Abstract
Introduction and hypothesis
Retropubic midurethral sling surgery involves the blind passage of trocars near vital organs. We quantified the proximity of surgeons’ mental representation of trocar position relative to actual position using a pelvis simulation platform. We hypothesized that novice surgeons, compared with experts, would estimate the trocar’s location to be further from the actual location.
Methods
Novice and expert surgeons performed bilateral retropubic trocar passes of a Gynecare TVT trocar (#810041B-#810,051) on the simulation platform. We measured the trocar tip’s position using a motion capture system, and recorded vocalizations when they perceived contacting the bone and crossing three landmark-oriented planes. We calculated differences (∆Bone, ∆Turn, ∆Top, ∆Pop) between vocalization times and when the trocar crossed the corresponding plane. We performed Mann–Whitney and Chi-squared tests to investigate differences between novices and experts and Levene’s test to assess equality of variances for subject-level variation.
Results
A total of 34 trials, including 22 expert and 12 novice trials, were performed by six participants. ∆Bone was significantly smaller among novice surgeons (1.27 vs 2.81 s, p=0.013). There were no significant differences in the remaining three deltas or in vocalizing early versus late. Levene’s test revealed no significant differences in within-subject variability for any of the four deltas. Novices passed the trocar anterior to the pubic bone on three passes.
Conclusions
Novices were similar to expert surgeons in their estimation of the trocar’s location and may have relied more heavily on anticipatory mechanisms to compensate for lack of experience. Teaching surgeons should make sure the novice surgeon trocar pass starts posterior to the bone.
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Data Availability
The datasets analysed during the current study are available from the corresponding author on reasonable request.
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Funding
National Institute of Biomedical Imaging and Bioengineering (1R21EB025272-01A1).
Faith Mueller received funding as a medical student from the Sarah Morrison Award, awarded by the University Missouri Kansas City School of Medicine for promising medical student research proposals.
Neither funding source had any involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
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Faith Mueller: project development, data Collection, manuscript writing, other (funding acquisition); Md A. Arif: project development, data collection and analysis, manuscript editing; Austin Bachar: data management; Gregory W. King: project development, data collection and analysis, manuscript writing, other (funding acquisition); Antonis P. Stylianou: project development, manuscript editing, other (funding acquisition); Gary Sutkin: project development, data collection and analysis, manuscript writing, other (funding acquisition, Project administration).
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Brief summary
Novice and expert surgeons similarly estimated retropubic trocar tip location in this simulation experiment. Teaching surgeons can use this when assessing a novice’s blind pass
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Mueller, F., Arif, M.A., Bachar, A. et al. Surgeon estimation of retropubic trocar position in blind 3D space. Int Urogynecol J 34, 2439–2445 (2023). https://doi.org/10.1007/s00192-023-05541-1
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DOI: https://doi.org/10.1007/s00192-023-05541-1