title: Sequence and task analysis of instrument use in common laparoscopic procedures.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Pennsylvania State University, Post Office Box 850, Hershey, PA 17033, USA.
authors.forename: N Y
authors.initials: NY
authors.lastname: Mehta
authors.forename: R S
authors.initials: RS
authors.lastname: Haluck
authors.forename: M I
authors.initials: MI
authors.lastname: Frecker
authors.forename: A J
authors.initials: AJ
authors.lastname: Snyder
mesh_terms: D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D013647:Task Performance and Analysis; D014743:Videotape Recording