Discussion
This is the first randomized controlled trial to investigate the impact of educational videos on the performance of robotic simulation training. We found that educational video training improved the performance in robotic simulation. Moreover, CUSUM analysis confirmed the positive effect of the educational video on shortening the learning curve.Educational video should be exemplary for early training in robotic surgery and have the potential to maximize trainees’ learning and skill improvement [Regarding the evidence on robotic simulation training, several randomized controlled trials have been performed to investigate the effect of an affordable surgical robot simulator or procedural virtual reality, showing effective impact in improving robotic surgical skills [We determined that the overall scores of all drills, would be the best index for estimating the impact of educational video training. The mean overall scores in the video group were 18.4 times higher than those in the control group, probably due to educational video training.Participants in the control group improved their overall, efficiency and penalty scores through self-learning, and eventually reached the same level as that of the video group. However, the video group had significantly higher efficiency and lower penalty scores, especially during the initial phase. We propose that participants in the video group had improved their scores through both educational video training and self-learning. The penalty scores in the video group were lower throughout the drills, especially in collisions and out-of-view instruments (Fig. CUSUM analysis has been used to evaluate the learning curves for surgical procedures [Considering the positive effect of video training, our findings indicate that surgical video training could lead to improved robotic surgery performance in the clinical setting. Therefore, a structured training model for robotic surgery, that includes simulation, biotissue, and video training, should improve surgical skills and shorten learning curves [The present study had several limitations. Although this was a randomized controlled trial, the sample size was small. Further studies with larger sample sizes are required to externally validate our findings. The association between the performance of simulation training and performance in a real operating room has not yet been investigated. Therefore, future studies focusing on these are required to confirm the effect of simulation training on performance in the clinical setting. Finally, the effect of educational video on each drill was unclear. A further investigation should be helpful to understand which surgical skills can be improved through the video training.In conclusion, this study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.