Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment
Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment
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DOI：
10.1007/s11548-011-0650-9
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发表时间：
2012-03-01
影响因子：
3
通讯作者：
Moreno, J.
中科院分区：
文献类型：
--
作者：
Pagador, J. B.;Sanchez-Margallo, F. M.;Moreno, J.
腹腔镜手术是一项复杂的手术，需要对手术技能进行客观评估。分析腹腔镜手术任务的组成部分，以改善目前的客观评估tools.Twelve受试者参加了这项研究，分为三组的四名外科医生（新手，中间和专家）。一个盒子训练器和有机组织被用来进行实验，而工具的运动记录与增强现实触觉系统。所有受试者均为右撇子，并形成外科结。腹腔镜手术分为四个子任务。在刀具运动分析（TMA）过程中应用了不同的客观指标。统计学分析结果表明，当Pa <0.05时，三组的结果比较有显著性差异。第一、二、四子任务指标在三组间有显著性差异。子任务1和2的指标比子任务4有更显着的差异。几乎所有的指标都显示，与中级和新手相比，专家完成的任务执行上级（更短的时间、总路径长度和移动次数）。缝合学习过程中最重要的子任务是针刺和第一个结。TMA可能是一个有用的客观评估工具，以区分手术经验，并可用于在未来的测量和认证的手术熟练程度。
The laparoscopic suturing task is a complex procedure that requires objective assessment of surgical skills. Analysis of laparoscopic suturing task components was performed to improve current objective assessment tools.Twelve subjects participated in this study as three groups of four surgeons (novices, intermediates and experts). A box-trainer and organic tissue were used to perform the experiment while tool movements were recorded with the augmented reality haptic system. All subjects were right-handed and developed a surgeon's knot. The laparoscopic suturing procedure was decomposed into four subtasks. Different objective metrics were applied during tool-motion analysis (TMA). Statistical analysis was performed, and results from three groups were compared using the Jonckheere-Terpstra test, considering significant differences when P a parts per thousand currency sign 0.05.Several first, second and fourth subtask metrics had significant differences between the three groups. Subtasks 1 and 2 had more significant differences in metrics than subtask 4. Almost all metrics showed superior task executions accomplished by experts (lower time, total path length and number of movements) compared with intermediates and novices.The most important subtasks during suture learning process are needle puncture and first knot. The TMA could be a useful objective assessment tool to discriminate surgical experience and could be used in the future to measure and certify surgical proficiency.