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Sequence and task analysis of instrument use in common laparoscopic procedures
N Y Mehta1, R S Haluck, M I Frecker
1Department of Surgery, Pennsylvania State University, Post Office Box 850, Hershey, PA 17033, USA.
Background:
In the area of instrument evaluation, one aspect that still requires objective assessment is the dynamics of instrument maneuver and exchange. If we could gain a better understanding of these phenomena, we could improve the design of the instruments themselves.
Methods:
A total of 29 laparoscopic procedures were videotaped and reviewed using time motion analysis. Instrument multifunctionality was determined using a standardized list of laparoscopic maneuvers. State transition diagrams were utilized to document the sequence of instrument exchanges.
Results:
The curved dissector, atraumatic grasper, and cautery scissors were identified as the most multifunctional instruments; each was able to perform five distinct maneuvers. Instrument sequences were found to consist of a three-part dissect --> clip --> cut cycle and a two-part dissect --> suction cycle of instrument exchange.
Conclusion:
This study demonstrated that laparoscopic instruments are often used to perform a variety of maneuvers in addition to their primary function. Furthermore, there are common patterns in instrument exchange that provide a potential source of design parameters for improved surgical efficiency.
