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Published in: Surgical Endoscopy 3/2004

01-03-2004 | Original article

Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system

Authors: J. D. Hernandez, S. D. Bann, Y. Munz, K. Moorthy, V. Datta, S. Martin, A. Dosis, F. Bello, A. Darzi, T. Rockall

Published in: Surgical Endoscopy | Issue 3/2004

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Abstract

Background

Robotic telemanipulation systems provide solutions to the problems of less dexterity and visual constraints of minimally invasive surgery (MIS). However, their influence over surgeons’ dexterity and learning curve needs to be assessed. We present motion analysis as an objective method to measure performance and learning progress.

Methods

Thirteen surgeons completed five synthetic small bowel anastomoses using the da Vinci system. Objective Structured Assessment of Technical Skills (OSATS) allowed qualitative analysis. Quantitative analysis used API software of the system to retrieve real-time robotic signal data of time, path length, and number of movements. Wilcoxon signed ranks test was used for statistical analysis. A p value <0.05 was considered significant.

Results

OSATS global scores were 18.6 points for the first attempt and 26 for the fifth attempt (p < 0.02, Cronbach’s alpha = 0.894). Paired data of motion analysis for attempts 1 vs 5 showed significant change: time taken 3507 sec and 2287 sec (p < 0.008), total number of movements 2411 and 1387 (p = 0.01), total path length 21,630 cm and 13,941 cm (p = 0.01).

