{"title":"以腹腔镜湿实验室培训中的组织牵引为重点的手术技能分析","authors":"Koki Ebina PhD , Takashige Abe MD, PhD , Madoka Higuchi MD, PhD , Kiyohiko Hotta MD, PhD , Jun Furumido MD, PhD , Naoya Iwahara MD, PhD , Taku Senoo PhD , Shunsuke Komizunai PhD , Teppei Tsujita PhD , Kazuya Sase PhD , Xiaoshuai Chen PhD , Yo Kurashima MD, PhD , Hiroshi Kikuchi MD, PhD , Haruka Miyata MD, PhD , Ryuji Matsumoto MD, PhD , Takahiro Osawa MD, PhD , Sachiyo Murai , Atsushi Konno PhD , Nobuo Shinohara MD, PhD","doi":"10.1016/j.sopen.2024.08.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Tissue handling is one of the pivotal parts of surgical procedures. We aimed to elucidate the characteristics of experts' left-hand during laparoscopic tissue dissection.</p></div><div><h3>Methods</h3><p>Participants performed tissue dissection around the porcine aorta. The grasping force/point of the grasping forceps were measured using custom-made sensor forceps, and the forceps location was also recorded by motion capture system (Mocap). According to the global operative assessment of laparoscopic skills (GOALS), two experts scored the recorded movies, and based on the mean scores, participants were divided into three groups: novice (<10), intermediate (10≤ to <20), and expert (≤20). Force-based metrics were compared among the three groups using the Kruskal-Wallis test. Principal component analysis (PCA) using significant metrics was also performed.</p></div><div><h3>Results</h3><p>A total of 42 trainings were successfully recorded. The statistical test revealed that novices frequently regrasped a tissue (median total number of grasps, novices: 268.0 times, intermediates: 89.5, experts: 52.0, <em>p</em> < 0.0001), the traction angle became stable against the aorta (median weighted standard deviation of traction angle, novices: 30.74°, intermediates: 26.80, experts: 23.75, <em>p</em> = 0.0285), and the grasping point moved away from the aorta according to skill competency [median percentage of grasping force applied in close zone (0 to 2.0 cm from aorta), novices: 34.96 %, intermediates: 21.61 %, experts: 10.91 %, <em>p</em> = 0.0032]. PCA showed that the efficiency-related (total number of grasps) and effective tissue traction-related (weighted average grasping position in Y-axis and distribution of grasping area) metrics mainly contributed to the skill difference (proportion of variance of first principal component: 60.83 %).</p></div><div><h3>Conclusion</h3><p>The present results revealed experts' left-hand characteristics, including correct tissue grasping, sufficient tissue traction from the aorta, and stable traction angle. Our next challenge is the provision of immediate and visual feedback onsite after the present wet-lab training, and shortening the learning curve of trainees.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 7-13"},"PeriodicalIF":1.4000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400112X/pdfft?md5=13bde8195065c48c12bdb4ef1663f2eb&pid=1-s2.0-S258984502400112X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Surgical skill analysis focused on tissue traction in laparoscopic wet lab training\",\"authors\":\"Koki Ebina PhD , Takashige Abe MD, PhD , Madoka Higuchi MD, PhD , Kiyohiko Hotta MD, PhD , Jun Furumido MD, PhD , Naoya Iwahara MD, PhD , Taku Senoo PhD , Shunsuke Komizunai PhD , Teppei Tsujita PhD , Kazuya Sase PhD , Xiaoshuai Chen PhD , Yo Kurashima MD, PhD , Hiroshi Kikuchi MD, PhD , Haruka Miyata MD, PhD , Ryuji Matsumoto MD, PhD , Takahiro Osawa MD, PhD , Sachiyo Murai , Atsushi Konno PhD , Nobuo Shinohara MD, PhD\",\"doi\":\"10.1016/j.sopen.2024.08.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Tissue handling is one of the pivotal parts of surgical procedures. We aimed to elucidate the characteristics of experts' left-hand during laparoscopic tissue dissection.</p></div><div><h3>Methods</h3><p>Participants performed tissue dissection around the porcine aorta. The grasping force/point of the grasping forceps were measured using custom-made sensor forceps, and the forceps location was also recorded by motion capture system (Mocap). According to the global operative assessment of laparoscopic skills (GOALS), two experts scored the recorded movies, and based on the mean scores, participants were divided into three groups: novice (<10), intermediate (10≤ to <20), and expert (≤20). Force-based metrics were compared among the three groups using the Kruskal-Wallis test. Principal component analysis (PCA) using significant metrics was also performed.