Laparoscopic Training Tasks Research Articles

Can you feel the force just right? Tactile force feedback for training of minimally invasive surgery—evaluation of vibration feedback for adequate force application

BackgroundTissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills.MethodsStandard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion.ResultsA total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities.ConclusionContinuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.

Video game experience affects performance, cognitive load, and brain activity in laparoscopic surgery training.

Video games can be a valuable tool for surgery training. Individuals who interact or play video games tend to have a better visuospatial ability when compared to non-gamers. Numerous studies suggest that video game experience is associated with faster acquisition, greater sharpening, and longer retention of laparoscopic skills. Given the neurocognitive complexity of surgery skill, multimodal approaches are required to understand how video game playing enhances laparoscopy skill. Twenty-seven students with no laparoscopy experience and varying levels of video game experience performed standard laparoscopic training tasks. Their performance, subjective cognitive loading, and prefrontal cortical activity were recorded and analyzed. As a reference point to use in comparing the two novice groups, we also included data from 13 surgeons with varying levels of laparoscopy experience and no video game experience. Results indicated that video game experience was correlated with higher performance (R2 = 0.22, p <0.01) and lower cognitive load (R2 = 0.21, p <0.001), and the prefrontal cortical activation of students with gaming experience was relatively lower than those without gaming experience. In terms of these variables, gaming experience in novices tended to produce effects similar to those of laparoscopy experience in surgeons. Our results suggest that along the dimensions of performance, cognitive load, and brain activity, the effects of video gaming experience on novice laparoscopy trainees are similar to those of real-world laparoscopy experience on surgeons. We believe that the neural underpinnings of surgery skill and its links with gaming experience need to be investigated further using wearable functional brain imaging.

Ergonomic Design and Assessment of an Improved Handle for a Laparoscopic Dissector Based on 3D Anthropometry.

Laparoscopic surgery (LS) has been shown to provide great benefits to patients compared with open surgery. However, surgeons experience discomfort, low-efficiency, and even musculoskeletal disorders (MSDs) because of the poor ergonomic design of laparoscopic instruments. A methodology for the ergonomic design of laparoscopic dissector handles considering three-dimensional (3D) hand anthropometry and dynamic hand positions was addressed in this research. Two types of hand positions for grasping and stretching were scanned from 21 volunteers using a high-resolution 3D scanner. The 3D anthropometric data were extracted from these 3D hand pose models and used to design an improved handle (IH) that provides additional support for the thumb, a better fit to the purlicue, and a more flexible grasp for the index finger. Thirty subjects were invited to evaluate the IH in terms of muscular effort, goniometric study of motion, and efficiency and effectiveness during four trials of a laparoscopic training task. Questionnaires provided subjective parameters for ergonomic assessment. Positive results included less muscle load in the trapezius as well as significant but small angular differences in the upper limb. No significant reduction in the trial time and no increased percentage of the achievement were observed between the IH and the commercial handle (CH). Improved intuitiveness, comfort, precision, stability, and overall satisfaction were reported. IH provides significant ergonomic advantages in laparoscopic training tasks, demonstrating that the proposed methodology based on 3D anthropometry is a powerful tool for the handle design of laparoscopic dissectors and other surgical instruments.

Creating a Proficiency-based Remote Laparoscopic Skills Curriculum for the COVID-19 Era

