Performance of robotic simulated skills tasks is positively associated with clinical robotic surgical performance

Objective To compare user performance of four fundamental inanimate robotic skills tasks ( FIRST ) as well as eight da Vinci Skills Simulator ( dVSS ) virtual reality tasks with intra‐operative performance (concurrent validity) during robot‐assisted radical prostatectomy ( RARP ) and to show that a positive correlation exists between simulation and intra‐operative performance. Materials and Methods A total of 21 urological surgeons with varying robotic experience were enrolled. Demographics were captured using a standardized questionnaire. User performance was assessed concurrently in simulated ( FIRST exercises and dVSS tasks) and clinical environments (endopelvic dissection during RARP ). Intra‐operative robotic clinical performance was scored using the previously validated six‐metric Global Evaluative Assessment of Robotic Skills ( GEARS ) tool. The relationship between simulator and clinical performance was evaluated using Spearman's rank correlation. Results Performance was assessed in 17 trainees and four expert robotic surgeons with a median (range) number of previous robotic cases (as primary surgeon) of 0 (0–55) and 117 (58–600), respectively ( P = 0.001). Collectively, the overall FIRST (ρ = 0.833, P < 0.001) and dVSS (ρ = 0.805, P < 0.001) simulation scores correlated highly with GEARS performance score. Each individual FIRST and dVSS task score also demonstrated a significant correlation with intra‐operative performance, with the exception of Energy Switcher 1 exercise ( P = 0.063). Conclusions This is the first study to show a significant relationship between simulated robotic performance and robotic clinical performance. Findings support implementation of these robotic training tools in a standardized robotic training curriculum.