Introduction

Cognitive training techniques such as mental imagery (MI) have been successfully used as training aids for sport, music and rehabilitation medicine. By stimulating similar neural pathways to motor tasks, MI practice leads to improved motor performance. Studies have shown that MI may be effective in surgery although so far this has been limited to laparoscopic technical skills training. Given the unique training challenges posed by robotic surgery, the potential for MI to supplement training outside of the costly and stressful operating room environment is considerable._x000D_ _x000D_ This studies aims to establish the feasibility of cognitive training for technical and non-technical skills training in robotic surgery.

Methods

A double blind, randomised controlled trial of 61 robotic novices was performed. ISRCTN registry ID ISRCTN47552076. All participants underwent initial basic robotic skills training using a robotic virtual reality simulator. Baseline ability was recorded. Participants were randomised to either MI or standard training in robotic technical and NTS skills. _x000D_ _x000D_ Participants performed 3 dry-lab warm-up exercises before completing a urethrovesical anastomosis (UVA) within a simulated operating room environment. Alongside completion of the UVA task, subjects were required to manage 3 NTS scenarios. Performances were video-recorded and analysed post hoc by blinded, expert robotic surgeons. Technical skills were assessed using GEARS and NOTSS was used for NTS.

Results

28 subjects underwent cognitive training and 33 underwent standard training. No significant differences in surgical experience or baseline ability between the 2 study groups. Cognitive training resulted in a significantly better technical performance compared to standard training (total GEARS score 13.37 vs 10.94, p = 0.007). No difference was seen in NTS performance (mean total NOTSS score for MI and standard training respectively 23.5 vs 27.0 p = 0.18).

Conclusions

This RCT provides strong evidence for the role of cognitive training in technical skills training in robotic surgery but not in NTS training. Further assessment of cognitive training in more experienced robotic surgeons is now required to determine the optimal integration of cognitive training into the robotic surgical curriculum.

Funding

none