Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting?

Robotic surgery allows three-dimensional (3D) viewing of tissues. We compared two-dimensional (2D) and 3D suturing drills using the daVinci surgical system to determine if the latter is advantageous.

Twenty-eight anastomotic drills were completed by seven surgeons using the daVinci robot. Three surgeons had considerable (>6 months) robotic experience, and four had none. Drills were performed randomly in both dimensional modes in a blinded fashion. Drill 1 was an interrupted four stitch and drill 2 a running closure. All tasks were kept uniform. We recorded time to completion, difficulty, and accuracy. The drills were evaluated by two independent reviewers for accuracy and major errors (i.e., broken suture, torn graft).

The average operative time per drill in two dimensions was 13.1 minutes (range 6.9-21.9 minutes) and in three dimensions was 8.5 minutes (range 4.7-12.8 minutes) (P<0.001). Drill 1 was 6.1 minutes faster in three dimensions (mean 9.2 minutes; P<0.01), and drill 2 was 2.9 minutes faster (mean 7.8 minutes; P=0.03). Both advanced and novice groups were faster in 3D (P<0.01). There were two major errors in the 3D performances and 5 in the 2D exercises (P<0.05). The participants correctly identified the dimensional mode 92.9% of the time (P<0.01).

The anastomosis was completed 65% faster using 3D with equal, if not greater, accuracy. Drill 1 was improved to a greater degree than drill 2, suggesting most benefit of 3D views during knot tying. Use of three dimensions outperformed two dimensions in both groups. Surgeons can immediately benefit from 3D viewing during robotic surgery.