A prospective study of the effect of video games on robotic surgery skills using the high-fidelity virtual reality RobotiX simulator

Figures & data

Table 1 Demographics of participants

	Total NO	Gamers NO	Nongamers NO	p-value
Number (NO) of participants	32	12	20
Median age (IQR) years	25 (24–26)	24 (23.8–25)	25 (24–26)	0.111
Male/female	15/17	10/2	5/15
Handedness (left/right/ambidextrous)	4/26/2	2/8/2	2/18/0
Medical student/intern	30/2	11/1	19/1
Median year of study (IQR)	3.5 (3.5–4.5)	3.5 (3.5–3.8)	3.5 (3.5–4.5)	0.732
Experience with simulated surgery* (Y/N)	8/24	4/8	4/16
VR game experience (Y/N)	4/28	3/9	1/19
Prior video gameplay in hours/week (IQR)	3.9 (0.6–13)	17 (12.8–21.4)	1 (0–3)	0.004

Notes: *Porcine models, VR (not robotic surgery), box-trainer, physical models.

Abbreviations: Y, yes; N, no; IQR: interquartile range; VR, virtual reality.

Table 2 Comparison of performance metrics between gamers and non-gamers

Performance metrics (unit)		Gamers		Nongamers		p-value
		Median	IQR	Median	IQR
Time and economy
Time, s	3728.5		3055–4698.3	4229.5	3815–4869.5	0.432
Movements of left ins., NO	2122.5		2038.3–2443	2571.5	2288.8–3450.8	0.012
Movements of right ins., NO	2504		2165.8–3074.8	2996.5	2633.8–3720.3	0.103
Path length of left ins., mm	20,178.0		17,558.5–22,132.6	25,304	20,375.4–36,771.8	0.015
Path length of right ins., mm	21,920.9		18,891.1–25,208.5	28,473.2	22,724.5–34,211.2	0.063
Distance by camera, mm	3905.1		2598–5473	4628.8	1522.3–5829.5	0.527
Instrument collisions, NO	152.5		94.8–213	199	146.8–273.2	0.081
Path instruments are out of view, mm	4880.9		1727.5–7437.2	4266.7	2957.3–9213.7	0.161
Times instruments are out of view, NO	208		108–355.8	210	93–328.5	0.527
Time instruments are out of view, s	564.5		143.5–1234	463	279–1111.3	0.578
Clutch usage, NO	25		20.8–32.8	26.5	18–53.5	0.618
Safety and complications
Misapplied energy, NO	0		0	0	0	0.790
Injury to urethra NO	16		11.5–31.5	17.5	10.8–35.8	0.192
Injury to bladder neck, NO	3		2–4.8	4	2–8.5	0.211
Suspected injury to bladder, NO	0		0	0	0–1	0.104
Injury to the NVB, NO	0		0–3.8	3,5	1.8–8	0.071
Respect for tissue NO	13		7.3–27	14	8.5–35.3	0.046
Suspected injury to the UO, NO	1		0.8–2	1	1–2	0.599
Suspected injury to the EF/US, NO	10.5		4.5–16.3	13	6.8–18.5	0.442
Wound separation, mm	2.09		1.05–3.14	2.09	1.05–3.14	0.652
Improper suturing technique, NO	2		0–4	3	1–5.5	0.134
Needle handling
Percentage of stitches in optimal depth	56.6		52.6–75	62.3	55.9–69.8	0.388
Unnecessary needle piercing points, NO	134.5		80–194.3	182	101.8–252.8	0.234
Entrance and exit points for needle, NO	52		49.5–58	56	51.5–60.5	0.136

Note: P-values for metrics showing significant differences are marked with bold.

Abbreviations: ins., instrument(s); NVB, neurovascular bundle; UO, urethral orifice; EF, endopelvic fascia; US, urethral sphincter; NO, number; IQR: interquartile range.

Figure 1 Guided urethrovesical anastomosis on RobotiX Mentor. The initial target point for guided sewing is marked with yellow and with an arrow indicating the direction (A). A green target point designates accurate needle puncture (B), whereas a red target point designates inaccurate needle puncture (C). The guided task provides step-by-step instructions (D).

Figure 2 Mean performance metrics for Time and economy. Time is measured in second; path length left/right ins. measured in 10² mm. Distance camera and path ins. out of view measured in mm. Clutch usage measured in numbers*10^-2. Metrics showing significant difference are marked with *.

Abbreviation: ins., instrument(s).

Figure 3 Mean performance metrics for safety and complications. Metrics showing significant difference are marked with *.

Abbreviations: NVB, neurovascular bundle; UO, urethral orifice; EF, endopelvic fascia; US, urethral sphincter.