OBJECTIVESocial distancing restrictions due to COVID-19 challenged our ability to educate incoming surgery interns who depend on early simulation training for basic skill acquisition. This study aimed to create a proficiency-based laparoscopic skills curriculum using remote learning.DESIGNContent experts designed 5 surgical tasks to address hand-eye coordination, depth perception, and precision cutting. A scoring formula was used to measure performance: cutoff time - completion time - (K × errors) = score; the constant K was determined for each task. As a benchmark for proficiency, a fellowship-trained laparoscopic surgeon performed 3 consecutive repetitions of each task; proficiency was defined as the surgeon's mean score minus 2 standard deviations. To train remotely, PGY1 surgery residents (n = 29) were each issued a donated portable laparoscopic training box, task explanations, and score sheets. Remote training included submitting a pre-test video, self-training to proficiency, and submitting a post-test video. Construct validity (expert vs. trainee pre-tests) and skill acquisition (trainee pre-tests vs. post-tests) were compared using a Wilcoxon test (median [IQR] reported).SETTINGThe University of Texas Southwestern Medical Center in Dallas, TexasPARTICIPANTSSurgery internsRESULTSExpert and trainee pre-test performance was significantly different for all tasks, supporting construct validity. One trainee was proficient at pre-test. After 1 month of self-training, 7 additional residents achieved proficiency on all 5 tasks after 2-18 repetitions; trainee post-test scores were significantly improved versus pre-test on all tasks (p = 0.01).CONCLUSIONSThis proficiency-based curriculum demonstrated construct validity, was feasible as a remote teaching option, and resulted in significant skill acquisition. The remote format, including video-based performance assessment, facilitates effective at-home learning and may allow additional innovations such as video-based coaching for more advanced curricula.

Laparoscopic skills training: the effects of viewing mode (2D vs. 3D) on skill acquisition and transfer

BackgroundThree-dimensional (3D) visual displays have been suggested to aid laparoscopic skills training by providing the depth cues not present in traditional two-dimensional (2D) displays. However, few studies have robustly investigated the impact of viewing mode (2D vs. 3D) on learning outcomes.PurposeTo examine how viewing mode (2D vs. 3D) impacts the acquisition and transferability of basic laparoscopic skills by comparing performance between transfer and control groups on a complete proficiency-based training program.MethodA counterbalanced between-subjects design was employed. Each participant was randomly allocated to one of four groups, comprising two transfer groups (trained in one viewing mode and tested in the alternate mode: the 2D → 3D and 3D → 2D groups) and two control groups (trained and tested in one viewing mode: the 2D → 2D and 3D → 3D groups). Participants completed proficiency-based training in six laparoscopic training tasks. Testing included two further repetitions of all tasks under test conditions. Objective performance measures included the total number of repetitions to reach proficiency, and total performance scores (i.e. time + error penalties across all repetitions) in training and testing.ResultsThe groups trained in 3D demonstrated superior training performance (i.e. less time + errors) and took fewer repetitions to reach proficiency than the groups trained in 2D. The groups tested in 3D also demonstrated superior test performance compared to those tested in 2D. However, training mode did not yield significant test differences between the groups tested in 2D (i.e. 2D → 2D vs. 3D → 2D), or between the groups tested in 3D (i.e. 3D → 3D vs. 2D → 3D).ConclusionNovices demonstrate superior performance in laparoscopic skills training using a 3D viewing mode compared to 2D. However, this does not necessarily translate to superior performance in subsequent testing or enhanced learning overall. Rather, test performance appears to be dictated by the viewing mode used during testing, not that of prior training.

Haptic exploration improves performance of a laparoscopic training task

BackgroundLaparoscopy has reduced tactile and visual feedback compared to open surgery. There is increasing evidence that visual and haptic information converge to form a more robust mental representation of an object. We investigated whether tactile exploration of an object prior to executing a laparoscopic action on it improves performance.MethodsA prospective cohort study with 20 medical students randomized in two different groups was conducted. A silicone ileocecal model, on which a laparoscopic action had to be performed, was used inside an outside a ForceSense box trainer. During the pre-test, students either did a combined manual and visual exploration or only visual exploration of the caecum model. To track performance during the trials of the study we used force, motion and time parameters as representatives of technical skills development. The final trial data were used for statistical comparison between groups.ResultsAll included time and motion parameters did not show any clear differences between groups. However, the force parameters Mean force non-zero (p = 004), Maximal force (p = 0.01) Maximal impulse (p = 0.02), Force volume (p = 0.02) and SD force (p = 0.01) showed significant lower values in favour of the tactile exploration group for the final trials.ConclusionsBy adding haptic sensation to the existing visual information during training of laparoscopic tasks on life-like models, tissue manipulation skills improve during training.

