Robotic Minimally Invasive Surgical skill assessment based on automated video-analysis motion studies

Abstract

Abstract²Assessment of surgical skill, arising from the synthesis of the cognitive and sensorimotor capabilities of the surgeon, has predominantly been a subjective task. Development of quantitative metrics-of-performance with clinical relevance and other desirable characteristics (repeatability and stability) has always lagged behind. New opportunities for objective and automated assessment frameworks have arisen by virtue of technological advances in computation, video-processing, and data-acquisition, especially in the robotic Minimally Invasive Surgical (rMIS) realm. Most efforts focus on semi-quantitative (Likert scale) or inadequately validated, spatially-or temporally-aggregated quantitative metrics derived from direct physical measurements. In this work we propose an automated surgical expertise evaluation method, by adapting well-established motion studies methodologies, especially for MIS evaluation. This method relies on segmenting a primary task into sub-tasks, which can be evaluated by statistical analyses of micromotions. Motion studies were developed by 2 methods: (A) manual annotation process by experts (to serve as a benchmark); and (B) automatedkinematic-analysis-of-videos; for economy, repeatability as well as dexterity. The da Vinci SKILLS simulator was used to serve as a uniform testbed. Surgeons with varied levels of expertise were recruited to perform two representative simplified tasks (Peg Board and Pick & Place). The automated kinematic analysis of video was compared with the ground truth data (obtained by manual labeling) using misclassification rate and true classification confusion matrix. Future studies aimed towards analyzing real surgical procedures are already underway.

A multi-disciplinary review of knowledge acquisition methods: From human to autonomous eliciting agents

“…The Sensori-Motor Process Charts are techniques that focus on mental activities [207,109]. They take into account sensors and sensory information and their relation to the task of interest and produce skill charts based on the patterns observed during the task performance.…”

Video-Analytics for Enhancing Safety and Decision-Support in Surgical Workflows

“…The method based on 'Therbligs' involves discretizing manipulation tasks (widely used in industrial engineering) as applied to surgical procedures. Detailed explanation on our micromotion analysis method with full results is presented already in (Jun, Narayanan et al (2012), Jun, Narayanan et al (2013)). The method enabled us to convert the video feeds into discrete states ('Therbligs') and derive useful performance-metrics in terms of ineffective motions (missed or repeated sub-sequences) and dexterity (simultaneous instances of both hands performing useful sub-tasks) by comparing with the corresponding task templates as summarized in Table.2.…”

Product of tracking experts for visual tracking of surgical tools

“…Jun et al [13] discuss how video-based motion analysis methods can be useful in surgical expertise evaluation. Voros et al [24] use tool location data for identifying surgical gestures and providing context specific feedback.…”