Impact of manual dexterity on laparoscopic and robotic surgery

Abstract

Introduction Manual dexterity of surgeon has been known to be related with surgical proficiency. Recently, for objective measurement of the surgical skill, the inanimate method using several kinds of simulators has been introduced. Using these simulators, we aimed to investigate the impact of dexterity on laparoscopic and robotic surgery in terms of dexterity speed and ambidexterity during the initial course of training.

Methods Fellow surgeons (n = 15), surgical residents (n = 13) and medical students (n = 4) participated in this study. The sum (Peg Sum) and difference (Peg Diff) of the performance time for the Grooved pegboard test by right and left hand was used as an index of dexterity speed and ambidexterity, respectively. The performance times for 3 sessions of laparoscopic suture using the D-box trainer and performance scores for 3 sessions of two robotic suturing programs with different difficulty levels provided by da Vinci®Skills SimulatorTM were analyzed according to the manual dexterity.

Results Neither dexterity speed nor ambidexterity was a significant factor (P = 0.187, P = 0.252, respectively) for performance time during laparoscopic suture which was more influenced by participants status whether they were fellow surgeons, residents or students (P = 0.016). In the easy robotic suturing task, there was a significant interaction between the effects of ambidexterity and session number on the performance score (P = 0.036, by mixed repeated measures ANOVA). Participants with higher ambidexterity achieved better scores than those with lower ambidexterity in session 1 (77.1 ± 8.3 vs. 68.0 ± 17.6

P = 0.070), however, this difference was not apparent in session 3 (80.9 ± 13.3 vs. 83.3 ± 11.2

P = 0.589). However, in the difficult robotic suturing task, the difference in scores associated with the ambidexterity was maintained throughout all 3 consecutive sessions (P = 0.036).

Conclusions The degree of ambidexterity simply measured by the Grooved pegboard test was a significant factor for proficiency with simulated robotic surgery. The surgeons with low ambidexterity can be skillful for relatively easy task of robotic surgery, after several repetitive trainings. However, for advanced robotic surgery with difficult task, training of non-dominant hand might be significant.