Blood Flow Velocity of the Middle Cerebral Arteries: A Real-Time Measure of Attentional Load in the Laparoscopic Surgery Environment?

Laparoscope (camera) rotations in laparoscopic surgery, and the resulting perceptual-motor distortions, increases the workload (attentional load) of surgeons. When attentional load is high, risks of surgical errors and patient injury increase. Blood flow velocity (BFV) changes of the middle cerebral arteries (MCAs) may serve as a real-time measure of attentional load in this environment. Seventeen undergraduates performed a laparoscopic training task (peg-transfer task) in a laparoscopic simulator at a non-rotated camera angle (0° condition−camera directly in front of the participant) and a rotated condition (camera was rotated 135° to the side). Performance (transfer speed) was superior in the 0° condition and performance in both camera conditions improved over time. Further, BFV was greater at the 135° rotation and declined over time in both conditions. The decline in BFV co-occurred with improved peg-transfer performance that occurred in both camera conditions. The results suggest that BFV changes of the MCAs are a sensitive indicator of attentional load induced by the perceptual-motor distortions inherent in laparoscopy. Thus, it may be possible to use BFV changes of the MCAs, a non-invasive measure, to assess real-time attentional load and attentional resource utilization in the surgical environment

Effects of Varied Surgical Simulation Training Schedules on Motor-Skill Acquisition.

There have been many studies to evaluate the effect of training schedules on retention; however, these usually compare only 2 drastically different schedules, massed and distributed, and they have tended to look at declarative knowledge tasks. This study examined learning on a laparoscopic surgery simulator using a set of procedural or perceptual-motor tasks with some declarative elements. The study used distributed, massed, and 2 hybrid-training schedules that are neither distributed nor massed. To evaluate the training schedules, 23 participants with no previous laparoscopic experience were recruited and randomly assigned to 1 of the 4 training schedules. They performed 3 laparoscopic training tasks in eight 30-minute learning sessions. We compared how task time decreased with each schedule in a between-participants design. We found participants in all groups demonstrated a decrease in task completion time as the number of training sessions increased; however, there were no statistically significant differences in participants' improvement on task completion time between the 4 different training schedule groups, which suggested that time on task is more important for learning these tasks than the training schedule.

The Impact of Distance Between Displays on Visual Scanning in the Laparoscopic Training Environment: The Role of Effort

The laparoscopic environment induces high attentional demands on operators due to the perceptual-motor distortions inherent in this environment. Further, successful surgical outcomes necessitate surgeons to have adequate situation awareness of the patient and the surgery. Thus, surgeons need to obtain information that is often displayed visually at different locations in the operating theater, requiring visual scanning. The present study assessed the impact of the distance between different displays on visual scanning behavior when performing a concurrent laparoscopic training task. The results of the present study have practical implications for laparoscopic surgery, indicating that critical information displayed visually should be located close to the monitor that displays the target tissue. Further, relatively difficult laparoscopic procedures (e.g., those with increased disruption of hand-eye mapping) might result in longer viewing times, and thus critical information might not be attended to because of decreased frequency of visual scanning.

The Effect of Interruptions on Novices Learning a Challenging Surgical Skill

The goal of this study was to examine how interruptions affect the acquisition of laparoscopic skills among novices. Undergraduate students with no prior laparoscopic experience completed a basic laparoscopic training task requiring them to pick up and transfer colored objects in a predetermined sequence. The number of colored objects in the sequence was varied to produce three levels of task demand. During execution of the primary task, participants were exposed to a visual interruption by having their video display go blank. The length of interruptions was also varied to examine its effect on memory for the sequence of object moves. Results show greater perceived workload and sequence errors as the demand of the ring transfer task increased. Interruptions from simulated equipment failure were not found to negatively impact recollection of the predetermined color sequences.

