Skip to main content
SpringerLink
Log in

Analysis of laparoscopic dissection skill by instrument tip force measurement

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

When comparing a single-stroke dissection maneuver among surgeons with differing experience levels, there are major differences in the force applied to the instrument tip. It is difficult to explain to surgeons in training the appropriate force and for the surgeons to ascertain the force intuitively. We quantified the force pattern during single-stroke laparoscopic dissection maneuvers to reveal the factors related to expertise.

Methods

We recorded the force pattern of a single maneuver and measured the magnitude of vertical (VF) and horizontal forces (HF) on the instrument tip using a box trainer (ex vivo). We compared VF and HF among surgeons: experts (n = 10), intermediates (n = 10), and novices (n = 10). The dissection time of a single stroke (T), magnitude of the VF and HF, and the timing of the peak vertical force (TPV) and horizontal force (TPH) were evaluated as performance parameters.

Results

The dissection time of a single stroke (T) was shortest in the expert group (p < 0.05). The average maximum magnitude of VF and HF was smallest in the expert group. TPV occurred significantly earlier than TPH in all three groups (p < 0.05). TPV in the expert group occurred earlier than in the intermediate and novice groups (p < 0.05). With increasing experience, TPV occurred earlier.

Conclusions

Expert surgeons apply the most efficient vertical forces to make an initial dissection point and then change to the horizontal direction to separate surrounding tissues from the target organ. Measuring instrument tip force could help in understanding and improving the safety margin in laparoscopic surgical dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. De Visser H, Heijnsdijk EA, Herder JL, Pistecky PV (2002) Forces and displacements in colon surgery. Surg Endosc 16:1426–1430

    Article  PubMed  Google Scholar 

  2. Wagner CR, Stylopoulos N, Jackson PG, Howe RD (2007) The benefit of force feedback in surgery: examination of blunt dissection. Presence 16:252–262

    Article  Google Scholar 

  3. Peirs J, Clijnen J, Reynaerts D, Brussel HV, Herigers P, Corteville B, Boone S (2004) A micro optical force sensor for force feedback during minimally invasive robotic surgery. Sens Actuators A115:447–455

    Article  Google Scholar 

  4. Hanna G, Drew T, Arnold G, Fakhry M, Cuschieri A (2008) Development of force measurement system for clinical use in minimal access surgery. Surg Endosc 22:467–471

    Article  PubMed  Google Scholar 

  5. Chmarra MK, Jansen FW, Grimbergen CA, Dankelman J (2008) Retracting and seeking movements during laparoscopic goal-oriented movements. Is the shortest path length optimal? Surg Endosc 22:943–949

    Article  PubMed  Google Scholar 

  6. Chmarra MK, Kolkman W, Jansen FW, Grimbergen CA, Dankelman J (2007) The influence of experience and camera holding on laparoscopic instrument movements measured with the TrEndo tracking system. Surg Endosc 21:2069–2075

    Article  PubMed  CAS  Google Scholar 

  7. Chmarra MK, Grimbergen CA, Dankelman J (2007) Systems for tracking minimally invasive surgical instruments. Minim Invasive Ther 16:328–340

    Article  CAS  Google Scholar 

  8. Egi H, Okajima M, Yoshimitsu M, Ikeda S, Miyata Y, Masugami H, Kawahara T, Kurita Y, Kaneko M, Asahara T (2008) Objective assessment of endoscopic surgical skills by analyzing direction-dependent dexterity using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). Surg Today 38:705–710

    Article  PubMed  Google Scholar 

  9. Scott-Conner CEH (1999) The SAGES manual: fundamentals of laparoscopy and GI endoscopy. Springer, New York

    Book  Google Scholar 

  10. Metha NY, Haluck RS, Frecker MI, Snyder AJ (2002) Sequence and task analysis of instrument use in common laparoscopic procedures. Surg Endosc 16:280–285

    Article  Google Scholar 

  11. Ito A, Tsujiuchi N, Koizumi T, Oshima H, Nojiri Y, Tsuchiya Y, Hirama N, Kurogi S (2005) Relative movement evaluation between developed distributed-type tactile sensor and the contacting object. IEEE/RSJ Int Conf Intell Robots Syst 2–6:1659–1664

    Google Scholar 

  12. Matsuda T, Ono Y, Terachi T, Naito S, Baba S, Miki T, Hirao Y, Okuyama A (2006) The endoscopic surgical skill qualification system in urological laparoscopy: a novel system in Japan. J Urol 176:2168–2172

    Article  PubMed  Google Scholar 

  13. Habuchi T, Terachi T, Mimata H, Kondo Y, Kanayama H, Ichikawa T, Nutahara K, Miki T, Ono Y, Baba S, Naito S, Matsuda T (2012) Evaluation of 2,590 urological laparoscopic surgeries undertaken by urological surgeons accredited by an endoscopic surgical skill qualification system in urological laparoscopy in Japan. Surg Endosc 26:1656–1663

    Article  PubMed  Google Scholar 

  14. Camarillo DB, Krummell TM, Salisbury JK (2004) Robotic technology in surgery: past, present, and future. Am J Surg 188:2S–15S

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Supported in part by Grants-in-Aid for Scientific Research from Japan and a Japanese Foundation for Research and Promotion of Endoscopy (JFE) grant.

Disclosures

Kenji Yoshida, Hidefumi Kinoshita, Yoshihiro Kuroda, Osamu Oshiro, and Tadashi Matsuda have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-3-1 Shinmachi Hirakatashi, Osaka, 573-1191, Japan

    Kenji Yoshida, Hidefumi Kinoshita & Tadashi Matsuda

  2. Graduate School of Engineering Science, Osaka University, Osaka, Japan

    Yoshihiro Kuroda & Osamu Oshiro

Authors
  1. Kenji Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidefumi Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshihiro Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Osamu Oshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tadashi Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenji Yoshida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshida, K., Kinoshita, H., Kuroda, Y. et al. Analysis of laparoscopic dissection skill by instrument tip force measurement. Surg Endosc 27, 2193–2200 (2013). https://doi.org/10.1007/s00464-012-2739-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2739-9

Keywords

Search

Navigation