Eectiveness of grasping and duration of clamping using laparoscopic graspers E. A. M. Heijnsdijk, 1,2 J. Dankelman, 1 D. J. Gouma 2 1 Man-Machine Systems Group, Faculty of Design, Engineering, and Production, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands 2 Department of Surgery, Academic Medical Center, University of Amsterdam, Post Oce Box 22700, 1100 DE Amsterdam, The Netherlands Received: 24 September 2001/Accepted in ®nal form: 31 January 2002/Online publication: 7 May 2002 Abstract Background: Manipulating tissue with laparoscopic forceps is more dicult than using the hands. This study investigates the eectiveness of grasping and the dura- tion of tissue-clamping using laparoscopic forceps. Methods: Video recordings of 10 laparoscopic colec- tomies and 15 cholecystectomies were analyzed using time-action analysis. Results: The results indicated that 62% of the grasping actions were successful: the tissue was clamped su- ciently to perform an action. Of all the clamping actions on the colon, 10% were repeated actions. On the gall- bladder 7% were repeated actions. The bowel slipped out of the grasper in 7% of the clamping actions, whereas the gallbladder slipped in 17%. In 89%, the colon was clamped less than 1 min. The maximum clamping time was 7 min for the colon, and 55 min for the gallbladder. Conclusion: The low percentage of successful grasping actions indicates that the design of laparoscopic graspers is not optimal. Key words: Laparoscopicinstruments ÐTissuedamage During laparoscopic surgery, long rigid graspers with limited force feedback are used [2]. Therefore, it is dicult to position the jaws on the tissue in the desired way, and the surgeon may apply an inappropriate amount of force on the tissue. Because the tips of laparoscopic graspers are small, high pressures can be generated locally on the tissue [3], resulting in damage or even perforation. Too little force results in the tissue slipping out of the forceps, leading to procedure delay. In a study analyzing surgical errors during laparoscopic cholecystectomy, most of the errors in using graspers involved dropping and tearing the gall- bladder [6]. To design new, safer graspers, the problems with currently used graspers should be evaluated in more detail. Evaluation of phenomena such as tissue damage with these new graspers will require insight into the usage of graspers and the duration for which tissue is clamped during laparoscopic procedures. The purpose of this study was to evaluate the general use of laparoscopic graspers by determining the fre- quency and duration of clamping and the outcome of grasping actions. Two dierent procedures, laparo- scopic colectomy and cholecystectomy, were analyzed using time-action analysis. Colectomies were chosen because in this type of procedure a large part of the colon needs to be dissected, and therefore, the colon frequently is manipulated. Cholecystectomies were an- alyzed because with this procedure, the gallbladder is held aside for a long time and often perforated [6, 7]. Materials and methods To evaluate the use of grasping forceps, video recordings of laparo- scopic procedures in 25 surgeries were analyzed. Recordings were made of 10 colectomies and 10 cholecystectomies performed by experienced surgeons in various hospitals. In addition, we recorded ®ve cholecys- tectomies performed by residents with less than 1 year of experience. The procedures were recorded with two small CCD cameras, giving an overview image of the operation theater and a close-up of the surgeon's hands, as previously described [4]. With a mixing device, the images of the cameras and the laparoscopic image were recorded si- multaneously. After the operations, the procedures were analyzed. The duration of clamping, the clamped tissue, the type of grasper, and the outcome of grasping action were analyzed for each clamping action of the laparoscopic graspers. The following de®nitions for the outcome of grasping actions were used: · Successful clamping: The tissue is clamped and manipulated in such a way that the action the surgeon wants to perform e.g, dissecting or Surg Endosc 2002) 16: 1329±1331 DOI: 10.1007/s00464-001-9179-2 Ó Springer-Verlag New York Inc. 2002 Correspondence to: E. A. M. Heijnsdijk