Visual clues act as a substitute for haptic feedback in robotic surgery.

OBJECTIVE: The lack of haptic feedback (HF) in robotic surgery is one of the major concerns of novice surgeons to that field. The superior visual appearances acquired during robotic surgery may give clues that make HF less important.
METHODS: We surveyed 52 individuals on their perception of HF during robotic surgery. The first group of 34 surgically inexperienced people used the da Vinci robot for their first time (drylab). The second group included 8 laparoscopic surgeons with experience up to a fifth robotic operation. The third group included 10 surgical experts with substantial experience (150-650 robotic cases). Visual analog assessment was made of perception of HF, how much HF was missed, how much the absence of HF impaired the operators' level of comfort. Robotic experts were asked if complications have occurred as a result of a lack of HF.
RESULTS: Of the first group, 50% reported the perception of HF, as did 55% of the second group and 100% of the third group (difference between group 1 and group 3: p < 0.05). The first group missed HF for 6.5; the second group for 4.3, and the third group for 4 (difference between groups 1 and 3: p < 0.05). The surgical experts claimed to have missed HF for 7.2 s when they first started robotic surgery (Difference to now: p < 0.05). The lack of HF caused discomfort for the first group of 4; for the second group of 4,4, and for the third group of 2,6. One complication was reported by the robotic experts as resulting from the lack of HF.
CONCLUSIONS: The data support the conclusion that even beginners quickly experience the perception of HF when performing robotic surgery. With more experience, perception of HF and the level of comfort with robotic surgery increases significantly. This perception of HF makes "real" HF less important and demonstrates that its importance is overestimated by novices in robotic surgery.