Presentation Authors: Kai-Ho Fok*, Sophia Duong, Brian Carrillo, J Ted Gerstle, Georges Azzie, Monica A Farcas, Toronto, Canada
Introduction: An intracorporeal suturing task simulator has been developed that can measure forces in real time during the performance of the task. These forces have been described and have been shown to be greater in larger size simulators. We analyze the forces on deconstructed task segments to allow for targeted assessment and teaching.
Methods: Participants performed a defined intracorporeal suturing task on a pediatric (PLS) simulator. Expertise level was assigned based on number of laparoscopic cases. Real-time force and torque data were collected in 3 degrees of freedom using a custom-designed force sensing platform. The task was deconstructed into four segments: loading needle/pull-through, double-throw knot, first single-throw knot, and second single-throw knot. Force analysis parameters (FAPs) were calculated for each of the segments. FAPs included maximum, mean, and number of extreme force events. Outcomes were analyzed using one-way ANOVAs and paired sample t-tests (p < 0.05).
Results: One-hundred two participants were recorded (20 experts, 52 intermediates, 30 novices). The largest differences were seen in the &[Prime]double-throw knot segment&[Prime]. In this segment, significant differences were identified between expert and novices in mean forces exerted in the &[Prime]side-to-side&[Prime] direction. Experts exerted a mean force to the right whereas novices exerted a mean force to the left. Congruently, differences were also seen in this segment between novices, intermediates, and experts in the torque applied in the &[Prime]side-to-side axis&[Prime]. Experts applied significantly more torque towards the right than novices and intermediates. Similar differences were not found in other segments. In the &[Prime]first single throw segment&[Prime], the novices had a significantly larger number of extreme force events in the &[Prime]up-and-down&[Prime] direction. Analyzing maximum forces did not demonstrate any significant differences between the groups in any segment.
Conclusions: We demonstrate an ability to detect real-time assessment of forces during the performance of an intracorporeal suturing task. Deconstruction of the task into segments allows us to gain insight into the specific forces applied which distinguish expertise level. Further studies on forces applied during specific laparoscopic maneuvers may reveal greater insights that distinguish experts and allow for teaching in a more focused and effective manner.