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laparoscopic sacrocolpopexy procedure—posterior mesh attachment. The authors
found that the model demonstrated construct validity with experts performing sig-
nificantly better than the trainee group in total score and every domain of the
GOALS scale (33 vs 20.5, p = 0.002). Face and content validity was also suggested
as 75% (all experts) “agreed” or “strongly agreed” that the model was realistic and
useful for training laparoscopic sacrocolpopexy [ 64 ].
Robotic-Assisted Surgery
Robotic surgery, utilized by the urologic specialty more than any other, is an addi-
tional surgical tool that represents the next step up from laparoscopy. With it come a
number of advantages over traditional laparoscopy, including improved ergonomics,
instruments with “wrists,” higher camera magnification, three- dimensional vision,
and improved depth perception [ 65 , 66 ]. Since it was first introduced, the number of
robotic surgeries done around the world has grown exponentially. In 2014, Intuitive
Surgical, makers of the da Vinci Surgical System (the only robotic surgical device
in use today), reported 570,000 robotic cases had been performed [ 67 ]. However,
with its incorporation, there is concern that many surgeons have been inadequately
trained prior to doing robotic cases [ 67 ]. Even within residency programs, which are
specifically designed to train residents, many residents feel inadequately prepared
to perform minimally invasive surgery at graduation [ 68 , 69 ].
Similar to the creation of the Fundamentals of Laparoscopic Skills curriculum,
there has been the creation of the Fundamentals of Robotic Surgery (FRS), repre-
senting a push toward standardization of training in robotic surgery. They have
formed a curriculum based around the development of basic robotic skills through
simulation exercises that can be applied to a number of specialties. As the result of
a conglomeration of 14 international surgical societies, FRS is the first consensus
robotic curriculum [ 20 ]. Robotic simulation is similar to other surgical simulation
modalities, consisting of physical models, animal models, and virtual reality.
Basic Robotic Skills
A cornerstone of the FRS program is the acquisition of basic robotic skills. These
skills are absolutely essential to become a safe and proficient surgeon. For simula-
tion purposes, the development of psychomotor skills is paramount, since it has
been shown to have a steep learning curve. The FRS program has 10 tasks which
teach 16 psychomotor skills. These tasks are FLS peg transfer, FLS suturing and
knot tying, FLS pattern cutting, running suture, dome with four towers for ambidex-
terity, vessel dissection and clipping, fourth-arm retraction and cutting, energy and
mechanical cutting, docking task, and trocar insertion task [ 20 ]. For simplicity,
these tasks are all performed on a single device, the “FRS dome” (Fig. 24.6).
W. Baas et al.