Allwyn S Rajamani1, Ashwin Rammohan2, Sasikala Mohan3, Poonguzhali Srinivasan4, Shanmugam Arthanari5, Umamaheshwaran Muthusamy6, Vijayanand Sivasubramanian7, Palaniappan Ravichandran8. 1. Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. allwyn4joy@gmail.com. 2. The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. ashwinrammohan@gmail.com. 3. Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. sasikalamohanphd@gmail.com. 4. Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. psrinivasanengineer@gmail.com. 5. Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. shanmugamarthanarime@gmail.com. 6. The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. umamaheswaranmuthuswamy@gmail.com. 7. The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. vijayanandmch@gmail.com. 8. The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. drpravichandransge@gmail.com.
Abstract
INTRODUCTION: Suturing is an integral part of all surgeries. In minimal access surgery, the force exerted is based only on visual perception (tautness of the thread and degree of tissue deformation). An unbalanced suture force can cause tissue rupture or cut-through resulting in avoidable morbidity and mortality. There is a need to find ways of improving surgical dexterity and finesse without adversely affecting patient outcomes. AIM: We aimed to calculate the knot-tying force in minimal access pancreatic surgery (MAPS) performed by experienced surgeons (ES) and use this information to develop a surgical suturing model to train the surgical trainees. We have developed a firmware for force sensor calibration and post-data analysis, using which we aimed to compare the differences in forces applied by a trainee as compared to ES. RESULTS: Our technology showed that, as compared to the ES, the trainee's (TS) knot was unbalanced with significant differences in force applied per knot for each of the knots (P < 0.01). The shape of the Force curve for each suture was also different for the TS as compared to the ES. After using the training tool, the forces applied by the TS and the Force curve for the whole suture were similar to those of the ES. CONCLUSION: Our firmware promises to be an excellent training tool for organ anastomosis. Considering the complexity and likely complications of MAPS, it is a sine qua non that the surgeon be highly experienced and skilled. Surgical simulation is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they can safely operate on humans.
INTRODUCTION: Suturing is an integral part of all surgeries. In minimal access surgery, the force exerted is based only on visual perception (tautness of the thread and degree of tissue deformation). An unbalanced suture force can cause tissue rupture or cut-through resulting in avoidable morbidity and mortality. There is a need to find ways of improving surgical dexterity and finesse without adversely affecting patient outcomes. AIM: We aimed to calculate the knot-tying force in minimal access pancreatic surgery (MAPS) performed by experienced surgeons (ES) and use this information to develop a surgical suturing model to train the surgical trainees. We have developed a firmware for force sensor calibration and post-data analysis, using which we aimed to compare the differences in forces applied by a trainee as compared to ES. RESULTS: Our technology showed that, as compared to the ES, the trainee's (TS) knot was unbalanced with significant differences in force applied per knot for each of the knots (P < 0.01). The shape of the Force curve for each suture was also different for the TS as compared to the ES. After using the training tool, the forces applied by the TS and the Force curve for the whole suture were similar to those of the ES. CONCLUSION: Our firmware promises to be an excellent training tool for organ anastomosis. Considering the complexity and likely complications of MAPS, it is a sine qua non that the surgeon be highly experienced and skilled. Surgical simulation is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they can safely operate on humans.
Authors: Camilo Correa-Gallego; Helen E Dinkelspiel; Isabel Sulimanoff; Sarah Fisher; Eduardo F Viñuela; T Peter Kingham; Yuman Fong; Ronald P DeMatteo; Michael I D'Angelica; William R Jarnagin; Peter J Allen Journal: J Am Coll Surg Date: 2013-11-23 Impact factor: 6.113
Authors: Tim Horeman; Mathijs D Blikkendaal; Daisy Feng; Arjan van Dijke; FrankWillem Jansen; Jenny Dankelman; John J van den Dobbelsteen Journal: J Surg Educ Date: 2013-09-18 Impact factor: 2.891
Authors: S R Dawe; G N Pena; J A Windsor; J A J L Broeders; P C Cregan; P J Hewett; G J Maddern Journal: Br J Surg Date: 2014-05-15 Impact factor: 6.939