The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut; Drexel University College of Medicine, Philadelphia, Pennsylvania.
The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut.
J Surg Res. 2014 Mar;187(1):53-8. doi: 10.1016/j.jss.2013.10.014. Epub 2013 Oct 12.
Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform.
Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task.
Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P < 0.001). Subgroup analysis of senior residents revealed a lower robotic-PT score when compared with laparoscopic-PT (92 versus 105; P < 0.05). Scores for CC and IS were similar in this subgroup (64 ± 9 versus 69 ± 15 and 95 ± 3 versus 92 ± 10; P > 0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%).
For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology.
确定可以从腹腔镜手术转移到机器人手术的技能集是设计最佳培训课程的重要考虑因素。我们测试了腹腔镜技能转移到机器人平台的程度。
研究了 14 名医学生和 14 名没有机器人手术经验但有不同程度腹腔镜经验的外科住院医师。在腹腔镜箱式训练器和达芬奇机器人上进行了三项腹腔镜手术基本技能：针转移（PT）、圆圈切割（CC）和体腔内缝合（IS）。还进行了一项问卷调查，以评估受试者对每个任务的舒适度。
使用腹腔镜手术的标准基本技能评分标准，得分越高表示表现越好。对于该组，PT 和 CC 评分在机器人和腹腔镜模式之间相似（90 与 90 和 52 与 47；P>0.05）。然而，对于高级 IS 任务，机器人-IS 评分明显高于腹腔镜-IS（80 与 53；P<0.001）。高级住院医师的亚组分析显示，与腹腔镜-PT 相比，机器人-PT 评分较低（92 与 105；P<0.05）。该亚组的 CC 和 IS 评分相似（64±9 与 69±15 和 95±3 与 92±10；P>0.05）。参与者对于所有练习都更喜欢机器人而非腹腔镜（PT，66.7%；CC，88.9%；IS，94.4%）。
对于简单任务，具有先前技能的参与者使用机器人的表现更差。然而，随着任务难度的增加，机器人的表现与腹腔镜相当或更好。腹腔镜技能似乎很容易转移到机器人平台上，即使对于对该技术不熟悉的受试者，困难的任务（如 IS）实际上也得到了增强。
