Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review

BACKGROUND: There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools for technical skills assessment, providing evaluation statuses to guide research and inform implementation into training curricula. METHODS: A systematic literature search was conducted in accordance with the PRISMA guidelines. Ovid Embase/Medline, PubMed and Web of Science were searched. Inclusion criterion: robotic surgery technical skills tools. Exclusion criteria: non-technical, laparoscopy or open skills only. Manual tools and automated performance metrics (APMs) were analysed using Messick's concept of validity and the Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence and Recommendation (LoR). A bespoke tool analysed artificial intelligence (AI) studies. The Modified Downs-Black checklist was used to assess risk of bias. RESULTS: Two hundred and forty-seven studies were analysed, identifying: 8 global rating scales, 26 procedure-/task-specific tools, 3 main error-based methods, 10 simulators, 28 studies analysing APMs and 53 AI studies. Global Evaluative Assessment of Robotic Skills and the da Vinci Skills Simulator were the most evaluated tools at LoR 1 (OCEBM). Three procedure-specific tools, 3 error-based methods and 1 non-simulator APMs reached LoR 2. AI models estimated outcomes (skill or clinical), demonstrating superior accuracy rates in the laboratory with 60 per cent of methods reporting accuracies over 90 per cent, compared to real surgery ranging from 67 to 100 per cent. CONCLUSIONS: Manual and automated assessment tools for robotic surgery are not well validated and require further evaluation before use in accreditation processes.PROSPERO: registration ID CRD42022304901

Robot-Assisted Minimally Invasive Surgical Skill Assessment—Manual and Automated Platforms

The practice of Robot-Assisted Minimally Invasive Surgery (RAMIS) requires extensive skills from the human surgeons due to the special input device control, such as moving the surgical instruments, use of buttons, knobs, foot pedals and so. The global popularity of RAMIS created the need to objectively assess surgical skills, not just for quality assurance reasons, but for training feedback as well. Nowadays, there is still no routine surgical skill assessment happening during RAMIS training and education in the clinical practice. In this paper, a review of the manual and automated RAMIS skill assessment techniques is provided, focusing on their general applicability, robustness and clinical relevance

Automated Virtual Coach for Surgical Training

Surgical educators have recommended individualized coaching for acquisition, retention and improvement of expertise in technical skills. Such one-on-one coaching is limited to institutions that can afford surgical coaches and is certainly not feasible at national and global scales. We hypothesize that automated methods that model intraoperative video, surgeon's hand and instrument motion, and sensor data can provide effective and efficient individualized coaching. With the advent of instrumented operating rooms and training laboratories, access to such large scale intra-operative data has become feasible. Previous methods for automated skill assessment present an overall evaluation at the task/global level to the surgeons without any directed feedback and error analysis. Demonstration, if at all, is present in the form of fixed instructional videos, while deliberate practice is completely absent from automated training platforms. We believe that an effective coach should: demonstrate expert behavior (how do I do it correctly), evaluate trainee performance (how did I do) at task and segment-level, critique errors and deficits (where and why was I wrong), recommend deliberate practice (what do I do to improve), and monitor skill progress (when do I become proficient). In this thesis, we present new methods and solutions towards these coaching interventions in different training settings viz. virtual reality simulation, bench-top simulation and the operating room. First, we outline a summarizations-based approach for surgical phase modeling using various sources of intra-operative procedural data such as – system events (sensors) as well as crowdsourced surgical activity context. We validate a crowdsourced approach to obtain context summarizations of intra-operative surgical activity. Second, we develop a new scoring method to evaluate task segments using rankings derived from pairwise comparisons of performances obtained via crowdsourcing. We show that reliable and valid crowdsourced pairwise comparisons can be obtained across multiple training task settings. Additionally, we present preliminary results comparing inter-rater agreement in relative ratings and absolute ratings for crowdsourced assessments of an endoscopic sinus surgery training task data set. Third, we implement a real-time feedback and teaching framework using virtual reality simulation to present teaching cues and deficit metrics that are targeted at critical learning elements of a task. We compare the effectiveness of this real-time coach to independent self-driven learning on a needle passing task in a pilot randomized controlled trial. Finally, we present an integration of the above components of task progress detection, segment-level evaluation and real-time feedback towards the first end-to-end automated virtual coach for surgical training

