116 Chapter 4 The first day of the course included a half-day introductory session given by a technician who explained all the main features of the robotic system in order to familiarize with the equipment and face troubleshooting. The remaining part of the day was dedicated to VR simulation and dry lab training on specific models as the suturing pad, the vesico-urethral anastomosis model and the Venezuelan Chicken. During the second day, half of the participants attended a live case observation at OLV hospital in Aalst. There was the possibility to directly interact with the mentors/ trainers and at the same time, the participants were continuously stimulated watching important surgical details. 3D screens and double console were available in order to allow the trainees the same vision of the surgical field of the operating surgeon. The remaining part of the group had cadaver lab training on canine model. The participants trained the main steps of the radical prostatectomy and pelvic lymphadenectomy under the guidance of an expert trainer. One dog was available for three participants. The group who had live case observation during the second day of the course received the cadaver lab training on the fourth day of the course and vice versa. The third day and the fifth (last) day of the course were based on dry lab for all the participants. The model used was the living pig model and the trainees had the opportunity to train the main steps of the radical prostatectomy and pelvic lymphadenectomy under the guidance of an expert trainer. Before starting the participants were advised about the main features of the model receiving specific warnings about the fragility of the model (bleeding, urine extravasation etc.). One pig was available for three participants. Surgical skills assessment method The participants have been assessed before and at the end of the training. The assessment method was based on the performance of pre-selected exercises on virtual reality (VR) simulator. The exercises were selected based on a publication of Larcher et al.17 The selected exercises are listed below. • Endowrist Manipulation 2- Match Board 2 • Energy and dissection-Energy Switch 2 • Camera and clutching - Ring Walk 3 • Needle Driving - Suture Sponge 2 • Needle Driving - Tubes
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