVSS	18	IG: 14 credentialed gynaecological surgeons (naive to RAS) CG: 4 credentialed gynaecological surgeons (credentialed in RAS, but naive to dVSS simulator)	IG: online introduction, 10 tasks on dVSS until proficiency reached, standardized pig laboratory training, OR assessment CG: normal clinical activities, OR assessment	PB2, MB2, MB3, SS2, tubes, RW3, CT2, ED1, ED2, ES1	Robotic supracervical hysterectomy (human patients)	Operative time, EBL, GOALS	IG significantly outperformed CG in terms of operative time and EBL. No significant difference in mean GOALS scores
Gerull et al.31   USA	NCT III	dVSS	31	Surgical residents naive to RAS (general surgery, urology, obstetrics and gynaecology)	Pretest/post-test test on live robotic procedure, in between completion of dVSS proficiency-based training curriculum	CT2, ED1, ES2, RR2, RW3, SS3, TR, tubes	Varying RAS procedures (human patients)	RO-SCORE, NTLX workload	Completion of dVSS curriculum associated with significant improvement across all domains of RO-SCORE and significant reduction of NTLX workload in all domains
Vargas et al.32   USA	RCT II	dVSS	38	Medical students naive to RAS	IG: online introduction, baseline dVSS performance, 4 dVSS tasks to proficiency (maximum 10 ×), OR assessment CG: online introduction, baseline dVSS performance, no further training, OR assessment	CC1, SS1, SS2, tubes	Robotic cystostomy closure (live animal models)	GEARS, operating time	No significant differences between IG and CG
Wang et al.33   China	NRCT III	dVSS	6	Certified robotic urologists, no robotic RARP experience	IG: baseline training on dVSS, 20 × tubes task on dVSS, OR assessment (9 patients per group) CG: no further training, OR assessment (9 patients per group)	Tubes	Robotic vesicourethral anastomosis (as part of RARP) (human patients)	Operating time (anastomosis and entire operation), EBL, creatinine in drainage, duration of catheter drainage, LOS	IG significantly faster than CG at creating anastomosis; no other differences between IG and CG
Whitehurst et al.34   USA	RCT II	dV-Trainer	20	IG: 4 residents, 3 fellows, 3 attending surgeons (gynaecology and urology) naive to RAS CG: 2 residents, 6 fellows, 2 attending surgeons (gynaecology and urology) naive to RAS	IG: baseline cognitive skills and FLS test on dV, online didactic module, dV-Trainer tasks to proficiency, OR assessment CG: baseline cognitive skills and FLS test on dV; 3 FLS tasks on dV (PT, CC, ICSK) to proficiency, OR assessment	PP, RW1, PB1	Robotic cystostomy closure (live animal models)	GEARS, operating time, hand velocity	No significant differences between IG and CG on operative performance, which indicates skill transfer in this design

LOE, level of evidence according to the Oxford Centre for Evidence-Based Medicine; OR, operating room; NRCT, non-randomized controlled trial; dVSS, daVinci^® Skills Simulator; IG, intervention group; CG, control group; RAS, robot-assisted surgery; PB, peg board; MB, match board; SS, suture sponge; RW, ring walk; CT, camera targeting; ED, energy dissection; ES, energy switcher; EBL, estimated blood loss; GOALS, Global Operative Ashtrtytty5r6sessment of Laparoscopic Skills; NCT, non-controlled trial; RR, ring and rail; TR, thread the rings; RO-SCORE, Robotic Ottawa Surgical Competency Operating Room Evaluation; NTLX, NASA Task Load Index; CC, camera clutching; GEARS, Global Evaluative Assessment of Robotic Skills; RARP, robot-assisted radical prostatectomy; LOS, length of stay; dV-Trainer, daVinci^® Trainer; FLS, Fundamentals of Laparoscopic Surgery; dV, daVinci^® Surgical System; PT, Peg Transfer; ICSK, Intracorporal suturing and knot tying.