Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Urology, Kanagawa Prefecture Cancer Center, Yokohama, Japan.
Asian J Endosc Surg. 2021 Jul;14(3):504-510. doi: 10.1111/ases.12904. Epub 2020 Nov 30.
In laparoscopic surgery, surgical instruments are inserted from a trocar to the target organ in a blind fashion, which carries a risk of organ injury. To clarify the risks associated with surgical instrument insertion, we measured grip strength and pushing/pressing force during surgical instrument insertion in laparoscopic surgery.
Using forceps with sensors inside a trocar, 10 urologists performed a laparoscopic procedure in pigs, in which they were asked to touch the abdominal wall. The surgeons closed their eyes during the procedure and stopped moving the forceps when they felt them come into contact with the abdominal wall. They were ordered to grip the forceps strongly or softly and to move them rapidly or slowly during the procedure. Grip strength and the pushing/pressing force when the forceps hit the abdominal wall were measured and analyzed.
The mean pushing/pressing force when the surgeons gripped the forceps strongly and moved them rapidly (strong/rapid), strongly/slowly, softly/rapidly, and softly/slowly were 2.8, 2.0, 1.7, and 1.1 N, respectively. The pushing/pressing force was significantly greater when the surgeons gripped the forceps strongly, regardless of the forceps speed (P < .001). The pushing/pressing force was significantly greater when the surgeons moved the forceps rapidly, regardless of grip strength (P < .001).
When surgeons insert laparoscopic instruments through trocars, the instruments should be gripped softly and moved slowly to avoid organ injuries.
在腹腔镜手术中，手术器械通过套管针插入到目标器官，这存在损伤器官的风险。为了明确与手术器械插入相关的风险，我们测量了腹腔镜手术中器械插入时的握力和推/压力。
10 名泌尿科医生使用带有内置传感器的器械通过套管针在猪身上进行腹腔镜手术，要求他们触摸腹壁。手术过程中，医生闭着眼睛，当他们感觉到器械接触到腹壁时停止移动。医生被要求在手术过程中有力或轻柔地握住器械，并快速或缓慢地移动器械。测量并分析握力和器械撞击腹壁时的推/压力。
当医生用力快速（强/快）、用力缓慢（强/慢）、轻柔快速（柔/快）和轻柔缓慢（柔/慢）握住器械时，平均推/压力分别为 2.8、2.0、1.7 和 1.1 N。无论器械速度如何，当医生用力握住器械时，推/压力均显著增大（P <.001）。无论握力如何，当医生快速移动器械时，推/压力均显著增大（P <.001）。
当医生通过套管针插入腹腔镜器械时，应轻柔握持并缓慢移动，以避免器官损伤。
