Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment

Pagador, J. Blas; Sánchez‐Margallo, Francisco M.; Sánchez-Peralta, Luisa F.; Sánchez‐Margallo, Juan A.; Moyano-Cuevas, José Luis; Enciso, Silvia; Usón‐Gargallo, Jesús; Moreno, José A.

doi:10.1007/s11548-011-0650-9

Cited by 27 publications

(22 citation statements)

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“…Therefore, the more the novices train, the faster they move the instrument but they do not do it in the most correct way. A similar result can be found in [34], where Pagador et al expose that intermediate surgeons could feel self-confident and move tools quicker than needed when accomplishing a surgeon's knot. We agree with Pagador et al because in our opinion, repeating a task without proper feedback or mentoring do not lead to an expert execution which is also supportedbyKolozsvarietal.in [13] where they state the four criteria requested for a deliberate practice: improve a specific aspect of performance; the need of valid, thorough and immediate feedback; opportunity to perform the tasks repeatedly within a controlled environment; and training sessions limited to 1 h. Therefore, VR simulators as SINERGIA together with a suitable mentorship could be a proper environment for this deliberate practice.…”

Section: C> C> C> C> C>supporting

confidence: 62%

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

et al. 2012

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Purpose Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to Ave tasks included in SINERGIA laparoscopic virtual reality simulator. Methods Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1-R8) of the Ave mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of Rl, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results In total, 84.38 % of the metrics provided by SINER-GIA and included in this study show significant differences when comparing Rl and R8. Metrics are mostly improved in the Arst session of training (75.00 % when Rl and R4 are compared vs. 37.50 % when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics psychomotor skills are improved. On the other hand, Navigation just improves 60 % of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the Arst part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

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Section: C> C> C> C> C>supporting

confidence: 62%

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

et al. 2012

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“…Sin embargo, esta tarea requiere de procedimientos más automáticos, como los basados en el análisis de los movimientos del instrumental. Para el desarrollo de este tipo de sistemas, bien sea para su aplicación en cirugía guiada por imagen 21 , para cirugía robótica 22 o bien para evaluación de destrezas, se han utilizado diversas tecnologías de seguimiento como sistemas electromagnéticos 13 , mecánicos 23 , ópticos 24 o basados en vídeo 12,14 .…”

Section: Discussionunclassified

“…Esto puede deberse a que la experiencia conlleva movimientos más rápidos y, en ocasiones, con menor delicadeza, frente a la posible inseguridad presente en determinados momentos en el grupo de cirujanos de nivel intermedio. Para la tarea de sutura se han obtenido diferencias estadísticamente significativas en los parámetros de tiempoestudios previos 13 hemos utilizado el mismo dispositivo pero, en este caso, para analizar el movimiento del instrumental durante una tarea de sutura laparoscópica, realizada por cirujanos noveles, de experiencia intermedia y expertos. La tarea de sutura fue dividida en 4 subtareas, tal y como hemos contemplado en el presente estudio, analizadas de forma individual.…”

Section: Discussionunclassified

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

Sánchez‐Margallo

Pagador

et al. 2014

Cirugía Española

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RESUMENIntroducción: En este trabajo se estudia la utilidad de un sistema de evaluación de destrezas quirúrgicas basado en el análisis de los movimientos del instrumental laparoscópico. Método: El sistema consta de un simulador físico laparoscópico y un sistema de seguimiento y evaluación de habilidades técnicas quirúrgicas. En el estudio han participado 6 cirujanos con experiencia intermedia (entre 1 y 50 intervenciones laparoscópicas) y 5 cirujanos expertos (más de 50 intervenciones laparoscópicas), todos ellos con la mano derecha como dominante. Cada sujeto realizó 3 repeticiones de una tarea de corte con la mano derecha en tejido sintético, una disección de la serosa gástrica y una sutura en la disección realizada. Para cada ejercicio se analizaron los parámetros de tiempo, distancia recorrida, velocidad, aceleración y suavidad de movimientos para los instrumentos de ambas manos.Resultados: En la tarea de corte, los cirujanos expertos muestran menor aceleración (p = 0,014) y mayor suavidad en los movimientos (p = 0,023) en el uso de la tijera. Respecto a la actividad de disección, los cirujanos expertos requieren menos tiempo (p = 0,006) y recorren menos distancia con ambos instrumentos (p = 0,006 para disector y p = 0,01 para tijera). En la tarea de sutura, los cirujanos expertos presentan menor tiempo de ejecución que los cirujanos de nivel intermedio (p = 0,037) y recorren menos distancia con el disector (p = 0,041). Conclusiones: El sistema de evaluación se mostró útil en las tareas de corte, disección y sutura, y constituye un progreso en el desarrollo de sistemas avanzados de entrenamiento y evaluación de destrezas quirúrgicas laparoscópicas. Usefulness of an optical tracking system in laparoscopic surgery for motor skills assessmentABSTRACT Introduction: The objective of this study is to assess the usefulness of an evaluation system of surgical skills based on motion analysis of laparoscopic instruments. Method: This system consists of a physical laparoscopic simulator and a tracking and assessment system of technical skills in laparoscopy. Six surgeons with intermediate experience (between 1 and 50 laparoscopic surgeries) and 5 experienced surgeons (more than 50 laparoscopic surgeries) took part in this study. All participants were right-handed. The subjects performed 3 repetitions of a cutting task on synthetic tissue with the right hand, dissection of a gastric serous layer, and a suturing task in the dissection previously done. Objective metrics such as time, path length, speed of movements, acceleration and motion smoothness were analyzed for the instruments of each hand. Results: In the cutting task, experienced surgeons show less acceleration (P=.014) and a smoother motion (P=.023) using the scissors. Regarding the dissection activity, experienced surgeons need less time (P=.006) and less length with both instruments (P=.006 for dissector and P=.01 for scissors). In the suturing task, experienced surgeons require less time (P=.037) and distance travelled (P=.041) by the dissector. Conclusions: ...

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“…Electromagnetic tracking systems have no problems with occlusions (39,58), although the accuracy of position and orientation measurements with this technology could be degraded with magnetic field distortions caused by the metallic objects in the clinical scenario (15,41). For intra-corporeal applications of this tracking technology, a drastic reduction of the sensor size, owing to the reduced workspace, is required (46).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies use this technology for surgical skills assessment during a suturing task (39). On the other hand, the Imperial College Surgical Assessment Device (ICSAD) (40) uses an electromagnetic sensor attached to the dorsum of each hand in order to analyse the surgeon's performance.…”

Section: Extra-corporeal Systemsmentioning

confidence: 99%

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

Sánchez‐Margallo

García

et al. 2013

Minimally Invasive Therapy & Allied Technologies

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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.

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Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment

Abstract: The most important subtasks during suture learning process are needle puncture and first knot. The TMA could be a useful objective assessment tool to discriminate surgical experience and could be used in the future to measure and certify surgical proficiency.

Cited by 27 publications

References 27 publications

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

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

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