title: Performance of basic manipulation and intracorporeal suturing tasks in a robotic surgical system: single- versus dual-monitor views.
abstract: BACKGROUND
  Technical advances in the application of laparoscopic and robotic surgical systems have improved platform usability. The authors hypothesized that using two monitors instead of one would lead to faster performance with fewer errors.
  
  
  METHODS
  All tasks were performed using a surgical robot in a training box. One of the monitors was a standard camera with two preset zoom levels (zoomed in and zoomed out, single-monitor condition). The second monitor provided a static panoramic view of the whole surgical field. The standard camera was static at the zoomed-in level for the dual-monitor condition of the study. The study had two groups of participants: 4 surgeons proficient in both robotic and advanced laparoscopic skills and 10 lay persons (nonsurgeons) who were given adequate time to train and familiarize themselves with the equipment. Running a 50-cm rope was the basic task. Advanced tasks included running a suture through predetermined points and intracorporeal knot tying with 3-0 silk. Trial completion times and errors, categorized into three groups (orientation, precision, and task), were recorded.
  
  
  RESULTS
  The trial completion times for all the tasks, basic and advanced, in the two groups were not significantly different. Fewer orientation errors occurred in the nonsurgeon group during knot tying (p=0.03) and in both groups during suturing (p=0.0002) in the dual-monitor arm of the study. Differences in precision and task error were not significant.
  
  
  CONCLUSIONS
  Using two camera views helps both surgeons and lay persons perform complex tasks with fewer errors. These results may be due to better awareness of the surgical field with regard to the location of the instruments, leading to better field orientation. This display setup has potential for use in complex minimally invasive surgeries such as esophagectomy and gastric bypass. This technique also would be applicable to open microsurgery.
authors.affiliation: Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Rachit D
authors.initials: RD
authors.lastname: Shah
authors.forename: Alex
authors.initials: A
authors.lastname: Cao
authors.forename: Lavie
authors.initials: L
authors.lastname: Golenberg
authors.forename: R Darin
authors.initials: RD
authors.lastname: Ellis
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Auner
authors.forename: Abhilash K
authors.initials: AK
authors.lastname: Pandya
authors.forename: Michael D
authors.initials: MD
authors.lastname: Klein
mesh_terms: D016288:Computer Terminals / Q000592:standards*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D013536:Suture Techniques / Q000295:instrumentation*