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Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage

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Abstract

Introduction and hypothesis

Surgeon kinematics play a significant role in the prevention of patient injury. We hypothesized that elbow extension and ulnar wrist deviation are associated with bladder injury during simulated midurethral sling (MUS) procedures.

Methods

We used motion capture technology to measure surgeons’ flexion/extension, abduction/adduction, and internal/external rotation angular time series for shoulder, elbow, and wrist joints. Starting and ending angles, minimum and maximum angles, and range of motion (ROM) were extracted from each time series. We created anatomical multibody models and applied linear mixed modeling to compare kinematics between trials with versus without bladder penetration and attending versus resident surgeons. A total of 32 trials would provide 90% power to detect a difference.

Results

Out of 85 passes, 62 were posterior to the suprapubic bone and 20 penetrated the bladder. Trials with versus without bladder penetration were associated with more initial wrist dorsiflexion (−27.32 vs −9.03°, p = 0.01), less final elbow flexion (39.49 vs 60.81, p = 0.03), and greater ROM in both the wrist (27.48 vs 14.01, p = 0.02), and elbow (20.45 vs 12.87, p = 0.04). Wrist deviation and arm pronation were not associated with bladder penetration. Compared with attendings, residents had more ROM in elbow flexion (14.61 vs 8.35°, p < 0.01), but less ROM in wrist dorsiflexion (13.31 vs 20.33, p = 0.02) and arm pronation (4.75 vs 38.46, p < 0.01).

Conclusions

Bladder penetration during MUS is associated with wrist dorsiflexion and elbow flexion but not internal wrist deviation and arm supination. Attending surgeons exerted control with the wrist and forearm, surgical trainees with the elbow. Our findings have direct implications for MUS teaching.

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Data Availability

Data is available upon reasonable request by contacting the primary author.

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Acknowledgements

The authors acknowledge Austin Bachar, who designed the figures demonstrating upper-extremity angles.

Funding

Dr. Sutkin has research funding from the Intuitive Foundation. That funding and research are unrelated to the work described in this manuscript.

This study was funded by the National Institute of Biomedical Imaging and Bioengineering (1R21EB025272-01A1).

Author information

Authors and Affiliations

  1. Urogynecology and Reconstructive Pelvic Surgery, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA

    Gary Sutkin

  2. School of Computing & Engineering, University of Missouri Kansas City, Kansas City, MO, USA

    Md. A. Arif, Gregory W. King & Antonis P. Stylianou

  3. Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA

    An-Lin Cheng

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  1. Gary Sutkin
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  2. Md. A. Arif
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  5. Antonis P. Stylianou
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Contributions

G. Sutkin: protocol development, data collection and analysis, manuscript writing; M.A. Arif: protocol development, data collection, manuscript editing; G.W. King: protocol development, data collection, manuscript editing; A.-L. Cheng: protocol development, data analysis, manuscript editing; A.P. Stylianou: protocol development, data management and analysis, manuscript editing.

Corresponding author

Correspondence to Gary Sutkin.

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Ethics Approval

This study was approved/expedited by the University of Missouri Kansas City IRB (#2019360).

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None.

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Handling Editor: Jaromir Masata

Editor in Chief: Maria A. Bortolini

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Sutkin, G., Arif, M.A., Cheng, AL. et al. Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05772-w

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