Perceptual and instrumental impacts of robotic laparoscopy on surgical performance

New technologies in surgery are in constant and considerable evolution; they transform the surgeon s activity and practice. In laparoscopic surgery, new systems allow the use of two(2D) or three-dimensional (3D) vision. However, the literature reports contradictory results concerning the benefits of 3D vision: some studies show that better motor performances are obtained with 3D vision [1, 8, 19, 25, 26] while others fail to reveal any difference in performance between 2D and 3D vision [5, 6, 12, 20]. In some studies [5], only complex tasks were performed faster and more easily with a 3D view whereas no difference between the use of 2D and 3D views appeared when performing the easiest tasks. The divergence in these results is partially due to the fact that first-generation 3D systems, with their lower resolution, were compared with standard 2D systems [10]. Nowadays, new 3D systems allow a natural bidimensional view and thus suppress the bias observed in previous studies. In this paper, we used a new-generation 3D system, the da Vinci robotic system. This robotic system allows a 3D visualization of the operative field to be gained, restores the degrees of freedom (DOFs) lost in classical laparoscopy, and improves the dexterity of the surgeon s hand and wrist. Only one published study [13] has compared the performance obtained using classical laparoscopic techniques and those using this robotic system. This study revealed advantages of the da Vinci robotic system, particularly when it was used with the 3D view option. However, only six subjects participated in this study and the chosen tasks were very specific to the robotic system training. Our objective was therefore to study, with more participants, the impact of the da Vinci robotic system on standard and ecological surgical tasks of increasing complexity (ecological in the sense that our tasks were similar to the gestures made by the surgeon in a real situation, for which we used bench models developed and validated in several studies [7, 22, 23]). To analyse the nature of the benefits brought about by these expensive new technologies precisely, we independently differentiated and studied the influence of the 3D view (afferent component), comparing 2D and 3D view, and the influence of movement freedom restauration (DOFs, efferent component), comparing the classical laparoscopy with the robotic system. We also studied the impact of the use of the robotic technology on the subject s self-confidence, satisfaction and facility, knowing that these three factors influence both the performance and acceptance of new technology in the operating room [16, 17]. To avoid any bias from earlier laparoscopic experience in our comparison between classical and robotic laparoscopic techniques, we only selected medical students without any prior experience in open, minimally invasive or robotically assisted surgery.