title: Is a robotic system really better than the three-dimensional laparoscopic system in terms of suturing performance?: comparison among operators with different levels of experience.
abstract: High-quality three-dimensional (3D) vision systems are now available for laparoscopic surgery and may improve surgical performance relative to two-dimensional (2D) laparoscopy. It is unclear whether 3D laparoscopy is superior to 3D robotic systems. The effect of surgeon experience on surgical performance with different instruments also remains unclear. This study compared the ability of experienced and inexperienced surgeons to perform a suturing task with 2D laparoscopy, 3D laparoscopy, and a 3D robot.
  
  
  
  The 20 recruited surgeons consisted of experts (≥100 laparoscopic cases, n = 9), surgeons with intermediate experience (20-99 cases, n = 7), and novices (<20 cases, n = 4). All performed a suturing task three times with each instrument. Task failure rates and completion times were measured.
  
  
  
  All novices failed to complete the task with 2D or 3D laparoscopy, but all completed the task with the robot. The intermediate group failed the task with 2D laparoscopy (23.8% failure rate) more often than with 3D laparoscopy (4.8%) or the robot (0%; P = 0.04). Expert failure rates were low for all instruments. Intermediate group task completion times were similar to 2D laparoscopy (median 312 s; range 229-495 s), 3D laparoscopy (324 s; 170-443 s), and the robot (319 s; 213-433 s) (P = 0.237). The expert times differed significantly (P = 0.01); post hoc analyses showed that their total completion time with 3D laparoscopy (177 s; 126-217 s) was significantly shorter than with 2D laparoscopy (244 s; 155-270 s; P = 0.004). It also tended to be shorter than with the robot (233 s; 187-461 s; P = 0.027).
  
  
  
  Novices benefited particularly from the robot. The intermediate group completed the task equally well and equally quickly with 3D laparoscopy and the robot. The experts completed the task equally well regardless of instrument, but their times were much faster with 3D laparoscopy. Thus, well-trained laparoscopic surgeons may not really benefit from 3D robot systems if 3D laparoscopy is available.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.|Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
authors.forename: Aung Myint
authors.initials: AM
authors.lastname: Oo
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Son
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Shin
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea. viscaria@snubh.org.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.|Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.|Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
mesh_terms: D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D066231:Surgeons / Q000592:standards*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014741:Video Recording
keywords: Laparoscopy; Robotic surgery; Suturing; Three-dimensional imaging