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Robotic versus Non-Robotic Instruments in Spatially Constrained Operative Workspaces - A Pre-Clinical Randomised Crossover Study

Title: Robotic versus Non-Robotic Instruments in Spatially Constrained Operative Workspaces - A Pre-Clinical Randomised Crossover Study
Authors: Cundy, TP
Marcus, HJ
Hughes-Hallett, A
MacKinnon, T
Najmaldin, AS
Yang, GZ
Darzi, A
Item Type: Journal Article
Abstract: Objective To compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces. Materials and Methods Surgeons performed intracorporeal sutures with various instruments within three different cylindrical workspace sizes. Three pairs of instruments were compared: 3‐mm non‐robotic mini‐laparoscopy instruments; 5‐mm robotic instruments; and 8‐mm robotic instruments. Workspace diameters were 4, 6 and 8 cm, with volumes of 50, 113 and 201 cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. Results A total of 23 participants performed 276 suture task repetitions. The overall median task performance scores for the 3‐, 5‐ and 8‐mm instruments were 421, 398 and 402, respectively (P = 0.12). Task scores were highest (best) for the 3‐mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for the 4‐, 6‐ and 8‐cm diameter workspaces being 388, 415 and 420, respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with the robotic instruments. Conclusions Smaller workspaces limit the performance of both robotic and non‐robotic instruments. In operating workspaces <200 cm3, 3‐mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace‐restricted anatomical areas.
Issue Date: 11-Aug-2015
Date of Acceptance: 10-Nov-2014
URI: http://hdl.handle.net/10044/1/58789
DOI: https://dx.doi.org/10.1111/bju.12987
ISSN: 1464-4096
Publisher: Wiley
Start Page: 415
End Page: 422
Journal / Book Title: BJU International
Volume: 116
Issue: 3
Copyright Statement: © 2014 The Authors. BJU International © 2014 BJU International Published by John Wiley & Sons Ltd This is the accepted version of the following article: Cundy, T. P., Marcus, H. J., Hughes‐Hallett, A. , MacKinnon, T. , Najmaldin, A. S., Yang, G. and Darzi, A. (2015), Robotic vs non‐robotic instruments in constrained workspaces. BJU Int, 116: 415-422. doi:10.1111/bju.12987, which has been published in final form at https://dx.doi.org/10.1111/bju.12987
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: NF-SI-0510-10186
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
robotic
robot-assisted
spatial constraints
suturing
workspace
LAPAROSCOPIC SURGERY
LEARNING-CURVES
PERFORMANCE
PYELOPLASTY
ANASTOMOSIS
SYSTEM
SKILLS
MODEL
Adult
Clinical Competence
Cross-Over Studies
Female
Humans
Laparoscopy
Male
Robotic Surgical Procedures
Spatial Behavior
Surgeons
Task Performance and Analysis
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2015-08-11
Appears in Collections:Faculty of Engineering
Division of Surgery
Computing
Faculty of Medicine



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