Endoscopic surgery suturing techniques: a randomized study on learning

F J Voskens; E M van der Schans; J P Ruurda; I A M J Broeders

doi:10.1186/s12893-022-01513-2

Endoscopic surgery suturing techniques: a randomized study on learning

BMC Surg. 2022 Feb 17;22(1):59. doi: 10.1186/s12893-022-01513-2.

Authors

F J Voskens^{1

2}, E M van der Schans^{3

4}, J P Ruurda⁵, I A M J Broeders^{3

4}

Affiliations

¹ Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands. frankvoskens@gmail.com.
² University of Twente, Robotics and Mechatronics, Enschede, The Netherlands. frankvoskens@gmail.com.
³ Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.
⁴ University of Twente, Robotics and Mechatronics, Enschede, The Netherlands.
⁵ Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center, Utrecht, The Netherlands.

Abstract

Background: Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices.

Methods: Participants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception.

Results: A total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188-291) in the laparoscopic group versus 378 s (282-471) in the FlexDex group versus 189 s (160-247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120-190), 232 s (180-265) and 172 s (134-199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users.

Conclusions: Ex vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.

Keywords: Laparoscopic suturing; Learning curve; Medical robots and systems; Robotic suturing; Surgical robotics.

Publication types

Randomized Controlled Trial

MeSH terms

Clinical Competence
Humans
Laparoscopy* / methods
Learning Curve
Robotics*
Suture Techniques
Sutures