Assessing Instrument Usage Patterns in Multiple Long Duration Colorectal Surgical Proceduresto Categorise Decisions Made by Surgeons and Elicit Specific Design Needs

Abstract

The aims of this study are twofold: firstly to apply a method of categorizing surgical instrument use during long duration laparoscopic procedures, and secondly to validate this method by applying it to multiple instances of a single procedure. Case studies were performed on several separate high definition recordings of laparoscopic sigmoid colectomy procedures to assess the actions performed by the surgeon. The Observer XT V11.0(Noldus 2011) software package was used to study specific instrument usage, the actions associated with each instrument, idle behavior time and instrument changeover times. The Observer XT V11.0 software package was an effective method of categorizing the actions during the procedure. The data from the case studies indicated that for this specific right handed operator, the right hand led the procedure, using the most instruments and separate actions. The left hand provided support through actions such as grasping and maneuvering only. The most used instrument was the suction/irrigation instrument, followed by the grasping instruments. Key operations such as stapling/dissecting occupied the least amount of time. More time was spent maneuvering the internal anatomy than mobilizing the sigmoid colon or creating an anastomosis or stoma. Once the actions of each hand during each procedure were categorized, high level statistical analyses were applied to the data. It was necessary to perform these analyses to normalize the data as each part of the laparoscopic sigmoid colectomy procedure utilized different instruments for different durations. The future applications of this work lie in the innovation of new instruments or approaches to laparoscopic surgery. In these case studies, more time was spent navigating to the surgery site than performing the mobilization of the colon. There would appear to be a previously unmet clinical need to innovate new approaches to this type of surgery to shorten the duration of the surgery while preserving or improving the clinical outcome for the patient. More case studies are needed to confirm the validity of this claim.