Manual robot assisted endoscopic suturing: Time-action analysis in an experimental model

BackgroundRobotic surgery systems were introduced to overcome the disadvantages of endoscopic surgery. The goal of this study was to assess whether robot assistance could support endoscopic surgeons in performing a complex endoscopic task.MethodsFive experienced endoscopic surgeons performed end-to-end anastomosis on post-mortem porcine small intestine. The procedure was performed both with standard endoscopic techniques and with robotic assistance (da Vinci system, Intuitive Surgical, Sunny vale, CA). It was performed in three different working directions with a horizontal, vertical, and diagonal position of the bowel. Anastomosis time, number of stitches, knots, time per stitch, suture ruptures, and the number of stitch errors were recorded. Also, an action analysis was performed.ResultsAnastomosis time, number of stitches, and the number of knots did not differ significantly between the two groups. The time needed per stitch was significantly shorter with robot assistance (81.4 sec/stitch vs 95.9 sec/stitch, p = 0.005). More suture ruptures occurred in the robot group (0 (0–2) vs 0 (0–0), p = 0.003). In the standard group more stitch errors were found (2 (0–5) vs 0 (0–3), p = 0.017). These results were comparable for three different working directions. The action analysis, however, showed significant benefits of robotic assistance. The benefits were greatest in a vertical bowel position.ConclusionRobot assistance might offer added value to experienced endoscopic surgeons in the performance of a small-bowel anastomosis in an experimental setup, even though total anastomosis time could not be demonstrated to be shorter and some suture tears occurred due to the lack of force feedback.

[1]  J. Dankelman,et al.  Peroperative analysis of the surgical procedure , 2001, Surgical Endoscopy And Other Interventional Techniques.

[2]  D. Nio,et al.  Efficiency of manual versus robotical (Zeus) assisted laparoscopic surgery in the performance of standardized tasks , 2001, Surgical Endoscopy And Other Interventional Techniques.

[3]  A. Cuschieri,et al.  Ergonomic principles of task alignment, visual display, and direction of execution of laparoscopic bowel suturing , 2002, Surgical Endoscopy And Other Interventional Techniques.

[4]  J. Rastad,et al.  Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses , 1994, The British journal of surgery.

[5]  V. Vanek,et al.  The cost of laparoscopic versus open cholecystectomy in a community hospital , 1995, Surgical Endoscopy.

[6]  M. Rhodes,et al.  Long‐term pain: Less common after laparoscopic than open cholecystectomy , 1994, The British journal of surgery.

[7]  J. Marescaux,et al.  Telerobotic Laparoscopic Cholecystectomy: Initial Clinical Experience With 25 Patients , 2001, Annals of surgery.

[8]  G. Ballantyne.  Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. , 2002, Surgical endoscopy.

[9]  Nathaniel J Soper,et al.  The effect of robotic assistance on learning curves for basic laparoscopic skills. , 2002, American journal of surgery.

[10]  S Larsson,et al.  Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period , 2000, The British journal of surgery.

[11]  M. Gagner,et al.  Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems , 2003, Surgical Endoscopy And Other Interventional Techniques.

[12]  G. Sung,et al.  Robotic laparoscopic surgery: a comparison of the DA Vinci and Zeus systems. , 2001, Urology.

[13]  I. Broeders,et al.  Robot-assisted surgical systems: a new era in laparoscopic surgery. , 2002, Annals of the Royal College of Surgeons of England.

[14]  I. B. Borel Rinkes,et al.  Feasibility of Robot-Assisted Laparoscopic Surgery: An Evaluation of 35 Robot-Assisted Laparoscopic Cholecystectomies , 2002, Surgical laparoscopy, endoscopy & percutaneous techniques.

[15]  B Kiaii,et al.  A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis. , 2000, The Annals of thoracic surgery.

[16]  G. Ballantyne.  Robotic surgery, telerobotic surgery, telepresence, and telementoring , 2002, Surgical Endoscopy And Other Interventional Techniques.

[17]  Kim Ca,et al.  Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks. , 1999 .

[18]  Benjamin R. Lee,et al.  Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? , 2002, Urology.

[19]  I. Broeders,et al.  Robot-assisted laparoscopic intestinal anastomosis , 2003, Surgical Endoscopy And Other Interventional Techniques.

[20]  V. Vanek,et al.  Results of Laparoscopic Versus Open Cholecystectomy in a Community Hospital , 1995, Southern medical journal.

[21]  P. Green,et al.  Vascular applications of telepresence surgery: initial feasibility studies in swine. , 1996, Journal of vascular surgery.

[22]  J. Himpens,et al.  Feasibility of Robotic Laparoscopic Surgery: 146 Cases , 2001, World Journal of Surgery.