Is a robotic system really better than the three-dimensional laparoscopic system in terms of suturing performance?: comparison among operators with different levels of experience.

Background: High-quality three-dimensional (3D) vision systems are now available for laparoscopic surgery and may improve surgical performance relative to two-dimensional (2D) laparoscopy. It is unclear whether 3D laparoscopy is superior to 3D robotic systems. The effect of surgeon experience on surgical performance with different instruments also remains unclear. This study compared the ability of experienced and inexperienced surgeons to perform a suturing task with 2D laparoscopy, 3D laparoscopy, and a 3D robot.

Methods: The 20 recruited surgeons consisted of experts (≥100 laparoscopic cases, n = 9), surgeons with intermediate experience (20-99 cases, n = 7), and novices (<20 cases, n = 4). All performed a suturing task three times with each instrument. Task failure rates and completion times were measured.

Results: All novices failed to complete the task with 2D or 3D laparoscopy, but all completed the task with the robot. The intermediate group failed the task with 2D laparoscopy (23.8% failure rate) more often than with 3D laparoscopy (4.8%) or the robot (0%; P = 0.04). Expert failure rates were low for all instruments. Intermediate group task completion times were similar to 2D laparoscopy (median 312 s; range 229-495 s), 3D laparoscopy (324 s; 170-443 s), and the robot (319 s; 213-433 s) (P = 0.237). The expert times differed significantly (P = 0.01); post hoc analyses showed that their total completion time with 3D laparoscopy (177 s; 126-217 s) was significantly shorter than with 2D laparoscopy (244 s; 155-270 s; P = 0.004). It also tended to be shorter than with the robot (233 s; 187-461 s; P = 0.027).

Conclusions: Novices benefited particularly from the robot. The intermediate group completed the task equally well and equally quickly with 3D laparoscopy and the robot. The experts completed the task equally well regardless of instrument, but their times were much faster with 3D laparoscopy. Thus, well-trained laparoscopic surgeons may not really benefit from 3D robot systems if 3D laparoscopy is available.