Robotic surgery versus laparoscopy; a comparison between two robotic systems and laparoscopy

Abstract

Laparoscopy has found a role in standard urologic practice, and with training programs continuing to increase emphasis on its use, the division between skill sets of established non-laparoscopic urologic practitioners and urology trainees continues to widen. At the other end of the spectrum, as technology progresses apace, advanced laparoscopists continue to question the role of surgical robotics in urologic practice, citing a lack of significant advantage to this modality over conventional laparoscopy. We seek to compare two robotic systems (Zeus and DaVinci) versus conventional laparoscopy in surgical training modules in the drylab environment in the context of varying levels of surgical expertise. A total of 12 volunteers were recruited to the study: four staff, four postgraduate trainees, and four medical student interns. Each volunteer performed repeated time trials of standardized tasks consisting of suturing and knot tying using each of the three platforms: DaVinci, Zeus and conventional laparoscopy. Task times and numbers of errors were recorded for each task. Following each platform trial, a standardized subjective ten-point Likert score questionnaire was distributed to the volunteer regarding various operating parameters experienced including: visualization, fluidity, efficacy, precision, dexterity, tremor, tactile feedback, and coordination. Task translation from laparoscopy to Zeus robotics appeared to be difficult as both suture times and knot-tying times increased in pairwise comparisons across skill levels.

Keywords: Conventional laparoscopy; DaVinci; Drylab; Education; Minimally invasive surgery; Robotic; Surgery; Telesurgery; Zeus.

Fig. 1

Drylab module setup for suturing skills. Participants were required to pass a 5-0 prolene suture immediately into and out of the adjacent marked dots spaced 3 mm apart on a latex sheet, and run six passes through consecutive dot series. Setup is identical for knot-tying tasks; however, participants are required to drive one pass of a 5-0 prolene suture through adjacent marked dots, followed by three throws of a half-hitch knot

Fig. 2

a Overall platform performance times for suturing and knot-tying modules. Zeus assisted task times were significantly longer compared to conventional laparoscopy and DaVinci platforms for both suturing and knot-tying tasks. A trend towards significance was demonstrated in task performance times between DaVinci and laparoscopy (*P < 0.05, **P < 0.05). b Overall platform performance errors for suturing and knot-tying modules. Zeus-assisted task errors were significantly more numerous compared to conventional laparoscopy and DaVinci platforms for both suturing and knot-tying tasks. A trend towards significance was demonstrated in task performance errors between DaVinci and laparoscopy (*P < 0.05, **P < 0.05)

Fig. 3

a Suturing task performance times stratified by skill level of participant. The Zeus robotic platform demonstrated significantly inferior times compared with laparoscopic and DaVinci platforms across skill levels. However, with increasing surgeon skill, there is an incremental loss of significant performance time benefit seen with laparoscopic and DaVinci platforms (*P < 0.05, **P < 0.05). b Suturing task performance errors stratified by skill level of participant. The Zeus robotic platform demonstrated significantly higher error rates compared with laparoscopic and DaVinci platforms across skill levels. In a similar fashion as to performance times, surgical experience appears to blunt the significance of platform dependence (*P < 0.05, **P < 0.05)

Fig. 4

a Knot-tying task times stratified by skill level of participant. DaVinci robotic-assisted knot-tying times were significantly shorter compared to laparoscopic and Zeus-assisted platforms (*P < 0.05, **P < 0.05). b Knot-tying errors stratified by skill level of participant. A significantly reduced error rate was found between Zeus and the remaining two platforms. This trend was maintained across MSI and PGY skill levels, but lost when staff surgeons performed this task

Fig. 5

a–c Subjective assessment of surgical platform across eight domains stratified by platform type for MSI, PGY, and staff study participants. Note that Likert scores ranged from 0 to 10 where 0 was the worst possible score, and 10 was the best (*P < 0.05)