Conclusions

A rapid learning curve to a competent level using the da Vinci system is possible aided by the system’s intuitive motion. Motion analysis is a useful tool to measure performance in the da Vinci system compared to OSATS and time alone.
Literature
1.
go back to reference Buess, GF, Schurr, MO, Fischer, SC 2000Robotics and allied technologies in endoscopic surgery.Arch Surg132229235CrossRef Buess, GF, Schurr, MO, Fischer, SC 2000Robotics and allied technologies in endoscopic surgery.Arch Surg132229235CrossRef
2.
go back to reference Cadiere, GB, Himpens, J, Germay, O, Izizaw, R, Degueldre, M, Vandromme, J, Capelluto, E, Bruyns, J 2001Feasibility of robotic laparoscopic surgery: 146 cases.World J Surg2514671477PubMed Cadiere, GB, Himpens, J, Germay, O, Izizaw, R, Degueldre, M, Vandromme, J, Capelluto, E, Bruyns, J 2001Feasibility of robotic laparoscopic surgery: 146 cases.World J Surg2514671477PubMed
3.
go back to reference Cadiere, GB, Himpens, J, Vertruyen, M, Favretti, F 1999The world’s first obesity surgery performed by a surgeon at a distance.Obes Surg9206209CrossRefPubMed Cadiere, GB, Himpens, J, Vertruyen, M, Favretti, F 1999The world’s first obesity surgery performed by a surgeon at a distance.Obes Surg9206209CrossRefPubMed
4.
go back to reference Cheah, WK, Lee, B, Lenzi, JE, Goh, PMY 2000Telesurgical laparoscopic cholecystectomy between two countries.Surg Endosc1410851086 Cheah, WK, Lee, B, Lenzi, JE, Goh, PMY 2000Telesurgical laparoscopic cholecystectomy between two countries.Surg Endosc1410851086
5.
go back to reference Chitwood, RW, Nifong, LW, Chapman, WHH, Felger, JE, Bailey, BM, Ballint, T, Mendleson, KG, Kim, VB, Young, JA, Albrecht, RA 2001Robotic surgical training in an academic institution.Ann Surg234475486CrossRefPubMed Chitwood, RW, Nifong, LW, Chapman, WHH, Felger, JE, Bailey, BM, Ballint, T, Mendleson, KG, Kim, VB, Young, JA, Albrecht, RA 2001Robotic surgical training in an academic institution.Ann Surg234475486CrossRefPubMed
6.
go back to reference Cichon, R, Kappert, U, Schneider, J, Schramm, I, Gulielmos, V, Tugtekin, SM, Schuler, S 2000Robotic-enhanced arterial revascularization for multivessel coronary artery disease.Ann Thorac Surg7010601062CrossRefPubMed Cichon, R, Kappert, U, Schneider, J, Schramm, I, Gulielmos, V, Tugtekin, SM, Schuler, S 2000Robotic-enhanced arterial revascularization for multivessel coronary artery disease.Ann Thorac Surg7010601062CrossRefPubMed
7.
go back to reference Damiano, RJ, Ehrman, WJ, Ducko, CT, Tabaie, HA, Stephenson, ER, Kingsley, CP, Chambers, CE 2000Initial United States clinical trial of roboticaily assisted endoscopic coronary artery bypass grafting.J Thorac Cardiovasc Surg1197782PubMed Damiano, RJ, Ehrman, WJ, Ducko, CT, Tabaie, HA, Stephenson, ER, Kingsley, CP, Chambers, CE 2000Initial United States clinical trial of roboticaily assisted endoscopic coronary artery bypass grafting.J Thorac Cardiovasc Surg1197782PubMed
8.
go back to reference Darzi, A, Smith, S, Taffinder, N 1999Assessing operative skill.Br Med J318887888 Darzi, A, Smith, S, Taffinder, N 1999Assessing operative skill.Br Med J318887888
9.
go back to reference Datta, V, Mackay, S, Chang, A, Darzi, A 2002The relationship between motion analysis and surgical technical assessments.Am J Surg1847073CrossRefPubMed Datta, V, Mackay, S, Chang, A, Darzi, A 2002The relationship between motion analysis and surgical technical assessments.Am J Surg1847073CrossRefPubMed
10.
go back to reference Datta, V, Mackay, S, Mandalia, M, Darzi, A 2001The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model.J Am Coll Surg193479485CrossRefPubMed Datta, V, Mackay, S, Mandalia, M, Darzi, A 2001The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model.J Am Coll Surg193479485CrossRefPubMed
11.
go back to reference Falcone, T, Goldberg, J, Margossian, H, Stevens, L 2000Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study.Fertil Steril7310401042 Falcone, T, Goldberg, J, Margossian, H, Stevens, L 2000Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study.Fertil Steril7310401042
12.
go back to reference Falk, V, Mintz, D, Grünenfelder, J, Fann, JI, Burdon, TA 2001Influence of three-dimensional vision on surgical telemanipulator performance.Surg Endosc1512821288PubMed Falk, V, Mintz, D, Grünenfelder, J, Fann, JI, Burdon, TA 2001Influence of three-dimensional vision on surgical telemanipulator performance.Surg Endosc1512821288PubMed
