Abstract
Purpose
The laparoscopic suturing task is a complex procedure that requires objective assessment of surgical skills. Analysis of laparoscopic suturing task components was performed to improve current objective assessment tools.
Methods
Twelve subjects participated in this study as three groups of four surgeons (novices, intermediates and experts). A box-trainer and organic tissue were used to perform the experiment while tool movements were recorded with the augmented reality haptic system. All subjects were right-handed and developed a surgeon’s knot. The laparoscopic suturing procedure was decomposed into four subtasks. Different objective metrics were applied during tool-motion analysis (TMA). Statistical analysis was performed, and results from three groups were compared using the Jonckheere–Terpstra test, considering significant differences when P ≤ 0.05.
Results
Several first, second and fourth subtask metrics had significant differences between the three groups. Subtasks 1 and 2 had more significant differences in metrics than subtask 4. Almost all metrics showed superior task executions accomplished by experts (lower time, total path length and number of movements) compared with intermediates and novices.
Conclusion
The most important subtasks during suture learning process are needle puncture and first knot. The TMA could be a useful objective assessment tool to discriminate surgical experience and could be used in the future to measure and certify surgical proficiency.
Similar content being viewed by others
References
Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery—a review. Surg Endosc 18(7): 1022–1028
Beldi G, Ipaktchi R, Wagner M, Gloor B, Candinas D (2006) Laparoscopic ventral hernia repair is safe and cost effective. Surg Endosc 20(1): 92–95
Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247(5): 819–824
Usón J, Sánchez FM, Pascual S, Climent S (2007) In: Usón J (ed) Formación en Cirugía Laparoscópica Paso a Paso, 3rd edn. Minimally Invasive Surgery Centre, Cáceres
Fried GM (2008) FLS assessment of competency using simulated laparoscopic task. J Gastrointest Surg 12(2): 210–212
Schout BM, Hendrikx JM, Scheele F, Bemelmans BLH, Scherpbier JJ (2010) Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 24(3): 536–546
Dhariwal AK, Prabhu RY, Dalvi AN, Supe AN (2007) Effectiveness of box trainers in laparoscopic training. J Minim Access Surg 3(2): 57–63
Lamata P, Gómez E, Sánchez-Margallo F, López Ó, Monserrat C, García V, Alberola C, Rodríguez Florido M, Ruiz J, Usón J (2007) Sinergia laparoscopic virtual reality simulador: didactic design and technical development. Comput Methods Programs Biomed 85(3): 273–283
Sánchez-Margallo JA, Sánchez-Margallo FM, Pagador JB, Gómez EJ, Sánchez-González P, Usón J, Moreno J (2011) Video-based assistance system for training in minimally invasive surgery. Minim Invasive Ther Allied Technol 20(4): 197–205
Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers. Is one superior to the other?. Surg Endosc 18: 485–494
Botden SM, Jakimowicz JJ (2009) What is going on in augmented reality simulation in laparoscopic surgery?. Surg Endosc 23(8): 1693–1700
Solis J, Oshima N, Ishii H et al (2008) Towards understanding the suture/ligature skills during the training process using WKS-2RII. Int J Comput Assist Radiol Surg 3(3–4): 231–239
Pagador JB, Uson J, Sánchez MA, Moyano JL, Moreno J, Bustos P, Mateos J, Sánchez-Margallo FM (2011) Electronic device for endosurgical skills training (EDEST): study of reliability. Int J Comput Assist Radiol Surg 6(3): 367–374
Reiley CE, Lin HC, Yuh DD, Hager GD (2011) Review of methods for objective surgical skill evaluation. Surg Endosc 25(2): 356–366
Xeroulis G, Dubrowski A, Leslie K (2009) Simulation in laparoscopic surgery: a concurrent validity study for FLS. Surg Endosc 23(1): 161–165
Datta V, Bann S, Mandalia M, Darzi A (2006) The surgical efficiency score: a feasible, reliable, and valid method of skills assessment. Am J Surg 192(3): 372–378
Gunther S, Rosen J, Hannaford B, Sinanan M (2007) The red DRAGON: a multi-modality system for simulation and training in minimally invasive surgery. Stud Health Technol Inform 125: 149–154
Feng C, Haniffa H, Rozenblit J, Hamilton A, Salkini M (2006) Surgical training and performance assessment using a motion tracking system. Proceedings of European modeling and simulation symposium (EMSS), pp 647–652
Yamaguchi S, Yoshida D, Kenmotsu H, Yasunaga T, Konishi K, Ieiri S, Nakashima H, Tanoue K, Hashizume M (2011) Objective assessment of laparoscopic suturing skills using a motion-tracking system. Surg Endosc 25(3): 771–775
Pagador JB, Sánchez LF, Sánchez JA, Bustos P, Moreno J, Sánchez-Margallo FM (2011) Augmented reality haptic (ARH): an approach of electromagnetic tracking in minimally invasive surgery. Int J Comput Assist Radiol Surg 6(2): 257–263
Munz Y, Almoudaris AM, Moorthy K et al (2007) Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 193(6): 774–783
Dosis A, Aggarwal R, Bello F et al (2005) Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 140(3): 293–299
Pagador JB, Sánchez-Margallo FM, Sánchez-Peralta L, Sánchez-Margallo JA, Enciso S, Moreno J (2010) Objective assessment of basic laparoscopic skills using automatic video-based technique. Minim Invasive Ther Allied Technol 19(Suppl1): 55
Sheskin D (2007) Handbook of parametric and nonparametric statistical procedures. Chapman & Hall/CRC, London
Reiley CE, Hager GD (2009) Task versus subtask surgical skill evaluation of robotic minimally invasive surgery. Med Image Comput Comput-Assist Interv: MICCAI 12(Pt 1): 435–442
Jayaraman S, Trejos AL, Naish MD, Lyle A, Patel RV, Schlachta CM (2011) Toward construct validity for a novel sensorized instrument-based minimally invasive surgery simulation system. Surg Endosc 25(5): 1439–1445
Darzi a, Smith S, Taffinder N (1999) Assessing operative skill. Needs to become more objective. BMJ 318(7188): 887–888
McClusky Da, Smith CD (2008) Design and development of a surgical skills simulation curriculum. World J Surg 32(2): 171–181
Chung J, Sackier J (1998) A method of objectively evaluating improvements in laparoscopic skills. Surg Endosc 12: 1111–1116
Moorthy K, Munz Y, Dosis A et al (2004) Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity. Surg Endosc 18(11): 1608–1612
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(4): 943–949
Allen B, Nistor V, Dutson E et al (2010) Support vector machines improve the accuracy of evaluation for the performance of laparoscopic training tasks. Surg Endosc 24(1): 170–178
Seymour NE (2008) VR to OR: a review of the evidence that virtual reality simulation improves operating room performance. World J Surg 32(2): 182–188
Elneel FH, Carter F, Tang B, Cuschieri A (2008) Extent of innate dexterity and ambidexterity across handedness and gender: implications for training in laparoscopic surgery. Surg Endosc 22: 31–37
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pagador, J.B., Sánchez-Margallo, F.M., Sánchez-Peralta, L.F. et al. Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment. Int J CARS 7, 305–313 (2012). https://doi.org/10.1007/s11548-011-0650-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-011-0650-9