Analysis of mechanical forces used during laparoscopic training procedures.

Objective: To assess the significance of a surgeon's experience on the mechanical forces applied to tissues through laparoscopic instruments. Materials and Methods: A total of 34 participants were enrolled into the study (8 experts, 10 intermediates, and 16 novices). Laparoscopic graspers with a sensing module to detect load were used by participants to carry out six ex vivo tasks: to grasp a porcine ureter in three positions either 1, 5, or 10 times, in turn, with both dominant and nondominant hands. The data were logged and recorded by a custom data acquisition software to calculate the peak force (F-max) and mean force (F-rms). Results: Significant correlation was observed between F-max and F-rms (Pearson correlation, r=0.97, p<0.0005). No statistical significant difference was observed when comparing the effect of the three different tasks on peak force (F(2,1084)=0.28, p=0.753). There was a statistically significant difference in mechanical forces applied with those more experienced applying consistently lower mechanical forces (F(2,1084)=21.36, p<0.0005). In individual training groups, the effect of dominant hand was significant in the novice (significantly lower, F(1,510)=6.70, p=0.010) and consultants (significantly higher, F(1,250)=9.601, p<0.020) with the intermediate group showing no significant difference between the hands. Conclusion: Outcomes have suggested a relationship between the training level of the surgeon and the forces imparted on the tissue. This demonstrates a need for further training in surgeons until a consistent low force can be applied to tissues. Whether such measures could be used as an indicator of surgeon proficiency is unclear; however, it has the potential to be used to determine whether more training is needed for surgeons.