Prospective randomized trial comparing Robotic against laparoscopic suture for closure of gastric perforation in ex-vivo model

Liu Liu, PhD, Philip Chiu, MD, Anthony Teoh, FRCSEd, Simon Wong, FRCSEd, Shirley Liu, FRCSEd, Cch Lam, RN, Enders Ng, MD

Dept of Surgery and CUHK Jockey Club Minimally Invasive Surgical Skills Center, The Chinese University of Hong Kong

Aims: To compare the performance of Da Vinci Surgical Robotic suturing (DVSS) against laparoscopic suturing (LS) for gastric perforation induced in an ex-vivo porcine model by novices.

Methods: A total of 20 medical students without surgical experience were recruited. After a standardized training protocol using virtual simulator on laparoscopic suturing and video training, the participants were randomly divided into two groups (n =10 for DVSS and 10 for LS). Each participant would perform five suturing of a 2 cm long gastric perforation with tying of 3 knots using either LS or DVSS. The completeness of closure was assessed by a composite scoring system basing on operative time, accuracy of suturing and knot security. The air bursting pressure for the closed gastric perforation was examined. The performances of participants were assessed by using Global Rating Scale (GRS). The workload incurred was assessed using Administration (NASA) Task Load Index (TLX) questionnaire.

Results: Compared to LS group, participants in DVSS group achieved significantly higher rate of complete closure for the gastric perforation (Table 1). The overall and GRS scores were higher for the DVSS group than LS group, and the DVSS group had lower stress from the workload incurred. In addition, air bursting pressure was higher for DVSS group compared to LS group. Compared to the first gastric perforation closure, participants’ overall scores significantly improved after the fifth gastric suturing closure in both groups. The participants in DVSS also showed better learning curve compared to LS group (Figure 1).

Conclusion: Robotic suturing significantly shortened operative time and improved the security of closure for gastric perforation when compared to laparoscopic suturing. In addition, the workload incurred on the novice surgeon was much smaller when using the robotic system for suturing.

Variable DVSS (n=50) LS (n=50) p
Total operative time (s) 805.7 ± 293.8 1041.4 ± 208.2 < 0.001
Overall completeness score 815.5 ± 378.1 391.9 ± 307.4 < 0.001
Success of closure 36 (72%) 25 (50%) 0.020
GRS score 21.78 ± 4.16 17.49 ± 4.07 < 0.001
NASA-TLX scores 53.40 ± 16.78 61.32 ± 22.37 0.048
Air bursting pressure (mmHg) 84.25 ± 20.23 60.92 ± 21.93 < 0.001


Session: Poster Presentation

Program Number: P644

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