Digest of the Philadelphia College of Osteopathic Medicine (Winter 2007)

The Winter 2007 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles: Opening Remarks Remembering Harry Ginsburg, DO ’42 PCOM Updates and Kudos Building Partnerships: Assessing the Value of Physician-Patient Communications Recognizing Leadership, Loyalty, Service: Founders’ Day 2007 Places, Camera, Action . . . Learning Primary Care Skills Out of Africa: True Tales of a Medical Missionary Class Notes In Memoriam My Turn PCOM Eventshttps://digitalcommons.pcom.edu/digest/1195/thumbnail.jp

Machine Medical Ethics

In medical settings, machines are in close proximity with human beings: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. Machines in these contexts are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness? The essays in this collection by researchers from both humanities and science describe various theoretical and experimental approaches to adding medical ethics to a machine, what design features are necessary in order to achieve this, philosophical and practical questions concerning justice, rights, decision-making and responsibility, and accurately modeling essential physician-machine-patient relationships. This collection is the first book to address these 21st-century concerns

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion

The Workplace of the Future

The Fourth Industrial Revolution is a global development that shows no signs of slowing down. In his book, The Workplace of the Future: The Fourth Industrial Revolution, the Precariat and the Death of Hierarchies, Jon-Arild Johannessen sets a chilling vision of how robots and artificial intelligence will completely disrupt and transform working life. The author contests that once the dust has settled from the Fourth Industrial Revolution, workplaces and professions will be unrecognizable and we will see the rise of a new social class: the precariat. We will live side by side with the 'working poor' – people who have several jobs, but still can’t make ends meet. There will be a small salaried elite consisting of innovation and knowledge workers. Slightly further into the future, there will be a major transformation in professional environments. Johannessen also presents a typology for the precariat, the uncertain work that is created and develops a framework for the working poor, as well as for future innovation and knowledge workers, and sets out a new structure for the social hierarchy. A fascinating and thought-provoking insight into the impact of the Fourth Industrial Revolution, The Workplace of the Future will be of interest to professionals and academics alike. The book is particularly suited to academic courses in management, economy, political science and social sciences

Multicase Historic Studies of Innovative Work Behavior Among Intellectually Gifted Adults

ABSTRACT This qualitative research study was conducted to examine whether investing in innovation and gifted intelligence would improve America\u27s economic well-being. The investment issue became a problem because educational researchers researched innovation as creativity rather than as productive behavior. Moreover, in the literature, adult giftedness was perceived as negative development rather than as alternate normative behavior. The purpose of this research study was to generate new knowledge about innovation and adult giftedness. WICS (wisdom, intelligence, creativity, synthesized) theory of intelligence provided the theoretical framework because intelligence is a measure of human productivity potential. The neuropsychological conceptual framework facilitated a cognitive map of the innovation process. The multicase historic research design provided the answers to the research questions. Four real life historic events embedded with innovation activities and behavior utilized comparative methodology to mark patterns in behavior and cognition. Raw data gleaned from archival/historic research was analyzed utilizing content analysis of primary resources. The key results were: (a) the innovation process is a psychological tool that transcends creative activities; (b) empathy, intellectual complexity and moral intelligence is linked to wisdom and continuous learning; and (c) transcendent experiences are intrinsic motivations to reach beyond expected productive behavior. Outcomes from this study are useful for I-O psychologists because high intelligence can increase organizational productivity levels and sustain business. The positive social change implications are business administration will have to redirect business strategies to focus on employees and relationships, and training and development