69RobotiX Mentor metrics are in some ways more detailed than the other simula-
tors, offering kinematic results such as left and right instrument as well as camera
path length, the path length of instruments that traveled out of view, as well as total
time, number of movements per right and left instrument, instrument collisions, and
clutch usage.
Working at any of these simulators, it is usually clear if an attempt at a particular
exercise went successfully or if it went poorly. It is not clear, unfortunately, what
that success necessarily entailed or how that success correlates to success on a simi-
lar exercise on a different simulator.
Fundamentals of Robotic Surgery
The Fundamentals of Robotic Surgery (FRS) is a robotic surgical skills training and
assessment program that was developed through a consensus conference involving
subject matter experts from varied backgrounds including surgeons, medical educa-
tors, behavioral psychologists, and cognitive scientists. The goal of the development
process for FRS was to develop a proficiency-based curriculum of basic technical
skills on which surgeons could be trained and assessed in order to ensure that they
have acquired the basic technical skills in robotic surgery before beginning training
in RALS procedures across a wide range of specialties. The FRS curriculum in its
current form is divided into four modules, including an introduction to surgical
robotic systems, didactic instructions, psychomotor skills curriculum, and team
training.
Training begins with a rigorous four-course online curriculum which focuses
upon skills needed for performing surgical procedures. Although it does include
some pre- and postoperative care beyond manual skills once the patient is in the
confines of the operating floor, the main focus is upon all the technical skills from
the time the patient enters the operating room until the patient leaves. In addition, it
includes information on the physical robot component vernacular and identification,
as well as emergency protocols and communication skills. The didactic component
does not include basic surgical knowledge such as indications and contraindica-
tions, importance of comorbidities, postoperative complications, and nonsurgical
complications; the training begins and ends at the operating room door.
Processes such as operating room arrangement, port and robotic arm placement,
docking and undocking, and instrument operation are all presented. Each psycho-
motor exercise is introduced. The seven tasks that need to be completed and poten-
tial errors are presented. Each of the four courses is followed by a short quiz which
requires a minimum of 70% correct to proceed. The entire curriculum has a larger,
cumulative, cognitive test as well upon module completion.
FRS validation testing was done with both VR simulation using the dVSS and
dV-Trainer, as well as a physical dome model, which was created using the identi-
cal VR exercises which are on both simulators. Each study group included the
same seven psychomotor skill exercises; docking and instrument insertion, ring
and rail transfer, knot tying, suturing, fourth arm cutting, puzzle piece dissection,
5 Performance Assessment in Minimally Invasive Surgery