A laboratory study on anticipatory movement in laparoscopic surgery: a behavioral indicator for team collaboration.

BACKGROUND: To assess team collaboration in the context of laparoscopic surgery, laparoscopic cutting tasks performed by single operators and dyad teams were observed. Our previous work suggested that the anticipatory movement performed by a teammate may lead to a shorter total task time than for a single bimanual operator. This report further explores this phenomenon by quantifying the frequency of anticipatory movements and discussing their significance to team collaboration.
METHODS: Subjects were required to reach, grasp, and cut a piece of thread using a laparoscopic grasper and scissors. The task was performed by either 8 individual subjects bimanually or 16 paired subjects unimanually (using their preferred hands). The performances were video recorded. The total task time, the time used for thread grasping and cutting, and the number of anticipatory movements were computed and compared between the single operator and the dyad team group. In this report, anticipatory movement is defined as movements of the scissors before the completion of grasping and holding the thread.
RESULTS: Shorter durations of total task time were shown for the dyad than for the bimanual group. Anticipatory movements were counted significantly more often when the scissors were controlled by a teammate on the dyad team (96%) than when they were controlled by the preferred hand of the operator (45%). The number of anticipatory movements increased with practice, but no significant difference was shown among practice phases.
CONCLUSION: Higher frequency of anticipatory movement was observed in the dyad team, which led to superior performance for team collaboration, as compared with that of the single operator. Performance of anticipatory movements in the dyad team was explained by a shared mental model, which postulates combined capacity for information processing among team members. Results have implications for surgical education, team training, and error prevention in the performance of laparoscopic surgery.