Surgical robotics has been promoted as an enabling technology. This study tests the
hypothesis that use of the robotic surgical system can significantly improve technical
ability by comparing the performance of both experts and novices on a complex laparoscopic
task and a robotically assisted task.
Laparoscopic experts (LE) with substantial laparoscopic and robotic experience (n
= 9) and laparoscopic novices (LN) (n = 20) without any robotic experience performed
sequentially 10 trials of a suturing task using either robotic or standard laparoscopic
instrumentation fitted to the ProMIS surgical simulator. Objective performance metrics
provided by ProMIS (total task time, instrument pathlength, and smoothness) and an
assessment of learning curves were analyzed.
Compared with LNs, the LEs demonstrated significantly better performance on all assessment
measures. Within the LE group, there was no difference in smoothness (328 +/- 159
vs 355 +/- 174; P = .09) between robot-assisted and standard laparoscopic tasks. An
improvement was noted in total task time (113 +/- 41 vs 132 +/- 55 sec; P < .05) and
instrument pathlengths (371 +/- 163 vs 645 +/- 269 cm; P < .05) when using the robot.
This advantage in terms of total task time, however, was lost among the LEs by the
last 3 trials (114 +/- 40 vs 118 +/- 49 s; P = .84), while instrument pathlength remained
better consistently throughout all the trials. For the LNs, performance was significantly
better in the robotic trials on all 3 measures throughout all the trials.
The ProMIS surgical simulator was able to distinguish between skill levels (expert
versus novice) on robotic suturing tasks, suggesting that the ProMIS is a valid tool
for measuring skill in robot-assisted surgery. For all the ProMIS metrics, novices
demonstrated consistently better performance on a suturing task using robotics as
compared to a standard laparoscopic setup. This effect was less evident for experts
who demonstrated improvements only in their economy of movement (pathlength), but
not in the speed or smoothness of performance. Robotics eliminated the early learning
curve for novices, which was present when they used standard laparoscopic tools. Overall,
this study suggests that, when performing complex tasks such as knot tying, surgical
robotics is most useful for inexperienced laparoscopists who experience an early and
persistent enabling effect. For experts, robotics is most useful for improving economy
of motion, which may have implications for the highly complex procedures in limited
workspaces (eg, prostatectomy).
Copyright 2010 Mosby, Inc. All rights reserved.