title: An assessment of the physical impact of complex  surgical tasks on surgeon errors and discomfort:  a comparison between robot-assisted,  laparoscopic and open approaches.
abstract: OBJECTIVE
  To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis.
  
  
  RESULTS
  The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P < 0.005). The number of errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P < 0.005). Limitations of the present study include the small sample size and variation in prior surgical experience of the participants.
  
  
  CONCLUSIONS
  In an in vitro model of anastomosis surgery, robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.
authors.forename: Oussama
authors.initials: O
authors.lastname: Elhage
authors.forename: Ben
authors.initials: B
authors.lastname: Challacombe
authors.forename: Adam
authors.initials: A
authors.lastname: Shortland
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards; D008297:Male; D009048:Motor Skills; D012371:Robotics; D066231:Surgeons / Q000592:standards; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000592:standards*; D013647:Task Performance and Analysis; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000592:standards