Does robotic assistance improve efficiency in performing complex minimally invasive surgical procedures?
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We used a model of biliary-enteric anastomosis to test whether da Vinci robotics improves performance on a complex minimally invasive surgical (MIS) procedure.
An ex vivo model for choledochojejunostomy was created using porcine livers with extrahepatic bile ducts and contiguous intestines. MIS choledochojejunostomies were performed in two arms: group 1 (laparoscopic, n = 30) and group 2 (da Vinci assisted, n = 30). Procedures were performed by three surgeons with graduated MIS expertise: surgeon A (MIS + robotics), surgeon B (experienced MIS), and surgeon C (basic MIS). Each surgeon performed ten procedures per group. The primary objective was time to complete anastomoses using each method. Secondary objectives included anastomosis quality, impact of experience on performance, and learning curve.
da Vinci led to faster anastomoses than laparoscopy (28.0 vs. 35.9 min, p = 0.002). Surgeon A’s mean operative times were equivalent with both techniques (24.5 vs. 22.3 min). Surgeons B and C experienced faster operative times with robotics over laparoscopy alone (39.4 vs. 28.6 min, p = 0.01; and 43.8 vs. 33.0 min, p = 0.008, respectively). Surgeon A did not demonstrate a learning curve with either laparoscopy (22.4 vs. 22.4 min, p = not significant, NS) or robotics (24.7 vs. 19.8 min, p = NS). Surgeon B demonstrated nonsignificant improvement with laparoscopy (46.6 vs. 39.5 min, p = NS). With robotic assistance, a learning curve was demonstrated (36.8 vs. 24.7 min, p = 0.02). Surgeon C demonstrated a learning curve with laparoscopy (58.3 vs. 33.2 min, p = 0.004), but no improvement was noted with robot assistance (32.2 vs. 34.7 min, p = NS).
da Vinci improves time to completion and quality of choledochojejunostomy over laparoscopy in an ex vivo bench model. This advantage is more pronounced in the hands of surgeons with less MIS experience. Conversely, robotics may allow less experienced surgeons to perform more complex operations without first developing advanced laparoscopic skills; however, there may be benefit to first obtaining fundamental skills.
- Jayaraman S, Davies W, Schlachta CM (2008) Robot-assisted minimally invasive common bile duct exploration: a Canadian first. Can J Surg 51:E93–E94
- Gutt CN, Oniu T, Mehrabi A et al (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397 CrossRef
- Chitwood WR Jr, Nifong LW, Chapman WH, Felger JE, Bailey BM, Ballint T et al (2001) Robotic surgical training in an academic institution. Ann Surg 234:475–486 CrossRef
- Gettman MT, Neururer R, Bartsch G, Peschel R (2002) Anderson–Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology 60:509–513 CrossRef
- Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784 CrossRef
- Chekan EG, Clark L, Wu J, Pappas TN, Eubanks S (1999) Laparoscopic biliary and enteric bypass. Semin Surg Oncol 16:313–320 CrossRef
- Jeyapalan M, Almeida JA, Michaelson RL, Franklin ME Jr (2002) Laparoscopic choledochoduodenostomy: review of a 4-year experience with an uncommon problem. Surg Laparosc Endosc Percutan Tech 12:148–153 CrossRef
- Schob OM, Schmid RA, Morimoto AK, Largiader F, Zucker KA (1997) Laparoscopic Roux-en-Y choledochojejunostomy. Am J Surg 173:312–319 CrossRef
- Ruurda JP, van Dongen KW, Dries J, Borel Rinkes IH, Broeders IA (2003) Robot-assisted laparoscopic choledochojejunostomy. Surg Endosc 17:1937–1942 CrossRef
- Meehan JJ, Elliot S, Sandler A (2007) The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 42:2110–2114 CrossRef
- Rothlin MA, Schob O, Weber M (1999) Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: a case controlled study. Surg Endosc 13:1065–1069 CrossRef
- El-Hakim A, Leung RA, Tewari A (2006) Robotic prostatectomy: a pooled analysis of published literature. Expert Rev Anticancer Ther 6:11–20 CrossRef
- Hakimi AA, Feder M, Ghavamian R (2007) Minimally invasive approaches to prostate cancer: a review of the current literature. Urol J 4:130–137
- Wexner SD, Begamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH et al (2008) The current status of robotic pelvic surgery: results from a multinational interdisciplinary consensus conference. Surg Endosc 23:438–443 CrossRef
- Welling TH, Heidt DG, Englesbe MJ, Magee JC, Sung RS, Campbell DA et al (2008) Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient, and technical factors. Liver Transpl 14:73–80 CrossRef
- Maheshwari A, Maley W, Li Z, Thuluvath PJ (2007) Biliary complications and outcomes of liver transplantation from donors after cardiac death. Liver Transpl 13:1645–1653 CrossRef
- Alsharabi A, Zieniewicz K, Michałowicz B, Patkowski W, Nyckowski P, Wróblewski T et al (2007) Biliary complications in relation to the technique of biliary reconstruction in adult liver transplant recipients. Transplant Proc 39:2785–2787 CrossRef
- Does robotic assistance improve efficiency in performing complex minimally invasive surgical procedures?
Volume 24, Issue 3 , pp 584-588
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Biliary-enteric anastomosis
- Learning curve
- Industry Sectors
- Author Affiliations
- 1. CSTAR (Canadian Surgical Technologies and Advanced Robotics), Lawson Health Research Institute, London, ON, Canada
- 2. Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, 339 Windermere Road, University Hospital, London, ON, N6A 5A5, Canada