Are the "visual haptics" conferred via robotics non-inferior to actual haptics?

BACKGROUND

Critics often cite the lack of tactile feel as a major drawback of robotic surgery. Although robotic surgeons are believed to develop a sense of "visual haptics" through personal experience combined with the enhanced 3D vision, this phenomenon has not been formally scrutinized. Therefore, our objective was to determine whether surgeons' discernment of objects' physical properties using robotic technology was non-inferior to discernment via surgeons' hands.

METHODS

This was a non-randomized parallel group study using an inanimate model consisting of four identical balloons fixed to posterboard and containing substances meant to simulate physical properties encountered in surgery-namely air, water, petroleum jelly, or a firm substance. Two groups of board-certified surgeons discerned contents of each balloon by feeling with their hands or by manipulating them using robotic instruments.

RESULTS

Using the Farrington-Manning test of binary non-inferiority, we expected 100% correct balloon discernment by hands-on surgeons and prospectively set 80% correct discernment by robotic surgeons as our definition of non-inferiority. A total of 76 board-certified surgeons made up our study group. There were 57 'hands-on surgeons' in Group A and 19 robotic surgeons in Group B. The mean number of years in practice, mean age, and proportion of females to males between Group A and Group B were similar (p values 0.17, 0.16, and 0.69, respectively). As expected, 100% of Group A discerned all four balloons correctly. Of the 19 robotic surgeons, one made two discernment errors (i.e., mixed up water and petroleum jelly-filled balloons). Therefore, the actual risk difference between groups was 2.6% which met our definition of non-inferiority (p =  < 0.0001).

CONCLUSIONS

Object discernment via "visual haptics" provided by the robotic surgery system was non-inferior to actual haptic discernment by 'hands-on surgeons.'