School of Computing and Engineering, University of Missouri Kansas City, MO.
Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, MO.
Surgery. 2022 Sep;172(3):1024-1028. doi: 10.1016/j.surg.2022.06.011. Epub 2022 Jul 9.
Vital injuries during midurethral sling surgery are avoided by maintaining constant trocar contact with bone, and yet this is challenging for a teaching surgeon to monitor during this blind procedure. We modified a retropubic trocar with a load cell to distinguish on-bone and off-bone movement and tested it on a midurethral sling surgery 3-dimensional surgery simulator.
Two experts and 3 novice surgeons performed retropubic trocar passage on the physical pelvic floor model using the modified trocar. Biofidelity was assessed comparing expert performance on a Thiel-embalmed cadaver and the physical model. The test-retest was assessed comparing performance on the physical pelvic model 2 weeks apart. The force variables were analyzed with paired and independent t tests. We performed post hoc analyses comparing the experts to novices on the physical model.
The root-mean-squared force was similar between the cadaver and model (24.3 vs 21.1 pounds, P = .62), suggesting biofidelity. Root-mean-squared force was also similar between the test and retest (14.0 vs 19.1 pounds, P =. 30). The expert surgeons exhibited a larger maximum force amplitude (51.2 vs 22.7 pounds, P = .03), shorter time to maximum force (2.7 vs 9.5 seconds, P = .03) and larger maximum rate of force development (171.5 vs 54.0 pounds/second, P = .01).
This study suggested high test-retest reliability and adequate biofidelity of the modified trocar used on our midurethral sling surgery 3-dimensional surgery simulator. This innovative trocar can be used both in simulation and in the operating room to help the novice surgeons stay on the bone and to help the attending surgeon monitor safe surgery.
为避免在进行中尿道吊带手术时造成重要损伤，需要保持套管针始终与骨接触，但在这个盲视操作过程中，这对教学医师来说是难以监测的。我们对经耻骨套管针进行了改良，使其带有一个力传感器，以区分针在骨上和针离开骨的运动，并在中尿道吊带手术的三维手术模拟器上进行了测试。
两位专家和三位新手外科医生使用改良套管针在实体骨盆模型上进行经耻骨套管针穿刺。通过在经过鞣制的尸体标本上和实体模型上比较专家表现来评估生物仿真度。通过相隔 2 周在实体骨盆模型上的重复测试来评估测试-再测试的可靠性。采用配对和独立 t 检验分析力变量。我们在实体模型上对专家和新手进行了事后分析。
尸体标本和模型之间的均方根力相似（24.3 磅对 21.1 磅，P=0.62），表明生物仿真度良好。测试和再测试之间的均方根力也相似（14.0 磅对 19.1 磅，P=0.30）。与新手相比，专家外科医生的最大力振幅更大（51.2 磅对 22.7 磅，P=0.03），达到最大力的时间更短（2.7 秒对 9.5 秒，P=0.03），最大力发展速率更大（171.5 磅/秒对 54.0 磅/秒，P=0.01）。
这项研究表明，我们在中尿道吊带手术三维手术模拟器上使用的改良套管针具有较高的测试-再测试可靠性和足够的生物仿真度。这种创新的套管针既可以用于模拟，也可以用于手术室，帮助新手外科医生保持在骨上，并帮助主治外科医生监测安全手术。
