Robotic surgery training and performance

Background: To understand the process of skill acquisition in robotic surgery and to allow useful real-time feedback to surgeons and trainees in future generations of robotic surgical systems, robotic surgical skills should be determined with objective variables. The aim of this study was to assess skill acquisition through a training protocol, and to identify variables for the quantification of proficiency. Methods: Seven novice users of the da Vinci Surgical System engaged in 4 weeks of training that involved practicing three bimanual tasks with the system. Seven variables were determined for assessing speed of performance, bimanual coordination, and muscular activation. These values were compared before and after training. Results: Significant improvements were observed through training in five variables. Bimanual coordination showed differences between the surgical tasks used, whereas muscular activation patterns showed better muscle use through training. The subjects also performed the surgical tasks considerably faster within the first two to three training sessions. Conclusions: The study objectively demonstrated that the novice users could learn to perform surgical tasks faster and with more consistency, better bimanual dexterity, and better muscular activity utilization. The variables examined showed great promise as objective indicators of proficiency and skill acquisition in robotic surgery

Objective assessment of proficiency with bimanual inanimate tasks in robotic laparoscopy

Purpose: Development of objective criteria and optimum training protocols are priorities for robotic laparoscopy. However, studies that have attempted to objectify learning have been limited due to lack of task complexity and absence of comparisons between experts and novices. Our aim was to address these limitations and assess proficiency in robotic laparoscopy using bimanual inanimate tasks. Materials and Methods: Six experts and 18 novice users of the da Vinci surgical system (Innovative Surgical, Sunnyvale, CA) performed three bimanual surgical manipulations, two of them in opposite directions, for a total of five different test tasks. During each task, elapsed time and kinematics with respect to the instrument tips were measured and a bimanual coordination analysis was conducted to assess the relationship between the simultaneous movements of both arms. Specifically, task completion time, total traveling distance of the instrument tips, and mean absolute relative phase—a variable for the assessment of bimanual coordination—were calculated for each task and compared between groups. Results: The experts showed significantly shorter task completion times for all tasks (p\u3c 0.05). Significantly higher mean absolute relative phase values were observed for the experts in two tasks (p\u3c 0.05). There were no significant differences regarding total travel distance. Conclusion: Expert users of the da Vinci surgical system performed the designed surgical tasks faster and with higher bimanual dexterity than novices. Bimanual coordination analysis and the tasks used in this study show promise for becoming important components of the objective criteria needed to quantify proficiency in robotic laparoscopy

Objective evaluation of expert and novice performance during robotic surgical training tasks

Background - Robotic laparoscopic surgery has revolutionized minimally invasive surgery for the treatment of abdominal pathologies. However, current training techniques rely on subjective evaluation. The authors sought to identify objective measures of robotic surgical performance by comparing novices and experts during three training tasks. Methods - Five novices (medical students) were trained in three tasks with the da Vinci Surgical System. Five experts trained in advanced laparoscopy also performed the three tasks. Time to task completion (TTC), total distance traveled (D), speed (S), curvature (Ƙ), and relative phase (Φ) were measured. Results - Before training, TTC, D, and Ƙ were significantly smaller for experts than for novices (p \u3c 0.05), whereas S was significantly larger for experts than for novices before training (p \u3c 0.05). Novices performed significantly better after training, as shown by smaller TTC, D, and Ƙ, and larger S. Novice performance after training approached expert performance. Conclusion - This study clearly demonstrated the ability of objective kinematic measures to distinguish between novice and expert performance and training effects in the performance of robotic surgical training tasks

Критичний аналіз проекту Закону України № 9223 від 19.04.2023 в частині кримінальної відповідальності за дії, передбачені ст. 114-3 КК України

