Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial

Jason D. Kelly, Timothy M. Kowalewski, Tim Brand, Anna French, Michael Nash, Lois Meryman, Nicholas Heller, Nancy Organ, Evalyn George, Roger Smith, Mathew D. Sorensen, Bryan Comstock, Thomas S. Lendvay

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Trial design: This was a randomized controlled trial. Background: Intraoperative errors correlate with surgeon skill and skill declines with intervals of inactivity. The goals of this research were to identify the optimal virtual reality (VR) warm-up curriculum to prime a surgeon's technical skill and validate benefit in the operating room. Materials and methods: Surgeons were randomized to receive six trial sessions of a designated set of VR modules on the da Vinci Skills Simulator to identify optimal VR warm-up curricula to prime technical skill. After performing their curricula, warm-up effect was assessed based on performance on a criterion task. The optimal warm-up curriculum was chosen from the group with the best task time and video review–based technical skill. Robot-assisted surgery–experienced surgeons were then recruited to either receive or not receive warm-up before surgery. Skill in the first 15 min of surgery was assessed by blinded surgeon and crowdworker review as well as tool motion metrics. The intervention was performing VR warm-up before human robot-assisted surgery. Warm-up effect was measured using objective performance metrics and video review using the Global Evaluative Assessment of Robotic Skills tool. Linear mixed effects models with a random intercept for each surgeon and nonparametric modified Friedman tests were used for analysis. Results: The group performing only a Running Suture task on the simulator was on average 31.3 s faster than groups performing other simulation tasks and had the highest Global Evaluative Assessment of Robotic Skills scores from 41 surgeons who participated. This was chosen as the optimal curriculum. Thereafter, 34 surgeons completed 347 surgeries with corresponding video and tool motion data. No statistically significant differences in skill were observed with the warm-up intervention. Conclusions: We conclude that a robotic VR warm-up before performing the early stages of surgery does not impact the technical skill of the surgeon.

Original languageEnglish (US)
Pages (from-to)107-116
Number of pages10
JournalJournal of Surgical Research
StatePublished - Aug 1 2021

Bibliographical note

Funding Information:
This study was supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. W81XWH-15-2-0030 . The views, opinions, and endorsement by the author(s) do not reflect those of the US Army or the Department of Defense.

Funding Information:
The Seattle Children's Core for Biomedical Statistics is supported by the Center for Clinical and Translational Research at Seattle Children's Research Institute and grant UL1RR025014 from the NIH National Center for Research Resources.

Publisher Copyright:
© 2021 Elsevier Inc.


  • Virtual reality
  • Warm-up robotic surgery readiness


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