13.
go back to reference Falk, V, McLoughlin, J, Guthart, G, Salisbury, JK, Walther, T, Gummert, J, Mohr, FW 1999Dexterity enhancement in endoscopic surgery by a computer-controlled mechanical wrist.Minim Invasive Therap Allied Technol8235242 Falk, V, McLoughlin, J, Guthart, G, Salisbury, JK, Walther, T, Gummert, J, Mohr, FW 1999Dexterity enhancement in endoscopic surgery by a computer-controlled mechanical wrist.Minim Invasive Therap Allied Technol8235242
14.
go back to reference Falk, V, Autschbach, R, Krakor, R, Walther, T, Diegeler, A, Onnasch, JF, Chitwood, WR, Mohr, FW 1999Computer-enhanced mitral valve surgery: Toward a total endoscopic procedure.Semin Thorac Cardiovasc Surg11244249PubMed Falk, V, Autschbach, R, Krakor, R, Walther, T, Diegeler, A, Onnasch, JF, Chitwood, WR, Mohr, FW 1999Computer-enhanced mitral valve surgery: Toward a total endoscopic procedure.Semin Thorac Cardiovasc Surg11244249PubMed
15.
go back to reference Faulkner, H, Regehr, G, Martin, J, Reznick, R 1996Validation of an objective structured assessment of technical skill for surgical residents.Acad Med7113631365PubMed Faulkner, H, Regehr, G, Martin, J, Reznick, R 1996Validation of an objective structured assessment of technical skill for surgical residents.Acad Med7113631365PubMed
16.
go back to reference Goff, BA, Lentz, GM, Mandell, LS 1999Formal teaching of surgical skills in an obstetric gynaecologic residency.Obstet Gynecol93785790CrossRefPubMed Goff, BA, Lentz, GM, Mandell, LS 1999Formal teaching of surgical skills in an obstetric gynaecologic residency.Obstet Gynecol93785790CrossRefPubMed
17.
go back to reference Hinder, RA, Perdikis, G, Klinger, PJ, De Vault, KR 1997The surgical option for gastroesophageal reflux disease.Am J Med103144S148SCrossRefPubMed Hinder, RA, Perdikis, G, Klinger, PJ, De Vault, KR 1997The surgical option for gastroesophageal reflux disease.Am J Med103144S148SCrossRefPubMed
18.
go back to reference Loulmet, D, Carpentier, A, d’Attellis, N, Berrebi, A, Cardon, C, Ponzio, O, Aupecle, B, Relland, JYM 1999Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.J Thorac Cardiovasc Surg118410PubMed Loulmet, D, Carpentier, A, d’Attellis, N, Berrebi, A, Cardon, C, Ponzio, O, Aupecle, B, Relland, JYM 1999Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.J Thorac Cardiovasc Surg118410PubMed
19.
go back to reference McMahon, AJ, Russell, AT, Baxter, JN, Ross, S, Anderson, JR, Morran, CG, Sunderland, G, Galloway, D, Ramsey, G, O’Dwyer, PJ 1994Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial.Lancet343135138CrossRefPubMed McMahon, AJ, Russell, AT, Baxter, JN, Ross, S, Anderson, JR, Morran, CG, Sunderland, G, Galloway, D, Ramsey, G, O’Dwyer, PJ 1994Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial.Lancet343135138CrossRefPubMed
20.
go back to reference MacRae, H, Regehr, G, Leadbetter, W, Reznick, RK 2000A comprehensive examination for senior surgical residents.Am J Surg179190193CrossRefPubMed MacRae, H, Regehr, G, Leadbetter, W, Reznick, RK 2000A comprehensive examination for senior surgical residents.Am J Surg179190193CrossRefPubMed
21.
go back to reference Marescaux, J, Leroy, J, Rubino, F, Smith, M, Vix, M, Simone, M, Mutter, D 2002Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.Ann Surg235487492CrossRefPubMed Marescaux, J, Leroy, J, Rubino, F, Smith, M, Vix, M, Simone, M, Mutter, D 2002Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.Ann Surg235487492CrossRefPubMed
22.
go back to reference Martin, JA, Regehr, G, Reznick, R, MacRae, H, Mumaghan, J, Hutchinson, C, Brown, M 1997Objective structured assessment of technical skills (OSATS) for surgical residents.Br J Surg84273278CrossRefPubMed Martin, JA, Regehr, G, Reznick, R, MacRae, H, Mumaghan, J, Hutchinson, C, Brown, M 1997Objective structured assessment of technical skills (OSATS) for surgical residents.Br J Surg84273278CrossRefPubMed
23.
go back to reference Patkin, M, Isabel, L 1995Ergonomics, engineering and surgery of endosurgical dissection.J R Coll Surg Edinb40120132PubMed Patkin, M, Isabel, L 1995Ergonomics, engineering and surgery of endosurgical dissection.J R Coll Surg Edinb40120132PubMed
24.