Статтю присвячено науково-практичному аналізу положень проекту Закону України № 9223 від 19.04.2023, яким пропонується впровадження кримінальної відповідальності за дії, передбачені ст. 114-3 КК України, а саме, - створення, придбання, використання або збут облікових записів, що містять завідомо неправдиві відомості щодо користувача, в інформаційних (автоматизованих), електронних комунікаційних мережах, за допомогою яких поширюється недостовірна інформація (у тому числі від імені інших осіб, причетність яких до оприлюднення інформації не підтверджена) або здійснюється втручання в діяльність фізичних і юридичних осіб, якщо такі дії вчинені на шкоду суверенітету, територіальній цілісності та недоторканості, обороноздатності, національній, державній, економічній чи інформаційній безпеці України, та ін. Автором проаналізовано диспозицію вказаної статті та виявлено низку недоліків, які не можуть бути усунені застосуванням засобів законодавчої техніки та конструювання.             Найбільш принциповими зауваженнями є такі: невідповідність назви статті її змісту та переліку видів діянь, які утворюють відповідні форми об’єктивної сторони складу кримінального правопорушення; акцент уваги авторів законопроекту перенесено зі злочинних дій, які полягають в поширенні (розміщенні) за допомогою фейкового акаунту завідомо неправдивої інформації, на дії, які у вузькому сенсі передують такому поширенню, наприклад, створення фейкового акаунта; невідповідність Розділу Особливої частини КК України, в яку пропонується помістити ст. 114-3 КК України, фактичному родовому об’єкту складу цього кримінального правопорушення; наявність в диспозиції статті конструктивних категорій, які не відповідають змісту вчинюваних дій. З урахуванням виявлених недоліків автором запропоновано концептуально змінити підходи до визначення дій, які необхідно криміналізувати, визначивши їх як «умисне поширення завідомо для суб’єкта неправдивої соціально значущої інформації». Додатково висловлено низку пропозицій щодо обов’язкових елементів, що доцільно передбачити в новій нормі, яку запропоновано помістити до Розділу IX Особливої частини КК України (Кримінальні правопорушення проти громадської безпеки)

Enhanced Robotic Surgical Training Using Augmented Visual Feedback

The goal of this study was to enhance robotic surgical training via real-time augmented visual feedback. Thirty novices (medical students) were divided into 5 feedback groups (speed, relative phase, grip force, video, and control) and trained during 1 session in 3 inanimate surgical tasks with the da Vinci Surgical System. Task completion time, distance traveled, speed, curvature, relative phase, and grip force were measured immediately before and after training and during a retention test 2 weeks after training. All performance measures except relative phase improved after training and were retained after 2 weeks. Feedback-specific effects showed that the speed group was faster than other groups after training, and the grip force group applied less grip force. This study showed that the real-time augmented feedback during training can enhance the surgical performance and can potentially be beneficial for both training and surgery

Electromyographic response is altered during robotic surgical training with augmented feedback

There is a growing prevalence of robotic systems for surgical laparoscopy. We previously developed quantitative measures to assess robotic surgical proficiency, and used augmented feedback to enhance training to reduce applied grip force and increase speed. However, there is also a need to understand the physiological demands of the surgeon during robotic surgery, and if training can reduce these demands. Therefore, the goal of this study was to use clinical biomechanical techniques via electromyography (EMG) to investigate the effects of real-time augmented visual feedback during short-term training on muscular activation and fatigue. Twenty novices were trained in three inanimate surgical tasks with the da Vinci Surgical System. Subjects were divided into five feedback groups (speed, relative phase, grip force, video, and control). Time- and frequency-domain EMG measures were obtained before and after training. Surgical training decreased muscle work as found from mean EMG and EMG envelopes. Grip force feedback further reduced average and total muscle work, while speed feedback increased average muscle work and decreased total muscle work. Training also increased the median frequency response as a result of increased speed and/or reduced fatigue during each task. More diverse motor units were recruited as revealed by increases in the frequency bandwidth post-training. We demonstrated that clinical biomechanics using EMG analysis can help to better understand the effects of training for robotic surgery. Real-time augmented feedback during training can further reduce physiological demands. Future studies will investigate other means of feedback such as biofeedback of EMG during robotic surgery training

Electromyographic response is altered during robotic surgical training with augmented feedback

