Need Help with Port-placement in Robot-Assisted Surgery: A Survey Study

Jinling Wang, PhD, Katherine S Lin, MD, Keith A Watson, MD, Michael L Galloway, DO, Minia Hellan, MD, Caroline G.L. Cao, PhD. Wright State University

Introduction: Robot-assisted laparoscopic surgery has been widely adopted and the number of procedures done with the da Vinci® Surgical System is growing rapidly. Although the advantages of robot-assisted surgery over traditional laparoscopic surgery are obvious, there are several limitations of robot-assisted surgery such as higher costs, and longer setup time. One of the critical steps in setting up the robotic system is port-placement, in which the locations of the ports are selected to ensure adequate visualization of the surgical site, avoid external arm collision, and provide maximal instrument reach. The purpose of this study was to identify the key factors influencing the performance of the port-placement task in robot-assisted surgery, and gather domain expert input about the design of enabling technology for this important task.

Methods and Procedures: An 18-item questionnaire was handed out at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2015 Annual Meeting and at Miami Valley Hospital in Dayton, OH. Participants had the option to fill out the questionnaire online through Qualtrics (online survey software). Twenty-three hardcopy questionnaires were returned. Sixty-four questionnaires were submitted online but only 22 were complete a completion rate of 34%. In total, 45 questionnaires were analyzed. 42% of the questionnaires were from attending surgeons and 58% from residents.

Results: 47% of the participants listed port-placement as the most challenging task in using the robotic system, followed by learning to use the robotic system (21%), setup (14%), team work (14%), and lack of tactile feedback (4%). The results showed that in the past 3 years, 36% of the attending surgeons and 61% of the residents were involved in a case where the robotic approach was abandoned or convert due to poorly placed ports. Both attending surgeons (53%) and residents (53%) had to work harder at a case due to the poorly placed ports in the last 3 years. Fifty-nine percent (59%) of the participants listed choosing port locations as the most challenging part in the port-placement task. Patients’ body habitus and previous surgery history were the key patient characteristics that could cause difficulty for the port-placement task.

Conclusion: Results confirmed that port placement is a challenging task in using the robotic system. There is overwhelming support from the surgeons surveyed to develop assistive technology for this important task. Therefore, our next step will be to develop a patient-specific port-placement decision aid for robot-assisted laparoscopic surgery.

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