Haptic Guidance and Haptic Error Amplification in a Virtual Surgical Robotic Training Environment

Teleoperated robotic systems have introduced more intuitive control for minimally invasive surgery, but the optimal method for training remains unknown. Recent motor learning studies have demonstrated that exaggeration of errors helps trainees learn to perform tasks with greater speed and accuracy. We hypothesized that training in a force field that pushes the operator away from a desired path would improve their performance on a virtual reality ring-on-wire task. Forty surgical novices trained under a no-force, guidance, or error-amplifying force field over five days. Completion time, translational and rotational path error, and combined error-time were evaluated under no force field on the final day. The groups significantly differed in combined error-time, with the guidance group performing the worst. Error-amplifying field participants showed the most improvement and did not plateau in their performance during training, suggesting that learning was still ongoing. Guidance field participants had the worst performance on the final day, confirming the guidance hypothesis. Participants with high initial path error benefited more from guidance. Participants with high initial combined error-time benefited more from guidance and error-amplifying force field training. Our results suggest that error-amplifying and error-reducing haptic training for robot-assisted telesurgery benefits trainees of different abilities differently.Comment: 11 pages, 7 Figure, Under Revie

Compensatory Paracrine Mechanisms That Define The Urothelial Response to Injury in Partial Bladder Outlet Obstruction

Diseases and conditions affecting the lower urinary tract are a leading cause of dysfunctional sexual health, incontinence, infection, and kidney failure. The growth, differentiation, and repair of the bladder's epithelial lining are regulated, in part, by fibroblast growth factor (FGF)-7 and -10 via a paracrine cascade originating in the mesenchyme (lamina propria) and targeting the receptor for FGF-7 and -10 within the transitional epithelium (urothelium). The FGF-7 gene is located at the 15q15-q21.1 locus on chromosome 15 and four exons generate a 3.852-kb mRNA. Five duplicated FGF-7 gene sequences that localized to chromosome 9 were predicted not to generate functional protein products, thus validating the use of FGF-7-null mice as an experimental model. Recombinant FGF-7 and -10 induced proliferation of human urothelial cells in vitro and transitional epithelium of wild-type and FGF-7-null mice in vivo.To determine the extent that induction of urothelial cell proliferation during the bladder response to injury is dependent on FGF-7, an animal model of partial bladder outlet obstruction was developed. Unbiased stereology was used to measure the percentage of proliferating urothelial cells between obstructed groups of wild-type and FGF-7-null mice. The stereological analysis indicated that a statistical significant difference did not exist between the two groups, suggesting that FGF-7 is not essential for urothelial cell proliferation in response to partial outlet obstruction. In contrast, a significant increase in FGF-10 expression was observed in the obstructed FGF-7-null group, indicating that the compensatory pathway that functions in this model results in urothelial repair

Compensatory Paracrine Mechanisms That Define The Urothelial Response to Injury in Partial Bladder Outlet Obstruction

Diseases and conditions affecting the lower urinary tract are a leading cause of dysfunctional sexual health, incontinence, infection, and kidney failure. The growth, differentiation, and repair of the bladder's epithelial lining are regulated, in part, by fibroblast growth factor (FGF)-7 and -10 via a paracrine cascade originating in the mesenchyme (lamina propria) and targeting the receptor for FGF-7 and -10 within the transitional epithelium (urothelium). The FGF-7 gene is located at the 15q15-q21.1 locus on chromosome 15 and four exons generate a 3.852-kb mRNA. Five duplicated FGF-7 gene sequences that localized to chromosome 9 were predicted not to generate functional protein products, thus validating the use of FGF-7-null mice as an experimental model. Recombinant FGF-7 and -10 induced proliferation of human urothelial cells in vitro and transitional epithelium of wild-type and FGF-7-null mice in vivo. To determine the extent that induction of urothelial cell proliferation during the bladder response to injury is dependent on FGF-7, an animal model of partial bladder outlet obstruction was developed. Unbiased stereology was used to measure the percentage of proliferating urothelial cells between obstructed groups of wild-type and FGF-7-null mice. The stereological analysis indicated that a statistical significant difference did not exist between the two groups, suggesting that FGF-7 is not essential for urothelial cell proliferation in response to partial outlet obstruction. In contrast, a significant increase in FGF-10 expression was observed in the obstructed FGF-7-null group, indicating that the compensatory pathway that functions in this model results in urothelial repair

Crowd Sourced Assessment of Technical Skills (CSATS): A Scalable Assessment Tool for the Nursing Workforce

Background: In the current healthcare environment, education for technical skills focuses on quality improvement that demands ongoing skill assessment. Objectively assessing competency is a complex task that, when done effectively, improves patient care. Current methods are time-consuming, expensive, and subjective. Crowdsourcing is the practice of obtaining services from a large group of people, typically the general public on an online community. CSATS (Crowd Sourced Assessment of Technical Skills) uses crowdsourcing as an innovative way to rapidly, objectively, and comprehensively assess technical skills. We hypothesized that CSATS could accurately evaluate the technical skill proficiency of nurses.Methods: An interface displaying one of 34 video-recorded nurses performing a glucometer skills test and a corresponding survey listing each required step were uploaded to an Amazon.com hosted crowdsourcing site, Mechanical Turk™. The crowd evaluated completion and sequence of the glucometer steps in each video.Results: In under 4 hours, we obtained 1,300 crowd ratings, approximately 38 per video that evaluated the user’s performance based on completion and correct order of steps. The crowd identified individual performance variance, specific steps frequently missed by users, and provided feedback tailored to each user. CSATS identified 15% of nurses who would benefit from additional training. Conclusion: Our study showed that healthcare-naïve crowd workers can assess technical skill proficiency rapidly and accurately at nominal cost. CSATS may be a valuable tool to assist educators in creating targeted training curricula for nurses in need of follow up while rapidly identifying nurses whose technical skills meet expectations, thus, dramatically reducing the resource burden for training.</p

An Instrumented Minimally Invasive Surgical Tool: Design and Calibration

Minimally invasive surgical procedures have improved the standard of patient care by reducing recovery time, chance of infection, and scarring. A recent review estimates that leaks occur in 3% to 6% of bowel anastomoses, resulting in “increased morbidity and mortality and adversely [affecting] length of stay, cost, and cancer recurrence” [23]. Many of these leaks are caused by poor handling and ischemic tissue

Effect of Time Delay on TeleSurgical Performance

Abstract — In the area of surgical robotics no standard means of performance evaluation has been established. Thousands of surgeons have gone through the SAGES FLS Program, and the psychomotor skill portion of the program is considered the gold standard in laparoscopic skills evaluation. This research describes the use of the FLS Block Transfer task to evaluate the performance of both surgeons and non-surgeons teleoperating under different time delay conditions on the University of Washington RAVEN Surgical Robot. Time delays of 0ms, 250ms, and 500ms were used and a statistically significant difference in mean block transfer time as well as mean tool tip path length were shown. For this task no significant difference was shown between the surgeon and non-surgeon groups. Clearly surgeon input and feedback is key to surgical robotic system development, but this result implies that non-surgeon subjects can be tested for simple usability evaluations. I