133 research outputs found

    Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

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    Minimally invasive surgery is a highly demanding surgical approach regarding technical requirements for the surgeon, who must be trained in order to perform a safe surgical intervention. Traditional surgical education in minimally invasive surgery is commonly based on subjective criteria to quantify and evaluate surgical abilities, which could be potentially unsafe for the patient. Authors, surgeons and associations are increasingly demanding the development of more objective assessment tools that can accredit surgeons as technically competent. This paper describes the state of the art in objective assessment methods of surgical skills. It gives an overview on assessment systems based on structured checklists and rating scales, surgical simulators, and instrument motion analysis. As a future work, an objective and automatic assessment method of surgical skills should be standardized as a means towards proficiency-based curricula for training in laparoscopic surgery and its certification

    Application of Human Factors in Surgery: Studies on Technique, Displays, and Performance.

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    The overall goal of this work is to develop a framework that can be used to describe surgical procedures, measure performance, and identify ergonomic risk factors that may affect surgical outcomes and musculoskeletal stresses. Variations in technique commonly exist in surgical procedures; however, clinical evidence to support one technique over another is limited. Identifying best methods in surgical techniques and visualization equipment can reduce the risk factors for musculoskeletal fatigue among surgeons while improving surgical outcomes. This work presents a taxonomy that systematically quantifies differences in techniques among surgeons and cases. Using observed variations among surgeons, hypotheses were formulated on the relationship between different methods and outcomes that can be tested in future studies. The taxonomy was also used to formulate hypotheses on ergonomics factors that may impact surgeon’s musculoskeletal stresses and performance. Hypotheses on the effect of alternative video displays on postures and performance were tested in the laboratory setting. Results found that neck angles were significantly more erect on video displays than microscopes during simulated microsurgery skill tasks. In addition, more neck and shoulder movements were observed on the video displays than microscopes. Performance times on video displays were slower than microscopes and loupes. However, differences in performance times were smaller on the x (left/right) and y (fore/aft)-axes than the vertical z-axis. In addition, video displays were not significantly worse than other displays in overshoot and distance moved metrics that may be indicative of mechanical stress blood vessels may be exposed to in microsurgery. Contribution of this work includes: 1) development of a taxonomy for identifying best methods among variations in surgeon techniques that can be used for evidence-based training and assessment, 2) determining the impact of visualization equipment on surgeon’s risk for musculoskeletal symptoms and fatigue, and 3) measuring the impact of video displays on simulated microsurgery task performance and the limitations of such displays in surgery. Application of this work can be used to improve outcomes for both patients and medical practitioners during surgical procedures.PhDIndustrial and Operations EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/110344/1/dennyyu_1.pd

    Haptic-Enhanced Learning in Preclinical Operative Dentistry

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    Background: Virtual reality haptic simulators represent a new paradigm in dental education that may potentially impact the rate and efficiency of basic skill acquisition, as well as pedagogically influence the various aspects of students’ preclinical experience. However, the evidence to support their efficiency and inform their implementation is still limited. Objectives: This thesis set out to empirically examine how haptic VR simulator (Simodont®) can enhance the preclinical dental education experience particularly in the context of operative dentistry. We specify 4 distinct research themes to explore, namely: simulator validity (face, content and predictive), human factors in 3D stereoscopic display, motor skill acquisition, and curriculum integration. Methods: Chapter 3 explores the face and content validity of Simodont® haptic dental simulator among a group of postgraduate dental students. Chapter 4 examines the predictive utility of Simodont® in predicting subsequent preclinical and clinical performance. The results indicate the potential utility of the simulator in predicting future clinical dental performance among undergraduate students. Chapter 5 investigates the role of stereopsis in dentistry from two different perspectives via two studies. Chapter 6 explores the effect of qualitatively different types of pedagogical feedback on the training, transfer and retention of basic manual dexterity dental skills. The results indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visualdisplay VR-driven feedback. A pedagogical model for integration of haptic dental simulator into the dental curriculum has been proposed in Chapter 7. Conclusion: The findings from this thesis provide new insights into the utility of the haptic virtual reality simulator in undergraduate preclinical dental education. Haptic simulators have promising potential as a pedagogical tool in undergraduate dentistry that complements the existing simulation methods. Integration of haptic VR simulators into the dental curriculum has to be informed by sound pedagogical principles and mapped into specific learning objectives

    Surgical Skill and Video Games: A Meta-Analytic Review

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    As the popularity of video games has grown over the past decade, so has interest in their capacity to serve as tools for education. The technology behind modern laparoscopic surgery draws strong parallels to modern video games, and as such has inspired initial research into the potential relationship between video game play and surgical performance. To date, a number of researchers have conducted studies on this relationship; however, no structured, statistical review of accessible data has taken place. Thus, the goal of this analysis was to examine the available literature and report the significance of the cumulative findings. Through my process, a total of 21 studies involving 1220 participants were gathered through multi-step review, and organized into one of three experimental domains - game training, VR training, and gaming history. Effect size analysis using Hedge’s G and Fisher’s Z yielded statistically significant results in all three domains, thus supporting the consensus belief that video game play has a positive effect on laparoscopic surgical training and performance. Given the particularly strong effect of virtual reality training on surgical performance, it would be valuable to investigate the differential effects of virtual reality, and how these effects might be further developed into more effective educational instruments

