title: Prospective Evaluation of Innovative Force Assessing Firmware in Simulation to Improve the Technical Competence of Surgical Trainees.
abstract: BACKGROUND
  Suturing is an integral part of all surgeries. In minimal access surgery, the force exerted is based only on visual perception (tautness of the thread and degree of tissue deformation). An unbalanced suture force can cause tissue rupture or cut-through resulting in avoidable morbidity and mortality. There is a need to find ways of improving surgical dexterity and finesse without adversely affecting patient outcomes.
  
  
  OBJECTIVE
  We aimed to calculate the knot-tying force in minimal access pancreatic surgery (MAPS) performed by experienced surgeons (ES) and use this information to develop a surgical suturing model to train the surgical trainees. We have developed a firmware for force sensor calibration and post-data analysis, using which we aimed to compare the differences in forces applied by a trainee as compared to ES.
  
  
  RESULTS
  Our technology showed that, as compared to the ES, the trainee's (TS) knot was unbalanced with significant differences in force applied per knot for each of the knots (P < 0.01). The shape of the Force curve for each suture was also different for the TS as compared to the ES. After using the training tool, the forces applied by the TS and the Force curve for the whole suture were similar to those of the ES.
  
  
  CONCLUSIONS
  Our firmware promises to be an excellent training tool for organ anastomosis. Considering the complexity and likely complications of MAPS, it is a sine qua non that the surgeon be highly experienced and skilled. Surgical simulation is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they can safely operate on humans.
authors.affiliation: Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. allwyn4joy@gmail.com.
authors.forename: Allwyn S
authors.initials: AS
authors.lastname: Rajamani
authors.affiliation: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. ashwinrammohan@gmail.com.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.affiliation: Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. sasikalamohanphd@gmail.com.
authors.forename: Sasikala
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. psrinivasanengineer@gmail.com.
authors.forename: Poonguzhali
authors.initials: P
authors.lastname: Srinivasan
authors.affiliation: Centre for Medical Electronics, College of Engineering Guindy, Anna University, Chennai, India. shanmugamarthanarime@gmail.com.
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Arthanari
authors.affiliation: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. umamaheswaranmuthuswamy@gmail.com.
authors.forename: Umamaheshwaran
authors.initials: U
authors.lastname: Muthusamy
authors.affiliation: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. vijayanandmch@gmail.com.
authors.forename: Vijayanand
authors.initials: V
authors.lastname: Sivasubramanian
authors.affiliation: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India. drpravichandransge@gmail.com.
authors.forename: Palaniappan
authors.initials: P
authors.lastname: Ravichandran
mesh_terms: D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D008953:Models, Anatomic; D010179:Pancreas / Q000601:surgery*; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*; D066231:Surgeons; D013536:Suture Techniques / Q000193:education*; D013537:Sutures