Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
J Minim Invasive Gynecol. 2018 Jan;25(1):76-83. doi: 10.1016/j.jmig.2017.07.010. Epub 2017 Jul 19.
To examine whether a robotic surgical platform can complement the fine motor skills of the nondominant hand, compensating for the innate difference in dexterity between surgeon's hands, thereby conferring virtual ambidexterity.
Crossover intervention study (Canadian Task Force classification II-1).
Centers for medical simulation in 2 tertiary care hospitals of Harvard Medical School.
Three groups of subjects were included: (1) surgical novices (medical graduates with no robotic/laparoscopic experience); (2) surgeons in training (postgraduate year 3-4 residents and fellows with intermediate robotic and laparoscopic experience); and (3) advanced surgeons (attending surgeons with extensive robotic and laparoscopic experience).
Each study group completed 3 dry laboratory exercises based on exercises included in the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Each exercise was completed 4 times: using the dominant and nondominant hands, on a standard laparoscopic FLS box trainer, and in a robotic dry laboratory setup. Participants were randomized to the handedness and setting order in which they tackled the tasks.
Performance was primarily measured as time to completion, with adjustments based on errors. Means of performance for the dominant versus nondominant hand for each task were calculated and compared using repeated-measures analysis of variance. A total of 36 subjects were enrolled (12 per group). In the laparoscopic setting, the mean overall time to completion of all 3 tasks with the dominant hand differed significantly from that with the nondominant hand (439.4 seconds vs 568.4 seconds; p = .0008). The between-hand performance difference was nullified with the robotic system (374.4 seconds vs 399.7 seconds; p = .48). The evaluation of performance for each individual task also revealed a statistically significant disparate performance between hands for all 3 tasks when the laparoscopic approach was used (p = .003, .02, and .01, respectively); however, no between-hand difference was observed when the tasks were performed robotically. On analysis across the 3 surgeon experience groups, the performance advantage of robotic technology remained significant for the surgical novice and intermediate-level experience groups.
Robot-assisted laparoscopy may eliminate the operative handedness observed in conventional laparoscopy, allowing for virtual ambidexterity. This ergonomic advantage is particularly evident in surgical trainees. Virtual ambidexterity may represent an additional aspect of surgical robotics that facilitates mastery of minimally invasive skills.
研究机器人手术平台是否能够补充非优势手的精细运动技能，从而弥补外科医生双手天生灵巧度的差异，从而实现虚拟的双手灵巧度。
交叉干预研究（加拿大任务组分类 II-1）。
哈佛医学院 2 家医疗模拟中心。
共有 3 组受试者：（1）手术新手（无机器人/腹腔镜经验的医学毕业生）；（2）培训中的外科医生（研究生 3-4 年级住院医师和研究员，具有中级机器人和腹腔镜经验）；（3）高级外科医生（具有丰富机器人和腹腔镜经验的主治医生）。
每个研究组都完成了 3 项基于腹腔镜手术基础（FLS）课程中包含的练习的干实验室练习。每个练习完成 4 次：使用优势手和非优势手，在标准腹腔镜 FLS 箱训练器上，以及在机器人干实验室设置中。参与者根据完成任务的惯用手和设置顺序进行随机分组。
主要以完成时间作为性能测量指标，并根据错误进行调整。计算并比较了每个任务中惯用手与非惯用手的性能平均值，使用重复测量方差分析进行比较。共有 36 名受试者入组（每组 12 名）。在腹腔镜环境中，使用优势手完成所有 3 项任务的总完成时间明显短于非优势手（439.4 秒对 568.4 秒；p = .0008）。使用机器人系统时，双手之间的性能差异被消除（374.4 秒对 399.7 秒；p = .48）。对每个单独任务的性能评估也表明，当使用腹腔镜方法时，所有 3 个任务的双手表现均存在统计学上显著的差异（p = .003、.02 和.01）；然而，当任务在机器人上执行时，没有发现双手之间的差异。在对 3 组外科医生经验进行分析时，机器人技术的性能优势仍然在手术新手和中级经验组中显著。
机器人辅助腹腔镜手术可能消除传统腹腔镜手术中观察到的手术手性，从而实现虚拟双手灵巧度。这种符合人体工程学的优势在外科医生培训中尤为明显。虚拟双手灵巧度可能是手术机器人的另一个方面，有助于掌握微创技能。
