Cost-adjusted surgical robotic performance: The plea for a cheaper robot

Abstract

Despite their high cost, surgical robotic systems continue to gain prominence in the operating room. In this study, the initial performance of a diverse population of surgeons and surgical residents with no previous surgical robotics experience was characterized. The objectives of this study were (1) To compare the initial performance of different surgical robotic systems; (2) To determine the inter-robot transferability of skills acquired on a surgical robot; and (3) To determine if differences exist in the initial robotic surgery learning curve among surgeons of varying levels of surgical experience. A multi-institutional group of 38 surgeons and 28 surgeons-in-training were evaluated using three surgical skill tests: “paper cut,” “ring swap,” and “thread the needle.” Every participant was timed on each of two robots, Intuitive Surgical’s daVinci Surgical System and endoVia’s Laprotek System. The order in which the subjects were tested on each of the two robots was determined at random. Composite scores representing participant performance on each of the two robots and overall performance were calculated. The “paper cut” test took participants twice as long and the “ring swap” test took over three times as long on the Laprotek robot compared to the daVinci robot ( P < 0.0001 for both). However, when adjusted for robot cost ($1.25M for daVinci and $250K for Laprotek), scores were significantly better on the Laprotek robot for both tests ( P < 0.0001 for both). Participant times were significantly faster on each of the two robots among participants who had used the other robot first ( P < 0.05 for daVinci and P < 0.01 for Laprotek). A trend toward better overall performance on both robots was found among inexperienced surgeons compared to more experienced surgeons. Among surgeons with little or no previous surgical robotic experience, basic surgical tasks are easier to perform using the daVinci robot than using the Laprotek robot. However, daVinci’s relative ease of use may not justify its 5-fold greater cost. Basic surgical robotic skills acquired on one robot are transferable to use on a second robot. Less experienced “younger” surgeons may acquire basic surgical robotic skills faster than their more experienced “older” colleagues.