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Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial

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Abstract

Background

Robotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills.

Methods

We conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20 h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2.

Results

Sixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p < 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group.

Conclusion

There was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.

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Acknowledgements

We would like to thank the participants who volunteered for this study. We would like to also thank the Hospital de Clínicas de Porto Alegre for allowing us to use the dV-Trainer robotic surgical simulator and the Surgical Skills Laboratory in this study. Finally, we would like to thank the Instituto Simutec for allowing us to use their facilities to perform the laparoscopic training sessions.

Funding

The authors have not disclosed any funding.

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Author notes

  1. Roberto Vanin Pinto Ribeiro and João Maximiliano have contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Roberto Vanin Pinto Ribeiro

  2. Division of Cardiovascular Surgery, Department of Surgery, Dalhousie University, Halifax, Canada

    Roberto Vanin Pinto Ribeiro

  3. Division of Plastic Surgery, Department of Surgery, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre, RS, 90035-007, Brazil

    João Maximiliano & Eduardo Madalosso Zanin

  4. Department of Surgery, Universidade Federal do Mato Grosso, Sinop, Brazil

    Guilherme Barreiro

  5. Department of Anesthesiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Olavo Haas de Souza Gastal

  6. Division of General Surgery, Department of Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Pauline Simas Machado, Luciano Paludo Marcelino & Leandro Totti Cavazzola

  7. Division of Digestive and General Surgery, Department of Surgery, Hospital Geral de Caxias do Sul, Universidade de Caxias do Sul, Caxias do Sul, Brazil

    Henrique Rasia Bosi

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  1. Roberto Vanin Pinto Ribeiro
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Correspondence to João Maximiliano.

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Drs. Roberto Vanin Pinto Ribeiro, João Maximiliano, Guilherme Barreiro, Olavo Haas de Souza Gastal, Pauline Simas Machado, Luciano Paludo Marcelino, Henrique Rasia Bosi, Eduardo Madalosso Zanin, and Leandro Totti Cavazzola have no relevant disclosures related to this study.

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Ribeiro, R.V.P., Maximiliano, J., Barreiro, G. et al. Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial. Surg Endosc 36, 7325–7333 (2022). https://doi.org/10.1007/s00464-022-09118-9

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