Fahy Aodhnait S, Jamal Luai, Gavrilovic Bojan, Carillo Brian, Gerstle Justin T, Nasr Ahmed, Azzie Georges
1 Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada.
2 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
J Laparoendosc Adv Surg Tech A. 2018 Dec;28(12):1520-1524. doi: 10.1089/lap.2018.0255. Epub 2018 Jul 13.
In pediatric minimal access surgery, the operative domain may vary from that of an adult to that of a neonate. This study aimed to quantify the impact of decreased operative domain on forces generated in the performance of a defined intracorporeal suturing task. One hundred five participants performed a defined intracorporeal suturing task in small and large simulators. Time to task completion and force analysis parameters (FAPs = total, maximum, and mean forces in , and axes) were measured. Expertise level was assigned based on the number of laparoscopic cases. Outcomes were analyzed using paired sample -tests, value of <.05. Time to task completion varied significantly for experts between adult and pediatric simulators but not for intermediates or novices. Total, maximum, and mean forces in the ("side to side") axis were significantly greater in the larger laparoscopic simulator for all levels of expertise. In the axis ("in and out" movement) and axis ("up and down" movement), total and mean forces were higher in the adult simulator regardless of the level of expertise. Differences in maximum force between the adult and pediatric simulators in the axis ("up and down" movement) varied significantly for novices and intermediates but not for experts. Forces were greater, particularly in the side-to-side plane, in the larger simulator for participants of all levels in the performance of this defined intracorporeal suturing task. Further analysis will determine the reasons for and implications of the increased force parameters in the simulator of larger domain.
在小儿微创外科手术中，手术操作区域可能因成人和新生儿而异。本研究旨在量化手术操作区域减小对执行特定体内缝合任务时所产生力量的影响。105名参与者在小型和大型模拟器中执行特定的体内缝合任务。测量任务完成时间和力分析参数（FAPs = x、y和z轴上的总力、最大力和平均力）。根据腹腔镜手术病例数确定专业水平。使用配对样本t检验分析结果，p值<0.05。对于专家而言，成人模拟器和小儿模拟器之间的任务完成时间差异显著，但对于中级或新手则不然。对于所有专业水平的参与者，在较大的腹腔镜模拟器中，x轴（“左右”方向）上的总力、最大力和平均力显著更大。在y轴（“进出”运动）和z轴（“上下”运动）上，无论专业水平如何，成人模拟器中的总力和平均力都更高。对于新手和中级人员，成人模拟器和小儿模拟器在z轴（“上下”运动）上的最大力差异显著，但对于专家则不然。在执行此特定体内缝合任务时，对于所有水平的参与者，较大模拟器中的力更大，尤其是在左右平面。进一步分析将确定较大操作区域模拟器中力参数增加的原因及影响。
