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Robot improves suture proficiency more rapidly for surgeons inexperienced in laparoscopic techniques
Date:4/20/2009

y limited experience. Each surgeon performed at random five freehand laparoscopies and four to five RALS. After gaining more experience by completing the five freehand laparoscopies and five RALS, the urologic surgeon who had started the study with limited technical knowledge performed an additional nine freehand laparoscopies, nine RALS and four open pyeloplasties. The study also evaluated the quality of the suture (for example, water tightness and patency) immediately after the operation and two weeks after the operation. The degree of inflammation was assessed 15 days after the procedure by measuring the amount of collagen III deposited on the ureteral wall. Only those sutures performed by the surgeon with limited laparoscopic experience and the last four sutures in each group for the other two surgeons were assessed to control for variability.

Study results showed that RALS had a shorter procedural time and a flatter learning curve compared with freehand laparoscopy (p < 0.01), even despite user differences in familiarity with laparoscopic techniques. Combining all the surgeons' times for each group, the mean suture time for RALS was 40.913.4 minutes, compared with 62.214.9 minutes with freehand laparoscopy (p>0.01) and 22.44.1 minutes with open surgery (p<0.01). With experience, the mean suture time for RALS of 22.34.6 minutes approached that of open surgery (p=0.80); the mean operative time for freehand laparoscopy also improved to 31.43.4 minutes (p>0.10 compared with open surgery).

Measurements for water tightness of the suture and patency of the unblocked connection between the kidney and the ureter were comparable to those in the open operation group. However, with experience, both the RALS and freehand laparoscopy procedural times and the measurements for water tightness and patency of the suture approached those of the open surgical procedure group. Histologic evaluation demonstrated that there was significantly less collagen III depos
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