Yamazaki Yuta, Kanaji Shingo, Kudo Takuya, Takiguchi Gosuke, Urakawa Naoki, Hasegawa Hiroshi, Yamamoto Masashi, Matsuda Yoshiko, Yamashita Kimihiro, Matsuda Takeru, Oshikiri Taro, Nakamura Tetsu, Suzuki Satoshi, Otake Yoshito, Sato Yoshinobu, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.
J Gastrointest Surg. 2022 May;26(5):1006-1014. doi: 10.1007/s11605-021-05161-4. Epub 2021 Nov 9.
Whether surgical device usage in laparoscopic gastrectomy differs with respect to operator's skill levels is unknown. Further, device usage analysis using artificial intelligence has not been reported to date. Herein, we compared the patterns of surgical device usage during laparoscopic gastrectomy for gastric cancer among surgeons at different skill levels. The data of device usage was acquired from laparoscopic video recordings using an automated surgical-instrument detection system.
In total, 100 video recordings of infrapyloric lymphadenectomy and 33 of D2 suprapancreatic lymphadenectomy during laparoscopic gastrectomy for gastric cancer were analyzed in this retrospective study. The system's accuracy was evaluated by comparing the automatic and the manual usage time. Surgical device usage patterns were compared between qualified and nonqualified surgeons of The Japan Society for Endoscopic Surgery Endoscopic Surgical Skill Qualification System.
For every device, the automatic detection time and manual detection time were consistent with each other. In infrapyloric lymphadenectomy, the usage time proportions of dissector forceps and clip applier were higher among nonqualified operators than among qualified operators (dissector, 5.1% vs. 2.3%, P < 0.001; clip applier, 1.6% vs. 1.3%, P < 0.01). In suprapancreatic lymphadenectomy, the usage time proportions of energy devices, clip applier, and grasper forceps were significantly different (energy devices, 59.6% vs. 50.6%, P < 0.001; clip applier, 1.4% vs. 0.9%, P < 0.001; only grasper forceps; 18.3% vs. 27.9%, P = 0.022).
Quantitative analysis of laparoscopic device usage using the automated surgical device detection system showed that the patterns of device usage during laparoscopic gastrectomy differed depending on surgeons' skill levels. These differences could suggest how the qualified and nonqualified surgeons performed the procedures.
腹腔镜胃切除术中医用器械的使用是否因术者技术水平而异尚不清楚。此外，迄今为止尚未见使用人工智能进行器械使用分析的报道。在此，我们比较了不同技术水平的外科医生在腹腔镜胃癌胃切除术中手术器械的使用模式。器械使用数据通过自动手术器械检测系统从腹腔镜视频记录中获取。
在这项回顾性研究中，共分析了100例腹腔镜胃癌胃切除术中幽门下淋巴结清扫术的视频记录以及33例D2胰上淋巴结清扫术的视频记录。通过比较自动和手动使用时间来评估该系统的准确性。对日本内镜外科学会内镜手术技能资格系统中合格和不合格的外科医生之间的手术器械使用模式进行了比较。
对于每种器械，自动检测时间和手动检测时间相互一致。在幽门下淋巴结清扫术中，不合格术者使用剥离钳和施夹器的时间比例高于合格术者（剥离钳，5.1%对2.3%，P<0.001；施夹器，1.6%对1.3%，P<0.01）。在胰上淋巴结清扫术中，能量器械、施夹器和抓钳的使用时间比例有显著差异（能量器械，59.6%对50.6%，P<0.001；施夹器，1.4%对0.9%，P<0.001；仅抓钳，18.3%对27.9%，P=0.022）。
使用自动手术器械检测系统对腹腔镜器械使用进行定量分析表明，腹腔镜胃切除术中器械的使用模式因外科医生的技术水平而异。这些差异可能提示合格和不合格外科医生的手术操作方式。
