The Essential Role of Simulation in Robotics Surgery

Simulation isn't optional; it's the foundation of safe, successful patient outcomes.

By: Agnes Ryzynski, Director, Sunnybrook Canadian Simulation Centre, Library Services & Archives; Victoria May, Simulation Project Lead, Sunnybrook Canadian Simulation Centre and Tarsila Da Cruz, Manager, Sunnybrook Canadian Simulation Centre & Library Services.

At Sunnybrook Health Sciences Centre, preparation and education are the backbone to our ability to perform some of the most delicate and complex surgical procedures. This is why, before any of Sunnybrook’s cutting-edge surgical robotics systems transition into patient care, the Sunnybrook Canadian Simulation Centre works in close collaboration with surgical teams to provide novel comprehensive training through high-fidelity simulations directly in the operating room (OR).

Take, for instance, Sunnybrook’s latest robotic surgical offering: a mitral valve cardiac robotic surgery designed to transform heart care. It’s part of a larger surgical robotics and digital navigation strategy supported by Sunnybrook Foundation that promises to advance practice, improve patient outcomes and enhance research, education, recruitment and retention across the hospital.

For Dr. Derrick Tam, a minimally invasive cardiac valve surgeon in Sunnybrook’s Schulich Heart Program who is spearheading the robotic valve cardiac surgery program, the benefits of robotic surgery for patients are clear. His team spent hours training over multiple sessions with the robot in simulated surgeries before operating on their first patient in early April.

“Because the procedure allows for small incisions and no bones that need to be broken, patients tend to recover faster, have shorter hospital stays and can return to work earlier,” Dr. Tam says.

It benefits him as a surgeon too: “The robotic technology has a high-definition 3D camera, allowing me to see parts of the heart that would be difficult to see with a conventional incision. The technology also eliminates a natural hand tremor we all have when performing precise tasks.”

The simulations were key to the surgical teams’ success, according to Marie-Antonette Dandal, the manager for surgical performance improvement at Sunnybrook.

“The OR robotics simulation really played a significant role in onboarding our perioperative team. It has been a critical tool in the optimization of robotics assisted procedures, enabling workflow standardization, efficient improvements and enhanced team coordination,” she says. “It prepares the staff to attend to intraoperative emergencies especially robotics malfunctions and emergency situations.”

The simulations focus on optimizing safety by refining surgical team ergonomics and noise management, while addressing key crises like cardiac arrest, airway emergencies, surgical bleeding and even fires. They also focus on strengthening team dynamics through role clarity, situational awareness, leadership and closed-loop communication for coordinated responses under pressure.

“Simulation has been critical as we launched our robotics surgery programs with teams from cardiac, gynecology, gyne-oncology, urology and otolaryngology surgical programs,” says Dr. Frances Wright, Sunnybrook’s Surgeon-in-Chief. “The ability to practice and troubleshoot in a safe environment has optimized success.”

The simulations began with an assessment to identify workflow inefficiencies and technical challenges, followed by training in a controlled environment with teams made up of nurses, perfusionists, anesthesiologists, anesthesia assistants, surgeons, medical fellows, and a robotics representative.

Early in the sessions, simulations revealed key areas for improvement, such as optimizing OR setup, ensuring proper placement of critical equipment and monitoring systems, and identifying where additional training was needed in areas like robot docking/undocking and structured emergency responses.

Data from simulations were analyzed and interprofessional teams addressed findings and assigned action items to ensure all issues were addressed before the robotic system was used on patients. The program engaged 60 interprofessional team members in ten high-fidelity simulations, identifying over 50 changes to improve workflow and safety.

The Sunnybrook Canadian Simulation Centre team’s expertise in education, clinical practice, and quality improvement ensured the success of these simulations. Accredited by the Royal College of Physicians and Surgeons of Canada, the simulation program enhances training, improves overall surgical safety, efficiency and interdisciplinary collaboration.

As robotic surgery grows, it will continue to drive transformation, improve patient outcomes and optimize OR performance. By making simulation a vital, ongoing and dynamic part of its process, Sunnybrook reinforces its commitment to excellence and keeps pushing the boundaries of surgical innovation and patient safety.