    Metrics for Evaluating Surgical Microscope Usage During Myringotomy

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    Abstract Although teaching and learning surgical microscope manoeuvring is a fundamental step in middle ear surgical training, currently there is no objective method to teach or assess this skill. This thesis presents an experimental study designed to implement and test sets of metrics capable of numerically evaluating microscope manoeuvrability and qualitatively assessing surgical expertise of a subject during a middle ear surgery called myringotomy. The experiment involved performing a myringotomy on a fixed cadaveric ear. As participants, experienced ear-nose-throat (ENT) surgeons and ENT surgical residents were invited. While performing the procedure, their microscope manoeuvring motions were captured as translational and angular coordinates using an optical tracker. These data were analyzed in terms of motion path length, velocity, acceleration, jitter, manoeuvring volume, smoothness, rotation and time. Participants’ hand motion, body posture and microscopic view were also video recorded to qualitatively assess their surgical expertise. Several metrics were statistically identified as discriminatory. These metrics will be incorporated into a myringotomy surgical simulator to train ENT residents

    Application of intraoperative quality assurance to laparoscopic total mesorectal excision surgery

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    Introduction: The role of laparoscopy in the surgical management of rectal cancer is debated. Randomised trials have reported contrasting results with inadequate specimens obtained in a minority of patients. The reasons behind these findings are unclear. Complex surgical interventions and human performance are prone to variation, which may account for outcome differences, but neither are robustly measured. Application of quality assurance (QA) to the intraoperative period could explore surgical performance and any relationship with subsequent outcomes. The overarching aim of this thesis is the promotion of oncological and patient safety through application of QA to laparoscopic TME surgery. Methods: Evidence synthesis of QA tools was obtained through a systematic review to identify reported objective laparoscopic total mesorectal excision (TME) assessment tools. Development of novel QA tools for laparoscopic TME was performed and applied and validated using case video from two multicentre randomised trials with reliability and validity of the laparoscopic TME performance tool (L-TMEpt) assessed. A multicentre randomised trial comparing 3D vs. 2D laparoscopic TME was performed incorporating objective performance analyses. Scores divided surgeons into quartiles and compared with histopathological and clinical endpoints. A novel intraoperative adverse event classification was developed and piloted. Results: 176 cases from 48 credentialed surgeons were analysed. L-TMEpt inter-rater, test-retest and internal consistency reliabilities were established. Substantial variation in surgical performance were seen. Scores were strongly associated with the number of intraoperative errors, plane of mesorectal dissection and short-term patient morbidity. Upper quartile surgeons obtained excellent results compared with the lower quartile (mesorectal fascia 93% vs. 59%, NNT 2.9, p=0.002; 30-day morbidity 23% vs. 48%, NNT 4, p=0.043). Conclusions: Intraoperative QA using assessment tools can objectively and reliably measure complex cancer interventions. Laparoscopic TME surgical performance assessment showed substantial variation which is strongly associated with clinical outcomes holding implications for surgical trial design and interpretation.Open Acces

    Performance Factors in Neurosurgical Simulation and Augmented Reality Image Guidance

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    Virtual reality surgical simulators have seen widespread adoption in an effort to provide safe, cost-effective and realistic practice of surgical skills. However, the majority of these simulators focus on training low-level technical skills, providing only prototypical surgical cases. For many complex procedures, this approach is deficient in representing anatomical variations that present clinically, failing to challenge users’ higher-level cognitive skills important for navigation and targeting. Surgical simulators offer the means to not only simulate any case conceivable, but to test novel approaches and examine factors that influence performance. Unfortunately, there is a void in the literature surrounding these questions. This thesis was motivated by the need to expand the role of surgical simulators to provide users with clinically relevant scenarios and evaluate human performance in relation to image guidance technologies, patient-specific anatomy, and cognitive abilities. To this end, various tools and methodologies were developed to examine cognitive abilities and knowledge, simulate procedures, and guide complex interventions all within a neurosurgical context. The first chapter provides an introduction to the material. The second chapter describes the development and evaluation of a virtual anatomical training and examination tool. The results suggest that learning occurs and that spatial reasoning ability is an important performance predictor, but subordinate to anatomical knowledge. The third chapter outlines development of automation tools to enable efficient simulation studies and data management. In the fourth chapter, subjects perform abstract targeting tasks on ellipsoid targets with and without augmented reality guidance. While the guidance tool improved accuracy, performance with the tool was strongly tied to target depth estimation – an important consideration for implementation and training with similar guidance tools. In the fifth chapter, neurosurgically experienced subjects were recruited to perform simulated ventriculostomies. Results showed anatomical variations influence performance and could impact outcome. Augmented reality guidance showed no marked improvement in performance, but exhibited a mild learning curve, indicating that additional training may be warranted. The final chapter summarizes the work presented. Our results and novel evaluative methodologies lay the groundwork for further investigation into simulators as versatile research tools to explore performance factors in simulated surgical procedures
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