Robotic-assisted versus laparoscopic bowel anastomoses: randomized crossover in vivo experimental study

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Surgical Education

Background:

• Robotic-assisted surgery (RAS) may offer shorter initial learning curves than conventional laparoscopic surgery (LS).
• Evidence supporting this claim and the transferability of laparoscopic skills to robotic procedures is limited.
• Understanding skill acquisition and transfer is crucial for surgical training and adoption of new technologies.

Purpose of the Study:

• To compare surgical performance and workload between RAS and LS in a porcine model.
• To evaluate the transfer of skills from LS to RAS among surgeons with varying LS experience.
• To assess the initial learning curve differences between RAS and LS for bowel anastomosis.

Main Methods:

• A randomized controlled, assessor-blinded crossover study involving 40 RAS-naïve surgeons.
• Performance of linear-stapled side-to-side bowel anastomoses in a porcine model using both LS and RAS.
• Validated assessment tools (A-OSATS, OSATS) and workload measures (NASA-TLX, Borg-scale) were employed.

Main Results:

• No overall differences in surgical performance (A-OSATS, time, OSATS) between RAS and LS.
• Surgeons new to both techniques showed significantly higher A-OSATS scores in RAS, particularly in bowel positioning and enterotomy closure.
• No significant difference in RAS performance between LS novices and experienced surgeons, indicating limited skill transfer.
• Mental and physical workload was significantly higher after LS.

Conclusions:

• RAS demonstrated improved initial performance for linear stapled bowel anastomosis compared to LS.
• Surgical workload was higher in LS, suggesting potential benefits of RAS in reducing surgeon fatigue.
• Limited transfer of skills from conventional laparoscopy to robotic-assisted surgery was observed in this study.