A Microanalysis of Intracorporeal Video from a Robotic... : Journal of the American College of Surgeons (original) (raw)

Scientific poster presentation: Surgical education

A Microanalysis of Intracorporeal Video from a Robotic Surgery: Investigation into a Surgeon's Professional Vision

Green, Courtney A. MD; Chern, Hueylan MD; Sarin, Ankit MD; O'Sullivan, Patricia

University of California, San Francisco, San Francisco, CA

Free

INTRODUCTION: Without haptic feedback, robotic surgeons rely on visual processing to interpret the operative field. To provide guidance for teaching in this environment, we analyzed intracorporeal actions and behaviors of the robotic surgeon.

METHODS: Six hours of video was captured by the intracorporeal camera during a robotic assisted lower anterior resection. Review reduced the video to 35 minutes and finally, a 2-minute clip subjected to microanalysis. The clip was replayed multiple times (capturing 1, 2, 10, 60 and 120 second intervals) identifying activities such as right and left hand motion, tissue handling and camera adjustments recorded using a software program. Data were synthesized into themes.

RESULTS: Theme 1: Changes in operative focus occurred immediately after increased activity of camera adjustment and tissue manipulation. These changes occurred after camera and tissue adjustments failed to create an operative field with appropriate tension-counter tension. Theme 2: Techniques for handling tissue highlight specific nuances in operating robotically. The surgeon manipulated tissue predominantly using blunt adjustments and rarely grasped it, likely to avoid tissue trauma. A magnified operative field required precise dissection, which occurs robotically with movement of a single instrument against a static field (motionless second robotic arm). This meticulous technique is unlike the bimodal manipulation often seen in laparoscopic dissection.

CONCLUSIONS: With limited active participation in robotic cases, residents rely heavily on the captured image for skill acquisition. We recommend surgeons use focus shifts as an opportunity to describe their operative decision-making and highlight instrument manipulations specific to operating with robotic technology.