go back to reference Prasad, S, Maniar, HS, Soper, NJ, Damiano, RJ, Klingensmith Mary, E 2002The effect of robotic assistance on learning curves for basic laparoscopic skills.Am J Surg183702707CrossRefPubMed Prasad, S, Maniar, HS, Soper, NJ, Damiano, RJ, Klingensmith Mary, E 2002The effect of robotic assistance on learning curves for basic laparoscopic skills.Am J Surg183702707CrossRefPubMed
25.
go back to reference Ramsay, CR, Grant, A, Wallace, SA, Garthwaite, PH, Monk, AF, Russell, IT 2000Assessment of the learning curve in health technologies.Int J Technol Assess Health Care1610951108CrossRefPubMed Ramsay, CR, Grant, A, Wallace, SA, Garthwaite, PH, Monk, AF, Russell, IT 2000Assessment of the learning curve in health technologies.Int J Technol Assess Health Care1610951108CrossRefPubMed
26.
go back to reference Reznick, R, Regehr, G, MacRae, H, Martin, J, McCulloch, W 1997Testing technical skill via an innovative “bench station” examination.Am J Surg173226230CrossRefPubMed Reznick, R, Regehr, G, MacRae, H, Martin, J, McCulloch, W 1997Testing technical skill via an innovative “bench station” examination.Am J Surg173226230CrossRefPubMed
27.
go back to reference Ruurda, JP, Vroonhoven, ThJ, Broeders, IAMJ 2002Robot-assisted surgical systems: a new era in laparoscopic surgery.Ann R Coll Surg Engl84223226CrossRef Ruurda, JP, Vroonhoven, ThJ, Broeders, IAMJ 2002Robot-assisted surgical systems: a new era in laparoscopic surgery.Ann R Coll Surg Engl84223226CrossRef
28.
go back to reference Scott, DJ, Young, Wn, Tesfay, ST, Frawiey, WH, Rege, RV, Jones, DB 2001Laparoscopic skills training.Am J Surg182137142CrossRefPubMed Scott, DJ, Young, Wn, Tesfay, ST, Frawiey, WH, Rege, RV, Jones, DB 2001Laparoscopic skills training.Am J Surg182137142CrossRefPubMed
29.
go back to reference Shea, JA, Healey, MJ, Berlin, JA, Clarke, JR, Malet, PF, Staroscik, RN, Schwartz, JS, Williams, SV 1996Mortality and complications associated with laparoscopic cholecystectomy.A meta-analysis. Ann Surg224609620CrossRef Shea, JA, Healey, MJ, Berlin, JA, Clarke, JR, Malet, PF, Staroscik, RN, Schwartz, JS, Williams, SV 1996Mortality and complications associated with laparoscopic cholecystectomy.A meta-analysis. Ann Surg224609620CrossRef
30.
go back to reference Smith, CD, Farrell, TM, McNatt, SS, Metrevel, RM 2001Assessing laparoscopic manipulative skills.Am J Surg181547550CrossRefPubMed Smith, CD, Farrell, TM, McNatt, SS, Metrevel, RM 2001Assessing laparoscopic manipulative skills.Am J Surg181547550CrossRefPubMed
31.
go back to reference Taffinder, N, Smith, S, Mair, J, Russell, RC, Darzi, A 1999Can a computer measure surgical precision? Reliability, validity and feasibility of the ICSAD.Surg Endosc13 (suppl 1)81 Taffinder, N, Smith, S, Mair, J, Russell, RC, Darzi, A 1999Can a computer measure surgical precision? Reliability, validity and feasibility of the ICSAD.Surg Endosc13 (suppl 1)81
32.
go back to reference Watson, DI, Baigrie, RJ, Jamieson, GG 1996A learning curve for laparoscopic fundoplication: Definable, avoidable, or a waste of time?Ann Surg224198203CrossRefPubMed Watson, DI, Baigrie, RJ, Jamieson, GG 1996A learning curve for laparoscopic fundoplication: Definable, avoidable, or a waste of time?Ann Surg224198203CrossRefPubMed
33.
go back to reference Williams, LF, Chapman, WC, Bonau, RA, McGee, EC, Boyd, RW, Jacobs, JK 1993Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.Am J Surg165459465PubMed Williams, LF, Chapman, WC, Bonau, RA, McGee, EC, Boyd, RW, Jacobs, JK 1993Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.Am J Surg165459465PubMed
34.
go back to reference Z’graggen, K, Wehrli, H, Metzger, A, Buehler, M, Frei, E, Klaiber, C 1998Complications of laparoscopic surgery in Switzerland.Surg Endosc1213031310CrossRefPubMed Z’graggen, K, Wehrli, H, Metzger, A, Buehler, M, Frei, E, Klaiber, C 1998Complications of laparoscopic surgery in Switzerland.Surg Endosc1213031310CrossRefPubMed
Metadata
Title
Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system
Authors
J. D. Hernandez
S. D. Bann
Y. Munz
K. Moorthy
V. Datta
S. Martin
A. Dosis
F. Bello
A. Darzi
T. Rockall
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 3/2004
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-003-9047-3

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