Measuring Surgical Decisions: The Impact of Individual Operative Strategies on Procedural Efficiency During Simulated Laparoscopic Ventral Hernia Repair

Introduction: Wearable sensors, including motion capture, provide an opportunity for surgeons to evaluate different operative approaches. We hypothesized that operative strategy significantly influences procedure times and efficiency during simulated laparoscopic ventral hernia repair (LVH).

Methods: Participants completed a simulated LVH, starting with visualization of the hernia defect, and concluding just before tac placement. Video, audio, and motion data were collected for each surgeon. Anchoring suture protocols and methods of securement to the abdominal wall were coded for offline review and analysis.

Results: Participants (N=48) who placed extracorporeal mesh sutures (ES) completed the hernia repair with a significantly shorter median duration than the 11 who placed intracorporeal sutures with trans-facial fixation (ISTF) and the 11 who placed intracorporeal sutures with intra-abdominal fixation (ISIF) (ES=1512 sec, IST=2177 sec, ISIF=2143 sec p<0.01) (Figure 1). The difference between approaches was also highlighted by hand speeds, where the ES group exhibited higher left (ES=0.14m/s, ISTF=0.12m/s, ISIF=0.10m/s p <0.01) and right-hand speeds (ES=0.15m/s, ISTF=0.12m/s, ISIF=0.11m/s p<0.01) when compared to participants of other approaches. 

Conclusion: This study identified a significant impact of operative strategy on procedure duration and hand speed. As the surgical profession continues to adopt new surgical technologies, this increases the variety of operative strategies for surgeons to utilize, making it important for surgeons to track their performance and understand how their operative strategy impacts safe and efficient completion of cases.