There is currently no standardised surgical college accredited curriculum for robotic surgery and most hospitals have arbitrary criteria as to what constitutes adequate training. The robot is then handed over to the surgeon. Initial training in robotic instrumentation and buttons is conducted by the robot company representatives. Simulation has been fundamental to robotic surgical training since its inception in 2000 when the DaVinci surgical system received FDA approval. There are now over 5,500 Da Vinci robots installed globally and the number of surgical robots is expected to grow substantially in the next few years as new robotic vendors penetrate the market driving up demand for complex robotic surgical simulation training. Robotic surgery training requires a multifaceted pathway involving various simulation platforms and didactics. This would enable a transition in robotic surgical education where digital and synthetic organ models could be used in place of live animals and cadaver training to achieve robotic surgery competency. Expansion into multiple surgical disciplines and the widespread adoption of synthetic organ models for robotic simulation training will require the ability to engineer scalability for mass production. The development of synthetic models for the other specialties is not as mature. Validated and cost-effective high-fidelity procedural models exist for robotic surgery training in urology. The latest evolution in synthetic organ model training for robotic surgery has been driven by new 3D-printing technology. The effectiveness of these models as a training tool is limited by logistical, ethical, financial and infection control issues. Our review found that there is a lack of evidence in the literature to support the use of animal and cadaver for robotic surgery training. Live animal and cadavers have been the accepted standard for robotic surgical simulation since it began in the early 2000s. The widespread adoption of VR simulation has been limited by the high cost of these machines. The validity of virtual reality (VR) simulation curricula for psychomotor assessment and skill acquisition for the early phase of robotic surgery training has been demonstrated. There are six major commercial simulation machines available for robot-assisted surgery. Face, content, construct, concurrent and predictive validity criteria were applied to each simulation model. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. We conducted a comprehensive review of surgical simulation models used in robotic surgery education.
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