Are there advantages to robotic-assisted surgery over laparoscopy from the surgeon's perspective?

The advantages of a robotic approach are often difficult to quantify for surgical procedures that can be performed laparoscopically. Using a novel subjective rating scale, this study demonstrates a methodology to measure surgeon assessment of ease of use, comparing complex operations performed robotically and laparoscopically. A subjective assessment scale for robotic surgery was developed that included 13 task-related factors assessing operative challenges and ease of use. As part of a larger study comparing outcomes of laparoscopic and robotic biliary-enteric anastomosis, a surgeon performing 20 choledochojejunal anastomoses in an ex vivo pig model completed this scale after each procedure. Ten anastomoses were performed laparoscopically and ten using da Vinci robot assistance. Overall difficulty was also assessed using a 10-cm visual analog scale. Robotic surgery was associated with superior ease to laparoscopy in 8 of the 13 factors, including image quality, depth perception, comfort, eye fatigue, dexterity, precision of motion, speed of motion, and range of motion. The visual analog scale also showed a significant benefit in overall ease of the robotic over laparoscopic procedure. Nonsignificant trends favoring robotics were seen with fluidity of motion and equipment setup. Based on these results this study suggest that surgeon ease of use may be quantified using this assessment scale and that robot assistance may be advantageous over laparoscopy when performing complex surgical tasks in an ex vivo model from the surgeon's perspective.