Transfer of technical skills from virtual reality robotic simulation to non-virtual surgical performance: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Global skill scores: p = 0.205 (non-significant); Task completion time: p = 0.164 (non-significant)

• Effect Size: Pooled Hedges' g = 0.77 (medium-to-large effect, favouring VR training group); task completion time g = 0.47 (small-to-medium effect, favouring VR training group)

• Primary Outcome: Global technical skill scores following transfer from VR robotic simulation to non-virtual surgical performance

• Nnt Or Sensitivity: Not calculable from available data; no NNT, sensitivity/specificity, or hazard ratio reported. Effect sizes are standardised mean differences (Hedges' g) only. The wide CIs crossing zero preclude clinically actionable estimates.

• Confidence Interval: Global skill scores: 95% CI −0.64 to 2.18; Task completion time: 95% CI −0.35 to 1.29

Clinical Application

VR robotic simulators (e.g., da Vinci Skills Simulator, RobotiX Mentor) are commercially available and increasingly integrated into surgical training programmes globally. Implementation requires institutional investment in simulator hardware, dedicated training time, and validated assessment frameworks. Cost and access equity remain barriers in lower-resourced settings. Robotic surgery is expanding rapidly in Australia, with the da Vinci system used across major metropolitan hospitals. The Royal Australasian College of Surgeons (RACS) and relevant specialty societies (e.g., Urological Society of Australia and New Zealand, GESA) are developing structured robotic training curricula. VR simulation is not currently mandated by RACS credentialling frameworks, and no specific TGA or PBS implications apply to simulation training itself. This review's findings, while directionally supportive, are insufficiently robust to drive formal RACS curriculum mandates. Australian training programmes should treat VR-RSS as a supplementary tool pending higher-quality evidence. The National Surgical Skills Curriculum and emerging robotic surgery credentialling pathways in Australia would benefit from prospective multicentre RCTs conducted within the Australian training context. Surgical trainees and practising surgeons undertaking robotic surgical training, particularly those with limited access to operative volume. Most applicable to early-stage trainees on platforms such as the da Vinci Surgical System. Generalisability is limited by the small, likely homogeneous trial populations.

Abstract

Virtual Reality Robotic Surgery Simulators (VR-RSS) are widely used, but their educational value depends on whether skills acquired in virtual reality (VR) training transfer to non-virtual performance. This review evaluated whether VR training improves transferable robotic surgical skills. We searched PubMed, Scopus, Web of Science, and Cochrane from inception to March 3, 2026, for randomized trials evaluating VR robotic simulator training with transfer to non-virtual settings. Screening was performed in Rayyan. Data were extracted systematically, risk of bias was assessed with RoB 2, and random-effects meta-analyses using Hedges' g were conducted in R. Eight trials were included in the review, and seven were included in meta-analysis. Sample sizes ranged from 12 to 35 participants. Although the pooled standardized mean difference (SMD) for global technical skill scores favored the VR training group, it did not reach statistical significance (g = 0.77, 95% CI -0.64-2.18; p = 0.205). Task completion time was also shorter in the VR training group, but this difference was not statistically significant (g = 0.47, 95% CI -0.35-1.29; p = 0.164). This review suggests a potential benefit of VR-based robotic simulation for transferring trained skills to non-VR environments. Future studies should include larger sample sizes and longitudinal assessments using validated metrics to better characterize these trends.

References

1. 1.Alsamhori, J. F., & Khadra, H. (2026). Transfer of technical skills from virtual reality robotic simulation to non-virtual surgical performance: a systematic review and meta-analysis. Journal of Robotic Surgery. https://doi.org/10.1007/s00464-022-09558-3