68
or a gold star. Clicking on each score opens a secondary score sheet with a more
detailed explanation and key. These detailed reports can also be expanded to show
descriptions of each metric as well as a color-coded scale marking the range of
results.
Once the score sheet has been exited, it can be viewed again, upon any other
exercise’s completion. Metrics can also be compared over time by a bar graph on
each score report.
Data can also be drawn from the dVSS using a USB memory drive and viewed
on an external computer. With the skills simulator software, the drive must be wiped
of data and prepared for data upload. Once the drive is plugged into the simulator,
user data will automatically be copied over. Another method is to simply plug a
blank drive into the simulator and under the administrator login and export user
reports. This method will only show the number of attempts and highest score for
each module.
Mimic Technologies has made their own simulator as well, featuring many of the
same modules as the dVSS. The dV-Trainer is a standalone device that sits on an
adjustable table with a panel of foot pedals below. Processing and navigation occur
through an adjacent PC and monitor. Scores are automatically presented upon com-
pletion of a task. Each completion generates an overall percentage of success, which
is a summation of individual metrics described above for the dVSS. The metrics
graded are still dependent on the task (i.e., needle drops is a redundant score when
there was no needle present). The dV-Trainer has a plethora of additional exercises
not found on the dVSS, including full-length procedures with their Maestro-AR
augmented reality software. Trainees can perform partial nephrectomies, inguinal
hernia repairs, hysterectomies, and prostatectomies with VR instrumentation lay-
ered over actual 3D surgical video.
The Robotic Skills Simulator (RoSS) is also a standalone device. It looks similar
to the surgeon console for the actual da Vinci but is slightly smaller. Whereas the
dV-Trainer has utilized a tension-based system, RoSS uses standard linkage connec-
tions that simulate the master controller robotic arms. Simulated exercises for RoSS
are independent from the dVSS or dV-Trainer and range from basic coordinating
skills to full-length procedures. RoSS presents scores as a bar for each metric, which
starts out red, but turns green when a certain level is reached.
RoSS was also designed to perform more holistic evaluations using Fundamental
Skills of Robotic Surgery (FSRS) metrics. Four FSRS tasks are performed, with the
safety in operative field, critical error, economy, bimanual dexterity, and time met-
rics weighted and averaged [ 22 ]. In general, metrics are scored as an amalgamation
of camera movement, left and right tool grasps and number of times out of view, and
any instrument collisions or drops. RoSS also allows for data export under the
administrator login.
The final robotic simulator is also the most recently released. The RobotiX
Mentor by is a standalone device that has several unique features. Most obviously,
the simulated master controllers aren’t under any tension – they’re basically free
floating – and are only connected by a cord on each side. Each metric is scored on a
percentage, as with the dV-Trainer and most of the dVSS.
E.I. George et al.