Journal of endourology / Endourological Society | 27 Mar 2013
JE Angell, MS Gomez, MM Baig and R Abaza
Purpose: Robotic surgical technology has been adopted by surgeons with and without previous standard laparoscopic experience. The necessity or benefit of prior training and experience in laparoscopic surgery is unknown. We hypothesized that laparoscopic training enhances performance in robotic surgery. Materials and Methods: Fourteen medical students with no surgical experience were instructed to incise a spiral using the da Vinci® surgical robot with time to completion and errors recorded. Each student was then trained for one month in standard laparoscopy but with no further robotic exposure. Training included a validated laparoscopic training program including timed and scored parameters. After completion of the month-long training, the students repeated the cutting exercise using the da Vinci® robot as well as with standard laparoscopic instruments and were scored within the same parameters. Results: The mean time to completely incise the spiral robotically prior to training was 16.72 minutes with a mean of 6.21 errors. After one month of validated laparoscopic training, the mean robotic time fell to 9:03 minutes (p=0.0002) with 3.57 errors (p=0.02). Laparoscopic performance after one month of validated laparoscopic training was 13.95 minutes with 6.14 errors, which was no better than pre-training robotic performance (p=0.20) and worse than post-training robotic performance (p=0.01). Conclusions: Formal laparoscopic training improved performance of a complex robotic task. Initial robotic performance without any robotic or laparoscopic training was equivalent to standard laparoscopic performance after extensive training. Additionally, after laparoscopic training the robot allowed significantly superior speed and precision of the task. Laparoscopic training may improve proficiency in operation of the robot. This may explain the perceived ease with which robotics is adopted by laparoscopically trained surgeons and may be important in training future robotic surgeons.
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