A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance
A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance
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DOI：
10.1007/s00464-012-2524-9
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发表时间：
2013-03-01
影响因子：
3.1
通讯作者：
Marvik, Ronald
中科院分区：
文献类型：
--
作者：
Hofstad, Erlend Fagertun;Vapenstad, Cecilie;Marvik, Ronald
安全地进行微创手术 (MIS) 需要高水平的精神运动技能。为了确保高质量的技能，能够衡量和评估这些技能非常重要。为此，有必要确定表明不同熟练程度的表现之间差异的方面。 MIS 技能的测量和评估最好以自动和客观的方式进行。本研究的目的是调查一组九个运动相关指标，以了解其在执行迷宫任务期间评估 MIS 心理运动技能的相关性。 三十二名外科医生和医学生根据 MIS 经验水平分为三组；专家（> 500 个 MIS 程序）、中级人员（31-500 个 MIS）和新手（没有 MIS 经验）。参与者在 D-box Basic 模拟器（D-Box Medical，利尔，挪威）中执行迷宫任务。这项任务需要双手操作，并将针穿过 10 个孔的迷宫。使用九个与运动相关的指标来评估每个参与者的 MIS 技能。在测量仪器运动量的时间和参数方面，专家 (n = 7) 和中级 (n = 14) 的表现明显优于新手 (n = 11)。专家们的双手灵巧度明显更高，这表明与中级者和新手相比，他们可以更多地同时移动两种仪器。与中间人相比，专家们还使用非惯用手使用更短的器械路径长度来执行任务。外科医生在 MIS 中的表现可以通过时间和路径长度等指标来区分与新手。经验丰富的 MIS 外科医生与经验不足的外科医生的区别在于，他们用非惯用手控制器械的能力更强，并且两个器械的同步（协调）运动程度更高。
A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To assure high quality of skills, it is important to be able to measure and assess these skills. For that, it is necessary to determine aspects that indicate the difference between performances at various levels of proficiency. Measurement and assessment of skills in MIS are best done in an automatic and objective way. The goal of this study was to investigate a set of nine motion-related metrics for their relevance to assess psychomotor skills in MIS during the performance of a labyrinth task.Thirty-two surgeons and medical students were divided into three groups according to their level of experience in MIS; experts (> 500 MIS procedures), intermediates (31-500 MIS), and novices (no experience in MIS). The participants performed the labyrinth task in the D-box Basic simulator (D-Box Medical, Lier, Norway). The task required bimanual maneuvering and threading a needle through a labyrinth of 10 holes. Nine motion-related metrics were used to assess the MIS skills of each participant.Experts (n = 7) and intermediates (n = 14) performed significantly better than the novices (n = 11) in terms of time and parameters measuring the amount of instrument movement. The experts had significantly better bimanual dexterity, which indicated that they made more simultaneous movements of the two instruments compared to the intermediates and novices. The experts also performed the task with a shorter instrument path length with the nondominant hand than the intermediates.The surgeon's performance in MIS can be distinguished from a novice by metrics such as time and path length. An experienced surgeon in MIS can be differentiated from a less experienced one by the higher ability to control the instrument in the nondominant hand and the higher degree of simultaneous (coordinated) movements of the two instruments.