Impact and Characteristics of Forceps Manipulation of Three-Dimensional in Laparoscopic Hepaticojejunostomy Mimicking a Disease-Specific Simulator: A Comparison of Expert with Trainee
Impact and Characteristics of Forceps Manipulation of Three-Dimensional in Laparoscopic Hepaticojejunostomy Mimicking a Disease-Specific Simulator: A Comparison of Expert with Trainee
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DOI：
10.1089/lap.2019.0211
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发表时间：
2019-09-20
影响因子：
1.3
通讯作者：
Ieiri, Satoshi
中科院分区：
文献类型：
--
作者：
Yamada, Koji;Murakami, Masakazu;Ieiri, Satoshi
目的：各种研究表明，在内窥镜手术中，三维（3D）系统优于二维（2D）系统。然而，很少有研究集中在儿科内镜手术。本研究的目的是通过使用腹腔镜肝管空肠吻合模拟器比较专家和受训者，评估2D和3D环境对所需时间和钳子操作的影响。方法：我们已经开发了一个模拟腹腔镜肝管空肠吻合术的先天性胆管扩张。17名参与者（4名专家和13名实习生）使用我们的模拟器在2D和3D环境中进行肝管空肠吻合术。我们评估了两种情况下所需的时间、总路径长度和双侧钳的平均速度。结果如下：获得的结果显示所需时间的结果（秒; 2D，专家：810.43 +/- 321.64 vs.受训者：1136.02 +/- 409.96，P = .17）（秒; 3D，专家：660.21 +/- 256.48 vs.受训者：1017 +/- 280.93，P = 0.039），右侧镊子的总路径长度（mm; 2D，专家：38838.23 +/- 30686.63 vs.受训者：52005.47 +/- 31675.02，P = .48）（mm; 3D，专家组：24443.09 +/- 12316.32 vs.受训者组：45508.09 +/- 26926.27，P = 0.16），左侧镊子的总路径长度（mm; 2D，专家：131635.54 +/- 71669.94 vs.受训者：245242.48 +/- 130940.25，P = .48）（mm; 3D，专家组：88520.42 +/- 56766.63 vs.受训者组：230789.75 +/- 107315.85，P = 0.024），右钳平均速度（mm/秒; 2D，专家：44.80 +/- 21.85 vs.培训生：44.37 +/- 18.92，P = 0.97）（mm/秒; 3D，专家组：37.28 +/- 16.49 vs.受训者组：42.58 +/- 14.40，P = 0.54），左侧钳的平均速度（mm/秒; 2D，专家：156.65 +/- 38.69 vs.受训者：202.58 +/- 63.80，P = .20）（mm/秒; 3D，专家：125.64 +/- 44.30 vs.受训者：219.42 +/- 43.82，P < .01）。结论：专家在使用3D系统时表现得更有效。使用3D，专家级小儿外科医生的左侧镊子的总路径长度显著短于实习小儿外科医生，专家级小儿外科医生的左侧镊子尖端的平均速度显著慢于实习小儿外科医生。这些结果表明，辅助手的训练是必要的先进的小儿内镜手术，以避免器官损伤。
Purpose: Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in endoscopic surgery. However, few studies have focused on pediatric endosurgery. The purpose of this study was to assess the impact of 2D and 3D environments on the time taken and forceps manipulation by comparing experts and trainees using a laparoscopic hepaticojejunostomy simulator. Methods: We have developed a simulator of laparoscopic hepaticojejunostomy for congenital biliary dilatation. Seventeen participants of pediatric surgeons (4 experts and 13 trainees) performed hepaticojejunostomy using our simulator in both 2D and 3D environment. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations. Results: Obtained results show the findings for the required time (seconds; 2D, experts: 810.43 +/- 321.64 vs. trainees: 1136.02 +/- 409.96, P = .17) (seconds; 3D, experts: 660.21 +/- 256.48 vs. trainees: 1017 +/- 280.93, P = .039), total path length of right forceps (mm; 2D, experts: 38838.23 +/- 30686.63 vs. trainees: 52005.47 +/- 31675.02, P = .48)(mm; 3D, experts: 24443.09 +/- 12316.32 vs. trainees: 45508.09 +/- 26926.27, P = .16), total path length of left forceps (mm; 2D, experts: 131635.54 +/- 71669.94 vs. trainees: 245242.48 +/- 130940.25, P = .48)(mm; 3D, experts: 88520.42 +/- 56766.63 vs. trainees: 230789.75 +/- 107315.85, P = .024), average velocities of right forceps (mm/second; 2D, experts: 44.80 +/- 21.85 vs. trainees: 44.37 +/- 18.92, P = .97) (mm/second; 3D, experts: 37.28 +/- 16.49 vs. trainees: 42.58 +/- 14.40, P = .54), average velocities of left forceps (mm/second; 2D, experts: 156.65 +/- 38.69 vs. trainees: 202.58 +/- 63.80, P = .20) (mm/second; 3D, experts: 125.64 +/- 44.30 vs. trainees: 219.42 +/- 43.82, P < .01). Conclusion: The experts performed more effectively when using the 3D system. Using 3D, the total path length of the left forceps of expert pediatric surgeons was significantly shorter than trainee pediatric surgeons, and the average velocities of the left forceps tip of expert pediatric surgeons was significantly slower than trainee pediatric surgeons. These results suggest that training of assisting hand is necessary for advanced pediatric endosurgery to avoid organ injury.