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Crossover-effects in technical skills between laparoscopy and robot-assisted surgery.

Sem F Hardon1,2, E Willuth3, A Masie Rahimi4,5

  • 1Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. s.hardon@amsterdamumc.nl.

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|April 25, 2023
PubMed
Summary

Surgeons switching between laparoscopic and robot-assisted surgery experience skill changes. Experts maintain skills, but novices and intermediates may see decreased efficiency and tissue handling, necessitating simulation training.

Keywords:
AssessmentCrossover effectsLaparoscopyPatient safetyRobot-assisted surgeryTechnical skills

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Area of Science:

  • Surgical Technology
  • Minimally Invasive Surgery
  • Surgical Skills Assessment

Background:

  • Robot-assisted surgery (RAS) requires distinct skills from traditional laparoscopy.
  • Surgeons often alternate between laparoscopic and robot-assisted approaches.
  • Understanding skill crossover effects is crucial for surgical training and patient safety.

Purpose of the Study:

  • To investigate the crossover effects on technical skills when switching between laparoscopic and robot-assisted surgery.
  • To analyze how varying levels of surgical experience influence these skill transitions.

Main Methods:

  • An international multicenter crossover study involving 60 trainees (novice, intermediate, expert).
  • Standardized suturing tasks performed using both laparoscopic and da Vinci surgical robot trainers.
  • Objective assessment of tissue handling skills using the ForceSense system (five force parameters).
  • Statistical analysis of transition effects between the sixth and seventh trials.

Main Results:

  • Experts showed a 46% increase in tissue handling forces when switching from RAS to laparoscopy.
  • Intermediates and experts experienced decreased motion efficiency when switching from laparoscopy to RAS.
  • Intermediate trainees increased force exertion by 78% when switching to RAS after initial training.

Conclusions:

  • Crossover effects are highly dependent on prior laparoscopic experience.
  • Expert surgeons can alternate between approaches with minimal skill impairment.
  • Novices and intermediates may experience skill decay, potentially impacting patient safety; additional simulation training is recommended.