© Springer International Publishing AG 2018 53
T.S. Köhler, B. Schwartz (eds.), Surgeons as Educators,
https://doi.org/10.1007/978-3-319-64728-9_5
E.I. George, BS
Henry M. Jackson Foundation/Madigan Army Medical Center, Tacoma, WA, USA
A. Skinner, PhD
Black Moon, LLC, Washington, DC, USA
C.M. Pugh, MD, PhD, FACS
Department of Surgery, University of Wisconsin School of Medicine and Public Health,
Madison, WI, USA
T.C. Brand, MD, FACS (*)
Madigan Army Medical Center, Tacoma, WA, USA
e-mail: [email protected]
5
Performance Assessment in Minimally
Invasive Surgery
Evalyn I. George, Anna Skinner, Carla M. Pugh,
and Timothy C. Brand
Introduction
Since the mid-1980s, the method of choice for the most high-volume surgical pro-
cedures has shifted from traditional open surgery to laparoscopic surgery, also
referred to as minimally invasive surgery (MIS). This form of surgery reduces the
risk of infection, shortens postoperative hospitalization and recovery time, and
decreases postoperative pain and scarring [ 1 ].
The benefits are abundant, but there is a cost, and one that falls particularly heav-
ily onto the surgeon: MIS techniques are difficult to master. Laparoscopy involves
the use of long and often awkward instruments operating through an unintuitive
fulcrum. The length of the instruments exacerbates any tremor from the surgeon’s
hands as the surgeon performs delicate, dexterous tasks within small spaces.
Traditional laparoscopy also requires the surgeon to work within a 3-dimensional
space while relying primarily on visual feedback in the form of a 2-dimentional
video feed on a screen.
Robot-assisted laparoscopic surgery (RALS) reduces issues of tremor through
the use of robotic arms controlled by the surgeon from a surgical console, which
also provides the surgeon with better depth perception via stereoscopic vision.
However, the stereoscopic (3-dimentional) vision must be used to overcome the