Authors: Shiva Jayaraman Douglas Quan Ibrahim AlGhamdi Firas ElDeen Christopher M Schlachta
Publish Date: 2009/07/25
Volume: 24, Issue: 3, Pages: 584-588
Abstract
An ex vivo model for choledochojejunostomy was created using porcine livers with extrahepatic bile ducts and contiguous intestines MIS choledochojejunostomies were performed in two arms group 1 laparoscopic n = 30 and group 2 da Vinci assisted n = 30 Procedures were performed by three surgeons with graduated MIS expertise surgeon A MIS + robotics surgeon B experienced MIS and surgeon C basic MIS Each surgeon performed ten procedures per group The primary objective was time to complete anastomoses using each method Secondary objectives included anastomosis quality impact of experience on performance and learning curveda Vinci led to faster anastomoses than laparoscopy 280 vs 359 min p = 0002 Surgeon A’s mean operative times were equivalent with both techniques 245 vs 223 min Surgeons B and C experienced faster operative times with robotics over laparoscopy alone 394 vs 286 min p = 001 and 438 vs 330 min p = 0008 respectively Surgeon A did not demonstrate a learning curve with either laparoscopy 224 vs 224 min p = not significant NS or robotics 247 vs 198 min p = NS Surgeon B demonstrated nonsignificant improvement with laparoscopy 466 vs 395 min p = NS With robotic assistance a learning curve was demonstrated 368 vs 247 min p = 002 Surgeon C demonstrated a learning curve with laparoscopy 583 vs 332 min p = 0004 but no improvement was noted with robot assistance 322 vs 347 min p = NSda Vinci improves time to completion and quality of choledochojejunostomy over laparoscopy in an ex vivo bench model This advantage is more pronounced in the hands of surgeons with less MIS experience Conversely robotics may allow less experienced surgeons to perform more complex operations without first developing advanced laparoscopic skills however there may be benefit to first obtaining fundamental skills
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