Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 8/2020

Open Access 01-08-2020 | Laparoscopy | 2019 EAES Oral

Robot assisted versus laparoscopic suturing learning curve in a simulated setting

Authors: Erik Leijte, Ivo de Blaauw, Frans Van Workum, Camiel Rosman, Sanne Botden

Published in: Surgical Endoscopy | Issue 8/2020

Login to get access

Abstract

Background

Compared to conventional laparoscopy, robot assisted surgery is expected to have most potential in difficult areas and demanding technical skills like minimally invasive suturing. This study was performed to identify the differences in the learning curves of laparoscopic versus robot assisted suturing.

Method

Novice participants performed three suturing tasks on the EoSim laparoscopic augmented reality simulator or the RobotiX robot assisted virtual reality simulator. Each participant performed an intracorporeal suturing task, a tilted plane needle transfer task and an anastomosis needle transfer task. To complete the learning curve, all tasks were repeated up to twenty repetitions or until a time plateau was reached. Clinically relevant and comparable parameters regarding time, movements and safety were recorded. Intracorporeal suturing time and cumulative sum analysis was used to compare the learning curves and phases.

Results

Seventeen participants completed the learning curve laparoscopically and 30 robot assisted. Median first knot suturing time was 611 s (s) for laparoscopic versus 251 s for robot assisted (p < 0.001), and this was 324 s versus 165 (sixth knot, p < 0.001) and 257 s and 149 s (eleventh knot, p < 0.001) respectively on base of the found learning phases. The percentage of ‘adequate surgical knots’ was higher in the laparoscopic than in the robot assisted group. First knot: 71% versus 60%, sixth knot: 100% versus 83%, and eleventh knot: 100% versus 73%. When assessing the ‘instrument out of view’ parameter, the robot assisted group scored a median of 0% after repetition four. In the laparoscopic group, the instrument out of view increased from 3.1 to 3.9% (left) and from 3.0 to 4.1% (right) between the first and eleventh knot (p > 0.05).