Assessment of Performance Carryover Effects Due to Successive Exposure to Different Lateral Camera Rotations in a Laparoscopic Training Environment.

Objective The aim of this study was to assess performance carryover effects associated with different successive lateral camera rotations in the laparoscopic training environment. Background Laparoscopy requires surgeons to adapt to disruptions of visuomotor mapping. A gradual adaptation process is hypothesized to be effective up to a given rotation threshold; this threshold may have performance implications for successive exposure to different lateral camera rotations. Method Two experiments utilized a laparoscopic training task. Experiment 1 exposed novices to a subsequent rotation that was either 45° larger than one of the initial rotations of 45°, 75°, 105°, and 135° or 45° smaller than one of the initial rotations of 90°, 120°, 150°, and 180°. Experiment 2 exposed novices to either stepwise increasing rotations (0° to 180°) or stepwise decreasing rotations (180° to 0°). Results Regarding Experiment 1, performance generally improved for subsequent rotations that were 45° larger than the initial rotation, except for one condition (initial rotation, 105°; subsequent rotation, 150°). Performance generally improved for subsequent rotations that were 45° smaller than the initial rotation, except for one condition (initial rotation, 120°; subsequent rotation, 75°). Experiment 2 indicated worst performance at 120° for the increasing and decreasing conditions. This finding suggests an identical threshold for increasing and decreasing rotations, which is inconsistent with Experiment 1 results. Conclusion Improved performance due to carryover effects from successive exposure to lateral camera rotations in the laparoscopic training environment is contingent on the specific camera rotations. Application Supplementary laparoscopic training might be needed for surgeries that entail certain successive lateral camera rotations.

An automated skills assessment framework for laparoscopic training tasks.

Various sensors and methods are used for evaluating trainees' skills in laparoscopic procedures. These methods are usually task-specific and involve high costs or advanced setups. In this paper, we propose a novel manoeuver representation feature space (MRFS) constructed by tracking the vanishing points of the edges of the graspers on the video sequence frames, acquired by the standard box trainer camera. This study aims to provide task-agnostic classification of trainees in experts and novices using a single MRFS over two basic laparoscopic tasks. The system achieves an average of 96% correct classification ratio (CCR) when no information on the performed task is available and >98% CCR when the task is known, outperforming a recently proposed video-based technique by >13%. Robustness, extensibility and accurate task-agnostic classification between novices and experts is achieved by utilizing advanced computer vision techniques and derived features from a novel MRFS.

Impact of Super Monkey Ball and Underground video games on basic and advanced laparoscopic skill training

This abstract profiles the comparison of correlations between previously validated Super Monkey Ball (SMB) and recently introduced Underground (U) video game on the Nintendo Wii U to multiple validated tasks used for developing basic and advanced laparoscopic skills. Sixty-eight participants, 53 residents and 15 attending surgeons, performed the Top Gun Pea Drop, FLS Peg Pass, intracorporeal suturing, and two video games (SMB and U). SMB is an over-the-counter game, and U was formulated for laparoscopic skill training. Spearman's rank correlations were performed looking at performance comparing the three validated laparoscopic training tasks, and SMB/U. The SMB score had a moderate correlation with intracorporeal suturing (ρ=0.39, p<0.01), and the final score involving all three tasks (ρ=0.39, p<0.01), but low correlations with Pea Drop Drill and FLS Peg Transfer (ρ=0.11, 0.18, p<0.01). The U score had a small correlation with intracorporeal suturing and final score (ρ=0.09, 0.13, p<0.01). However, there were correlations between U score and Pea Drop Drill, and FLS Peg Transfer (ρ=0.24, 0.27, p<0.01, respectively). In this study, SMB had a very significant correlation with intracorporeal suturing. U demonstrated more of a correlation with basic skills. At this point, our conclusion would be that both are effective for laparoscopic skill training, and they should be used in tandem rather than alone.

