Robotic versus laparoscopic simulation training for laparoscopic skill acquisition in novices: a randomized controlled trial.

Background

Increasing technical demands and reduced operative exposure have reinforced the importance of simulation-based training in minimally invasive surgery. Robotic simulation offers an additional training modality. Yet, evidence for transfer of skills from robotic training to laparoscopic performance remains inconsistent.

Methods

We performed a single-center, randomized controlled trial including medical students enrolled at University of Geneva with no prior laparoscopic experience. Participants were randomized to either dry-lab laparoscopic training (LT) or robotic training (RT) on the da Vinci Skills Simulator. Performance was evaluated on a dry-lab laparoscopic simulator using two tasks, Peg Transfer and Precision Cutting, adapted from the Fundamentals of Laparoscopic Surgery program. A total of 98 novices (50 in LT group and 48 in RT group) completed the study protocol.

Results

Peg Transfer composite scores did not differ significantly between groups (LT: median 357 [IQR 232-440]; RT: median 322.5 [IQR 174.2-386]; 95% CI - 5.0 to 117.0; p = 0.074; effect size = 0.18). On the Precision Cutting task, the RT group had a shorter completion time than the LT group (LT: 479 s [IQR 379-644.5]; RT: 294.5 s [IQR 224.5-394.5]; 95% CI 116-241; p < 0.001; effect size = 0.54), with no significant difference in cutting deviation (LT 61.9 ± 28.1 mm; RT: 70.8 ± 30.3 mm; 95% CI - 20.7 to 2.8; p = 0.134; effect size = 0.31). Both groups showed significant within-session learning curves, with reductions in completion time of 43.2% and 36.4% for LT and RT groups, respectively (both p < 0.001). In exploratory analyses, male sex was associated with higher Peg Transfer scores.

Conclusions

Among novice learners, LT and RT demonstrated comparable performance on Peg Transfer composite score, with RT associated with faster task completion on a subsequent laparoscopic Precision Cutting task without a corresponding loss of accuracy. These findings suggest that robotic and laparoscopic simulation may offer similar benefits for laparoscopic skill acquisition, but warrant confirmation. CLINICAL TRIAL This study is registered on ClinicalTrials.gov (NCT04989881).