Microsurgery and Telemicrosurgery Training: A Comparative Study

Abstract

Telemicrosurgery (TMS) is a new technique inspired by telesurgery and conventional microsurgery (CMS). One of the difficulties of CMS is learning to control physiological tremor. TMS eliminates the physiological tremor, thus theoretically simplifying microsurgical procedures, but no tactile feedback is provided while tying knots. The objective of this study was to assess if the learning curve for performing microsurgical anastomosis for TMS than with CMS was comparable. Thirty earthworms were anastomosed with 10/0 nylon sutures. In this study 15 anastomoses were performed under operating microscope and 15 under Da Vinci S® robot (Intuitive Surgical, Sunnyvale, CA). A single operator without experience in either technique performed all anastomoses. The evaluation consisted of measuring the time to perform each stitch, as well as to complete the anastomosis. The integrity of the anastomosis was tested by injection of saline solution into the earthworm to assess permeability and watertightness. The average time to complete a single suture was 296 seconds in the CMS group and 529 seconds in the TMS group. Permeability and watertightness of anastomosis was 86.66% in both groups. Learning was faster with CMS than with TMS. For untrained surgeon, the absence of tactile feedback is a limiting factor with TMS, however, the benefits of the TMS are: three-dimensional high definition vision, abolition of physiological tremor, motion scaling of gestures down to 5 times, use of three instruments at once, and extreme mobility.

Nerve Transfer to the Deltoid Muscle Using the Nerve to the Long Head of the Triceps with the da Vinci Robot: Six Cases

“…Several publications have compared the surgeon's performance of robotic microsurgery to that of conventional freehand microsurgery. The repair quality of anastomosis showed similar results; the operative time was shorter in conventional freehand microsurgery, 17,18 but surgical comfort is superior with the telemanipulator.…”

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

“…Right now, few arguments exist to justify investing significant resources into surgical robots. In addition, published data indicates that robotic-assisted microsurgery is associated with prolonged operating time compared to conventional microsurgery ( 9 , 10, 15, 22, 34, 42 ). Subsequently, the number of patients that can be treated may decrease and waiting times suffer.…”

The Oberlin Procedure for Restoration of Elbow Flexion with the da Vinci Robot

“…The most important advantages of telemicrosurgery are the disappearance of physiologic tremors and the magnification of movements up to 10ϫ, which ameliorates precision performance. Several publications have compared telemicrosurgery to conventional microsurgery, 13,14 with similar results in terms of repair quality, operative time in favor of microsurgery, but unparalleled superior surgical comfort with the telemanipulators. Reasons for failure of the mini-invasive technique include number of incisions, absence of sensory feedback, and failure to maintain a dissection space.…”