Robotics versus laparoscopy--an experimental study of the transfer effect in maiden users

Abstract

Background: Robot-assisted laparoscopy (RL) is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL) remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique.

Methods: 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study.

Results: The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results.

Conclusion: The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females.

Figure 1

The mean time for each try to tie a knot for the 20 subjects with CL and RL in seconds. Statistics: Friedman's test: CL knot, sets 1,2, 3 and 4: 0.0001. RL knot, sets 1,2,3 and 4: 0.3 (ns). Wilcoxon Signed Rank test: CL knot, sets 1 and 4: 0.0001. RL knot, sets 1 and 4: 0.009.

Figure 2

The mean time for each try of continuous suturing for the 20 subjects with CL and RL in seconds. Statistics: Friedman's test. CL running suture, sets 1,2,3 and 4: 0,001. RL running suture, sets 1,2,3 and 4: 0,001. Wilcoxon Signed Rank test: CL running suture, sets 1 and 4: 0,001. RL running suture, sets 1 and 4: 0,002.