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Skills in minimally invasive and open surgery show limited transferability to robotic surgery: results from a prospective study

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Robotic-assisted surgery requires skills distinct from conventional laparoscopy or open surgery. Basic robotic skills training prior to patient contact should be required.

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Acknowledgements

The authors would like to thank Mr. Tilman Schlick from Intuitive Surgical Inc. for access to the dVSS which made the conduction of the study possible.

Funding

The current study was supported by the Heidelberg Surgery Foundation and by the Ministry of Science and Arts of the State Baden Wurttemberg.

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Authors and Affiliations

  1. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Karl-Friedrich Kowalewski, Mona W. Schmidt, Erica Wennberg, Emir Karadza, Hannes G. Kenngott, Beat P. Müller-Stich & Felix Nickel

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Tanja Proctor & Moritz Pohl

  3. Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Philipp Romero

Authors
  1. Karl-Friedrich Kowalewski
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  2. Mona W. Schmidt
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  3. Tanja Proctor
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  8. Hannes G. Kenngott
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  9. Beat P. Müller-Stich
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  10. Felix Nickel
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Contributions

Study conception and design: Kowalewski, Nickel, Müller-Stich, Kenngott. Acquisition of data: Schmidt, Karadza, Romero, Kowalewski. Statistical analysis: Proctor, Pohl, Wennberg. Analysis and interpretation of data: Kowalewski, Schmidt, Wennberg, Proctor, Pohl. Drafting of manuscript: Schmidt, Wennberg, Kowalewski, Karadza, Nickel. Critical revision: Müller-Stich, Kenngott, Nickel, Romero.

Corresponding author

Correspondence to Felix Nickel.

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Disclosure

Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, and Medtronic. Karl-Friedrich Kowalewski, Mona W. Schmidt, Tanja Proctor, Philipp Romero, Erica Wennberg, Emir Karadza Hannes Kenngott, and Beat Müller-Stich have no conflicts of interest or financial ties to disclose.

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Kowalewski, KF., Schmidt, M.W., Proctor, T. et al. Skills in minimally invasive and open surgery show limited transferability to robotic surgery: results from a prospective study. Surg Endosc 32, 1656–1667 (2018). https://doi.org/10.1007/s00464-018-6109-0

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