Muscle activity and hand motion in veterinarians performing laparoscopic training tasks with a box trainer.

To evaluate muscle activity and hand motion in veterinarians performing a standard set of laparoscopic training tasks. 12 veterinarians with experience performing laparoscopic procedures. Participants were asked to perform peg transfer, coordination, precision cutting, and suturing tasks in a laparoscopic box trainer. Activity of the right biceps brachii, triceps brachii, forearm flexor, forearm extensor, and trapezius muscles was analyzed by means of surface electromyography. Right hand movements and wrist angle data were registered through the use of a data glove, and risk levels for the wrist joint were determined by use of a modified rapid upper limb assessment (RULA) method. One-way repeated-measures ANOVA with a Bonferroni post hoc test was performed to compare values between tasks. Activity in the biceps muscle did not differ significantly among the 4 tasks. Activity in the triceps, forearm flexor, and forearm extensor muscles was significantly higher during precision cutting than during the coordination task. Activity in the trapezius muscle was highest during the suturing task and did not differ significantly among the other 3 tasks. The RULA score was unacceptable (score, 3) for the coordination, peg transfer, and precision cutting tasks but was acceptable (score, 2) for the suturing task. Results indicated that the ergonomics of laparoscopic training depended on the tasks performed and the design of the instruments used. Precision cutting and suturing tasks were associated with the highest muscle activity. Acceptable wrist position, as determined with the RULA method, was found with the suturing task, which was performed with an axial-handled instrument.

Increasing efficiency of surgical training: effects of spacing practice on skill acquisition and retention in laparoscopy training.

The goal of this study was to investigate the effects of spaced versus massed practice on skill acquisition and retention in the context of laparoscopic motor skill training. Reaching proficiency in performing laparoscopic surgery involves extensive training to acquire the required motor skills. Conventionally, training of such skills occurs during a full day training event utilizing surgical simulators that train specific motor skills pertinent to laparoscopic surgery. An important variable to consider is the optimal schedule for laparoscopic motor training. In this study, two groups of trainees without prior experience were trained on a variety of physical box-trainer tasks on different time-schedules. One group received three 75-min training sessions on a single day (massed condition) and the other received one 75-min training session per week for three consecutive weeks (spaced condition). Short- and long-term retention were assessed 2 weeks and 1 year after the completion of training. Outcome measures indicated better performance at the end of training, at a 2-week delayed retention session and at a 1-year retention session for the group that received training on a spaced schedule. This spacing effect was most pronounced for the more difficult laparoscopic training tasks such as intra-corporeal suturing. On average, 21 % of participants in the massed group and 65 % in the spaced group reached proficiency by the end of training. Spacing practice of laparoscopic motor skill training will facilitate skill acquisition, short-term and long-term retention, and thus, a more efficient learning process for trainees. Though more challenging in terms of logistics, training courses in medical centers should distribute practice sessions over longer time intervals.

Sideways camera rotations of 90° and 135° result in poorer performance of laparoscopic tasks for novices.

