Department of Plastic and Hand Surgery, University Hospital Zurich (USZ), Zurich, Switzerland.
University of Zurich (UZH), Zurich, Switzerland.
J Robot Surg. 2024 Sep 28;18(1):353. doi: 10.1007/s11701-024-02114-2.
Achieving precision in microsurgery requires skill, adequate instruments and magnification, as well as extensive training. Dedicated surgical robotic systems have enhanced and expanded the application of (super-)microsurgical techniques by introducing motion scaling and providing improved surgeon ergonomics. In this prospective preclinical trial, we analyzed the learning curve in robotic assisted microsurgery in 13 participants including medical students, residents, and attending physicians. Data on demographics as well as prior experience in surgery, microsurgery, and gaming were collected. In three study sessions, the participants performed nine microsurgical anastomoses each on 2 mm vessel models using the Symani Surgical System in combination the VITOM 3D exoscope. A senior expert microsurgeon reviewed the de-identified and blinded videos and scored all anastomoses using a modified "Structured Assessment of Microsurgical Skills" (SARMS) score. All participants significantly reduced their time needed per anastomosis and their overall SARMS score, as well as individual scores for motion and speed throughout the trial. We saw a significant correlation of prior years of practice in surgery with the overall mean time and mean SARMS score. In a separate analysis of the three sessions, this influence could no longer be seen in the last session. Furthermore, we found no significant effect of gender, age, hand dominance, or gaming experience on speed and quality of the anastomoses. In this study of 117 robotic assisted anastomoses, a rapid improvement of performance of all participants with different surgical skills levels could be shown, serving as encouraging evidence for further research in the implementation of microsurgical robotic systems.
实现微创手术的精确性需要技巧、适当的仪器和放大倍数，以及广泛的培训。专用的手术机器人系统通过引入运动缩放并提供更好的医生手术操作舒适性，增强和扩展了（超）显微手术技术的应用。在这项前瞻性临床前试验中，我们分析了 13 名参与者（包括医学生、住院医师和主治医生）在机器人辅助微创手术中的学习曲线。收集了人口统计学数据以及手术、显微手术和游戏方面的先前经验。在三个研究阶段，参与者使用 Symani 手术系统结合 VITOM 3D 内窥镜，在 2 毫米血管模型上完成了 9 次每个吻合的手术。一位资深专家显微外科医生审查了去标识和盲目的视频，并使用改良的“显微外科技能结构化评估”（SARMS）评分对所有吻合进行评分。所有参与者的吻合时间和总体 SARMS 评分以及运动和速度的个体评分都显著降低。我们发现，手术前几年的实践与总体平均时间和平均 SARMS 评分显著相关。在对三个阶段的单独分析中，在最后一个阶段不再可以看到这种影响。此外，我们发现性别、年龄、手优势或游戏经验对吻合的速度和质量没有显著影响。在这项 117 次机器人辅助吻合的研究中，所有不同手术技能水平的参与者的表现都有了迅速的提高，这为进一步研究显微手术机器人系统的应用提供了令人鼓舞的证据。
