Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Surg Endosc. 2018 Apr;32(4):1656-1667. doi: 10.1007/s00464-018-6109-0. Epub 2018 Feb 12.
There is limited evidence on the transferability of conventional laparoscopic and open surgical skills to robotic-assisted surgery. The primary aim of this study was to evaluate the transferability of expertise in conventional laparoscopy and open surgery to robotic-assisted surgery using the da Vinci Skills Simulator (dVSS). Secondary aims included evaluating the influence of individual participants' characteristics.
Participants performed four tasks on the dVSS: Peg Board 1 (PB), Pick and Place (PP), Thread the Rings (TR), and Suture Sponge 1 (SS). Participants were classified into three groups (Novice, Intermediate, Experts) according to experience in laparoscopic and open surgery. All tasks were performed twice except for SS. Performance was assessed using the built-in scoring system.
37 medical students and 25 surgeons participated. Experts did not perform significantly better than less experienced participants on the dVSS. Specifically, with regard to laparoscopic experience, total simulator scores were: Novices 68.2 ± 28.8; Intermediates 65.1 ± 31.2; Experts 65.1 ± 30.0; p = 0.611. Regarding open surgical experience, scores were: Novices 68.6 ± 28.7; Intermediates 68.2 ± 30.8; Experts 63.2 ± 30.3; p = 0.305. Although there were some significant differences among groups for single parameters in specific tasks, there was no constant superiority of one group. Laparoscopic and open surgical Novices improved significantly in overall score and time for all three tasks (p < 0.05). Laparoscopic intermediates improved only in PP time (4.64 ± 3.42; p = 0.006), open Intermediates in PB score (11.98 ± 13.01; p = 0.025), and open Experts in PP score (6.69 ± 11.48; p = 0.048). Laparoscopic experts showed no improvement. Participants with gaming experience had better overall scores than non-gamers when comparing all second attempts (Gamer 83.62 ± 7.57; Non-Gamer 76.31 ± 12.78; p = 0.008) as well as first and second attempts together (Gamer 72.08 ± 8.86; Non-Gamer 65.45 ± 11.68; p = 0.039). Musical and sports experience showed no correlation with robotic performance.
Robotic-assisted surgery requires skills distinct from conventional laparoscopy or open surgery. Basic robotic skills training prior to patient contact should be required.
目前关于传统腹腔镜和开放手术技能转化为机器人辅助手术的证据有限。本研究的主要目的是使用达芬奇技能模拟器（dVSS）评估传统腹腔镜和开放手术专业知识转化为机器人辅助手术的能力。次要目的包括评估个体参与者特征的影响。
参与者在 dVSS 上完成四项任务：钉板 1（PB）、拾放（PP）、穿环（TR）和海绵缝合 1（SS）。根据腹腔镜和开放手术的经验，参与者被分为三组（新手、中级、专家）。除 SS 外，所有任务均执行两次。使用内置评分系统评估性能。
共有 37 名医学生和 25 名外科医生参与。专家在 dVSS 上的表现并不明显优于经验较少的参与者。具体来说，就腹腔镜经验而言，总模拟器得分分别为：新手 68.2±28.8；中级 65.1±31.2；专家 65.1±30.0；p=0.611。就开放手术经验而言，得分分别为：新手 68.6±28.7；中级 68.2±30.8；专家 63.2±30.3；p=0.305。尽管在特定任务的单个参数方面，各组之间存在一些显著差异，但没有一组始终具有优势。腹腔镜和开放手术新手在所有三项任务的整体得分和时间上均有显著提高（p<0.05）。腹腔镜中级仅在 PP 时间上有所改善（4.64±3.42；p=0.006），开放中级仅在 PB 得分上有所改善（11.98±13.01；p=0.025），开放专家仅在 PP 得分上有所改善（6.69±11.48；p=0.048）。腹腔镜专家没有改善。与非游戏玩家相比，有游戏经验的参与者在比较所有第二次尝试时的整体得分更高（玩家 83.62±7.57；非玩家 76.31±12.78；p=0.008）以及第一次和第二次尝试的总和（玩家 72.08±8.86；非玩家 65.45±11.68；p=0.039）。音乐和运动经验与机器人表现没有相关性。
机器人辅助手术需要不同于传统腹腔镜或开放手术的技能。在接触患者之前，应该需要进行基本的机器人技能培训。
