A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects.
ABSTRACT To compare the efficacy of conventional and articulating laparoscopic needle-drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.
Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle-holder (Karl Storz, Tuttlingen, Germany) and the other using a first-generation articulating laparoscopic needle-holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4).
Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05).
The conventional laparoscopic needle-driver allowed laparoscopy-naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle-driver. Laparoscopic suturing with first-generation articulating needle-drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.
- [show abstract] [hide abstract]
ABSTRACT: The rapid emergence of laparoscopic surgery over the past decade has highlighted the need for teaching and assessing laparoscopic manipulative skills. Most analyses consist of a measurement of the time to complete a specified task and a subjective assessment by an observer. Objective assessments of accuracy in the performance of manipulative skills have been lacking. To quantify both speed and accuracy during laparoscopic skill performance, we have developed a skills assessment device (SAD) using a laparoscopic simulator platform and computer-based skills assessment software that precisely measures an instrument's movement during performance of timed laparoscopic manipulations. The SAD device measures the time necessary for an operator to complete a task, and the movements of the working end of laparoscopic instruments in three dimensions. Ten nonsurgeons performed 10 repetitions of a standardized laparoscopic manipulation. Data were captured in real time for both hands on a personal computer. Accuracy was determined by calculating the sum of all distances traveled. Duration was measured in seconds. Results are group means. The time necessary to perform defined laparoscopic manipulative skills improved dramatically during the first 3 repetitions and then stabilized. However, accuracy of manipulations continued to improve over all 10 repetitions. When untrained subjects are learning a laparoscopic manipulative task, measurement of time alone fails to account for the more protracted learning curve for accuracy. Therefore, devices and training programs that fail to consider objective assessments of accuracy may overestimate laparoscopic proficiency.The American Journal of Surgery 07/2001; 181(6):547-50. · 2.52 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: This study objectively surveyed and compared the ability of participants to perform laparoscopic and robotic tasks, and attempted to determine the key advantages of each modality. A task-based training course was developed that included laparoscopic and robotic task modules. Twenty-two participants (6 faculty members, 6 fellows, and 10 residents) completed a pretask and posttask questionnaire concerning 3 tasks, using both laparoscopy trainer and the daVinci robotic system (Intuitive Surgical, Inc). All tasks were timed and values were recorded. The surveys were completed by each participant to assess both pre- and posttask experiences. In the pretask survey, 55% of subjects reported participating in more than 20 laparoscopic cases, and only 27% had ever worked at a robotic console. The median number of beads threaded in 5 minutes was similar for the 2 methods, but the median time to complete 5 beads was 98 seconds for the laparoscope compared with 160 seconds using the robot (p = 0.001). The median number of loops completed in 5 minutes was greater (p < 0.001) using the robot (7.5 versus 2). Only 9% of subjects completed 9 loops in 5 minutes using the laparoscope; 50% did so using the robot (p < 0.05). The percentage of subjects completing 3 knots in 5 minutes was similar when using the laparoscope (45%) and robot (68%). Familiarity and tactile feedback were the primary advantages with laparoscopy, and EndoWrist (Intuitive Surgical, Inc) and stereoscopic visualization were perceived as advantages of the robot. As with any new technology, skills must be mastered to use robotic technology for the most benefit. The EndoWrist action and stereoscopic visualization were the most valued advantages of the robot. Most fellows and residents would seek additional training in robotics if given the opportunity.Journal of the American College of Surgeons 01/2007; 204(1):96-101. · 4.50 Impact Factor
Article: Surgery and ergonomics.[show abstract] [hide abstract]
ABSTRACT: This article will provide the reader with an overview of ergonomic issues relevant to the operating room environment. Minimally invasive surgical technologies have increased the therapeutic value of surgical procedures by allowing operations to be performed with less trauma to the patient. At the same time, the surgical team-and particularly the surgeon-have been further removed from direct interaction with the patient's tissues. A scientific and ergonomic approach to the analysis of the operating room environment and the performance and workload characteristics of members of the modern surgical team can provide a rational basis for maximizing the efficiency and safety of our increasingly technology-dependent surgical procedures.Archives of Surgery 10/1999; 134(9):1011-6. · 4.10 Impact Factor