LAUSR

INTRODUCTION AND OBJECTIVE With introduction of the daVinci single-port (SP) system, we evaluated which multi-port (MP) robotic skills are naturally transferable to the SP platform. METHODS Three groups of urologists: Group 1 (5 inexperienced in MP and SP) , Group 2 (5 experienced in MP without SP experience), and Group 3 (2 experienced in both MP and SP) were recruited to complete a validated urethrovesical anastomosis simulation using MP followed by SP robots. Performance was graded using both GEARS and RACE scales. Subjective cognitive load measurements [Surg-TLX and difficulty ratings (/20) of instrument collisions camera and endowrist movement] were collected. RESULTS GEARS and RACE scores for Groups 1 and 3 were maintained on switching from MP to SP (Group 3 scored significantly higher on both systems). Surg-TLX and difficulty scores were also maintained for both groups on switching from MP and SP except for a significant increase in SP camera movement (+7.2, p=0.03)] in Group 1 compared to Group 3 that maintained low scores on both. Group 2 demonstrated significant lower GEARS (-2.9, p=0.047) and RACE (-5.1, p=0.011) scores on SP vs MP. On sub-analysis, GEARS sub-scores for force sensitivity and robotic control (-0.7, p=0.04; -0.9, p=0.02) and RACE sub-scores for needle entry, needle driving, and tissue approximation (-0.9, p=0.01; -1.0, p=0.02; -1.0, p<0.01) significantly decreased. GEARS (depth perception, bimanual dexterity, and efficiency) and RACE sub-scores (needle positioning and suture placement) were maintained. All participants scored significantly lower in knot tying on the SP robot (-1.0, p=0.03; -1.2, p=0.02, respectively). Group 2 reported higher Surg-TLX (+13 pts, p=0.015) and difficulty ratings on SP vs MP (+11.8, p<0.01; +13.6, p<0.01; +14 pts, p<0.01). CONCLUSIONS The partial skill transference across robots raises the question regarding SP specific training for urologists proficient in MP. Novices maintained difficulty scores and cognitive load across platforms, suggesting that concurrent SP and MP training may be preferred.