Quantitative evaluation of surgical task performance by remote-access endoscopic telemanipulation

Background: The performance limitations inherent in minimally invasive surgery may be overcome by using an interface that provides intuitive orientation for video display and tool manipulation. A prototype remote-access endoscopic telemanipulator was designed to fulfill these requirements and used for a surgical anastomosis task. Methods: A remote-access telemanipulator system, employing remote center-of-motion geometry, was used to complete distant in vitro tubular anastomoses. The performance of four surgeons using this system was compared with that achieved in completing the same anastomosis task in an open environment using open surgical techniques and in a minimally invasive environment using standard laparoscopic methods. Results: The average performance times for completion of the anastomosis task was 1448 +/- 130 s using the telemanipulator system compared with 2108 +/- 291 a with laparoscopic instruments and 296 +/- 25 s with conventional techniques. Leakage rates from the tubular anastomoses were 5.2 +/- 1.4 mVs in the telemanipulator group, 6.9 +/- 2.0 ml/s in the laparoscopic group, and 3.2 +/- 0.9 ml/s in the conventional methods group. All experimental subjects were able to complete the assigned task in each experimental condition successfully without complications. Conclusions: Our results in this pilot study suggest that remote-access endoscopic telemanipulation can execute complex three-dimensional manipulations, and that the intuitive orientation of the surgeon's workstation may contribute to easier task completion.