There is a growing prevalence of robotic systems for surgical laparoscopy. We previously developed quantitative measures to assess robotic surgical proficiency, and used augmented feedback to enhance training to reduce applied grip force and increase speed. However, there is also a need to understand the physiological demands of the surgeon during robotic surgery, and if training can reduce these demands. Therefore, the goal of this study was to use clinical biomechanical techniques via electromyography (EMG) to investigate the effects of real-time augmented visual feedback during short-term training on muscular activation and fatigue. Twenty novices were trained in three inanimate surgical tasks with the da Vinci Surgical System. Subjects were divided into five feedback groups (speed, relative phase, grip force, video, and control). Time- and frequency-domain EMG measures were obtained before and after training. Surgical training decreased muscle work as found from mean EMG and EMG envelopes. Grip force feedback further reduced average and total muscle work, while speed feedback increased average muscle work and decreased total muscle work. Training also increased the median frequency response as a result of increased speed and/or reduced fatigue during each task. More diverse motor units were recruited as revealed by increases in the frequency bandwidth post-training. We demonstrated that clinical biomechanics using EMG analysis can help to better understand the effects of training for robotic surgery. Real-time augmented feedback during training can further reduce physiological demands. Future studies will investigate other means of feedback such as biofeedback of EMG during robotic surgery training

Parameters of internal gravity waves in the mesosphere-lower thermosphere region derived from meteor radar wind measurements

International audienceA procedure of revealing parameters of internal gravity waves from meteor radar wind measurements is presented. The method is based on dividing the measuring volume into different parts and, using wavelet analysis, calculating the phase progression of frequency peaks in the vertical and horizontal direction. Thus, the distribution of vertical and horizontal wavelengths and directions of IGW energy propagation, using meteor radar data, has been obtained. The method was applied to a 4-month data set obtained in July and August, 1998 and 1999. As expected, the majority of waves have been found to propagate upwards, although a considerable number seem to propagate downwards as well. High-frequency (intrinsic periods T* of less than 2 h) waves are dominating. The distribution of waves over the course of an average day is only weakly structured, with weak maxima in the morning and evening

\u3ci\u3eMedicine Meets Virtual Reality 14\u3c/i\u3e

Chapter, Real-Time Augmented Feedback Benefits Robotic Laparoscopic Training, co-authored by Nicholas Steriou, UNO faculty member. Machine intelligence will eclipse human intelligence within the next few decades - extrapolating from Moore’s Law - and our world will enjoy limitless computational power and ubiquitous data networks. Today’s iPod® devices portend an era when biology and information technology will fuse to create a human experience radically different from our own. Already, our healthcare system now appears on the verge of crisis; accelerating change is part of the problem. Each technological upgrade demands an investment of education and money, and a costly infrastructure more quickly becomes obsolete. Practitioners can be overloaded with complexity: therapeutic options, outcomes data, procedural coding, drug names etc. Furthermore, an aging global population with a growing sense of entitlement demands that each medical breakthrough be immediately available for its benefit: what appears in the morning paper is expected simultaneously in the doctor’s office. Meanwhile, a third-party payer system generates conflicting priorities for patient care and stockholder returns. The result is a healthcare system stressed by scientific promise, public expectation, economic and regulatory constraints and human limitations. Change is also proving beneficial, of course. Practitioners are empowered by better imaging methods, more precise robotic tools, greater realism in training simulators, and more powerful intelligence networks. The remarkable accomplishments of the IT industry and the Internet are trickling steadily into healthcare. The Medicine Meets Virtual Reality series can readily see the progress of the past fourteen years: more effective healthcare at a lower overall cost, driven by cheaper and better computers.https://digitalcommons.unomaha.edu/facultybooks/1236/thumbnail.jp

Robotic Surgery and Training: Electromyographic correlates of robotic laparoscopic training

Background: Robotic laparoscopic surgery has been shown to decrease task completion time, reduce errors, and decrease training time when compared to manual laparoscopic surgery. However, current literature has not addressed physiological effects, in particular muscle responses, to training with a robotic surgical system. We seek to determine the frequency response of electromyographic (EMG) signals of specific arm and hand muscles with training using the da Vinci Surgical System (dVSS). Methods: Seven right-handed medical students were trained in three tasks with da Vinci Surgical System over four weeks. These subjects, along with eight controls, were tested before and after training. Electromyographic (EMG) signals were collected from four arm and hand muscles during the testing sessions and the median EMG frequency and bandwidth were computed. Results: The median frequency and frequency bandwidth both increased after training for two of the three tasks. Conclusion: The results suggested that training reduces muscle fatigue as a result of faster and more deliberate movements. These changes occurred predominantly in muscles that were the dominant muscles for each task, whereas the more demanding task recruited more diverse motor units. An evaluation of the physiological demands of robotic laparoscopic surgery using electromyography can provide us with a meaningful quantitative way to examine performance and skill acquisition