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[133] Citation: Abstract
Background: One of the more difficult tasks in surgical education
is to teach the optimal application of instrument forces and torques
necessary to facilitate the conduct of an operation. For laparoscopic
surgery, such training has traditionally taken place in the operating
room, reducing operating room efficiency and potentially affecting the
safe conduct of the operation. Objective: The objective of the current
study was to measure and compare forces and torque signatures at the
tool/hand interface generated during laparoscopic surgery by novice (NS)
and experienced (ES) surgeons using a novel force-torque laparoscopic
instrument. Methods: Four surgeons (2-NS, 2-ES) performed a cholecystectomy
and Nissen fundoplication in a porcine model. An instrumented
laparoscopic grasper with interchangeable standard surgical tips
equipped with a three-axis force/torque sensor was used to measure the
force/torque signature at the hand/tool interface. Force/torque data
synchronized with visual view of the tool operative maneuvers were
collected simultaneously via a novel graphic user interface incorporated
picture-in-picture video technology. Subsequent frame by frame, video
analysis of the operation allowed to define states within each step of
the operation. Forces and torques measured within each state were
further analyzed using vector quantization and the hidden Markov statistical
model. Results: The NS group used a mean of 138% greater force and 130%
greater torque during all stages of an operation compared to the ES group.
Furthermore, the completion time of a laparoscopic cholecystectomy on a
porcine model was 270% greater in the NS group. State analysis suggests
that the majority of this time was consumed in an "idle" without useful
contribution to the conduct of the operation. Conclusions: Preliminary
data suggest that force/torque signatures provide an objective means of
distinguishing novice from skilled surgeons. Clinical force/torque sigy
may be helpful in both training and measuring technical proficiency during
laparoscopic surgery.
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Updated: Tue Jul 15 23:54:51 2008
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