Conclusion

The learning curve of minimally invasive suturing shows a shorter task time curve using robotic assistance compared to the laparoscopic curve. However, laparoscopic outcomes show good end results with rapid outcome improvement.
Appendix
Available only for authorised users
Literature
1.
Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T, Dutta S (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839CrossRef
2.
Mazzon G, Sridhar A, Busuttil G, Thompson J, Nathan S, Briggs T, Kelly J, Shaw G (2017) Learning curves for robotic surgery: a review of the recent literature. Curr Urol Rep 18:89CrossRef
3.
4.
Claassen L, van Workum F, Rosman C (2019) Learning curve and postoperative outcomes of minimally invasive esophagectomy. J Thorac Dis 11:S777–s785CrossRef
5.
Botden SM, de Hingh IH, Jakimowicz JJ (2009) Suturing training in augmented reality: gaining proficiency in suturing skills faster. Surg Endosc 23:2131–2137CrossRef
6.
Stefanidis D, Wang F, Korndorffer JR, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382CrossRef
7.
Zihni A, Gerull WD, Cavallo JA, Ge T, Ray S, Chiu J, Brunt LM, Awad MM (2018) Comparison of precision and speed in laparoscopic and robot-assisted surgical task performance. J Surg Res 223:29–33CrossRef
8.
Marecik SJ, Chaudhry V, Jan A, Pearl RK, Park JJ, Prasad LM (2007) A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents. Am J Surg 193:349–355 discussion 355 CrossRef
9.
Passerotti CC, Franco F, Bissoli JCC, Tiseo B, Oliveira CM, Buchalla CAO, Inoue GNC, Sencan A, Sencan A, do Pardo RR, Nguyen HT (2015) Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices. Int Urol Nephrol 47:1075–1084CrossRef
10.
Kassite I, Bejan-Angoulvant T, Lardy H, Binet A (2019) A systematic review of the learning curve in robotic surgery: range and heterogeneity. Surg Endosc 33:353–365CrossRef
11.
Pernar LIM, Robertson FC, Tavakkoli A, Sheu EG, Brooks DC, Smink DS (2017) An appraisal of the learning curve in robotic general surgery. Surg Endosc 31:4583–4596CrossRef
12.
Barrie J, Jayne DG, Wright J, Murray CJ, Collinson FJ, Pavitt SH (2014) Attaining surgical competency and its implications in surgical clinical trial design: a systematic review of the learning curve in laparoscopic and robot-assisted laparoscopic colorectal cancer surgery. Ann Surg Oncol 21:829–840CrossRef
13.
Darzi A, Smith S, Taffinder N (1999) Assessing operative skill. Needs to become more objective. BMJ (Clin Res ed) 318:887–888CrossRef
14.
Retrosi G, Cundy T, Haddad M, Clarke S (2015) Motion analysis-based skills training and assessment in pediatric laparoscopy: construct, concurrent, and content validity for the eoSim simulator. J Laparoendosc Adv Surg Tech Part A 25:944–950CrossRef
15.
Partridge RW, Hughes MA, Brennan PM, Hennessey IA (2014) Accessible laparoscopic instrument tracking (“InsTrac”): construct validity in a take-home box simulator. J Laparoendosc Adv Surg Tech Part A 24:578–583CrossRef
16.
Hennessey IA, Hewett P (2013) Construct, concurrent, and content validity of the eoSim laparoscopic simulator. J Laparoendosc Adv Surg Tech Part A 23:855–860CrossRef
17.
18.
Hovgaard LH, Andersen SAW, Konge L, Dalsgaard T, Larsen CR (2018) Validity evidence for procedural competency in virtual reality robotic simulation, establishing a credible pass/fail standard for the vaginal cuff closure procedure. Surg Endosc 32:4200–4208CrossRef
19.
Omar I, Dilley J, Pucher P, Pratt P, Ameen T, Vale J, Darzi A, Mayer E (2017) The robotix simulator: face and content validation using the fundamentals of robotic surgery(FRS)curriculum. J Urol 197:e700–e701CrossRef
20.
Amirian MJ, Lindner SM, Trabulsi EJ, Lallas CD (2014) Surgical suturing training with virtual reality simulation versus dry lab practice: an evaluation of performance improvement, content, and face validity. J Robot Surg 8:329–335CrossRef
21.
Hertz AM, George EI, Vaccaro CM, Brand TC (2018) Head-to-head comparison of three virtual-reality robotic surgery simulators. JSLS 22(e2017):00081
22.
Harrison P, Raison N, Abe T, Watkinson W, Dar F, Challacombe B, Van Der Poel H, Khan MS, Dasgupa P, Ahmed K (2018) The validation of a novel robot-assisted radical prostatectomy virtual reality module. J Surg Educ 75:758–766CrossRef
23.
Whittaker G, Aydin A, Raison N, Kum F, Challacombe B, Khan MS, Dasgupta P, Ahmed K (2016) Validation of the robotiX mentor robotic surgery simulator. J Endourol 30:338–346CrossRef
24.
Tanaka A, Graddy C, Simpson K, Perez M, Truong M, Smith R (2016) Robotic surgery simulation validity and usability comparative analysis. Surg Endosc 30:3720–3729CrossRef
25.
Watkinson W, Raison N, Abe T, Harrison P, Khan S, Van der Poel H, Dasgupta P, Ahmed K (2018) Establishing objective benchmarks in robotic virtual reality simulation at the level of a competent surgeon using the RobotiX mentor simulator. Postgrad Med J 94:270–277CrossRef
26.
Botden SM, Buzink SN, Schijven MP, Jakimowicz JJ (2007) Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator. World J Surg 31:764–772CrossRef
Metadata
Title
Robot assisted versus laparoscopic suturing learning curve in a simulated setting
Authors
Erik Leijte
Ivo de Blaauw
Frans Van Workum
Camiel Rosman
Sanne Botden
Publication date
01-08-2020
Publisher
Springer US
Keyword
Laparoscopy
Published in
Surgical Endoscopy / Issue 8/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07263-2

Other articles of this Issue 8/2020

Surgical Endoscopy 8/2020 Go to the issue

New Technology

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

2019 SAGES Oral

Reduction of invasive interventions in severely obese with osteoarthritis after bariatric surgery

OriginalPaper

Comparison of general anesthesia and conscious sedation in procedure-related complications during esophageal endoscopic submucosal dissection

2020 SAGES Oral

The role of preoperative workup in predicting dysphagia, dilation, or explantation after magnetic sphincter augmentation

2019 SAGES Oral Dynamic

Short-term outcomes of endoscopic gastro-jejunal revisions for treatment of dumping syndrome after Roux-En-Y gastric bypass

OriginalPaper

Robotic ventral hernia repair in morbidly obese patients: perioperative and mid-term outcomes