Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage

Area of Science:

• Urology
• Surgical Technique
• Biomechanics

Background:

• Surgeon kinematics are crucial for preventing patient injury during procedures.
• Midurethral sling (MUS) procedures carry a risk of iatrogenic bladder injury.

Purpose of the Study:

• To investigate the association between specific surgeon joint kinematics and bladder injury during simulated MUS procedures.
• To test the hypothesis that elbow extension and ulnar wrist deviation correlate with bladder penetration.

Main Methods:

• Motion capture technology recorded surgeon's shoulder, elbow, and wrist joint movements.
• Analysis included starting/ending angles, minimum/maximum angles, and range of motion (ROM).
• Linear mixed modeling compared kinematics between trials with and without bladder penetration, and between attending and resident surgeons.

Main Results:

• Bladder penetration was associated with greater initial wrist dorsiflexion and less final elbow flexion.
• Increased wrist and elbow ROM were observed in trials with bladder penetration.
• Resident surgeons showed greater elbow flexion ROM but less wrist dorsiflexion and arm pronation ROM compared to attendings.

Conclusions:

• Wrist dorsiflexion and elbow flexion are linked to bladder injury during MUS procedures.
• Ulnar wrist deviation and arm pronation were not significantly associated with bladder penetration.
• Findings suggest differences in kinematic control strategies between attending and resident surgeons, with implications for MUS surgical education.