Robot assisted versus laparoscopic suturing learning curve in a simulated setting

Abstract

Background Compared to conventional laparoscopy, robot assisted surgery is expected to have most potential in difficult areas and demanding technical skills like minimally invasive suturing. This study was performed to identify the differences in the learning curves of laparoscopic versus robot assisted suturing. Method Novice participants performed three suturing tasks on the EoSim laparoscopic augmented reality simulator or the RobotiX robot assisted virtual reality simulator. Each participant performed an intracorporeal suturing task, a tilted plane needle transfer task and an anastomosis needle transfer task. To complete the learning curve, all tasks were repeated up to twenty repetitions or until a time plateau was reached. Clinically relevant and comparable parameters regarding time, movements and safety were recorded. Intracorporeal suturing time and cumulative sum analysis was used to compare the learning curves and phases. Results Seventeen participants completed the learning curve laparoscopically and 30 robot assisted. Median first knot suturing time was 611 s (s) for laparoscopic versus 251 s for robot assisted (p < 0.001), and this was 324 s versus 165 (sixth knot, p < 0.001) and 257 s and 149 s (eleventh knot, p < 0.001) respectively on base of the found learning phases. The percentage of 'adequate surgical knots' was higher in the laparoscopic than in the robot assisted group. First knot: 71% versus 60%, sixth knot: 100% versus 83%, and eleventh knot: 100% versus 73%. When assessing the 'instrument out of view' parameter, the robot assisted group scored a median of 0% after repetition four. In the laparoscopic group, the instrument out of view increased from 3.1 to 3.9% (left) and from 3.0 to 4.1% (right) between the first and eleventh knot (p > 0.05). Conclusion The learning curve of minimally invasive suturing shows a shorter task time curve using robotic assistance compared to the laparoscopic curve. However, laparoscopic outcomes show good end results with rapid outcome improvement.

Comparison of Laparoscopic Steerable Instruments Performed by Expert Surgeons and Novices

“…Robotic surgery was currently largely employed in many surgical specialties, in particular in urologic procedures [3]. Robotic surgery offers a faster learning curve, especially regarding suture techniques [4][5][6], with the presumably shared benefits of laparoscopy including less perioperative morbidity, improved visibility and precision, and faster recovery. The disadvantages of the robotic approach include the cost of the device [7] and the fact that they are not currently available in veterinary medicine.…”

Feasibility of Single-Port Access (SPA) Laparoscopy for Large Ovarian Tumor Suspected to Be Borderline Ovarian Tumor

“…Limitations in space and movement of SPA laparoscopy lead to conflicts among instruments, thus inhibiting careful manipulation. Therefore, SPA laparoscopy usually requires a long learning curve, and skilled surgeons most often undertake the procedure (29,30). On the other hand, a relatively large umbilical hole created in SPA, compared with RAL, facilitates further extracorporeal procedures and aids in the removal of the bulky specimen.…”

The role of robotic surgery for endometriosis

“…It has been reported that the learning curve for RS is generally shorter than that for CL [64,65]. In particular, suturing technique is faster with a robot than in CL [66]. Of course, that might not be an important issue for experienced surgeons; however, it can be a strong advantage to beginners.…”