Analysis of Mechanical Forces Used During Laparoscopic Training Procedures

Objective: To assess the significance of a surgeon's experience on the mechanical forces applied to tissues through laparoscopic instruments.

Materials and Methods: A total of 34 participants were enrolled into the study (8 experts, 10 intermediates, and 16 novices). Laparoscopic graspers with a sensing module to detect load were used by participants to carry out six ex vivo tasks: to grasp a porcine ureter in three positions either 1, 5, or 10 times, in turn, with both dominant and nondominant hands. The data were logged and recorded by a custom data acquisition software to calculate the peak force (Fmax) and mean force (Frms).

Results: Significant correlation was observed between Fmax and Frms (Pearson correlation, r = 0.97, p < 0.0005). No statistical significant difference was observed when comparing the effect of the three different tasks on peak force (F(2,1084) = 0.28, p = 0.753). There was a statistically significant difference in mechanical forces applied with those more experienced applying consistently lower mechanical forces (F(2,1084) = 21.36, p < 0.0005). In individual training groups, the effect of dominant hand was significant in the novice (significantly lower, F(1,510) = 6.70, p = 0.010) and consultants (significantly higher, F(1,250) = 9.601, p < 0.020) with the intermediate group showing no significant difference between the hands.

Conclusion: Outcomes have suggested a relationship between the training level of the surgeon and the forces imparted on the tissue. This demonstrates a need for further training in surgeons until a consistent low force can be applied to tissues. Whether such measures could be used as an indicator of surgeon proficiency is unclear; however, it has the potential to be used to determine whether more training is needed for surgeons.