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...
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| Veröffentlicht in: | Surgical endoscopy 2013-06, Vol.27 (6), p.2193-2200 |
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| creator | Yoshida, Kenji Kinoshita, Hidefumi Kuroda, Yoshihiro Oshiro, Osamu Matsuda, Tadashi |
| description | 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
|
| doi_str_mv | 10.1007/s00464-012-2739-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1354793342</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2976301981</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-47a00f182dcae41e59275c997b79ef6b428afc0c6f04ac73feaf3107441cdc0c3</originalsourceid><addsrcrecordid>eNp1kE1LAzEQhoMotlZ_gBcJePGymq_dbI6l-AUVL3oOaTaR1P0ys3vovze1VUTwNMzMM-_wvgidU3JNCZE3QIgoREYoy5jkKlMHaEoFTx2j5SGaEsVJ2igxQScAa5JwRfNjNGGcC5GTYoqe5q2pNxAAdx7XpjexA9v1weIqADg7hK7F8B7qGq82OLQwxLFx7YCH0GPfRetw4wyM0W2np-jImxrc2b7O0Ovd7cviIVs-3z8u5svMCl4OmZCGEE9LVlnjBHW5YjK3SsmVVM4XK8FK4y2xhSfCWMm9M55TIoWgtkpzPkNXO90-dh-jg0E3Aayra9O6bgRNeS6kSiZZQi__oOtujMn0F8WFKvOcJ4ruKJv8Q3Re9zE0Jm40JXqbtd5lrVPWepu1VunmYq88rhpX_Vx8h5sAtgMgrdo3F3-9_lf1E1Wridw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1353498553</pqid></control><display><type>article</type><title>Analysis of laparoscopic dissection skill by instrument tip force measurement</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Yoshida, Kenji ; Kinoshita, Hidefumi ; Kuroda, Yoshihiro ; Oshiro, Osamu ; Matsuda, Tadashi</creator><creatorcontrib>Yoshida, Kenji ; Kinoshita, Hidefumi ; Kuroda, Yoshihiro ; Oshiro, Osamu ; Matsuda, Tadashi</creatorcontrib><description>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
< 0.05). The average maximum magnitude of VF and HF was smallest in the expert group. TPV occurred significantly earlier than TPH in all three groups (
p
< 0.05). TPV in the expert group occurred earlier than in the intermediate and novice groups (
p
< 0.05). With increasing experience, TPV occurred earlier.
Conclusions
Expert surgeons apply the most efficient vertical forces to make an initial dissection point and then change to the horizontal direction to separate surrounding tissues from the target organ. Measuring instrument tip force could help in understanding and improving the safety margin in laparoscopic surgical dissection.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2739-9</identifier><identifier>PMID: 23344506</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Adult ; Biomechanical Phenomena ; Clinical Competence - standards ; Dissection ; Dissection - instrumentation ; Dissection - standards ; Endoscopy ; Equipment Design ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Laparoscopy - instrumentation ; Laparoscopy - standards ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Proctology ; Psychomotor Performance - physiology ; Sensors ; Skills ; Surgeons ; Surgery ; Training ; Urology</subject><ispartof>Surgical endoscopy, 2013-06, Vol.27 (6), p.2193-2200</ispartof><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-47a00f182dcae41e59275c997b79ef6b428afc0c6f04ac73feaf3107441cdc0c3</citedby><cites>FETCH-LOGICAL-c438t-47a00f182dcae41e59275c997b79ef6b428afc0c6f04ac73feaf3107441cdc0c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2739-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2739-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23344506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoshida, Kenji</creatorcontrib><creatorcontrib>Kinoshita, Hidefumi</creatorcontrib><creatorcontrib>Kuroda, Yoshihiro</creatorcontrib><creatorcontrib>Oshiro, Osamu</creatorcontrib><creatorcontrib>Matsuda, Tadashi</creatorcontrib><title>Analysis of laparoscopic dissection skill by instrument tip force measurement</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>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
< 0.05). The average maximum magnitude of VF and HF was smallest in the expert group. TPV occurred significantly earlier than TPH in all three groups (
p
< 0.05). TPV in the expert group occurred earlier than in the intermediate and novice groups (
p
< 0.05). With increasing experience, TPV occurred earlier.
