Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Division of Cardiovascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada.
Surg Endosc. 2022 Oct;36(10):7325-7333. doi: 10.1007/s00464-022-09118-9. Epub 2022 Jun 8.
Robotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills.
We conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20 h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2.
Sixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p < 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group.
There was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.
机器人手术是大多数外科专业微创的有效选择。然而，在开始专门的机器人手术培训之前，掌握腹腔镜技术的必要性是值得怀疑的。我们比较了接受常规、腹腔镜或机器人技能培训的个体在发展基本机器人手术技能方面的情况。
我们进行了一项单中心、单盲随机试验。将医学生随机分配到 20 小时的常规、腹腔镜或机器人手术培训中。有过手术经验的学生被排除在外。参与者在接受培训前后使用 dV-Trainer 机器人手术模拟器进行以下练习：Camera Targeting 1、Peg Board 1、Ring and Rail 1 和 Ring and Rail 2。
66 名学生被随机分配到每个培训组。有 8 人未完成研究（常规组 2 人，腹腔镜组 3 人，机器人组 3 人）。所有组在培训后，复合评分和每个任务都有显著改善（p < 0.001）。常规组和腹腔镜组之间在复合评分或个别任务中没有差异。与其他组相比，机器人组在错误数量、运动经济性、工作空间利用率和完成时间方面的改善更大。与常规组相比，腹腔镜组显示出更好的摄像操作技能，而常规组显示出更好的错误和运动经济性。
在接受基本常规或腹腔镜手术技能培训的个体之间，基本机器人手术技能的获得没有差异。我们认为，在开始机器人手术培训之前，不需要掌握腹腔镜技术。然而，腹腔镜的基本原则仍然适用于机器人手术。未来的研究应该比较常规和腹腔镜训练在手术室中对机器人技能的可转移性。
