Abstract
Introduction
Robotic surgery has seen increasing use in the field of pediatric surgery. Our clinical experience suggested instrument size can impact on the surgical ability. This study aimed to compare the performance of robot-assisted laparoscopic skills in confined spaces using either 5 or 8 mm instruments.
Methods
A preclinical randomized crossover study design was implemented. 24 assessors performed three different reproducible drill procedures (M1: peg transfer, M2: circle cutting, M3: intracorporeal suturing). To assess surgical proficiency in confined working spaces, these exercises were performed with 5 and 8 mm instruments of the da Vinci® Surgical Systems Si in a cubic box with 60 mm-sized edges. Each performance was recorded and evaluated by two reviewers using both objective structured assessment of technical skills (OSATS) and global evaluative assessment of robotic skills (GEARS) scores. Parietal iatrogenic impacts and instrument collisions were specifically analyzed using a dedicated scoring system.
Results
Regardless of their experience, trainees performed significantly better when using 8 mm instruments in terms of OSATS scores (20.5 vs. 18.4; p < 0.01) and GEARS scores (23.4 vs. 21.9; p < 0.01) for most items, except for “depth perception” and “autonomy.” The 8 mm performances involved significantly less parietal box damage (4.1 vs. 3.4; p < 0.01), and tool collisions (4.1 vs. 3.2; p < 0.01).
Conclusions
In light of the better performances with 8 mm tools for specific tasks and parietal sparing constraints in restricted spaces, this study indicates that 5 mm instruments can be deemed to be less effective for reconstructive procedures in small children.
Similar content being viewed by others
References
Chaussy Y, Becmeur F, Lardy H, Aubert D (2013) Robot-assisted surgery: current status evaluation in abdominal and urological pediatric surgery. J Laparoendosc Adv Surg Tech A 23:530–538
Meehan JJ (2009) Robotic surgery in small children: is there room for this? J Laparoendosc Adv Surg Tech A 19:707–712
Ballouhey Q, Villemagne T, Cros J, Szwarc C, Braik K, Longis B, Lardy H, Fourcade L (2015) A comparison of robotic surgery in children weighing above and below 15.0 kg: size does not affect surgery success. Surg Endosc 29:2643–2650
Thakre AA, Bailly Y, Sun LW, Van Meer F, Yeung CK (2008) Is smaller workspace a limitation for robot performance in laparoscopy? J Urol 179:1138–1142
Pelizzo G, Nakib G, Goruppi I, Avolio L, Romano P, Raffaele A, Scorletti F, Mencherini S, Calcaterra V (2014) Pediatric robotic pyeloplasty in patients weighing less than 10 kg initial experience. Surg Laparosc Endosc Percutan Tech 24:e29–e31
Finkelstein JB, Levy AC, Silva MV, Murray L, Delaney C, Casale P (2015) How to decide which infant can have robotic surgery? Just do the math. J Pediatr Urol 11(170):e171–e174
Herz D, Smith J, McLeod D, Schober M, Preece J, Merguerian P (2016) Robot-assisted laparoscopic management of duplex renal anomaly: comparison of surgical outcomes to traditional pure laparoscopic and open surgery. J Pediatr Urol 12:44e1–44e7
Stocco L, Salcudean SE, Sassani F (1998) Fast constrained global minimax optimization of robot parameters. Robotica 16:595
Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1998) Development of a model for training and evaluation of laparoscopic skills. Am J Surg 175:482–487
Faulkner H, Regehr G, Martin J, Reznick R (1996) Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 71:1363–1365
Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ (2012) Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. J Urol 187:247–252
Panait L, Shetty S, Shewokis PA, Sanchez JA (2014) Do laparoscopic skills transfer to robotic surgery? J Surg Res 187:53–58
Hassan SO, Dudhia J, Syed LH, Patel K, Farshidpour M, Cunningham SC, Kowdley GC (2015) Conventional laparoscopic vs robotic training: which is better for naive users? A randomized prospective crossover study. J Surg Educ 72:592–599
Ballouhey Q, Villemagne T, Cros J, Vacquerie V, Bérenguer D, Braik K, Szwarc C, Longis B, Lardy H, Fourcade L (2015) Assessment of paediatric thoracic robotic surgery. Interact Cardiovasc Thorac Surg 20:300–303
Bruns NE, Soldes OS, Ponsky TA (2015) Robotic surgery may not “Make the Cut” in pediatrics. Front Pediatr 3:10
Jones VS (2015) Robotic-assisted single-site cholecystectomy in children. J Pediatr Surg 50:1842–1845
Acknowledgements
The authors thank R. Peymirat for his technical assistance with image editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Quentin Ballouhey, Pauline Clermidi, Jérôme Cros, Céline Grosos, Clémence Rosa-Arsène, Claire Bahans, François Caire, Bernard Longis, Roxane Compagnon, and Laurent Fourcade have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Ballouhey, Q., Clermidi, P., Cros, J. et al. Comparison of 8 and 5 mm robotic instruments in small cavities. Surg Endosc 32, 1027–1034 (2018). https://doi.org/10.1007/s00464-017-5781-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5781-9