Acquiring proficiency in surgical robotics: A comparison of rat femoral artery anastomosis by an attending plastic surgeon and a surgical resident using robotic and microscopic techniques

Abstract Introduction: The da Vinci™ surgical robotic system (Intuitive Surgical, Inc.) is currently used for a variety of minimally invasive procedures. Our previous studies demonstrated the potential of robotic microsurgery. This study compares both the outcome and feasibility of rat femoral artery anastomosis by an attending plastic surgeon and a surgical resident using both robotic and microscopic techniques (18.75X operating scope). Methods: Four cohorts of 10 (n = 40) SD rats (411.7g +/− 39.7) underwent femoral artery transection and reanastamosis, with two cohorts completed by each the attending and surgical resident either microscopically (Control) or robotically (Experimental). A laser flow-meter measured blood flow prior to transection (Pre), immediately after reanastomosis (Post), and at 24-hours post-operatively (24H). The repair time was recorded. Results were standardized using percent change and paired T-tests determined significance. Results: Blood flow percent change was not significantly different between the attending and resident in all groups (p0.05) (Table 1). The attending surgeon demonstrated a significantly lower time (minutes) than the resident in the robotic group (19.3 +/− 4.0, 25.5 +/− 3.0, respectively, ∗p = 0.001), while control groups were slightly different (13.8 +/− 7.6, 15.3 +/− 3.5, respectively, p=0.541). Table 1Blood flow percent changePost vs pre (% change)24 h vs pre (% change)Attending surgeonMicroscopic3.8 ± 17.8 (a)−16.4 ± 20.6 (b)Robotic−7.5 ± 14.8 (c)−9.6 ± 36.8 (d)ResidentMicroscopic2.7 ± 44.1 (e)−7.5 ± 36.4 (f)Robotic−22.0 ± 23.1 (g)−7.0 ± 44.2 (h)p = 0.947, a vs e; p=0.445, b vs f; p=0.082, c vs g; p=0.904, d vs h. Conclusions: This study demonstrates that both microscopic trained and non-microscopic trained surgeons can acquire proficiency with the robotic system. The prior training and experience of the attending surgeon may explain the shorter times in both groups and most likely will afford a more rapid attainment of proficiency in robotic microsurgery.