title: Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy.
abstract: BACKGROUND
  The value of robotic assistance for intracorporeal suturing is not well defined. We compared robotic suturing with laparoscopic suturing on the FLS model with a large cohort of surgeons.
  
  
  METHODS
  Attendees (n=117) at the SAGES 2006 Learning Center robotic station placed intracorporeal sutures on the FLS box-trainer model using conventional laparoscopic instruments and the da Vinci® robot. Participant performance was recorded using a validated objective scoring system, and a questionnaire regarding demographics, task workload, and suturing modality preference was completed. Construct validity for both tasks was assessed by comparing the performance scores of subjects with various levels of experience. A validated questionnaire was used for workload measurement.
  
  
  RESULTS
  Of the participants, 84% had prior laparoscopic and 10% prior robotic suturing experience. Within the allotted time, 83% of participants completed the suturing task laparoscopically and 72% with the robot. Construct validity was demonstrated for both simulated tasks according to the participants' advanced laparoscopic experience, laparoscopic suturing experience, and self-reported laparoscopic suturing ability (p<0.001 for all) and according to prior robotic experience, robotic suturing experience, and self-reported robotic suturing ability (p<0.001 for all), respectively. While participants achieved higher suturing scores with standard laparoscopy compared with the robot (84±75 vs. 56±63, respectively; p<0.001), they found the laparoscopic task more physically demanding (NASA score 13±5 vs. 10±5, respectively; p<0.001) and favored the robot as their method of choice for intracorporeal suturing (62 vs. 38%, respectively; p<0.01).
  
  
  CONCLUSIONS
  Construct validity was demonstrated for robotic suturing on the FLS model. Suturing scores were higher using standard laparoscopy likely as a result of the participants' greater experience with laparoscopic suturing versus robotic suturing. Robotic assistance decreases the physical demand of intracorporeal suturing compared with conventional laparoscopy and, in this study, was the preferred suturing method by most surgeons. Curricula for robotic suturing training need to be developed.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, 1000 Blythe Blvd., MEB 601, Charlotte, NC 28203, USA. Dimitrios.Stefanidis@Carolinashealthcare.org
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012371:Robotics / Q000379:methods*; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000295:instrumentation*; D016526:Workload