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capacity of the da Vinci offers unique opportunities of training while in the
OR. When two consoles are available, both show the same image visualized by the
patient cart’s endoscope. Instruments can be handed back and forth between con-
soles, either one at a time or all three arms at once. The operative field can also be
visualized from the surgical tower’s 2D touchscreen. Any guiding telestration on the
touchscreen will be visible in both consoles.
Mimic Technologies was the first to produce a robotic-specific box trainer, shown
in Fig. 5.12. MLabs features three physical dry lab training modules, which are also
replicated in VR on the dV-Trainer and dVSS VR simulators (described below): the
Pick & Place, Matchboard1, and Pegboard1 tasks. All three represent basic robotic
skills.
As with laparoscopic skills, assessing RALS dry labs can be difficult. Traditional
laparoscopic box trainers may be better than nothing for low-fidelity simulation but
lack the ability to judge and test depth perception that robotic surgery necessitates.
The MLabs trainer has been successfully evaluated evidence in several validity con-
structs including usability (face), content, known-groups (construct), and concur-
rent validity by Ramos et al. [ 21 ] This trainer provides an objective and low-cost
way to rehearse and assess robotic skills. This particular study was unique in that it
assessed validity evidence not only for the physical tool for training but a broader
evaluative one as well, discussed below.
There are several VR robotic simulators available on the market, each with their
own charms and detriments, and numerous others on the fringes of entering the
scene. So far, four simulators, each presented in Fig. 5.13, have demonstrated valid-
ity evidence as training tools for robotic surgery; the dV-Trainer by Mimic
Technologies out of Seattle, WA; the da Vinci Skills Simulator from Intuitive in
Sunnyvale, CA; the Robotic Skills Simulator through Simulated Surgical Skills
LLC, Williamsville, NY; and the RobotiX mentor by 3D Systems in Littleton,
CO. Each system has its own graded metrics, grading scale, and presentation of
score.
The da Vinci Skills Simulator (dVSS or “backpack”) is made by the same com-
pany that produces the da Vinci robot. Unlike other simulators, the dVSS is
Fig. 5.12 MLabs box
trainer
E.I. George et al.