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Robotic versus laparoscopic simulation training for laparoscopic skill acquisition in novices: a randomized
Margarida Rocha1, Nasser Bouhalassa2, Kiana Shahinfar3
1Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. margarida.rocha@etu.unige.ch.
Background:
Increasing technical demands and reduced operative exposure have reinforced the importance of simulation-based training in minimally invasive surgery. Robotic simulation offers an additional training modality. Yet, evidence for transfer of skills from robotic training to laparoscopic performance remains inconsistent.
Methods:
We performed a single-center, randomized controlled trial including medical students enrolled at University of Geneva with no prior laparoscopic experience. Participants were randomized to either dry-lab laparoscopic training (LT) or robotic training (RT) on the da Vinci Skills Simulator. Performance was evaluated on a dry-lab laparoscopic simulator using two tasks, Peg Transfer and Precision Cutting, adapted from the Fundamentals of Laparoscopic Surgery program. A total of 98 novices (50 in LT group and 48 in RT group) completed the study protocol.
Results:
Peg Transfer composite scores did not differ significantly between groups (LT: median 357 [IQR 232-440]; RT: median 322.5 [IQR 174.2-386]; 95% CI - 5.0 to 117.0; p = 0.074; effect size = 0.18). On the Precision Cutting task, the RT group had a shorter completion time than the LT group (LT: 479 s [IQR 379-644.5]; RT: 294.5 s [IQR 224.5-394.5]; 95% CI 116-241; p < 0.001; effect size = 0.54), with no significant difference in cutting deviation (LT 61.9 ± 28.1 mm; RT: 70.8 ± 30.3 mm; 95% CI - 20.7 to 2.8; p = 0.134; effect size = 0.31). Both groups showed significant within-session learning curves, with reductions in completion time of 43.2% and 36.4% for LT and RT groups, respectively (both p < 0.001). In exploratory analyses, male sex was associated with higher Peg Transfer scores.
Conclusions:
Among novice learners, LT and RT demonstrated comparable performance on Peg Transfer composite score, with RT associated with faster task completion on a subsequent laparoscopic Precision Cutting task without a corresponding loss of accuracy. These findings suggest that robotic and laparoscopic simulation may offer similar benefits for laparoscopic skill acquisition, but warrant confirmation.
Clinical Trial:
This study is registered on ClinicalTrials.gov (NCT04989881).