Evaluation of Surgical Devices Using an Artificial Pediatric Thoracic Model: A Comparison Between Robot-Assisted Thoracoscopic Suturing Versus Conventional Video-Assisted Thoracoscopic Suturing.

Background: Pediatric robot-assisted surgery is increasingly being performed, but it is difficult to perform this procedure in infants. A pediatric thoracoscopic model of a 1-year-old patient was developed in our previous study, and this model was used to evaluate the use of a surgical robot for infant surgery. Methods: Eight pediatric surgeons performed an intracorporeal suturing and knot-tying task using the da Vinci Xi Robotic Surgical System. The task completion time, number of needle manipulations, and force applied during suturing of the robot-assisted thoracoscopic surgery (RATS) group were compared with those of the video-assisted thoracoscopic surgery (VATS) group whose data had been collected from the same 8 surgeons in our previous study. Results: The RATS group showed a significantly shorter completion time than the VATS group in the knot-tying phase (P=.016) and in the total phase (P=.0078). The RATS group showed a significantly smaller number of manipulations than the VATS group in the total phase (P=.039). The RATS group showed a significantly smaller pushing force index than the VATS group in the suturing phase (P=.031), knot-tying phase (P=.031), and in the total phase (P=.031). A seventh rib in the model was dislocated in all RATS group cases. Conclusions: The da Vinci Surgical System might be useful in infants because of fast movement and small pushing force. However, the robotic 8mm instruments were too large for use in the thoracic cavity of the 1-year-old infant.