Rate of skill acquisition in the use of a robotic laparoscope holder (Freehand)

Background: Robotic equipment can greatly add to the ergonomics of a surgical procedure and pre-operative simulation can provide risk-free training of the surgeon leading to precision surgery and less trauma to the patient. Freehand® is a second-generation robotic camera-holding device, which has recently become available to laparoscopic surgeons. It is controlled by the operator selecting a direction using head movement followed by activation with a foot pedal. The purpose of this study was to assess the rate of skill acquisition in the use of the FreeHand® robotic laparoscope holder by a group of laparoscopic surgeons by enrolling them into a programme of training modules at The ICENI Centre, Colchester Hospital University, UK. Material and methods: Twenty surgical registrars performed a series of exercises, escalating in difficulty, to test their skill in controlling the FreeHand® robot. Subjective and objective assessments were evaluated by an observer and by tracking analysis software created for this trial. Results: The observed number of head movements showed a Percentage Performance Score (PPS) of 98% by the end of the third repetition of all exercises, the mean Total Head Movements Score (HMS) reached a plateau of performance at 72%. Fifty per cent of the participants selected ‘Effective control of movements without difficulty’ in the subjective evaluation by the end of the third repetition of exercises, while 35% selected ‘competent intuitive movements’. Conclusion: The FreeHand® robotic laparoscope holder is a useful device, which is easy to operate and requires a very short course of training to achieve competence in its use.