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KMID : 1004720080070010042
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Korean Journal of Endourology
2008 Volume.7 No. 1 p.42 ~ p.49
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Efficacy of the Articulating Laparoscopic Instrument in Laparoscopy-naive Residents: Comparison with the Conventional Laparoscopic Instrument
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Kang Min-Yong
Park Yong-Hyun
Kim Hyeon-Hoe
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Abstract
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Purpose: To determine if articulating laparoscopic instrument could improve the efficacy of laparoscopic skills in urologic residents without previous laparoscopic surgery.
Patients & Methods: 21 urologic residents were enrolled in a simulator-based laparoscopic training program. There were three series of laparoscopic tasks which composite of peg-board task (task 1), curved-line cutting-task (task 2) and suture and knot-tying task (task 3). In task 3, they were divided into two groups. Group 1 (n=11) used an articulating laparoscopic needle holder (CambridgeEndo, Framingham, MA, USA) and group 2 (n=10) used a conventional laparoscopic needle holder (Olympus, Tokyo, Japan). All residents performed each tasks for 10 times, and their proficiency was assessed by performance times (seconds), accuracy of works (Global Rating Scales; Objective Structured Assessment of Technical Skill), angle measurement of right upper arm, and visual analogue scale of pain after work.
Results: In task 1 and 2, mean performance time was significantly improved (p<0.05). In task 3, there were no significant differences of performance time, global rating scores of accuracy and total pain scores between group 1 and 2 (p>0.05). However, angle differences of right upper arm and pain scores of right wrist in group 1 was significantly smaller than those of group 2 (p<0.05). Improvement of proficiency in group 2 was bigger than in group 1 (p<0.05). As dividing each group by training year, there were also no significant differences of performance time, global rating scores of accuracy and total pain scores between group1 and 2 (p>0.05). However, residents in lower grade achieved greater improvement in performance time and global scores of accuracy compared with residents in higher grade, irregardless of instruments.
Conclusions: The articulating laparoscopic instrument might be more difficult to learn due to the complexity of distal tip-handling. However, it showed similar efficacy with the conventional laparoscopic instrument in performance time, accuracy, and post-work pain. Furthermore, the articulating instrument had some advantages of smaller range of motion of right upper arm and lesser pain of right wrist.
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KEYWORD
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Laparoscopy, Articulating instrument, Simulator-based training
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