Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems

Background: Our objective was to compare the performance of laparoscopic tasks by surgeons using standard laparoscopic instruments and two surgical robotic systems. Methods: Eighteen surgeons performed tasks in a training box using three different instrument systems: standard laparoscopic instruments, the Zeus Robotic Surgical System, and the da Vinci Surgical System. Basic tasks included running a 100-cm rope, placing beads onto pins, and dropping cotton peanuts into cylinders; fine tasks included intracorporeal knot tying and running stitches with 4-0, 6-0, and 7-0 sutures. Time (in seconds) required and precision (number of errors) in performing each task were recorded. Analysis of variance with pair-wise comparisons using the Bonferroni method and Friedman's nonparametric test were used for statistical analysis. Results: Standard instruments performed significantly faster than either robotic system on the rope and bead tasks (p < 0.05), whereas da Vinci performed significantly faster than Zeus in all three basic tasks (p < 0.05). No significant difference in precision was found between standard instruments and the robotic systems on any of the basic tasks. Knot-tying and running-suture time were similar between standard instruments and da Vinci, which were significantly faster than Zeus (p < 0.05) for all suture sizes. The robotic systems were similar in precision for fine suturing tasks and were significantly more precise in knot tying (Zeus and da Vinci) and running sutures (da Vinci) than standard instruments (p < 0.05). Conclusions: Basic laparoscopic task performance is generally faster and as precise using standard instruments compared to either robotic system. In performing fine tasks, neither robotic system is faster than standard instruments, although they may offer some advantage in precision.