Sequence and task analysis of instrument use in common laparoscopic procedures

Background: In the area of instrument evaluation, one aspect that still requires objective assessment is the dynamics of instrument maneuver and exchange. If we could gain a better understanding of these phenomena, we could improve the design of the instruments themselves. Methods: A total of 29 laparoscopic procedures were videotaped and reviewed using time motion analysis. Instrument multifunctionality was determined using a standardized list of laparoscopic maneuvers. State transition diagrams were utilized to document the sequence of instrument exchanges. Results: The curved dissector, atraumatic grasper, and cautery scissors were identified as the most multifunctional instruments; each was able to perform five distinct maneuvers. Instrument sequences were found to consist of a three-part dissect ? clip ? cut cycle and a two-part dissect ? suction cycle of instrument exchange. Conclusion: This study demonstrated that laparoscopic instruments are often used to perform a variety of maneuvers in addition to their primary function. Furthermore, there are common patterns in instrument exchange that provide a potential source of design parameters for improved surgical efficiency.

[1]  R. G. Bennetts,et al.  Introduction to Switching Theory and Logical Design , 1981 .

[2]  Amaral Jf.  The experimental development of an ultrasonically activated scalpel for laparoscopic use. , 1994 .

[3]  J. Amaral.  The experimental development of an ultrasonically activated scalpel for laparoscopic use. , 1994, Surgical laparoscopy & endoscopy.

[4]  G Berci,et al.  Multifunctional laparoscopic suturing instrument , 1995 .

[5]  C A Grimbergen,et al.  Quantitative standardised analysis of advanced laparoscopic surgical procedures. , 1995, Endoscopic surgery and allied technologies.

[6]  J. Amaral.  Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. , 1995, Surgical laparoscopy & endoscopy.

[7]  Shahram Payandeh,et al.  Task and Motion Analyses in Endoscopic Surgery , 1996, Dynamic Systems and Control.

[8]  T. G. Frank,et al.  Prehensile atraumatic grasper with intuitive ergonomics , 1997, Surgical Endoscopy.

[9]  A. Melzer,et al.  Deflectable endoscopic instrument system DENIS , 1997, Surgical Endoscopy.

[10]  J. Hunter,et al.  Standardizing laparoscopic procedure time and determining the effect of patient age/gender and presence or absence of surgical residents during operation , 1997, Surgical Endoscopy.

[11]  L S Schultz,et al.  Using 5-mm bipolar cutting forceps: a new multifunctional instrument. , 1997, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[12]  R. Berguer,et al.  Surgical technology and the ergonomics of laparoscopic instruments , 1998, Surgical Endoscopy.

[13]  J. Westwood,et al.  Medicine meets virtual reality : the convergence of physical & informational technologies : options for a new era in healthcare , 1999 .

[14]  J Dankelman,et al.  Peroperative time–motion analysis of diagnostic laparoscopy with laparoscopic ultrasonography , 1999, The British journal of surgery.

[15]  J Dankelman,et al.  Quantitative analysis of the functionality and efficiency of three surgical dissection techniques: a time-motion analysis. , 1999, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[16]  J Rosen,et al.  Surgeon-tool force/torque signatures--evaluation of surgical skills in minimally invasive surgery. , 1999, Studies in health technology and informatics.

[17]  C G Cao,et al.  Hierarchical decomposition of laparoscopic procedures. , 1999, Studies in health technology and informatics.

[18]  C A Grimbergen,et al.  Comparison of efficiencies of three techniques for colon surgery. , 2000, Journal of laparoendoscopic & advanced surgical techniques. Part A.