Comparison of robotic versus laparoscopic skills: Is there a difference in the learning curve?

Objectives. To evaluate the learning curve between robot-assisted and manual laparoscopic suturing, as well as to assess other skills. Laparoscopic reconstructive procedures have been limited by instrumentation, small working spaces, and fixed angles at the trocar level to place sutures. Robot-assisted laparoscopic suture placement may provide one means of increasing dexterity and facilitating laparoscopic reconstructive procedures. Methods. Eight physicians participated in this study. A series of five trials were performed to assess dexterity (task 1) and free-hand suturing (task 2). Each task was performed using robot-assisted and manual laparoscopy. The participants were categorized as novice and experienced laparoscopists. Task 1 involved passing sutures through the eye of seven needles positioned 1 cm apart in a P configuration. Task 2 involved tying one surgeon's knot, followed by two subsequent knots. Results. The average time for trials 1 and 5 of task 1, robot-assisted laparoscopy, was 242.6 and 101.8 seconds, respectively (P <0.001). Both groups demonstrated a statistically significant difference (P <0.001) between the first and last trial. The average time for trials 1 and 5 of task 1, manual laparoscopy, was 205.3 and 169 seconds, respectively. The differences in the learning curves for robot-assisted and manual laparoscopy were statistically significant in favor of robotic assistance. Manual laparoscopic suturing did not demonstrate as much of a difference for the experienced surgeon. Overall, the difference in improvement between robot-assisted and manual laparoscopy was not statistically significant. Conclusions. Robot-assisted laparoscopic allows suturing and dexterity skills to be performed quicker than does manual laparoscopy.