The impact of guided instrument insertion during laparoscopy: a randomized study with novices in an optical box trainer
The impact of guided instrument insertion during laparoscopy: a randomized study with novices in an optical box trainer
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DOI：
10.1007/s00464-019-06829-4
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发表时间：
2020-02-01
影响因子：
3.1
通讯作者：
Falch, Claudius
中科院分区：
文献类型：
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作者：
Kunert, Wolfgang;Land, Carolin;Falch, Claudius
背景在腹腔镜手术中，穿刺器经常处于腹腔镜视野之外。盲目插入腹腔镜手术工具是有潜在危险的，尤其是当它们是尖锐的或热的时候。将器械引导至目标点有可能提高器械插入的安全性。方法在本研究中，评价了机械和光学工具用于引导器械插入腹腔的效果。对照前瞻性随机研究测量了60名新手在无生命的标准化箱式训练器中插入器械的安全性和有效性。测试后的调查问卷的基础上，美国宇航局的任务负荷指数提示的主观印象的主题。结果与盲插（9次插入的中位数为112.0 s）相比，光学引导下的器械插入显示出更短（p = 0.002）的插入时间（9次插入的中位数为87.5 s）。与盲插（中位数1.0）相比，光学引导（中位数0.5）的错误数较低（p = 0.064）。与盲插相比，机械引导显示插入时间更短（p = 0.001）（9次插入的中位数为89.0 s），触摸错误更少（p = 0.044）（中位数为0）。两种引导工具（机械与光学引导）的结果无显著差异。在调查问卷中，89%的新手主观判断机械引导工具优于盲插。光学制导与机械制导的评估结果非常相似。结论在实验设置中，与盲插相比，使用引导工具插入器械更快、更安全。主观评估证实了工具引导的受益。
Background During laparoscopic operations, the trocars are often out of the viewing field of the laparoscope. Blind insertion of laparoscopic instruments is potentially dangerous especially when they are pointed or hot. A guidance of the instrument to the target point has the potential to improve the safety of instrument insertion. Methods In this study, the effect of a mechanical and an optical tool for guided instrument insertion into the abdominal cave was evaluated. The controlled prospective randomized study measured safety and efficiency of instrument insertion by 60 novices in an inanimate standardized box trainer. A post-test questionnaire based on the NASA Task Load Index prompted for the subjective impressions of the subjects. Results Instrument insertion with optical guidance showed a shorter (p = 0.002) insertion time (median 87.5 s for nine insertions) compared with blind insertion (median 112.0 s for nine insertions). The error number with optical guidance (median 0.5) was lower (p = 0.064) compared with blind insertion (median 1.0). The mechanical guidance showed a shorter (p = 0.001) insertion time (median 89.0 s for nine insertions) and less (p = 0.044) touch errors (median 0) compared with blind insertion. The results of the two guidance tools (mechanical vs. optical guidance) showed no significant difference. In the questionnaire, 89% of the novices subjectively judged the mechanical guidance tool better than blind insertion. The assessments of optical compared to mechanical guidance turned out quite similar. Conclusions In the experimental setup, instrument insertion with a guidance tool performed faster and safer compared with blind insertion. The subjective assessments confirmed the benefit of instrument guidance.