1092 SKILL ANALYSIS IN A LAPAROSCOPIC DISSECTION MANEUVER BY FORCE MEASUREMENT

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy III1 Apr 20101092 SKILL ANALYSIS IN A LAPAROSCOPIC DISSECTION MANEUVER BY FORCE MEASUREMENT Kenji Yoshida, Naoki Oguchi, Gen Kawa, Hidefumi Kinoshita, and Tadashi Matsuda Kenji YoshidaKenji Yoshida More articles by this author , Naoki OguchiNaoki Oguchi More articles by this author , Gen KawaGen Kawa More articles by this author , Hidefumi KinoshitaHidefumi Kinoshita More articles by this author , and Tadashi MatsudaTadashi Matsuda More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2289AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The dissection maneuver in laparoscopic surgery differs between expert and novice surgeons, which relates to the application of force on the instrument tip. However, it is difficult to ascertain the applied force from endoscopic images, and such to clearly explain the differences between surgeons. Thus, the aim of our study was to investigate the force measurement on the instrument tip and analyze surgeon skills during a dissection maneuver. METHODS We developed a system to measure the force on the instrument tip using a Box trainer. A spatula-shaped instrument was cut 61mm from the tip, and a 2cm square sensor capable of detecting vertical forces (VF) and shear forces (SF) was installed between the cutting edges. The measured force and endoscopic images were displayed on a computer screen. Participants performed a dissection task involving separation of an artery from surrounding fatty in a dead porcine kidney using their dominant hand. The dissection skill of experienced surgeons (experts; n=10) and those of junior residents (novices; n=10) were analyzed by the timing of the peak VF (TVF), the timing of the peak SF (TSF), the ratio of the forces at peak VF (RVF), and the ratio of the forces at peak SF (RSF); TVF (%) or TSF (%) = time to peak VF or SF/whole dissection time; RVF = SF/VF; and RSF = VF/SF. An example case of a measurement of force by an expert can be seen in Figure. RESULTS The peak VF of experts occurred at earlier timing than in novices (mean±SD; TVF experts, 33.3±11.7%; TVF novices, 73.0±21.3%; P<0.05), while there was no significant difference in the peak SF (TSF experts, 80.0±9.16%; TSF novices, 80.0±9.42%; P>0.05). Both the RVF (experts, 0.87±0.79; novices, 1.91±1.07, P<0.05) and RSF (experts; 0.17±0.12; novices, 0.47±0.26; P<0.05) of experts was smaller than in novices. CONCLUSIONS At the beginning of a dissection maneuver, experts applied the VF with a little SF. Further, after the peak VF, the SF was gradually applied with relaxing of the VF. By contrast, from beginning of a dissection maneuver, novices gradually applied the VF and SF without relaxing either force. These data suggest that experts try to keep the instrument tip visualized in the operative field for the safety dissection maneuver. Hirakatashi, Osaka, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e425 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenji Yoshida More articles by this author Naoki Oguchi More articles by this author Gen Kawa More articles by this author Hidefumi Kinoshita More articles by this author Tadashi Matsuda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...