Spirito, Lorenzo (2023) Assessing the Feasibility of Remote Surgical Training (ReST) Using the da Vinci Xi System. [Tesi di dottorato]

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Abstract

The research explores the feasibility and effectiveness of Remote Surgical Training (ReST) using the da Vinci Xi System, aiming to bridge the gap in remotely controlled training for robotic-assisted surgery. Unlike traditional mentoring, ReST allows tutors to assume control of the robotic instruments, providing real-time guidance to trainees during surgical procedures. The study was conducted at the Robotic Academy Intuitive Naples (RAIN) within the Antonio Cardarelli Hospital in Naples, Italy, from March 2021 to April 2023. The research team consisted of surgeons, engineers, tutors, trainers, potential trainees, human factors experts, and statisticians. Initially planned for 12 ReST tests and 12 control events, the study expanded to 15 tests and 15 controls. Surveys were developed for tutors, trainees, and trainers, assessing their experiences. The da Vinci Xi System was used for both ReST tests and control events, covering general urological, gynecological, and thoracic surgery. It's worth noting that during the tests at RAIN, surgeries were performed on pigs using the robotic system. ReST tests involved relocating the tutor's console to an adjacent room, connected to the robotic system via a cable. An environmental camera allowed remote monitoring, and audio communication utilized the da Vinci Xi System. Fifteen ReST tests were compared with fifteen control events where the tutor was physically present in the trainee's operating room.. The Global Evaluative Assessment of Robotic Skills (GEARS) tool demonstrated high internal consistency (Cronbach's α = 0.805). There were no significant score differences between the control and test groups across GEARS dimensions (Mann-Withney test). Participants' perceptions indicated good agreement on aspects like session effectiveness and interaction quality. Trainees valued clear instructions and feeling comfortable. Tutors emphasized the importance of trainees following instructions carefully. The physical proximity of the tutor was consistently ranked as the least important aspect. ReST is feasible and as effective as traditional training, with high satisfaction levels. Trainees, tutors, and trainers supported the format's safety for patient application. Future research should explore advanced forms of remote training, including long-distance network connections. The possibility of remote collaboration within surgical teams, enabled by advanced technologies like 5G and 6G, holds promise.

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