Nemani Arun, Sankaranarayanan Ganesh, Olasky Jaisa S, Adra Souheil, Roberts Kurt E, Panait Lucian, Schwaitzberg Steven D, Jones Daniel B, De Suvranu
Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA,
Surg Endosc. 2014 Aug;28(8):2443-51. doi: 10.1007/s00464-014-3495-9. Epub 2014 Mar 12.
A virtual reality-based simulator for natural orifice translumenal endoscopic surgery (NOTES) procedures may be used for training and discovery of new tools and procedures. Our previous study (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013) shows that developing such a simulator for the transvaginal cholecystectomy procedure using a rigid endoscope will have the most impact on the field. However, prior to developing such a simulator, a thorough task analysis is necessary to determine the most important phases, tasks, and subtasks of this procedure.
19 rigid endoscope transvaginal hybrid NOTES cholecystectomy procedures and 11 traditional laparoscopic procedures have been recorded and de-identified prior to analysis. Hierarchical task analysis was conducted for the rigid endoscope transvaginal NOTES cholecystectomy. A time series analysis was conducted to evaluate the performance of the transvaginal NOTES and laparoscopic cholecystectomy procedures. Finally, a comparison of electrosurgery-based errors was performed by two independent qualified personnel.
The most time-consuming tasks for both laparoscopic and NOTES cholecystectomy are removing areolar and connective tissue surrounding the gallbladder, exposing Calot's triangle, and dissecting the gallbladder off the liver bed with electrosurgery. There is a positive correlation of performance time between the removal of areolar and connective tissue and electrosurgery dissection tasks in NOTES (r = 0.415) and laparoscopic cholecystectomy (r = 0.684) with p < 0.10. During the electrosurgery task, the NOTES procedures had fewer errors related to lack of progress in gallbladder removal. Contrarily, laparoscopic procedures had fewer errors due to the instrument being out of the camera view.
A thorough task analysis and video-based quantification of NOTES cholecystectomy has identified the most time-consuming tasks. A comparison of the surgical errors during electrosurgery gallbladder dissection establishes that the NOTES procedure, while still new, is not inferior to the established laparoscopic procedure.
一种基于虚拟现实的自然腔道内镜手术（NOTES）模拟器可用于培训以及新工具和手术方法的探索。我们之前的研究（Sankaranarayanan等人，《外科内镜杂志》，2013年，第27卷，第1607 - 1616页）表明，使用硬式内窥镜为经阴道胆囊切除术开发这样一种模拟器将对该领域产生最大影响。然而，在开发这种模拟器之前，有必要进行全面的任务分析，以确定该手术最重要的阶段、任务和子任务。
在分析之前，已记录并去除标识的19例硬式内窥镜经阴道NOTES胆囊切除术和11例传统腹腔镜手术。对硬式内窥镜经阴道NOTES胆囊切除术进行了层次任务分析。进行了时间序列分析，以评估经阴道NOTES和腹腔镜胆囊切除术的手术表现。最后，由两名独立的合格人员对基于电外科手术的错误进行了比较。
腹腔镜和NOTES胆囊切除术最耗时的任务都是切除胆囊周围的乳晕和结缔组织、暴露胆囊三角以及用电外科手术将胆囊从肝床上剥离。在NOTES（r = 0.415）和腹腔镜胆囊切除术（r = 0.684）中，乳晕和结缔组织切除与电外科手术剥离任务之间的手术时间存在正相关，p < 0.10。在电外科手术任务中，NOTES手术在胆囊切除进展不足方面的错误较少。相反，腹腔镜手术因器械超出摄像头视野而产生的错误较少。
对NOTES胆囊切除术进行全面的任务分析和基于视频的量化确定了最耗时的任务。电外科胆囊剥离术中手术错误的比较表明，NOTES手术虽然仍属新技术，但并不逊于成熟的腹腔镜手术。