The aim of this study was to determine the impact of sideways visuomotor rotations between 0° and 180° on novice performance in a laparoscopic simulator. The laparoscopic surgical environment often involves visuomotor rotations because the laparoscope may be placed to the surgeon's side. Basic research by Cunningham indicated that visuomotor rotations between 90° and 135° result in peak performance decrements. Research by Ames and colleagues failed to replicate Cunningham's results in the laparoscopic environment, possibly due to (a) confounds from carryover effects or (b) use of an alternative laparoscopic training task rather than the straight-line pointing task used by Cunningham. Two experiments were conducted to determine if Cunningham's results generalize to the laparoscopic environment when controlling for carryover effects for a three-dimensional "straight-line" pointing task (Experiment 1) and a laparoscopic training task (Experiment 2). In Experiments 1 and 2, participants were assigned to one of five visuomotor rotations: 0°, 45°, 90°, 135°, or 180°. Utilizing a laparoscopic simulator, participants performed either a three-dimensional pointing task (Experiment 1) or a peg transfer task (Experiment 2). In both experiments, visuomotor rotations of 90° or 135° resulted in the poorest performance. When controlling for carryover effects, Cunningham's results generalize to novices' performance of a pointing and a peg transfer task in the laparoscopic environment. The results indicate that 90° and 135° sideways laparoscope placements may result in worse performance for novices in the laparoscopic environment, indicating potentially longer learning curves for these conditions in the laparoscopic as well as other teleoperation environments.

A Telerobotic System for Transnasal Surgery.

Mechanics-based models of concentric tube continuum robots have recently achieved a level of sophistication that makes it possible to begin to apply these robots to a variety of real-world clinical scenarios. Endonasal skull base surgery is one such application, where their small diameter and tentacle like dexterity are particularly advantageous. In this paper we provide the medical motivation for an endonasal surgical robot featuring concentric tube manipulators, and describe our model-based design and teleoperation methods, as well as a complete system incorporating image-guidance. Experimental demonstrations using a laparoscopic training task, a cadaver reachability study, and a phantom tumor resection experiment illustrate that both novice and expert users can effectively teleoperate the system, and that skull base surgeons can use the robot to achieve their objectives in a realistic surgical scenario.

Neuroanatomical correlates of laparoscopic surgery training

Better understanding of the brain regions involved in performing laparoscopic surgery is likely to provide important insights for improving laparoscopic training and assessment in the future. To our knowledge, this is the first study using real Fundamentals of Laparoscopy Training (FLS)-based laparoscopic surgery training tasks in the functional magnetic resonance imaging (fMRI) environment to provide extensive characterization of the brain regions involved in this specific task execution. Nine right-handed subjects practiced five FLS-modified laparoscopic surgery-training tasks with a training box for ten sessions in a simulated fMRI environment. Following the last practice session, they underwent 3 T fMRI while performing each task. An increase in the extent of brain activation was observed as the complexity of the tasks increased. Activation in the precentral gyrus, postcentral gyrus, and premotor regions was observed in the performance of all tasks, whereas the superior parietal lobe (SPL) was activated in the more complex tasks. The mean score and brain activation for performance with the dominant hand were larger than those observed during performance with the non-dominant hand. Performing more complex tasks requires higher visual spatial ability and motor planning. Given the need for ambidextrous skills during laparoscopic tasks, the finding that lower scores and smaller brain recruitment occurred in executing tasks with the non-dominant hand than with the dominant hand suggests designing future training tasks to train the non-dominant hand more effectively. This may serve to improve overall performance in bi-manual tasks. Studies of this kind may facilitate the evidence-based development of strategies to improve the quality of laparoscopy training and assessment.

879 MAGNETIC TRACKING TECHNOLOGY USED TO COMPARE ERGONOMICS OF SINGLE SITE AND CONVENTIONAL LAPAROSCOPIC SURGERY: PRELIMINARY RESULTS

