Analysis of laparoscopic dissection skill by instrument tip force measurement

Background When comparing a single-stroke dissection maneuver among surgeons with differing experience levels, there are major differences in the force applied to the instrument tip. It is difficult to explain to surgeons in training the appropriate force and for the surgeons to ascertain the force intuitively. We quantified the force pattern during single-stroke laparoscopic dissection maneuvers to reveal the factors related to expertise. Methods We recorded the force pattern of a single maneuver and measured the magnitude of vertical (VF) and horizontal forces (HF) on the instrument tip using a box trainer (ex vivo). We compared VF and HF among surgeons: experts ( n = 10), intermediates ( n = 10), and novices ( n = 10). The dissection time of a single stroke (T), magnitude of the VF and HF, and the timing of the peak vertical force (TPV) and horizontal force (TPH) were evaluated as performance parameters. Results The dissection time of a single stroke (T) was shortest in the expert group ( p