Assessment of Competence in Simulated Flexible Bronchoscopy Using Motion Analysis

Abstract

Background: Flexible bronchoscopy should be performed with a correct posture and a straight scope to optimize bronchoscopy performance and at the same time minimize the risk of work-related injuries and endoscope damage. Objectives: We aimed to test whether an automatic motion analysis system could be used to explore if there is a correlation in scope movements and the operator's level of experience. Our hypothesis was that experienced bronchoscopists move less and keep the flexible scope straighter than less-experienced bronchoscopists while performing procedures. Methods: Eleven novices, 9 intermediates and 9 experienced bronchoscopy operators performed 3 procedures each on a bronchoscopy simulator. The Microsoft Kinect system was used to automatically measure the total deviation of the scope from a perfectly straight, vertical line. Results: The low-cost motion analysis system could measure the accumulated deviation of the scope precisely during the procedure. The deviations were greatest for the novices and smallest for the most experienced operators for all 3 procedures (p = 0.01, p = 0.01 and p = 0.04, respectively). The total deviation from the straight scope correlated negatively with the performance on the simulator (virtual-reality simulator score; p < 0.001). Conclusion: The motion analysis system could discriminate between different levels of experience. Automatic feedback on correct movements during self-directed training on simulators might help new bronchoscopists learn how to handle the bronchoscope like an expert.

Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Systematic Review

“…The remaining studies [13, 19-23, 27, 28, 32, 34, 37, 38] either tested various training methods [20,27,28,32,34,37,38] , simulators [21][22][23]28] or a new approach to skills assessment [13,19] .…”

“…One study used alternative measurements to assess the learners' skills [19] . An additional study explored the possibility of using a motion sensor to assess the skills of an operator [13] .…”

Use of commercial off-the-shelf devices for detection of manual gestures in surgery. A Systematic Literature Review (Preprint)

“…Three studies explored the possibility of using the MK as a tool for skills learning in bronchoscopy and colonoscopy by means of simulation [50,51,108].…”

“…Two studies were aimed at comparing the performance of the MK with respect to a mouse [45,46]; one compared the performance of the LMC to that of a mouse [47]; and two studies compared different COTS devices [48,49]. Seven studies had the aim of performing construct [50][51][52] or concurrent validation of the devices [53][54][55][56].…”

Training for Bronchoscopists: Is Less More?

“…Several reports have since shown that virtual reality simulation can be an effective teaching tool, although superiority over other simulation models has not been proven [11]. In the latest issue of Respiration , Colella et al [12] go one step further by evaluating motion analysis of the bronchoscopist during a simulated flexible bronchoscopy. The authors state that only small movements in the bronchoscopist's left hand are necessary for adequate navigation through the patient's airways.…”