Zihni Ahmed, Gerull William D, Cavallo Jaime A, Ge Tianjia, Ray Shuddhadeb, Chiu Jason, Brunt L Michael, Awad Michael M
Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Surg Res. 2018 Mar;223:29-33. doi: 10.1016/j.jss.2017.07.037. Epub 2017 Nov 9.
Robotic platforms have the potential advantage of providing additional dexterity and precision to surgeons while performing complex laparoscopic tasks, especially for those in training. Few quantitative evaluations of surgical task performance comparing laparoscopic and robotic platforms among surgeons of varying experience levels have been done. We compared measures of quality and efficiency of Fundamentals of Laparoscopic Surgery task performance on these platforms in novices and experienced laparoscopic and robotic surgeons.
Fourteen novices, 12 expert laparoscopic surgeons (>100 laparoscopic procedures performed, no robotics experience), and five expert robotic surgeons (>25 robotic procedures performed) performed three Fundamentals of Laparoscopic Surgery tasks on both laparoscopic and robotic platforms: peg transfer (PT), pattern cutting (PC), and intracorporeal suturing. All tasks were repeated three times by each subject on each platform in a randomized order. Mean completion times and mean errors per trial (EPT) were calculated for each task on both platforms. Results were compared using Student's t-test (P < 0.05 considered statistically significant).
Among novices, greater errors were noted during laparoscopic PC (Lap 2.21 versus Robot 0.88 EPT, P < 0.001). Among expert laparoscopists, greater errors were noted during laparoscopic PT compared with robotic (PT: Lap 0.14 versus Robot 0.00 EPT, P = 0.04). Among expert robotic surgeons, greater errors were noted during laparoscopic PC compared with robotic (Lap 0.80 versus Robot 0.13 EPT, P = 0.02). Among expert laparoscopists, task performance was slower on the robotic platform compared with laparoscopy. In comparisons of expert laparoscopists performing tasks on the laparoscopic platform and expert robotic surgeons performing tasks on the robotic platform, expert robotic surgeons demonstrated fewer errors during the PC task (P = 0.009).
Robotic assistance provided a reduction in errors at all experience levels for some laparoscopic tasks, but no benefit in the speed of task performance. Robotic assistance may provide some benefit in precision of surgical task performance.
机器人平台在外科医生执行复杂腹腔镜任务时，具有提供额外灵活性和精准度的潜在优势，对于正在接受培训的医生尤其如此。在不同经验水平的外科医生中，很少有对腹腔镜和机器人平台的手术任务表现进行定量评估的研究。我们比较了新手以及有经验的腹腔镜和机器人外科医生在这些平台上进行腹腔镜手术基础任务的质量和效率指标。
14名新手、12名腹腔镜专家（已完成超过100例腹腔镜手术，无机器人手术经验）和5名机器人手术专家（已完成超过25例机器人手术）在腹腔镜和机器人平台上进行三项腹腔镜手术基础任务：移钉（PT）、图案切割（PC）和体内缝合。每个受试者在每个平台上以随机顺序对所有任务重复进行三次。计算每个平台上每项任务的平均完成时间和每次试验的平均错误数（EPT）。使用学生t检验比较结果（P < 0.05认为具有统计学意义）。
在新手当中，腹腔镜下进行图案切割时出现的错误更多（腹腔镜组EPT为2.21，机器人组为0.88，P < 0.001）。在腹腔镜专家中，与机器人平台相比，腹腔镜下进行移钉时出现的错误更多（移钉任务：腹腔镜组EPT为0.14，机器人组为0.00，P = 0.04）。在机器人手术专家中，与机器人平台相比，腹腔镜下进行图案切割时出现的错误更多（腹腔镜组EPT为0.80，机器人组为0.13，P = 0.02）。在腹腔镜专家中，与腹腔镜手术相比，在机器人平台上的任务表现更慢。在比较在腹腔镜平台上执行任务的腹腔镜专家和在机器人平台上执行任务的机器人手术专家时，机器人手术专家在图案切割任务中出现的错误更少（P = 0.009）。
对于某些腹腔镜任务，机器人辅助在所有经验水平上都减少了错误，但在任务执行速度方面没有优势。机器人辅助可能在手术任务执行的精准度方面提供一些益处。
