Four-Handed Solo Laparoscopic Anastomosis with the Support of Supernumerary Robotic Arms

This paper explores the potential of surgeons to perform solo laparoscopic anastomosis by introducing an innovative approach that uses feet-driven supernumerary robotic manipulation. This system allows surgeons to effectively and intuitively perform coordinated four-handed manipulation over two robotic arms. In a quasi-real-world medical scenario, a behavioral investigation is carried out to assess the feasibility and usability of the system during laparoscopic anastomosis performed by professional surgeons. The study compares the conventional dyad condition with the robotic-assisted solo condition regarding performance, usability, and workload. Eleven surgeons who possess expertise in laparoscopy, anastomosis, or both, have been involved in this investigation. The results demonstrate the system's feasibility in performing supernumerary laparoscopic tasks, highlighting its capability for enhancing the procedures. Using our robotic solution, surgeons were able to perform the surgical task, on average, 5.18% faster than when using the traditional setup in a human-dyad team (dyad condition: 295.09 [s]; solo condition: 280.55 [s]). They, however, reported a significant increase in the perceived workload when performing the task in the solo mode as compared to doing it in dyads. They could control the proposed bipedal system within ten minutes of training. Yet, a longer training period might be necessary to improve arms and feet coordination.