Collaborative performance in laparoscopic teams: behavioral evidences from simulation

To examine the frequency of movement de-synchronization between a surgeon and assistant in a laparoscopic simulation task, and test whether it can be a valid behavior marker for team performance.

Fourteen subjects formed a total of 22 dyad teams. Each team performed a laparoscopic task where the camera driver navigated a laparoscope for the operator to transport a plastic cylinder between targets. Key movement landmarks were annotated from recorded surgical videos and were used to identify team behaviors and performance. Task completion time, number of movement de-synchronization, and errors (cylinder drops) were compared over 3 performance groups (elite, intermediate, poor) and 2 types of movements (on-site manipulation vs. position-shifting.

Task completion time of elite teams was shorter than intermediate and poor teams (33.3 vs. 66.8 vs. 141.2 s, P < 0.001). Elite teams made fewer errors (0.1 vs. 0.5 vs. 0.9, P = 0.063) and recorded fewer numbers of de-synchronization than poor teams (2.9 vs. 3.0 vs. 4.9, P = 0.009). We also found that the on-site manipulation took longer task time (113.5 vs. 51.2 s, P < 0.001) and recorded fewer de-synchronization (0.6 vs. 5.3, P < 0.001) than position-shifting tasks. However, there is no significance in the measure of errors (P = 0.029). Interaction effects were revealed between performance groups and two movement types in task time (P = 0.010) and movement de-synchronization (P = 0.003).

Video analysis is a useful tool for identifying team behaviors during surgery. Movement de-synchronization between surgeons and assistant reveals team cooperation in laparoscopic procedure. The evidence where de-synchronization occurred frequently during the position-shifting tasks rather than during the on-site manipulation suggests team collaborative behaviors can be affected by different task requirements.