EVA: Endoscopic Video Analysis of the surgical scene for the assessment of MIS psychomotor skills

The present work covers the first validation efforts of the EVA Tracking System for the assessment of minimally invasive surgery (MIS) psychomotor skills. Instrument movements were recorded for 42 surgeons (4 expert, 22 residents, 16 novice medical students) and analyzed for a box trainer peg transfer task. Construct validation was established for 7/9 motion analysis parameters (MAPs). Concurrent validation was determined for 8/9 MAPs against the TrEndo Tracking System. Finally, automatic determination of surgical proficiency based on the MAPs was sought by 3 different approaches to supervised classification (LDA, SVM, ANFIS), with accuracy results of 61.9%, 83.3% and 80.9% respectively. Results not only reflect on the validation of EVA for skills? assessment, but also on the relevance of motion analysis of instruments in the determination of surgical competence

Assessment of joystick and wrist control in hand-held articulated laparoscopic prototypes

Various steerable instruments with flexible distal tip have been developed for laparoscopic surgery. The problem of steering such instruments, however, remains a challenge, because no study investigated which control method is the most suitable. This study was designed to examine whether thumb (joystick) or wrist control method is designated for prototypes of steerable instruments by means of motion analysis. Methods: Five experts and 12 novices participated. Each participant performed a needle-driving task in three directions with two prototypes (wrist and thumb) and a conventional instrument. Novices performed the tasks in three sessions, whereas experts performed one session only. The order of performing the tasks was determined by Latin squares design. Assessment of performance was done by means of five motion analysis parameters, a newly developed matrix for assigning penalty points, and a questionnaire. Results: The thumb-controlled prototype outperformed the wrist-controlled prototype. Comparison of the results obtained in each task showed that regarding penalty points, the up ? down task was the most difficult to perform. Conclusions: The thumb control is more suitable for steerable instruments than the wrist control. To avoid uncontrolled movements and difficulties with applying forces to the tissue while keeping the tip of the instrument at the constant angle, adding a ‘‘locking’’ feature is necessary. It is advisable not to perform the needle driving task in the up down directionBiomechanical EngineeringMechanical, Maritime and Materials Engineerin

Real-time 3D tracking of laparoscopy training instruments for assessment and feedback

Assessment of minimally invasive surgical skills is a non-trivial task, usually requiring the presence and time of expert observers, including subjectivity and requiring special and expensive equipment and software. Although there are virtual simulators that provide self-assessment features, they are limited as the trainee loses the immediate feedback from realistic physical interaction. The physical training boxes, on the other hand, preserve the immediate physical feedback, but lack the automated self-assessment facilities. This study develops an algorithm for real-time tracking of laparoscopy instruments in the video cues of a standard physical laparoscopy training box with a single fisheye camera. The developed visual tracking algorithm recovers the 3D positions of the laparoscopic instrument tips, to which simple colored tapes (markers) are attached. With such system, the extracted instrument trajectories can be digitally processed, and automated self-assessment feedback can be provided. In this way, both the physical interaction feedback would be preserved and the need for the observance of an expert would be overcome. Real-time instrument tracking with a suitable assessment criterion would constitute a significant step towards provision of real-time (immediate) feedback to correct trainee actions and show them how the action should be performed. This study is a step towards achieving this with a low cost, automated, and widely applicable laparoscopy training and assessment system using a standard physical training box equipped with a fisheye camera

Conception et évaluation d’un simulateur à réalité virtuelle d’intervention laparoscopique actionné par des embrayages magnétorhéologiques

La laparoscopie est une technique chirurgicale qui offre une alternative moins invasive à la chirurgie abdominale traditionnelle, en permettant aux patients de récupérer plus rapidement et avec moins de douleur. Dès son arrivée, cette nouvelle technique a su révolutionner le monde de la chirurgie, mais cette révolution est d'ailleurs venue avec un cout, une formation longue et difficile. Des simulateurs haptiques ont tenté de rendre cet apprentissage plus facile, mais leur cout élevé et leurs grosses dimensions les rendent difficiles d'accès pour les étudiants moyens. Afin de résoudre ce problème, des concepts qui utilisent des dispositifs haptiques sont offerts sur le marché pour concevoir des plateformes de simulation d'interventions laparoscopiques. Ces plateformes sont toutefois peu fidèles à la réalité et n'atteignent pas simultanément les performances dynamiques et cinétiques nécessaires à un apprentissage adéquat. En effet, les moteurs électriques utilisés obligent les concepteurs de dispositifs haptiques à faire un compromis entre la force produite et la réponse dynamique du système. Cette approche pourrait par contre être utilisée avec un dispositif haptique nouvelle-génération, le T-Rex. Ce dernier a été développé récemment par Exonetik, une compagnie issue de recherches de l'Université de Sherbrooke. Contrairement aux dispositifs haptiques offerts sur le marché, le T-Rex utilise la technologie d'actionneurs magnéto-rhéologiques développée par Exonetik. Cette technologie pourrait permettre d'atteindre les performances dynamiques et cinétiques nécessaires à la formation de chirurgiens. Ce projet de recherche présente l'analyse préliminaire du T-Rex d'Exonetik en tant que simulateur à réalité virtuelle d'interventions laparoscopiques. Un simulateur à réalité virtuelle d'interventions laparoscopiques utilisant le T-Rex d'Exonetik en tant qu'interface haptique a été conçu. Des critères de performances ont été établis à l'aide de la littérature pour faire une évaluation quantitative du système. Des simulations utilisant la méthode des éléments finis ont aussi été développées pour faire une évaluation qualitative du système auprès de résidents et de chirurgiens. L'évaluation quantitative du système démontre qu'il répond aux quatre critères cinématiques ainsi qu'à trois des quatre critères cinétiques. Les résultats démontrent donc que l'utilisation d'actionneurs magnéto-rhéologiques dans les simulateurs à réalité virtuelle d'interventions laparoscopiques a beaucoup de potentiel. Par contre, la friction dans le système se doit d'être adressée dans les itérations futures du système

Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care

A Novel Virtual Reality Curriculum Improves Laparoscopic Skill in Novices

A NOVEL VIRTUAL REALITY-BASED CURRICULUM IMPROVES LAPAROSCOPIC SKILL IN NOVICES. Michael Joel Martinez, Andrew John Duffy. Department of Surgery, Yale School of Medicine, New Haven, CT. Surgical skills training, facing work hours restrictions and increasing numbers of procedural skills to master, requires an innovative approach to ensure success. We developed a novel basic laparoscopic skill, virtual reality-based simulator curriculum on the LapSim (Surgical Science, Goteborg, Sweden), with a training module and a skills exam enabling trainees to develop a minimum skill level. We hypothesize that unskilled trainees laparoscopic skills performance will improve when compared to controls. Also, those who are able to successfully complete our training curriculum and pass the exam will demonstrate higher skills levels compared to non-passers during the training period. We anticipate that skills will begin to degrade after a period 30 days without repetitive training. We expect that individual trainee performance will correlate with past experience with video games, sports, or musical instruments. Thirty-two novice, pre-clinical medical students were randomized to various training schedules. All students trained on the curriculum with the goal of completing the practice drills and passing the skills exam. Students laparoscopic skills were assessed at baseline and at monthly intervals using two tasks from the Fundamentals of Laparoscopic Surgery (FLS) curriculum that are known to correlate with operative laparoscopic skill. Additional FLS testing was performed after a one month layoff to evaluate short-term skill degradation. Objective skill FLS scores were compared between training and non-training groups, and between passing and non-passing groups at the completion of the study. All participants prior experiences with video games, sports and musical instruments were correlated with study performance. Training improved FLS performance for all participants. There was significantly greater skill development in passers versus non-passer (p\u3c0.05). Skills did not degrade after a 30 day layoff but continued to improve for all participants even reaching a statistically significant improvement on one task. Performance was not correlated with past video game, sports, or musical instrument experience. Trainees who successfully completed the our curriculum demonstrated significantly higher laparoscopic skills. These skills should translate to improved operative performance. Skills were retained after the last training session and demonstrated improvement at 30 days. We demonstrated no performance correlation with prior video game, sports or musical experience

SmartSIM - a virtual reality simulator for laparoscopy training using a generic physics engine

International audienceVirtual reality (VR) training simulators have started playing a vital role in enhancing surgical skills, such as hand–eye coordination in laparoscopy, and practicing surgical scenarios that cannot be easily created using physical models. We describe a new VR simulator for basic training in lapa-roscopy, i.e. SmartSIM, which has been developed using a generic open‐source physics engine called the simulation open framework architecture (SOFA). This paper describes the systems perspective of SmartSIM including design details of both hardware and software components, while highlighting the critical design decisions. Some of the distinguishing features of SmartSIM include: (i) an easy‐to‐fabricate custom‐built hardware interface; (ii) use of a generic physics engine to facilitate wider accessibility of our work and flexibility in terms of using various graph-ical modelling algorithms and their implementations; and (iii) an intelligent and smart evaluation mechanism that facilitates unsupervised and independent learning

CogInfoCom-Driven Surgical Skill Training and Assessment : Developing a Novel Anatomical Phantom and Performance Assessment Method for Laparoscopic Prostatectomy Training

The systematic assessment and development of human learning capabilities is one of the biggest challenges in applied sciences. It can be observed within the medical domain how evidence-based paradigms are gradually gaining space. In this chapter, the development process of a laparoscopic box trainer is introduced. A simulator including a phantom for prostatectomy is described, which feeds into medical staff training and skill assessment. An overview of laparoscopic surgical simulators is provided. Based on the state of the art and our previous experience, a clear need was formulated to develop a partially physical, partially computer-integrated simulator. To gain a better understanding of the cognitive load and physical stress, force measurement was used in the test environment. The force and time data were used to evaluate the performance of the participant. A new assessment method was described, which can be used to point out the weak aspects of surgical technique, and the participants can do this on their own. Computer-integrated assistive technologies for surgical education are believed to rapidly become the gold standard on a global scale