</p></div><div><h3>Results</h3><p>A total of 42 trainings were successfully recorded. The statistical test revealed that novices frequently regrasped a tissue (median total number of grasps, novices: 268.0 times, intermediates: 89.5, experts: 52.0, <em>p</em> < 0.0001), the traction angle became stable against the aorta (median weighted standard deviation of traction angle, novices: 30.74°, intermediates: 26.80, experts: 23.75, <em>p</em> = 0.0285), and the grasping point moved away from the aorta according to skill competency [median percentage of grasping force applied in close zone (0 to 2.0 cm from aorta), novices: 34.96 %, intermediates: 21.61 %, experts: 10.91 %, <em>p</em> = 0.0032]. PCA showed that the efficiency-related (total number of grasps) and effective tissue traction-related (weighted average grasping position in Y-axis and distribution of grasping area) metrics mainly contributed to the skill difference (proportion of variance of first principal component: 60.83 %).</p></div><div><h3>Conclusion</h3><p>The present results revealed experts' left-hand characteristics, including correct tissue grasping, sufficient tissue traction from the aorta, and stable traction angle. Our next challenge is the provision of immediate and visual feedback onsite after the present wet-lab training, and shortening the learning curve of trainees.</p></div>\",\"PeriodicalId\":74892,\"journal\":{\"name\":\"Surgery open science\",\"volume\":\"21 \",\"pages\":\"Pages 7-13\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S258984502400112X/pdfft?md5=13bde8195065c48c12bdb4ef1663f2eb&pid=1-s2.0-S258984502400112X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery open science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S258984502400112X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery open science","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S258984502400112X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Surgical skill analysis focused on tissue traction in laparoscopic wet lab training
Background
Tissue handling is one of the pivotal parts of surgical procedures. We aimed to elucidate the characteristics of experts' left-hand during laparoscopic tissue dissection.
Methods
Participants performed tissue dissection around the porcine aorta. The grasping force/point of the grasping forceps were measured using custom-made sensor forceps, and the forceps location was also recorded by motion capture system (Mocap). According to the global operative assessment of laparoscopic skills (GOALS), two experts scored the recorded movies, and based on the mean scores, participants were divided into three groups: novice (<10), intermediate (10≤ to <20), and expert (≤20). Force-based metrics were compared among the three groups using the Kruskal-Wallis test. Principal component analysis (PCA) using significant metrics was also performed.
Results
A total of 42 trainings were successfully recorded. The statistical test revealed that novices frequently regrasped a tissue (median total number of grasps, novices: 268.0 times, intermediates: 89.5, experts: 52.0, p < 0.0001), the traction angle became stable against the aorta (median weighted standard deviation of traction angle, novices: 30.74°, intermediates: 26.80, experts: 23.75, p = 0.0285), and the grasping point moved away from the aorta according to skill competency [median percentage of grasping force applied in close zone (0 to 2.0 cm from aorta), novices: 34.96 %, intermediates: 21.61 %, experts: 10.91 %, p = 0.0032]. PCA showed that the efficiency-related (total number of grasps) and effective tissue traction-related (weighted average grasping position in Y-axis and distribution of grasping area) metrics mainly contributed to the skill difference (proportion of variance of first principal component: 60.83 %).
Conclusion
The present results revealed experts' left-hand characteristics, including correct tissue grasping, sufficient tissue traction from the aorta, and stable traction angle. Our next challenge is the provision of immediate and visual feedback onsite after the present wet-lab training, and shortening the learning curve of trainees.
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