Investigación con el sistema da Vinci® en el Hospital St Marys de Londres

ypothesis: The da Vinci™ Surgical System allows surgeons to overcome the limitations imposed by minimally invasive surgery (MIS) in terms of dexterity, operative field control and ergonomy. The studies included evaluate the learning curve, 3-D vision and motion analysis to reveal the system’s advantages over MIS and to establish performance assessment methods. Methods: system employed: da Vinci™ Surgical System. Three comparative experiments with 11 to 13 surgeons performing different tasks looking at: learning curve comparing experienced and non-experienced surgeons, advantages of 3D over 2D vision, and advantages of robotic surgery over Minimally Invasive Surgery (MIS). Assessment: measurement of surgeon’s performance by means of a global scale for skills (OSATS) and errors count, with blind scoring by experts. Additionally, motion analysis software for MIS (ICSAD) and robotic surgery (ROVIMAS), both developed by the Department and previously validated in other studies. Statistic calculations: SPSS 10,0™ software. P<0,05. Results: The learning curve rendered an OSATS score of 18 for the first attempt and 26 for the fifth (p=0,02, Cronbah alpha: 0.894). Motion analysis showed reduction in number of movements and path length (p=0,01). Comparing robotic surgery with 3-D vision vs. MIS rendered a 40% reduction in time taken (p=0,001) and 70% reduction in path length (0,008), with 93% less skill-related errors. 3-D vision was proved to be superior to 2-D in several trials. Conclusion: “Endowrist” instruments, tremor abolition, motion scaling and 3-D vision of the da Vinci™ Surgical System enhance the surgeon’s dexterity and performance in robotic assisted MIS.