Quantitative analysis of the functionality and efficiency of three surgical dissection techniques: A time-motion analysis

The increasing technological complexity of surgery demands objective evalua tion of surgical techniques. In particular, alternatives for laparoscopic l igation, such as monopolar coagulation and the relatively new bipolar sciss ors combining dissection with coagulation, should be analyzed and compared. This study tests the efficacy of quantitative time-motion analysis in eval uating and comparing the functionality and efficiency of dissection and lig ation techniques in a clinical setting. Standard dissection with ligation o f vessels, bipolar scissors, and monopolar coagulation were consecutively a pplied to dissect 4 of the small bowel mesentery of pigs, in random order. All actions performed were recorded and analyzed, using a standard action l ist. The efficiency of each technique was expressed in mean dissection time and number of actions, and the safety in occurrence of complications and s everity of microscopic damage. Time-motion analysis evaluated the efficienc y objectively and reproducibly (ICC 0.98). Bipolar scissors were significan tly more efficient (time 7 +/- 2 min? actions 129 +/- 33) than the standard technique (28 +/- 6, 771 +/- 185) and monopolar coagulation (14 +/- 5, 368 +/- 32) (p < 0.01). Furthermore, bipolar coagulation needed significantly less recoagulation of an oozing vessel (0.5% of the total dissected vessels ) than did monopolar coagulation (10.4 %), and the damaged zone was signifi cantly smaller (p < 0.05). Significantly less time was spent waiting or exc hanging instruments with bipolar scissors than with the standard technique (p < 0.05). This time-motion analysis objectively compared the efficiency a nd functionality of three surgical dissection techniques during clinical us e. Bipolar scissors were more efficient than were both other techniques, an d they coagulated vessels more safely than did monopolar coagulation.