Influence of instrument size on endoscopic task performance in pediatric intracorporeal knot tying
Influence of instrument size on endoscopic task performance in pediatric intracorporeal knot tying
复制标题
器械尺寸对小儿体内打结内镜任务表现的影响
DOI：
10.1007/s00464-007-9311-z
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
G. Hanna
中科院分区：
文献类型：
--
作者：
Alex C. H. Lee;M. Haddad;G. Hanna
背景：成人最小通道手术（MAS）设备的广泛可用性以及资源限制导致儿科外科医生采用成人设置。本研究探讨了器械尺寸对任务结果的影响，以及在小儿内镜下体内打结时对外科医生身体的影响。方法16名外科医生参加了这项研究，他们必须在一个40毫米的内窥镜视野的新生儿模拟盒内打结。所有外科医生使用成对的儿科针手打结20个结，使用成对的成人针手打结20个结。以结质量评分（KQS）和包绕长度作为结质量和包绕紧密度的指标。使用上肢肌群的肌电图（EMG）记录来指示肌肉恢复。外科医生还填写了一份关于不适和器械偏好的问卷。结果共分析了640个节。儿童持针者的中位时间短于成人持针者（94秒比103秒，p < 0.001）；而KQS （0.271 vs. 0.260, p = 0.509）和管周紧密度（86 mm vs. 86 mm, p = 0.255）差异无统计学意义。两个持针者的结完全滑落的比例也相似（19%对22%；p = 0.322）。除左前臂伸肌外，成人持针者上肢肌群的归一化肌电值均显著高于儿童持针者（p = 0.460）。外科医生报告说，在右前臂和手部使用儿科针托时，不适较少，13名外科医生表示总体上更喜欢较小的器械。结论在新生儿模拟盒中使用儿科针托可以更快地进行内镜打结，同时保持打结质量。上肢肌肉收缩减少，减少了外科医生的不适。
BackgroundThe widespread availability of adult minimal access surgical (MAS) equipment together with resource constraints have led pediatric surgeons to adopt the adult setup. This study examined the influence of instrument size on task outcome and physical impact on the surgeon in pediatric endoscopic intracorporeal knot tying.MethodsSixteen surgeons participated in this study in which they had to tie surgeon’s knots inside a neonatal simulator box with an endoscopic field of 40 mm. All surgeons tied 20 knots using paired pediatric needle-holders and 20 knots using paired adult needle-holders in a randomized order. Knot quality score (KQS) and wrap length were used as indices of knot quality and wrap tightness. Electromyographic (EMG) recordings of the upper limb muscle groups were used to indicate muscular recruitment. A questionnaire on discomfort and instrument preference was also completed by the surgeons.ResultsA total of 640 knots were analyzed. Median time was shorter for pediatric needle-holders than for adult needle-holders (94 s vs. 103 s; p < 0.001); however, KQS (0.271 vs. 0.260; p = 0.509) and the tightness around the tube (86 mm vs. 86 mm; p = 0.255) were not significantly different. The proportion of knots that completely slipped was also similar for both needle-holders (19% vs. 22%; p = 0.322). The normalized EMG values when using adult needle-holders were significantly higher than when using pediatric needle-holders in all upper limb muscle groups with the exception of left forearm extensors (p = 0.460). The surgeons reported less discomfort with the pediatric needle-holders in the right forearm and hand, and 13 surgeons expressed overall preference for the smaller instruments.ConclusionEndoscopic knot tying was performed faster in the neonatal simulator box using pediatric needle-holders while maintaining knot quality. Upper limb muscular recruitment was reduced resulting in less discomfort for the surgeon.
影响因子：
1.4
作者：
De Luca, CJ
通讯作者：
De Luca, CJ