Title
Retracting and seeking movements during laparoscopic goal-oriented movements. Is the shortest path length optimal?
Author
Chmarra, M.K.
Jansen, F.W.
Grimbergen, C.A.
Dankelman, J.
Faculty
Mechanical, Maritime and Materials Engineering
Department
Biomechanical Engineering
Date
2007-08-20
Abstract
Aims- Minimally invasive surgery (MIS) requires a high degree of eye–hand coordination from the surgeon. To facilitate the learning process, objective assessment systems based on analysis of the instruments’ motion are being developed. To investigate the influence of performance on motion characteristics, we examined goaloriented movements in a box trainer. In general, goal-oriented movements consist of a retracting and a seeking phase, and are, however, not performed via the shortest path length. Therefore, we hypothesized that the shortest path is not an optimal concept in MIS. Methods-Participants were divided into three groups (experts, residents, and novices). Each participant performed a number of one-hand positioning tasks in a box trainer. Movements of the instrument were recorded with the TrEndo tracking system. The movement from point A to B was divided into two phases: A-M (retracting) and M-B (seeking). Normalized path lengths (given in %) of the two phases were compared. Results- Thirty eight participants contributed. For the retracting phase, we found no significant difference between experts [median (range) %: 152 (129–178)], residents [164 (126–250)], and novices [168 (136–268)]. In the seeking phase, we find a significant difference (<0.001) between experts [180 (172–247)], residents [201 (163–287)], and novices [290 (244–469)]. Moreover, within each group, a significant difference between retracting and seeking phases was observed. Conclusions- Goal-oriented movements in MIS can be split into two phases: retracting and seeking. Novices are less effective than experts and residents in the seeking phase. Therefore, the seeking phase is characteristic of performance differences. Furthermore, the retracting phase is essential, because it improves safety by avoiding intermediate tissue contact. Therefore, the shortest path length, as presently used during the assessment of basic MIS skills, may be not a proper concept for analyzing optimal movements and, therefore, needs to be revised.
Subject
minimally invasive surgery
training
motion analysis
objective assessment
goal-oriented movement
path length
To reference this document use:
http://resolver.tudelft.nl/uuid:95a55f2e-dbb5-4eb8-9647-5fe1664d87b4
DOI
https://doi.org/10.1007/s00464-007-9526-z
Publisher
Springer
ISSN
0930-2794
Source
Surgical Endoscopy, 22 (4), 2008
Part of collection
Institutional Repository
Document type
journal article
Rights
(c) 2007 Chmarra, M.K. ; Jansen, F.W. ; Grimbergen, C.A. ; Dankelman, J. ; Springer