Moorthy K, Munz Y, Dosis A, Bann S, Darzi A
Department of Surgical Oncology and Technology, Imperial College of Science, Technology and Medicine, 10th Floor, QEQM Building, St. Mary's Hospital, Praed Street, London, W2 1NY, UK.
Surg Endosc. 2003 Sep;17(9):1481-4. doi: 10.1007/s00464-002-9224-9. Epub 2003 Jun 25.
The availability of objective means for assessment of surgical skills has made it possible to evaluate the effect of adverse environmental conditions on surgical performance.
Participants performed a laparoscopic transfer task under five conditions: a simple verbal mathematical task (M), operating theatre background noise at 80 to 85 dB (N), performance as quickly as possible (T), all three stressors combined (A), and quiet conditions (Q). The effect of these conditions on performance was evaluated by using a motion analysis system and an error score.
The study included 13 right-handed surgeons with varying levels of laparoscopic experience. There was a significant increase in the path length per movement of the right hand (p = 0.001) under T and a significant increase in the path length per movement of the left hand under M (p = 0.002), T (p = 0.01), and A (p = 0.02). A significantly higher number of errors occurred under all four stress-inducing conditions. The effect was more pronounced when all the stressors were applied in combination ( p = 0.001) followed by performance under M (p = 0.005), then T (p = 0.01) and N (p = 0.03).
All three stressors led to impaired dexterity and an increase in the incidence of errors.
客观评估手术技能的方法的出现使得评估不利环境条件对外科手术操作的影响成为可能。
参与者在五种条件下进行腹腔镜转移任务：简单的口头数学任务（M）、手术室背景噪音为80至85分贝（N）、尽可能快地操作（T）、所有三种压力源同时存在（A）以及安静条件（Q）。通过使用运动分析系统和错误评分来评估这些条件对操作的影响。
该研究纳入了13名具有不同腹腔镜经验水平的右利手外科医生。在T条件下右手每次移动的路径长度显著增加（p = 0.001），在M、T（p = 0.01）和A（p = 0.02）条件下左手每次移动的路径长度显著增加。在所有四种诱导压力的条件下出现的错误数量显著更高。当所有压力源同时存在时影响更为明显（p = 0.001），其次是在M条件下操作（p = 0.005），然后是T（p = 0.01）和N（p = 0.03）。
所有三种压力源都会导致灵活性受损和错误发生率增加。
