Joice P, Hanna G B, Cuschieri A
Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, Scotland.
Am J Surg. 1998 Oct;176(4):373-8. doi: 10.1016/s0002-9610(98)00202-5.
Ergonomic assessment of the instrument to needle to tissue relationship on efficiency and accuracy of laparoscopic suturing.
Video records of nine laparoscopic surgeons were analyzed for five technical variables of laparoscopic suturing. Surgeons undertook closure of 60 mm enterotomy using continuous 3/0 seromuscular atraumatic sutures. Subjects attempted to suture 3 to 5 mm from enterotomy edge and at 3 to 5 mm intervals. Vertical/horizontal deviations from desired entry/exit point of suture, execution time, and failure to complete sutures were recorded.
Visualization style used by some was significantly more accurate but slower than the nonvisualization style used by others. Needle insertion angle of 80 degrees to 100 degrees gripping the middle and proximal end of needle and holding the needle >90 degrees to instrument axis significantly improved task accuracy. Insertion angle <80 degrees produced three times the failure rate of 80 degrees to 100 degrees. Surgeon's performance was consistent with either suturing style.
Visualization style was slower but more accurate. Optimum conditions for good suturing include 80 degrees to 100 degrees needle insertion angle; holding angle >90 degrees, and gripping point at middle and proximal third of the shaft of the needle. Task accuracy was surgeon dependent.
对器械与针到组织的关系进行人体工程学评估，以了解其对腹腔镜缝合效率和准确性的影响。
分析了9名腹腔镜外科医生的视频记录，以获取腹腔镜缝合的五个技术变量。外科医生使用连续3/0浆肌层无创伤缝线对60毫米的肠切开术进行缝合。受试者试图在距肠切开边缘3至5毫米处并以3至5毫米的间隔进行缝合。记录缝线进出所需点的垂直/水平偏差、执行时间以及未能完成缝合的情况。
一些人使用的可视化方式明显更准确，但比其他人使用的非可视化方式慢。针的插入角度为80度至100度，夹住针的中部和近端，并使针与器械轴成大于90度的角度，可显著提高任务准确性。插入角度小于80度时的失败率是80度至100度时的三倍。外科医生的表现与任何一种缝合方式均相符。
可视化方式较慢但更准确。良好缝合的最佳条件包括针的插入角度为80度至100度；夹持角度大于90度，以及在针杆的中部和近端三分之一处的夹持点。任务准确性取决于外科医生。
