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Differences between experts and trainees in the motion pattern of the dominant upper limb during intracorporeal
T A Emam1, G B Hanna, C Kimber
1Department of Surgery and Surgical Skills Unit, Ninewells Hospital and Medical School, Dundee, Scotland.
Background:
Very little research has been carried out on the ergonomics of surgeon-instrument interface. The aim of this study is to investigate the effect of experience on the motion pattern of the dominant upper limb during endoscopic intracorporeal knot tying.
Methods:
Two groups of 5 surgeons (expert consultants and higher surgical trainees) tied 360 surgeon's knots inside an endoscopic trainer in a random sequence. Motion analysis at the elbow and shoulder joints of the dominant upper limb was carried out using 3-dimensional kinemetrix system. Each knot was distracted using a tensiometer. The endpoints were the execution time, knot quality score, angular velocity and range of movement. Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test were used for analysis.
Results:
The expert group had a better knot quality score (p < 0.005) and shorter execution time (p < 0.0001) than beginners. Motion analysis at the shoulder joint showed that experts had a higher angular velocity (p < 0.05) and a wider range of movement with more adduction (p < 0.01) compared to beginners. No significant differences were found at the elbow.
Conclusion:
The better task performance by expert surgeons is associated with controlled rapid manipulations and a wider range of movement at the shoulder joint of the dominant upper limb.