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A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis

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Abstract

Background

A virtual reality-based simulator for natural orifice translumenal endoscopic surgery (NOTES) procedures may be used for training and discovery of new tools and procedures. Our previous study (Sankaranarayanan et al. in Surg Endosc 27:1607–1616, 2013) shows that developing such a simulator for the transvaginal cholecystectomy procedure using a rigid endoscope will have the most impact on the field. However, prior to developing such a simulator, a thorough task analysis is necessary to determine the most important phases, tasks, and subtasks of this procedure.

Methods

19 rigid endoscope transvaginal hybrid NOTES cholecystectomy procedures and 11 traditional laparoscopic procedures have been recorded and de-identified prior to analysis. Hierarchical task analysis was conducted for the rigid endoscope transvaginal NOTES cholecystectomy. A time series analysis was conducted to evaluate the performance of the transvaginal NOTES and laparoscopic cholecystectomy procedures. Finally, a comparison of electrosurgery-based errors was performed by two independent qualified personnel.

Results

The most time-consuming tasks for both laparoscopic and NOTES cholecystectomy are removing areolar and connective tissue surrounding the gallbladder, exposing Calot’s triangle, and dissecting the gallbladder off the liver bed with electrosurgery. There is a positive correlation of performance time between the removal of areolar and connective tissue and electrosurgery dissection tasks in NOTES (r = 0.415) and laparoscopic cholecystectomy (r = 0.684) with p < 0.10. During the electrosurgery task, the NOTES procedures had fewer errors related to lack of progress in gallbladder removal. Contrarily, laparoscopic procedures had fewer errors due to the instrument being out of the camera view.

Conclusion

A thorough task analysis and video-based quantification of NOTES cholecystectomy has identified the most time-consuming tasks. A comparison of the surgical errors during electrosurgery gallbladder dissection establishes that the NOTES procedure, while still new, is not inferior to the established laparoscopic procedure.

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Acknowledgments

We would like to acknowledge the help from Dr. Michael Brunt for his assistance in acquiring laparoscopic cholecystectomy videos. We would also like to acknowledge Drs. Christopher Awtrey, David Rattner, and John Romanelli for their input on the task analysis trees. This work is supported by NIH/NIBIB 5R01EB010037, 1R01EB009362, and 2R01EB00580.

Disclosures

Drs. Arun Nemani, Ganesh Sankaranarayanan, Jaisa S. Olasky, Souheil Adra, Kurt E. Roberts, Lucian Panait, Steven D. Schwaitzberg, Daniel B. Jones, and Suvranu De have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA

    Arun Nemani, Ganesh Sankaranarayanan & Suvranu De

  2. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Jaisa S. Olasky, Souheil Adra & Daniel B. Jones

  3. Yale School of Medicine, New Haven, CT, USA

    Kurt E. Roberts

  4. Drexel University College of Medicine, Philadelphia, PA, USA

    Lucian Panait

  5. Cambridge Health Alliance, Cambridge, MA, USA

    Steven D. Schwaitzberg

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  1. Arun Nemani
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Correspondence to Suvranu De.

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Nemani, A., Sankaranarayanan, G., Olasky, J.S. et al. A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis. Surg Endosc 28, 2443–2451 (2014). https://doi.org/10.1007/s00464-014-3495-9

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