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Technical evaluation of robotic tele-cholecystectomy: a randomized single-blind controlled pilot study
Yuma Ebihara1,2, Satoshi Hirano3,4, Hironobu Takano2
1Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
Journal of Robotic Surgery
|January 5, 2023
Summary
Robotic telesurgery for cholecystectomy demonstrated comparable safety and performance to local robotic surgery. While task completion and skills assessment showed no significant differences, increased left-hand forceps path length in telesurgery suggests a need to address overshooting for future optimization.
Area of Science:
- Surgical Technology
- Medical Robotics
- Telemedicine
Background:
- Robotic telesurgery is emerging, but its efficacy versus local robotic surgery remains unclear.
- Evaluating robotic tele-cholecystectomy performance is crucial for its clinical adoption.
Purpose of the Study:
- To assess the performance and safety of robotic tele-cholecystectomy using a commercial system over a 250 km distance.
- To compare telesurgery outcomes with local robotic surgery in an artificial organ model.
Main Methods:
- A single-blind randomized crossover trial involving eight expert surgeons using the Saroa™ system.
- Surgeons performed cholecystectomy locally and via telesurgery, with assessments including task time, instrument path length, GEARS, GOALS, and fatigue.
- A stable 1 Gbps connection with a mean delay of 8 ms was utilized.
Main Results:
- All tele-cholecystectomies were performed safely, with no significant differences in completion time, GEARS, GOALS, or fatigue scores.
- The total path length of the left-hand forceps was significantly longer in telesurgery (P=0.041), attributed to overshooting.
- Instrument path length and operative efficiency were comparable between local and telesurgery groups.
Conclusions:
- Robotic tele-cholecystectomy using a commercial system is as safe and effective as local robotic surgery.
- Overshooting, leading to increased left-hand forceps path length, is a key area for improvement in robotic telesurgery.
- Further development is needed to optimize instrument control and mitigate overshooting in tele-robotic procedures.
