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Robot-Assisted Surgery Decreases Workload and Enhances Existing Laparoscopic Skills with Increasing Task Difficulty
*Lucian Panait, *William Roddick, *Leonidas Tapias, *Emily Hibbard, Juan A Sanchez
Saint Mary's Hospital, Waterbury, CT

Objective: We hypothesize that robotic surgery enhances user performance when performing basic laparoscopic maneuvers.
Design: Case-control study
Setting: Community-based general surgery residency program
Patients: Fourteen 3rd year medical students and 14 general surgery residents with no previous robotic, but varying degrees of laparoscopic experience volunteered to participate in the study.
Interventions: Subjects underwent skill evaluation on a laparoscopic box-trainer using standard instruments and with the da Vinci robot (Intuitive Surgical, Inc.). Three Fundamentals in Laparoscopic Surgery (FLS) tasks were employed in each setting: Peg Transfer (PT), Circle Cutting (CC), and Intracorporeal Suturing (IS).
Main Outcome Measures: Robotic FLS scores were compared with laparoscopic FLS scores. Task workload was assessed with a modified NASA-TLX questionnaire.
Results: Robotic-IS scores were significantly higher than Laparoscopic-IS (80 vs. 51, p<0.001). FLS scores for PT and CC were similar between robotic and laparoscopic modalities (88 vs. 87, and 53 vs. 44 respectively, p>0.05). Subgroup analysis of senior residents revealed a decrease in the Robotic-PT score when compared with the Laparoscopic-PT (93 vs. 105, p<0.05). Robotic-CC and robotic-IS were associated with decreased Mental Demand, Physical Demand, Temporal Demand, Performance, Effort and Frustration when compared with laparoscopic-CC and laparoscopic-IS, respectively (p<0.05).
Conclusions: When compared with straight laparoscopy, robotic surgery does not offer a benefit for simple tasks in advanced users. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy, and difficult tasks such as intracorporeal suturing are actually enhanced, even in novices. Transference of laparoscopic skills to a robotic platform is apparent, and associated with decreased task workload.

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