Robot-Assisted Microsurgery—what does the learning curve look like?

Abstract

BackgroundThe introduction of robot assistance in surgical practice has led to advancements such as the MUSA-2 robotic system, designed for microsurgical procedures. Advantages include tremor filtration and motion scaling. Initial studies show promising results in skill acquisition for robot-assisted microsurgery. This study evaluates the learning curve for microsurgical anastomosis with and without robot assistance among surgeons of varying experience levels.MethodsN=15 surgeons divided into three groups (novice, intermediate, and expert) based on microsurgical experience performed ten anastomoses by hand and ten with robot assistance on synthetic polyvinyl alcohol vessels (diameter of 2mm) in a laboratory setting. Participants were timed and mistakes such as backwall and leakage were assessed and recorded. Demographic information was collected.ResultsStatistical differences were found in hand-sewn anastomosis times between the intermediate and novice groups compared to the experts (p<0.01). However, no statistical difference was found in mean time between groups for the robot-assisted anastomoses. Novice doctors had the steepest learning curve for hand-sewn anastomosis. Experts had the fastest completion time at the end of the 10th robotic session, finishing at 14 minutes, compared to 33 minutes at the 2nd session. All groups cut their mean time in half through 10 robotic sessions.ConclusionThis study indicated similarities in learning curves for robot-assisted anastomosis among varied experience levels. Experts excelled technically in hand-sewn anastomoses, but robot-assistance enabled novice and intermediate surgeons to perform comparably to experts. Robot assistance may aid more novice learners in performing microsurgical anastomosis safely at earlier points in their education.