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment (1)1 Apr 2013879 MAGNETIC TRACKING TECHNOLOGY USED TO COMPARE ERGONOMICS OF SINGLE SITE AND CONVENTIONAL LAPAROSCOPIC SURGERY: PRELIMINARY RESULTS Ioannis Georgiopoulos, Loukas Rentzos, Iason Kyriazis, Panagiotis Kallidonis, Evangelos Liatsikos, and George Chryssolouris Ioannis GeorgiopoulosIoannis Georgiopoulos Patras, Greece More articles by this author , Loukas RentzosLoukas Rentzos Patras, Greece More articles by this author , Iason KyriazisIason Kyriazis Patras, Greece More articles by this author , Panagiotis KallidonisPanagiotis Kallidonis Patras, Greece More articles by this author , Evangelos LiatsikosEvangelos Liatsikos Patras, Greece More articles by this author , and George ChryssolourisGeorge Chryssolouris Patras, Greece More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.450AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimal invasive urologic surgery may benefit from ergonomic motion analysis, as the surgeonÆs joints are often in non-optimal positions, leading to premature fatigue. We propse to examine and compare the ergonomics of simulated single-site surgery and conventional laparoscopic surgery. METHODS A laparoscopic box trainer is used to simulate surgical conditions. To simulate conventional laparoscopic surgery, two instruments are inserted bilaterally and the camera in the center position. Single site surgery is simulated by inserting an Endocone® (Karl Storz, Germany) in the center position and inserting a double bent grasper, a straight grasper and the camera through it. Standard laparoscopic training tasks (object transfer, knot tying) are performed and ergonomic data is captured. Magnetic tracking technology is used to obtain position and orientation data for the operatorÆs wrists, elbows and shoulders at a rate of thirty times per second. The data is inserted into an algorithm which calculates the ergonomic scores for each posture throughout the execution of the laparoscopic task. At the end, the algorithm can compare the ergonomic performance of different laparoscopic methods using the analyzed scores. The analysis is based on the RULA method (Rapid Upper Limb Assessment). RESULTS Preliminary analysis of the data show that joints are in non-optimal positions in single site surgery, as compared to conventional laparoscopic surgery. This is demonstrated by the higher arm and wrist RULA scores obtained for tasks conducted through the single port systems (Test 10) in comparison to tasks conducted through a conventional laparoscopic setup (Test 1). CONCLUSIONS Ergonomic motion analysis may yield results that lead to the improvement of minimal invasive surgical techniques and equipment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e363 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ioannis Georgiopoulos Patras, Greece More articles by this author Loukas Rentzos Patras, Greece More articles by this author Iason Kyriazis Patras, Greece More articles by this author Panagiotis Kallidonis Patras, Greece More articles by this author Evangelos Liatsikos Patras, Greece More articles by this author George Chryssolouris Patras, Greece More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

25 Magnetic tracking technology used to compare ergonomics of single site and conventional laparoscopic surgery: Preliminary results

INTRODUCTION AND OBJECTIVES: Minimal invasive urologic surgery may benefit from ergonomic motion analysis, as the surgeonAEs joints are often in non-optimal positions, leading to premature fatigue. We propse to examine and compare the ergonomics of simulated single-site surgery and conventional laparoscopic surgery. METHODS: A laparoscopic box trainer is used to simulate surgical conditions. To simulate conventional laparoscopic surgery, two instruments are inserted bilaterally and the camera in the center position. Single site surgery is simulated by inserting an Endocone (Karl Storz, Germany) in the center position and inserting a double bent grasper, a straight grasper and the camera through it. Standard laparoscopic training tasks (object transfer, knot tying) are performed and ergonomic data is captured. Magnetic tracking technology is used to obtain position and orientation data for the operatorAEs wrists, elbows and shoulders at a rate of thirty times per second. The data is inserted into an algorithm which calculates the ergonomic scores for each posture throughout the execution of the laparoscopic task. At the end, the algorithm can compare the ergonomic performance of different laparoscopic methods using the analyzed scores. The analysis is based on the RULA method (Rapid Upper Limb Assessment). RESULTS: Preliminary analysis of the data show that joints are in non-optimal positions in single site surgery, as compared to conventional laparoscopic surgery. This is demonstrated by the higher arm and wrist RULA scores obtained for tasks conducted through the single port systems (Test 10) in comparison to tasks conducted through a conventional laparoscopic setup (Test 1). CONCLUSIONS: Ergonomic motion analysis may yield results that lead to the improvement of minimal invasive surgical techniques and equipment.