Surgical skill analysis focused on tissue traction in laparoscopic wet lab training

Koki Ebina, PhD; Takashige Abe, MD, PhD; Madoka Higuchi, MD, PhD; Kiyohiko Hotta, MD, PhD; Jun Furumido, MD, PhD; Naoya Iwahara, MD, PhD; Taku Senoo, PhD; Shunsuke Komizunai, PhD; Teppei Tsujita, PhD; Kazuya Sase, PhD; Xiaoshuai Chen, PhD; Yo Kurashima, MD, PhD; Hiroshi Kikuchi, MD, PhD; Haruka Miyata, MD, PhD; Ryuji Matsumoto, MD, PhD; Takahiro Osawa, MD, PhD; Sachiyo Murai; Atsushi Konno, PhD; Nobuo Shinohara, MD, PhD

Surgery Open Science (Sep 2024)

Surgical skill analysis focused on tissue traction in laparoscopic wet lab training

Koki Ebina, PhD,
Takashige Abe, MD, PhD,
Madoka Higuchi, MD, PhD,
Kiyohiko Hotta, MD, PhD,
Jun Furumido, MD, PhD,
Naoya Iwahara, MD, PhD,
Taku Senoo, PhD,
Shunsuke Komizunai, PhD,
Teppei Tsujita, PhD,
Kazuya Sase, PhD,
Xiaoshuai Chen, PhD,
Yo Kurashima, MD, PhD,
Hiroshi Kikuchi, MD, PhD,
Haruka Miyata, MD, PhD,
Ryuji Matsumoto, MD, PhD,
Takahiro Osawa, MD, PhD,
Sachiyo Murai,
Atsushi Konno, PhD,
Nobuo Shinohara, MD, PhD

Affiliations

Koki Ebina, PhD: Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
Takashige Abe, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan; Corresponding author at: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, North-15, West-7, North Ward, Sapporo 060-8638, Japan.
Madoka Higuchi, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Kiyohiko Hotta, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Jun Furumido, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Naoya Iwahara, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Taku Senoo, PhD: Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
Shunsuke Komizunai, PhD: Faculty of Engineering and Design, Kagawa University, Takamatsu, Japan
Teppei Tsujita, PhD: Department of Mechanical Engineering, National Defense Academy of Japan, Yokosuka, Japan
Kazuya Sase, PhD: Department of Mechanical Engineering and Intelligent Systems, Tohoku Gakuin University, Sendai, Japan
Xiaoshuai Chen, PhD: Graduate School of Science and Technology, Hirosaki University, Hirosaki, Japan
Yo Kurashima, MD, PhD: Clinical Simulation Center, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Hiroshi Kikuchi, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Haruka Miyata, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Ryuji Matsumoto, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Takahiro Osawa, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Sachiyo Murai: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan
Atsushi Konno, PhD: Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
Nobuo Shinohara, MD, PhD: Department of Renal and Genitourinary Surgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan

Journal volume & issue: Vol. 21
pp. 7 – 13

Abstract

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Background: Tissue handling is one of the pivotal parts of surgical procedures. We aimed to elucidate the characteristics of experts' left-hand during laparoscopic tissue dissection. Methods: Participants performed tissue dissection around the porcine aorta. The grasping force/point of the grasping forceps were measured using custom-made sensor forceps, and the forceps location was also recorded by motion capture system (Mocap). According to the global operative assessment of laparoscopic skills (GOALS), two experts scored the recorded movies, and based on the mean scores, participants were divided into three groups: novice (<10), intermediate (10≤ to <20), and expert (≤20). Force-based metrics were compared among the three groups using the Kruskal-Wallis test. Principal component analysis (PCA) using significant metrics was also performed. Results: A total of 42 trainings were successfully recorded. The statistical test revealed that novices frequently regrasped a tissue (median total number of grasps, novices: 268.0 times, intermediates: 89.5, experts: 52.0, p < 0.0001), the traction angle became stable against the aorta (median weighted standard deviation of traction angle, novices: 30.74°, intermediates: 26.80, experts: 23.75, p = 0.0285), and the grasping point moved away from the aorta according to skill competency [median percentage of grasping force applied in close zone (0 to 2.0 cm from aorta), novices: 34.96 %, intermediates: 21.61 %, experts: 10.91 %, p = 0.0032]. PCA showed that the efficiency-related (total number of grasps) and effective tissue traction-related (weighted average grasping position in Y-axis and distribution of grasping area) metrics mainly contributed to the skill difference (proportion of variance of first principal component: 60.83 %). Conclusion: The present results revealed experts' left-hand characteristics, including correct tissue grasping, sufficient tissue traction from the aorta, and stable traction angle. Our next challenge is the provision of immediate and visual feedback onsite after the present wet-lab training, and shortening the learning curve of trainees.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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