Current status of simulation-based training and assessment in urological robot-assisted surgery

There has been a steady, almost exponential increase in the number of robot-assisted surgeries (RAS) during the past few decades, and this increase has brought about the need to develop simulation-enhanced training [1]. Surgical education has been vastly influenced by the military and aviation industries, which excessively depend on simulation training before real-life exposure [2]. Through the use of simulation, a huge part of the procedure-learning curve can be gained using training models; thus, these simulators are considered a cost-effective answer of the procurement of basic technical skills, especially in RAS to enhance practice in the operating room. As a result, surgical simulation has advanced rapidly, and has become an established and valid approach of training [3]. Simulators available on the market are categorized as low-fidelity, high-fidelity, augmented-reality (AR), and virtual reality (VR) [4]. Low-fidelity simulators, such as the dry laparoscopic box trainer, are cheap and movable, but they are not able to recreate real surgical circumstances. High-fidelity simulators contain cadaveric and animal models, which furnish more realistic training but are not as easily usable for several reasons, such as costs, ethical issues, and so on. AR simulators furnish highly realistic surgical circumstances, containing surgical cases such as anatomical illustrations, narrative instructions, guided movements, radical prostatectomy, and so on [5]. VR simulators use a computer-derived virtual surgical area with tactile feedback and are considered a probable answer for learning of basic techniques in RAS. Currently there are 5 VR simulators available on the market: the Surgical Education Platform (SimSurgery, Oslo, Norway), the Robotic Surgical System (Simulated Surgical Systems, San Jose, CA, USA), the dVTrainer (Mimic, Seattle, WA, USA), the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA), and the recently introduced RobotiX Mentor (3D Systems, Simbionix Products, Cleveland, OH, USA). However, there is Current status of simulation-based training and assessment in urological robot-assisted surgery Editorial