Session: MP26: Surgical Technology & Simulation: Instrumentation & Technology I
MP26-10: Could finger assignment at the robotic console improve surgical education and ergonomics or cause any adverse events? a randomized prospective blinded simulation pilot study
Introduction: Robotic surgery has become a standard approach in urology. Greater range of motion may be attributed to the EndoWrist instruments that provide 7 degrees of freedom. This allows surgeons to gain precision and have fewer surgical complications. To our knowledge, no prior studies support one way to handle the controls at the surgical console. In our experience, volunteers report discomfort during wrist manipulation while using the thumb and middle finger (1&3). We hypothesize that using the thumb and index finger (1&2) will allow superior surgical proficiency via the Da Vinci Skills Simulator. Methods: After IRB approval, we recruited 42 medical students across all 4 years in one university-based medical center. Each volunteer was given a standardized orientation. Students were then randomly assigned to start with their thumb and index finger (1&2) or (1&3). Two standardized modules were used with metrics calculated upon completion. These include: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS. Results: Three were found to have statistically significant differences between the finger placement of 1&3compared to 1&2 (Figure 1). The number of collisions, wound approximation, and penalty score were all significant where 1&3 had a lower score in each. The number of collisions was 5.6 less in the 1&3 finger placement (p= 0.017). The wound approximation was 0.2 points smaller when using the 1&3 placement (p = 0.001). Lastly, the penalty assigned was 6.42 points lower when using 1&3 (p= 0.023). The overall score (p= 0.615), total time (p= 0.385), out of view (p=0.462), and economy of motion (p= 0.184) were not significant from one another. Conclusions: Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes. This may be due to decreased comfort in hand position resulting in a more cautious surgical approach. Better understanding of how finger placement can lead to decreased ergonomics and increased complications may shape robotic training. SOURCE OF Funding: N/A
