Robotic 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.
Five 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.
Anastomosis 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.
Robot 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.
Robotics Laparoscopic surgery Anastomosis
Ballantyne, GH 2002Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results.Surg Endosc1613891402CrossRefPubMedGoogle Scholar
Berggren, U, Gordh, T, Grama, D, Haglund, U, Rastad, J, Arvidsson, D 1994Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses.Br J Surg8113621365PubMedGoogle Scholar
Bowersox, JC, Shah, A, Jensen, J, Hill, J, Cordts, PR, Green, PS 1996Vascular applications of telepresence surgery: initial feasibility studies in swine.J Vasc Surg23281287PubMedGoogle Scholar
Cadiere, GB, Himpens, J, Germay, O, Izizaw, R, Degueldre, M, Vandromme, J, Capelluto, E, Bruyns, J 2001Feasibility of robotic laparoscopic surgery: 146 cases.World J Surg2514671477PubMedGoogle Scholar
Dakin, GF, Gagner, M 2003Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems.Surg Endosc17574579CrossRefPubMedGoogle Scholar
Boer, KT, Wit, LT, Davids, PH, Dankelman, J, Gouma, DJ 2001Analysis of the quality and efficiency in learning laparoscopic skills.Surg Endosc15497503CrossRefPubMedGoogle Scholar
Boer, KT, Dankelman, J, Gouma, DJ, Stassen, HG 2002Peroperative analysis of the surgical procedure.Surg Endosc16492499CrossRefPubMedGoogle Scholar
Emam, TA, Hanna, G, Cuschieri, A 2002Ergonomic principles of task alignment, visual display, and direction of execution of laparoscopic bowel suturing.Surg Endosc16267271CrossRefPubMedGoogle Scholar
Garcia-Ruiz, A, Gagner, M, Miller, JH, Steiner, CP, Hahn, JF 1998Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks.Arch Surg133957961CrossRefPubMedGoogle Scholar
Nilsson, G, Larsson, S, Johnsson, F 2000Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period.Br J Surg87873878CrossRefPubMedGoogle Scholar
Nio, D, Bemelman, WA, Boer, KT, Dunker, MS, Gouma, DJ, Gulik, TM 2002Efficiency of manual versus robotical (Zeus) assisted laparoscopic surgery in the performance of standardized tasks.Surg Endosc16412415CrossRefPubMedGoogle Scholar
Prasad, SM, Maniar, HS, Soper, NJ, Damiano, RJ,Jr., Klingensmith, ME 2002The effect of robotic assistance on learning curves for basic laparoscopic skills.Am J Surg183702707CrossRefPubMedGoogle Scholar