Laparoscopy and Robotics Face Validation of a Novel Robotic Surgical Simulator Stéfanie A. Seixas-Mikelus, Thenkurussi Kesavadas, Govindarajan Srimathveeravalli, Rameela Chandrasekhar, Gregory E. Wilding, and Khurshid A. Guru OBJECTIVES To assess the face validity of Robotic Surgery Simulator (RoSS), a novel virtual reality training platform for the da Vinci Surgical System (DVSS). METHODS Urologic surgeons, fellows, and residents attending the 2009 American Urologic Association Annual Meeting in April 2009 were invited to an orientation session with RoSS. Participants completed a questionnaire after orientation and two modules. RESULTS Thirty participants including 24 surgeons and fellows experienced with robotic surgery and 6 robotic surgery novices participated in the study. Eighty percent participants had at least 4 years of experience with robotic surgery and 77% had performed an average of 340 cases on the DVSS as primary console surgeons. Subjects indicated that RoSS was realistically close to the DVSS console in terms of virtual simulation and instrumentation. Fifty-two percent of subjects rated RoSS some- what close and 45% rated RoSS very close to the DVSS console. Thirty-seven percent rated RoSS pinch device somewhat close, and 47% very close to the DVSS. With regard to movement of the arms, 43% rated it somewhat close, 40% rated it very close, and 7% felt that it was just like the DVSS. Camera movement and clutch functions were rated not close (11%), somewhat close (57%), and very close (32%) to the DVSS. Data were further analyzed in terms of surgical volume. Thirty-eight percent of subjects had also tried the Mimic dV-Trainer robotic surgery simulator. CONCLUSIONS RoSS provides opportunity for robot-assisted surgical training for future error-free surgery. Further validation will be necessary to assess RoSS and the application of specific modules for robot-assisted surgical training. UROLOGY 76: 357–362, 2010. © 2010 Elsevier Inc. R obot-assisted surgery exemplifies our advance- ment in medical technology. Since the Food and Drug Association approval of the da Vinci surgi- cal robot (Intuitive Surgical, Sunnyvale, CA) in 2000, surgeons across multiple disciplines have incorporated it into their armamentarium. The da Vinci surgical robot (da Vinci surgical system [DVSS]) offers the established advantages of 3D vision and EndoWrist technology with 6° of freedom of movement. 1 Despite the widespread use and interest in robotic surgery, incorporating such technology into surgical ed- ucation and developing a training device for future ro- botic surgeons has remained a challenge. Limitations have included technical and financial barriers with ab- sence of well-constructed training modules. 1,2 The cost of the da Vinci Si System is approximately $1.7 million, with a maintenance fee running between $125 000 and $150 000 per year. Adding a second console for training purposes would bring the cost to approximately $2.25 million, an expense possibly restricting widespread adop- tion of this modality. Virtual reality simulation may be the answer to these obstacles by shortening the learning curve of robotic surgery and lowering the high cost asso- ciated with training on DVSS. Before a surgical simulator can be used to assess competency of surgeons, the simu- lator must undergo initial testing to objectively confirm face validity, which examines the realism of the simula- tor. 3 Robotic Surgery Simulator (RoSS) is a novel virtual reality simulator for the DVSS. Based on preliminary estimates the price ranges between $50 000 and $100 000. The purpose of this study was to assess the initial face validity of RoSS. MATERIAL AND METHODS Simulator Specifications RoSS 4,5 is a virtual reality surgical simulator for DVSS devel- oped in collaboration between Roswell Park Cancer Institute and the University at Buffalo (Fig. 1). RoSS consists of a mock-up of the DVSS-like master controls and provides a From the Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, State University of New York, Buffalo, New York; Virtual Reality Laboratory, Department of Mechanical and Aerospace Engineering, State University of New York, Buffalo, New York; and Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York Reprint requests: Khurshid A. Guru, M.D., Department of Urologic Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263. E-mail: khurshid.guru@roswellpark.org Submitted: September 10, 2009, accepted (with revisions): November 6, 2009 © 2010 Elsevier Inc. 0090-4295/10/$34.00 357 All Rights Reserved doi:10.1016/j.urology.2009.11.069