Transition effects from laparocscopic to robotic surgery skills in small cavities


Conventional laparoscopic surgery (LS) is being challenged by the ever-increasing use of robotic surgery (RS) to perform reconstructive procedures. The purpose of this study was to assess the acquisition of skills in both techniques and the potential transfer of skills from one technique to the other when restricted spaces are involved. A preclinical randomized crossover study design was implemented. Twelve subjects performed two different reproducible drill procedures: “Thread the Ring” (TR) and “Transfer the Plot” (TP). To assess surgical proficiency in confined workspaces, these exercises were performed with LS and RS technology in a pediatric laparoscopic surgery (PLS) simulator. Each performance was recorded and evaluated by two reviewers using objective structured assessment of technical skills (OSATS). The times to complete the TP and the TR procedure were significantly shorter with RS compared to LS (64 s vs. 319 s; p < 0.0001 for both TP and TR). A significant transfer effect of skills between LS and RS was noted for the TP exercise (p = 0.006). The percentage improvement was greater overall with LS, meaning a higher number of trials were required to adequately master the procedure. This study demonstrated that RS performed significantly better compared to LS on pediatric simulation devices. A transfer effect was identified from LS to RS exclusively. The learning curves showed that progression was definitely longer with LS. These results, indicate that novice surgeons should be encouraged to persist with learning LS, and they support the use of a pediatric robotic simulation device.

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Robotic surgery


Laparoscopic surgery


Pediatric laparoscopic surgery


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The authors thank R. Peymirat for his technical assistance with image editing.

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Correspondence to Q. Ballouhey.

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Appendix 1

Appendix 1

“The following instructions for the TP exercise were provided to all of the students: a series of six plots are transferred one by one; a ring on the left side of the pegboard is grasped with the instrument in the left hand, lifted off the peg, transferred to the grasper in the right hand, and then placed onto a peg on the right side of the pegboard. After all the rings are transferred left to right, the process is reversed [9].

The second exercise, TR, consists of successively channeling a suture needle through three 1 cm diameter vertical rings with one hand and recovering the thread with the other one.

Each exercise has to be executed five times per operator and per technique: standard laparoscopy and robotic platform.”

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Moncayo, S., Compagnon, R., Caire, F. et al. Transition effects from laparocscopic to robotic surgery skills in small cavities. J Robotic Surg 14, 525–530 (2020).

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  • Learning curve
  • Robotic surgery
  • Transfer effect
  • Simulation