title: A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents.
abstract: BACKGROUND
  Robotic surgery offers all the advantages of laparoscopy with additional increased accuracy. The use of robotic surgery has increased in the past 5 years. It has proven particularly useful in complex surgical procedures such as intracorporeal intestinal anastomosis. As the prevalence of robotic surgery increases, so will the need for residents to be able to perform surgery using the robotic system. Our goal was to compare hand-sewn, laparoscopic, and robotic suturing techniques performed by midlevel residents using a porcine intestinal model.
  
  
  METHODS
  Fifteen residents unfamiliar with the robotic suturing technique participated in performing an initial hand-sewn suture line and then were randomized with cross-over to laparoscopic or robotic suturing. Completion time, leak pressure, number of sutures per cm, and difficulty level were assessed.
  
  
  RESULTS
  The mean leak pressure for hand-sewn, laparoscopic, and robotic suturing was 9.5, 3.2, and 11.4 mm Hg, respectively. The laparoscopic group had 6 and the robotic group had 1 suture line that was inadequate for testing. Suture breakage was common in the robotic group. The anastomosis was considered hard by 92% in the laparoscopic group versus 17% in the robotic group. The time it took to complete 1 cm of anastomosis was .9, 8.7, and 8.3 minutes for hand-sewn, laparoscopic, and robotic suturing, respectively.
  
  
  CONCLUSIONS
  The robotic suture line performed by midlevel residents was superior to laparoscopy, although the time for anastomosis was equivalent.
authors.affiliation: Advocate Lutheran General Hospital, Department of Surgery, 1775 W. Dempster St., 8 South, Park Ridge, IL 60068, USA
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Marecik
authors.forename: Vivek
authors.initials: V
authors.lastname: Chaudhry
authors.forename: Azam
authors.initials: A
authors.lastname: Jan
authors.forename: Russell K
authors.initials: RK
authors.lastname: Pearl
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000193:education / Q000379:methods; D000818:Animals; D002983:Clinical Competence; D004522:Educational Status; D005260:Female; D013502:General Surgery / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007422:Intestines / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D023421:Models, Animal; D012371:Robotics; D013536:Suture Techniques / Q000193:education*; D013552:Swine; D013996:Time and Motion Studies