PS3-08: PERCEPTUAL EXPERTISE IN ROBOTIC SURGERY: MORE THAN FEELING WHAT WE SEE
Courtney A Green, MD, MAEd, Hueylan Chern, MD, Patricia O'Sullivan, EdD; University of California San Francisco

While tactile feedback can guide surgeons in open and laparoscopic surgery, all surgeons rely on perceptual expertise.  This skill is emphasized in robotic surgery because surgeons receive no haptic feedback. As part of a larger study on the perceptual expertise of robotic surgeons, we investigated the relationship between expertise and perception of feeling in robotic surgery.

Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed 8 video clips portraying key portions of two robotic general surgery procedures (cholecystectomy and hernia repair). The operating surgeons were kept anonymous. While watching, expert surgeons were instructed to comment on what they were seeing on the screen. All interactions with participants were in person, recorded and analyzed at a later date. Prior to watching the videos, surgeons completed a survey to collect demographic data and rated their ability to feel what they could only see.

Seventeen surgeons, from 13 different states, participated and included general, colorectal, hepatobiliary, bariatric/foregut, cardiothoracic, ob/gyn and urologic surgeons. The average participant was 46.76 (SD=6.64) years old, had 13.2 (SD=8.23) years of teaching experience and performed 643 (SD=467) robotic operations at the time of interviews.  Of the 17 participants, 14 (82.4%) were male, 11 (64.7%) currently work at urban academic hospitals, 12 (71.0%) have published literature on robotic surgery and 11 (64.7%) work with multiple levels of trainees using robotic technology.   Surgeon comments were categorized as follows: anatomy, instrumentation, skill level, technique, intention of movements and personal approach variations. When given the statement: “when operating robotically, I can feel what I see,” 13/17 participants agreed. We calculated the Spearman correlations between agreement and age (-.11), years of experience (-.44) and case volume (-.45).  All 17 participants used tactile descriptions when commenting on the visual images shown.

The use of tangible descriptions suggests that robotic experts integrate visual and tactile concepts with robotic operations. However, in our study, the less experienced surgeons were more likely to agree that they could feel what they see. Our results suggest that perceptual expertise of robotic surgeons manifests more complexly than replacing one perceptual sense with another.