Randomized control trial for evaluation of a hands-free pointer for surgical instruction during laparoscopic cholecystectomy.
BACKGROUND
Training surgeons in minimally invasive surgery (MIS) requires surgical residents to operate under the direction of a consultant. The inability of the instructing surgeon to point at the laparoscopic monitor without releasing the instruments remains a barrier to effective instruction. The wireless hands-free surgical pointer (WHaSP) has been developed to aid instruction during MIS.


METHODS
The objective of this study was to evaluate the effectiveness and likeability of the WHaSP as an instructional tool compared with the conventional methods. Data were successfully collected during 103 laparoscopic cholecystectomy procedures, which had been randomized to use or not use the WHaSP as a teaching tool. Audio and video from the surgeries were recorded and analyzed. Instructing surgeons, operating surgeons, and camera assistants provided feedback through a post-operative questionnaire that used a five-level Likert scale. The questionnaire results were analyzed using a Mann-Whitney U test.


RESULTS
There were no negative effects on surgery completion time or instruction practice due to the use of the WHaSP. The number of times an instructor surgeon pointed to the laparoscopic screen with their hand was significantly reduced when the WHaSP was utilized (p < 0.001). The questionnaires showed that WHaSP users found it to be comfortable, easy to use, and easy to control. Compared to when the WHaSP was not used, users found that communication was more effective (p = 0.002), locations were easier to communicate (p < 0.001), and instructions were easier to follow (p = 0.005).


CONCLUSIONS
The WHaSP system was successfully used in surgery. It integrated seamlessly into existing equipment within the operating room and did not affect flow. The positive outcomes of utilizing the WHaSP were improved communication in the OR, improved efficiency and safety of the surgery, easy to use, and comfortable to wear. The surgeons showed a preference for utilizing the WHaSP if given a choice.
Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada. atrejos@uwo.ca.|Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada. atrejos@uwo.ca.
Ana Luisa
AL
Trejos
Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada.
Karen
K
Siroen
Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada.
Christopher D W
CD
Ward
Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
Shahan
S
Hossain
Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada.|Department of Mechanical and Materials Engineering and Department of Electrical and Computer Engineering, The University of Western Ontario, London, ON, Canada.
Michael D
MD
Naish
Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada.|Department of Electrical and Computer Engineering and Department of Surgery, University of Western Ontario, London, ON, Canada.
Rajni V
RV
Patel
Canadian Surgical Technologies and Advanced Robotics, Lawson Health Research Institute, 339 Windermere Road, London, ON, Canada.|Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
Christopher M
CM
Schlachta
D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D017410:Practice Guidelines as Topic; D066231:Surgeons / Q000592:standards*
Hands-free pointing; Instructing technology; Medical mechatronic systems; Surgical instruction