Evaluation of a Navigation Grid to Increase the Efficacy of Instrument Movement During Laparoscopic Surgery

The Impact of Navigation Grid Overlay on Performance of Camera Assistants during Laparoscopic Abdominal Procedures: A Randomized Controlled Trial

OBJECTIVE

Camera assistance is important for proper visualization of the operative field in laparoscopic surgery. Navigation grid (NG) has been designed to help the camera assistants focus the camera on the target operative field. This is a randomized, controlled trial to study the effect of the NG on performance of camera assistants.

DESIGN

Minimally invasive operations were randomized (1:1) to either with or without use of NG for the camera assistant. The operations were recorded and the time spent inside and outside of the target area were reported.

SETTING

A tertiary care teaching hospital.

RESULTS

Fifty-eight operations (30 with and 28 without NG) were recorded. Sixteen camera assistants participated. Time spent outside the target area was significantly less with the use of NG (64.5 ± 63 seconds vs 396 ± 226.5 seconds; p < 0.0001). This impact of NG on performance of the camera assistants was significant regardless of their level of training.

CONCLUSIONS

NG improved performance of the camera assistant during laparoscopic abdominal procedures. This is a feasible tool that can help camera holders better assist the operating surgeons.

Improved Intraoperative Communication after Utilization of Navigational Grids during Laparoscopic Cholecystectomies

Efficient intraoperative communication (IC) between an attending and resident during surgery is highly valuable. Few tools, however, have been developed to improve IC. This study evaluates IC between residents and attendings after utilization of a navigational grid (NG) during laparoscopic cholecystectomies. Attendings and surgery residents completed a 10-question survey after performing a laparoscopic cholecystectomy. Surveys were collected for 12 weeks: six weeks before use of NGs and six weeks with use of NGs. The NGs were constructed to fit our 26”-surgical monitors and allowed the monitors to be divided into a 7 x 4 grid. Hunderd and fifteen surveys were collected: 50 from attendings (pre-NG: 31 vs NG: 19) and 65 from residents (42 vs 23). Before NGs, attendings were less likely than residents to perceive attending instructions to be clear (64.5 vs 93.0%, P = 0.0001) and less likely to believe IC left little room for confusion during the procedure (64.5 vs 90.5%, P = 0.007). After NGs, attendings believed intraoperative directional guidance was more concise and clear (64.5 vs 89.5%, P = 0.062); they also reported that NGs left little room for IC confusion during the procedure (64.5 vs 94.7%, P = 0.039). Surveys showed the grid's utility to be inversely correlated with years of experience. Residents (<two years) and attendings (<10 years) with less experience had the highest median in reported usefulness (7 out of 10). Our findings show that NGs can be a useful tool for improving IC, especially in residents and attendings with less experience.

'The other right': control strategies and the role of language use in laparoscopic training

CONTEXT

Laparoscopic techniques present a particular challenge to the academic surgeon in maintaining control and patient safety. The authors explored the use of verbal and physical control strategies including deixis, language used to locate subject in spatio-temporal, social and discoursal contexts, in this setting.

METHODS

Forty cases of laparoscopic cholecystectomy at an academic centre were video and audio-recorded. Surgeon and trainee discourses and physical gestures during the crucial anatomical steps of the operation were qualitatively analysed using a hybrid inductive and deductive technique with explicit attention to the use of deixis.

RESULTS

Laparoscopic surgeon educators use verbal and physical strategies and engage in bidirectional communication to maintain indirect control of an operation where direct control is not possible. Among verbal strategies, deictic language predominates.

DISCUSSION

As in open surgery, laparoscopic surgical educators attempt to exert control over surgical procedures when the instruments are in the hands of a trainee. One dominant strategy is the use of deictic language, which may be ambiguous. In addition to the physical manoeuvres and bidirectional communication used to disambiguate, instructors must attend to potential uncertainties and explicitly clarify frames of reference in order to enhance educational experiences and maximise patient safety.