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

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.