Objective evaluation of expert performance during human robotic surgical procedures

Robotic laparoscopic surgery has revolutionized minimally invasive surgery and has increased in popularity due to its important benefits. However, evaluation of surgical performance during human robotic laparoscopic procedures in the operating room is very limited. We previously developed quantitative measures to assess robotic surgical proficiency. In the current study, we want to determine if training task performance is equivalent to performance during human surgical procedures performed with robotic surgery. An expert with more than 5 years of robotic laparoscopic surgical experience performed two training tasks (needle passing and suture tying) and one human laparoscopic procedure (Nissan fundoplication) using the da Vinci™ Surgical System (dVSS). Segments of the human procedure that required needle passing and suture tying were extracted. Time to task completion, distance traveled, speed, curvature, and grip force were measured at the surgical instrument tips. Single-subject analysis was used to compare training task performance and human surgical performance. Nearly all objective measures (8 out of 13) were significantly different between training task performance and human surgical performance for both the needle passing and the suture tying tasks. The surgeon moved slower, made more curved movements, and used more grip force during human surgery. Even though it appears that the surgeon performed better in the training tasks, it is likely that during human surgical procedures, the surgeon is more cautious and meticulous in the movements performed in order to prevent tissue damage or other complications. The needle passing and the suture tying training tasks may be suitable to establish a foundation of surgical skill; however, further training may be necessary to improve transfer of learning to the operating room. We recommend that more realistic training tasks be developed to better predict performance during robotic surgical procedures and testing the transferability of basic skill acquisition to surgical performance.