41 The value of a 1-day multidisciplinary robot surgery training for novice robot surgeons exercises, they were aware this was not an opportunity for training. To include all essential robotic skills, exercises were selected based on four categories of essential robotic skills (Camera navigation and clutch control, wrist manipulation, needle driving, and suturing) identified at the fundamentals of robotic surgery (FRS) consortium meetings.8 The following exercises were performed by the participants: On the MIMIC dV-Trainer: • Pick and Place exercise (Figure. 2a), this exercise simulates the ability to move the arms of the robot. • Camera Targeting I exercise (Figure. 2b), this exercise simulates the ability to move the arms and camera of the robot. • Pick and Place clutching exercise (Figure. 2c), this exercise simulates the ability to move the arms and camera of the robot. On the Intuitive surgical da Vinci skills simulator • Energy and Dissection II exercise (Figure. 2d), this exercise simulates the ability to move the arms, the camera of the robot, and to used coagulation of blood vessels. On the 3D Systems RobotiX Mentor • Suturing exercise (Figure 2e), this exercise simulates the ability to move the arms and camera of the robot. All exercises resulted in simulator generated performance scores, which were used to assess the skills of the participant. These scores were based on a multitude of variables, for example, the mastery of the workspace, instrument collisions, economy of motion, and use of excessive force. To determine which of the participants passed the individual exercises the scores of the MIMIC dV-Trainer were analysed by the developer of the simulator.11 The threshold scores used are the same as the regular thresholds for the simulation exercises on the MIMIC dV-Trainer system. This means participant passed the exercise if their scores were equal or higher than the median score of data collected from more than 100 experienced surgeons with over 75 robotic cases completed.11 Each simulator and exercise had its own scale of scores and threshold score to indicate proficient comprehension of the exercise. Participants were kept unaware of their results of the skill simulation exercises. No reference scores were provided for participants for the individual skill simulation exercises. At the end of the training, the participants were asked to complete an online BPR
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