Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation
Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation
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DOI：
10.1007/s11548-016-1391-6
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发表时间：
2016-06-01
影响因子：
3
通讯作者：
Stoyanov, Danail
中科院分区：
文献类型：
--
作者：
Mazomenos, Evangelos B.;Chang, Ping-Lin;Stoyanov, Danail
经导管主动脉瓣植入术（TAVI）要求在主动脉解剖结构范围内精确有效地操作手术器械。操作性能和灵巧技能对患者安全至关重要，通过透视视频序列中导管/导丝的运动学分析得出的一些操作特征对客观方法进行评估。12名血管内外科医生分为两个经验组，专家组（）和新手组（），进行主动脉插管，代表TAVI中的瓣膜置入。每个参与者完成了两个TAVI实验，一个使用传统导管，一个使用麦哲伦机器人平台。记录荧光透视监视器的视频序列以进行手术处理。半自动跟踪软件提供了导管/导丝头端的2D坐标。此外，在视频中分割主动脉体模，并使用众包在可用视频帧的子集中手动注释整个导管的形状。TAVI手术分为两个阶段，开发了各种指标，代表导管的整体导航以及导管与血管壁的相对运动。专家始终表现出较低的手术时间和无量纲加加速度值，以及高于新手的平均速度和加速度。机器人导航导致两组中与血管壁的平均距离增加，这是安全性的替代指标，并降低了栓塞风险。通过生成的运动特征和建立的聚类算法实现了经验水平和设备类型的区分，通过分析导管/导丝运动模式可以评估手术技能。使用机器人血管内平台似乎可以实现更精确和受控的导管导航。
Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences.A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts () and novices (), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter's overall navigation as well as its relative movement to the vessel wall, were developed.Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms.Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to enable more precise and controlled catheter navigation.