The transferability of the minimal invasive surgeon’s skills to open surgery

Sundelin, Maria Ordell; Paltved, Charlotte; Kingo, Pernille Skjold; Blichert-Refsgaard, Linea; Lindgren, Maria S.; Kjölhede, Henrik; Jensen, Jørgen Bjerggaard

doi:10.1080/21681805.2022.2030401

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Study participants were randomly assigned to one of three groups: laparoscopic, open surgery, or robotic training. The training setup has previously been described [ 12 ]. In summary, they were given a baseline evaluation (pre-training test) in the surgical modality to which they were assigned.…”

Section: Methodsmentioning

confidence: 99%

The transferability of laparoscopic and open surgical skills to robotic surgery

et al. 2022

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Background Within the last decades, robotic surgery has gained popularity. Most robotic surgeons have changed their main surgical activity from open or laparoscopic without prior formal robotic training. With the current practice, it is of great interest to know whether there is a transfer of surgical skills. In visualization, motion scaling, and freedom of motion, robotic surgery resembles open surgery far more than laparoscopic surgery. Therefore, our hypothesis is that open-trained surgeons have more transfer of surgical skills to robotic surgery, compared to surgeons trained in laparoscopy. Methods Thirty-six surgically inexperienced medical students were randomized into three groups for intensive simulation training in an assigned modality: open surgery, laparoscopy, or robot-assisted laparoscopy. The training period was, for all study subjects, followed by performing a robot-assisted bowel anastomosis in a pig model. As surrogate markers of surgical quality, the anastomoses were tested for resistance to pressure, and video recordings of the procedure were evaluated by two blinded expert robotic surgeons, using a global rating scale of robotic operative performance (Global Evaluative Assessment of Robotic Skills (GEARS)). Results The mean leak pressure of bowel anastomosis was 36.25 (7.62–64.89) mmHg in the laparoscopic training group and 69.01 (28.02–109.99) mmHg in the open surgery group, and the mean leak pressure for the robotic training group was 108.45 (74.96–141.94) mmHg. The same pattern was found with GEARS as surrogate markers of surgical quality. GEARS score was 15.71 (12.37–19.04) in the laparoscopic training group, 18.14 (14.70–21.58) in the open surgery group, and 22.04 (19.29–24.79) in the robotic training group. In comparison with the laparoscopic training group, the robotic training group had a statistically higher leak pressure (p = 0.0015) and GEARS score (p = 0.0023). No significant difference, for neither leak pressure nor GEARS, between the open and the robotic training group. Conclusion In our study, training in open surgery was superior to training in laparoscopy when transitioning to robotic surgery in a simulation setting performed by surgically naive study subjects.

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Section: Methodsmentioning

confidence: 99%

The transferability of laparoscopic and open surgical skills to robotic surgery

et al. 2022

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“…Surgical techniques in medicine are subject to ongoing development 1 . Especially in the era of minimally invasive and robotic-assisted surgery, surgeons are constantly exposed to new techniques and surgical procedures, which signify new training options 2 and require a high level of skill in terms of adaptation and learning.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary multicenter study

Ackermann

Baumann

Pape

et al. 2023

International Journal of Surgery

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Background: Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. We need selection procedures and decision support systems for the recruitment of medical students and young surgeons. We aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students. Material and Methods: The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting. Results: In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multi-stage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries (r=0.28-0.45, P<0.001/r=0.1-0.28, P<0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance (r=0.18-0.27, P<0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, i.e. the higher the age, the lower the surgical performance (r=0.13/r=0.22, P<0.05/P<0.001). Conclusion: Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.

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“…12,13 Investigators have also examined the use of simulators specifically created for training in robotic surgery for training in other surgical modalities, such as laparoscopic and open surgery. 14,15 The major difference between robotic simulators and laparoscopic box simulators utilizing straight instruments are the 3-D field of view and enhanced dexterity in instrumentation, with improved degrees of freedom and articulation as well as improved ergonomics for the participant that are provided by the robotic simulators. 16 Studies 14,17,18 have shown that objective improvement in scores on validated 3-D simulators correlated with improved live surgical procedure outcomes.…”

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confidence: 99%

“…14,15 The major difference between robotic simulators and laparoscopic box simulators utilizing straight instruments are the 3-D field of view and enhanced dexterity in instrumentation, with improved degrees of freedom and articulation as well as improved ergonomics for the participant that are provided by the robotic simulators. 16 Studies 14,17,18 have shown that objective improvement in scores on validated 3-D simulators correlated with improved live surgical procedure outcomes. Robotic simulators have even been used for open surgical training because the psychomotor skills acquired are similar to traditional open surgical skills.…”

mentioning

confidence: 99%

“…Robotic simulators have even been used for open surgical training because the psychomotor skills acquired are similar to traditional open surgical skills. 14 Previous investigations 19 on the use of this simulator with minimally invasive surgery (MIS)-naïve students found a short learning curve and specific performance metrics that could be utilized during training for that cohort. It is unknown how minimally invasive surgical experience may affect those results.…”

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confidence: 99%

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Experienced veterinary surgeons require multiple attempts but gain proficiency rapidly in robotic simulator tasks

Buote,

Fransson,

Rishniw

2024

ajvr

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OBJECTIVE To assess attempts to proficiency of experienced veterinary surgeons for 2 surgical tasks when using a robotic simulator (Mimic dV-Trainer; Surgical Sciences) and determine factors associated with the successful performance of these tasks. METHODS Veterinary surgeons with rigid, minimally invasive surgery experience performed 2 tasks (“pick and place” and “knot the ring 1”) using the simulator until they attained proficiency. Individual performance variables were recorded. The number of attempts to proficiency was recorded. Performance variables were also assessed for effect on proficiency by the Kendall tau correlation and hierarchical multiple linear regression. The study period was from July 25, 2022, through December 14, 2022. RESULTS The 18 surgeons enrolled required a median of 8.5 attempts (95% CI, 7 to 12; range, 6 to 22) to reach proficiency for the basic task versus 27 attempts (95% CI, 21 to 38; range, 10 to 63) for the advanced task. Surgeons took a median of 6 minutes (range, 3 to 11 minutes) to complete training for the basic task and 12 minutes (range, 4 to 46 minutes) for the advanced task. The number of attempts to reach proficiency correlated strongly with economy of motion (tau = 0.72), instrument collisions (tau = 0.72), and time to completion (tau = 0.96). CLINICAL RELEVANCE Although experienced surgeons required a high number of attempts to gain proficiency in robotic simulator tasks, they did achieve proficiency quickly, encouraging future investigations into their use for training. Specific motion metrics were identified which improved efficiency during training.

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The transferability of the minimal invasive surgeon’s skills to open surgery

Cited by 4 publications

References 22 publications

The transferability of laparoscopic and open surgical skills to robotic surgery

The transferability of laparoscopic and open surgical skills to robotic surgery

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary multicenter study

Experienced veterinary surgeons require multiple attempts but gain proficiency rapidly in robotic simulator tasks

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