Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices.
BACKGROUND
Robotic assistance may provide for distinct technical advantages over conventional laparoscopic technique. The goals of this study were (1) to objectively evaluate the difference in the learning curves by novice and expert surgeons in performing fundamental laparoscopic skills using conventional laparoscopic surgery (CLS) and robotic-assisted laparoscopic surgery (RALS) and (2) to evaluate the surgeons' frustration level in performing these tasks.


METHODS
Twelve experienced and 31 novices in laparoscopy were prospectively evaluated in performing three standardized laparoscopic tasks in five consecutive, weekly training sessions. Analysis of the learning curves was based on the magnitude, rate, and quickness in performance improvement. The participant's frustration and mood were also evaluated during and after every session.


RESULTS
For the novice participants, RALS allowed for shorter time to task completion and greater accuracy. However, significant and rapid improvement in performance as measured by magnitude, rate, and quickness at each session was also seen with CLS. For the experienced surgeons, RALS only provided a slight improvement in performance. For all participants, the use of RALS was associated with less number of sessions in which they felt frustrated, less number of frustration episodes during a session, lower frustration score during and after the session, and higher good mood score.


CONCLUSIONS
The advantages of RALS may be of most benefit when doing more complex tasks and by less experienced surgeons. RALS should not be used as a replacement for CLS but rather in specific situations in which it has the greatest advantages.
Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
Carlo C
CC
Passerotti
Felipe
F
Franco
Julio C C
JC
Bissoli
Bruno
B
Tiseo
Caio M
CM
Oliveira
Carlos A O
CA
Buchalla
Gustavo N C
GN
Inoue
Arzu
A
Sencan
Aydin
A
Sencan
Rogerio Ruscitto
RR
do Pardo
Hiep T
HT
Nguyen
D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D010535:Laparoscopy / Q000193:education / Q000379:methods; D059032:Learning Curve; D020380:Needs Assessment; D010820:Physicians / Q000523:psychology*; D065287:Robotic Surgical Procedures / Q000193:education / Q000379:methods; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology; D013337:Students, Medical / Q000523:psychology*; D013647:Task Performance and Analysis