Conclusions
Expert surgeons apply the most efficient vertical forces to make an initial dissection point and then change to the horizontal direction to separate surrounding tissues from the target organ. Measuring instrument tip force could help in understanding and improving the safety margin in laparoscopic surgical dissection.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Biomechanical Phenomena</subject><subject>Clinical Competence - standards</subject><subject>Dissection</subject><subject>Dissection - instrumentation</subject><subject>Dissection - standards</subject><subject>Endoscopy</subject><subject>Equipment Design</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - instrumentation</subject><subject>Laparoscopy - standards</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Proctology</subject><subject>Psychomotor Performance - physiology</subject><subject>Sensors</subject><subject>Skills</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Training</subject><subject>Urology</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LAzEQhoMotlZ_gBcJePGymq_dbI6l-AUVL3oOaTaR1P0ys3vovze1VUTwNMzMM-_wvgidU3JNCZE3QIgoREYoy5jkKlMHaEoFTx2j5SGaEsVJ2igxQScAa5JwRfNjNGGcC5GTYoqe5q2pNxAAdx7XpjexA9v1weIqADg7hK7F8B7qGq82OLQwxLFx7YCH0GPfRetw4wyM0W2np-jImxrc2b7O0Ovd7cviIVs-3z8u5svMCl4OmZCGEE9LVlnjBHW5YjK3SsmVVM4XK8FK4y2xhSfCWMm9M55TIoWgtkpzPkNXO90-dh-jg0E3Aayra9O6bgRNeS6kSiZZQi__oOtujMn0F8WFKvOcJ4ruKJv8Q3Re9zE0Jm40JXqbtd5lrVPWepu1VunmYq88rhpX_Vx8h5sAtgMgrdo3F3-9_lf1E1Wridw</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Yoshida, Kenji</creator><creator>Kinoshita, Hidefumi</creator><creator>Kuroda, Yoshihiro</creator><creator>Oshiro, Osamu</creator><creator>Matsuda, Tadashi</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130601</creationdate><title>Analysis of laparoscopic dissection skill by instrument tip force measurement</title><author>Yoshida, Kenji ; Kinoshita, Hidefumi ; Kuroda, Yoshihiro ; Oshiro, Osamu ; Matsuda, Tadashi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-47a00f182dcae41e59275c997b79ef6b428afc0c6f04ac73feaf3107441cdc0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Biomechanical Phenomena</topic><topic>Clinical Competence - standards</topic><topic>Dissection</topic><topic>Dissection - instrumentation</topic><topic>Dissection - standards</topic><topic>Endoscopy</topic><topic>Equipment Design</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - instrumentation</topic><topic>Laparoscopy - standards</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Proctology</topic><topic>Psychomotor Performance - physiology</topic><topic>Sensors</topic><topic>Skills</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Training</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoshida, Kenji</creatorcontrib><creatorcontrib>Kinoshita, Hidefumi</creatorcontrib><creatorcontrib>Kuroda, Yoshihiro</creatorcontrib><creatorcontrib>Oshiro, Osamu</creatorcontrib><creatorcontrib>Matsuda, Tadashi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoshida, Kenji</au><au>Kinoshita, Hidefumi</au><au>Kuroda, Yoshihiro</au><au>Oshiro, Osamu</au><au>Matsuda, Tadashi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of laparoscopic dissection skill by instrument tip force measurement</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>27</volume><issue>6</issue><spage>2193</spage><epage>2200</epage><pages>2193-2200</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>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
< 0.05). The average maximum magnitude of VF and HF was smallest in the expert group. TPV occurred significantly earlier than TPH in all three groups (
p
< 0.05). TPV in the expert group occurred earlier than in the intermediate and novice groups (
p
< 0.05). With increasing experience, TPV occurred earlier.
Conclusions
Expert surgeons apply the most efficient vertical forces to make an initial dissection point and then change to the horizontal direction to separate surrounding tissues from the target organ. Measuring instrument tip force could help in understanding and improving the safety margin in laparoscopic surgical dissection.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23344506</pmid><doi>10.1007/s00464-012-2739-9</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2013-06, Vol.27 (6), p.2193-2200 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1354793342 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adult Biomechanical Phenomena Clinical Competence - standards Dissection Dissection - instrumentation Dissection - standards Endoscopy Equipment Design Female Gastroenterology Gynecology Hepatology Humans Laparoscopy Laparoscopy - instrumentation Laparoscopy - standards Male Medicine Medicine & Public Health Middle Aged Proctology Psychomotor Performance - physiology Sensors Skills Surgeons Surgery Training Urology |
| title | Analysis of laparoscopic dissection skill by instrument tip force measurement |
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