Operative efficiency and force stability during adoption of continuous force feedback in robotic hysterectomy and myomectomy: a single-surgeon cumulative analysis

Objective: Force feedback, a new capability of the da Vinci 5 surgical system, is contraindicated under United States labeling during the closure phase of hysterectomy and myomectomy. A companion report described the safety and force magnitude of continuous use through closure, but whether adopting it imposes a learning cost, or whether applied force drifts with experience, is unknown.Methods: We analyzed the 43 patients from the companion single-surgeon series with force feedback active throughout the procedure including closure. The temporal profile of console time (primary efficiency measure) was assessed by cumulative sum (CUSUM) analysis, by linear regression on case sequence adjusted for procedure, and by comparing the phases defined by the inflection. Safety outcomes were not re-analyzed.Results: The series comprised 22 hysterectomies and 21 myomectomies. The CUSUM curve showed an apparent inflection between cases 24 and 27, but console time was not associated with case sequence after adjustment for procedure (-0.22 minutes per case; 95% confidence interval, -1.01 to 0.56; p=0.57) and did not differ significantly between the early and late phases (median, 64 vs. 56 minutes; p=0.36). Mean applied force did not change across the series (-0.0025 N per case; p=0.53). Force feedback needle driver use during closure increased from 17 of 27 (63%) to 15 of 16 (94%; p=0.03).Conclusion: For an experienced robotic surgeon, adopting continuous force feedback through closure entailed no measurable learning penalty in operative time and no drift in applied force, while use of the feature during closure increased with experience.