+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Skills evaluation in minimally invasive surgery using force/torque signatures

Skills evaluation in minimally invasive surgery using force/torque signatures

Surgical Endoscopy 14(9): 791-798

One of the more difficult tasks in surgical education is to teach the optimal application of instrument forces and torques necessary to facilitate the conduct of an operation. For laparoscopic surgery, this type of training has traditionally taken place in the operating room, reducing operating room efficiency and potentially affecting the safe conduct of the operation. The objective of the current study was to measure and compare forces and torques (F/T) applied at the tool/hand interface generated during laparoscopic surgery by novice (NS) and experienced (ES) surgeons using an instrumented laparoscopic grasper and to use this data for evaluating the skill level. Ten surgeons (five-NS, five-ES) performed a cholecystectomy and Nissen fundoplication in a porcine model. An instrumented laparoscopic grasper with interchangeable standard surgical tips equipped with a three-axis F/T sensor located at the proximal end of the grasper tube was used to measure the F/T at the hand/tool interface. In addition, one axis force sensor located at the grasper's handle was used to measure the grasping force. F/T data synchronized with visual view of the tool operative maneuvers were collected simultaneously via a novel graphic user interface incorporated picture-in-picture video technology. Subsequent frame-by-frame video analysis of the operation allowed a definition of states associated with different tool/tissue interactions within each step of the operation. F/T measured within each state were further analyzed using vector quantization (VQ). The VQ analysis defines characteristic sets of F/T in the database that were defined as F/T signature. The magnitude of F/T applied by NS and ES were significantly different (p < 0.05) and varied based on the task being performed. Higher F/T magnitudes were applied by NS than by ES when performing tissue manipulation, whereas lower F/T magnitudes were applied by NS than by ES during tissue dissection. Furthermore, the time to complete the surgical procedure was longer for NS by a factor of 1.5-4.8 when compared to the time for ES. State analysis suggests that most of this time is consumed in an [idle] state, in which movements of the surgeon make no tissue contact. Preliminary data suggest that F/T magnitudes associated with the tool/tissue interactions provide an objective means of distinguishing novices from skilled surgeons. Clinical F/T analysis using the proposed technology and methodology may be helpful in training, developing surgical simulators, and measuring technical proficiency during laparoscopic surgery.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 047381344

Download citation: RISBibTeXText

PMID: 11000356

DOI: 10.1007/s004640000230

Related references

Surgeon-superintendents on convict ships. Australian and New Zealand Journal of Surgery 66(4): 253-256, 1996

Markov model-based estimation of individual survival probability for medullary thyroid cancer patients. Pathology Oncology Research 8(2): 93-104, 2002

Design and stability analysis of single-input fuzzy logic controller. IEEE Transactions on Systems Man and Cybernetics. Part B Cybernetics 30(2): 303-309, 2000

Development of force measurement system for clinical use in minimal access surgery. Surgical Endoscopy 22(2): 467-471, 2008

Visual clone identification of Penicillium commune isolates. Journal of Microbiological Methods 52(2): 221-229, 2003

Force characteristics of nickel-titanium tension coil springs. American Journal of Orthodontics and Dentofacial Orthopedics 115(5): 498-507, 1999

Evaluation of propranolol response by catheterization and Doppler ultrasonography in patients with cirrhosis. Acta Gastroenterologica Latinoamericana 28(4): 291-297, 1998

A modular diagnosis system based on fuzzy logic for UASB reactors treating sewage. Water Science and Technology 74(2): 309-317, 2016

Evaluation of force applied during deliveries complicated by shoulder dystocia using simulation. American Journal of Obstetrics and Gynecology 204(3): 234.E1-5, 2011

Skills improvement after observation or direct practice of a simulated laparoscopic intervention. Journal of Gynecology Obstetrics and Human Reproduction 47(3): 101-106, 2018

Training for medical teachers: a UK survey, 1993. Medical Education 28(2): 99, 1994

New skeletal myopathy and cardiomyopathy associated with a missense mutation in MYH7. Neurology 68(23): 2041-2042, 2007

Outcomes of minimally invasive suburethral slings with and without concomitant pelvic organ prolapse surgery. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics 127(1): 69-72, 2014

Minimally invasive versus open laminotomy. Spine Journal 14(6): 1081-1082, 2014

New model for in vivo investigation after microvascular breakdown in burns: use of intravital fluorescent microscopy. Burns 31(2): 168-174, 2005