title: Quantitative analysis of the functionality and efficiency of three surgical dissection techniques: a time-motion analysis.
abstract: The increasing technological complexity of surgery demands objective evaluation of surgical techniques. In particular, alternatives for laparoscopic ligation, such as monopolar coagulation and the relatively new bipolar scissors combining dissection with coagulation, should be analyzed and compared. This study tests the efficacy of quantitative time-motion analysis in evaluating and comparing the functionality and efficiency of dissection and ligation techniques in a clinical setting. Standard dissection with ligation of vessels, bipolar scissors, and monopolar coagulation were consecutively applied to dissect 4 of the small bowel mesentery of pigs, in random order. All actions performed were recorded and analyzed, using a standard action list. The efficiency of each technique was expressed in mean dissection time and number of actions, and the safety in occurrence of complications and severity of microscopic damage. Time-motion analysis evaluated the efficiency objectively and reproducibly (ICC 0.98). Bipolar scissors were significantly more efficient (time 7 +/- 2 min, actions 129 +/- 33) than the standard technique (28 +/- 6, 771 +/- 185) and monopolar coagulation (14 +/- 5, 368 +/- 32) (p < 0.01). Furthermore, bipolar coagulation needed significantly less recoagulation of an oozing vessel (0.5% of the total dissected vessels) than did monopolar coagulation (10.4%), and the damaged zone was significantly smaller (p < 0.05). Significantly less time was spent waiting or exchanging instruments with bipolar scissors than with the standard technique (p < 0.05). This time-motion analysis objectively compared the efficiency and functionality of three surgical dissection techniques during clinical use. Bipolar scissors were more efficient than were both other techniques, and they coagulated vessels more safely than did monopolar coagulation.
authors.affiliation: Delft University of Technology, Faculty of Design, Engineering and Production, The Netherlands. K.T.denBoer@amc.uva.nl
authors.forename: K T
authors.initials: KT
authors.lastname: den Boer
authors.forename: I H
authors.initials: IH
authors.lastname: Straatsburg
authors.forename: A V
authors.initials: AV
authors.lastname: Schellinger
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: J
authors.initials: J
authors.lastname: Dankelman
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000818:Animals; D004210:Dissection / Q000379:methods*; D004564:Electrocoagulation / Q000295:instrumentation; D005260:Female; D016558:Hemostasis, Endoscopic / Q000295:instrumentation; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008643:Mesentery / Q000473:pathology / Q000601:surgery; D013552:Swine; D013996:Time and Motion Studies