Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty
Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty
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DOI：
10.1007/s11548-015-1194-1
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发表时间：
2015-06-01
影响因子：
3
通讯作者：
Ishii, Masaru
中科院分区：
文献类型：
--
作者：
Ahmidi, Narges;Poddar, Piyush;Ishii, Masaru
先前使用术中工具运动进行手术技能评估的工作主要集中在高度结构化的手术任务，如胆囊切除术，并使用通用的运动指标，如时间和运动次数。其他统计方法，如隐马尔可夫模型（HMM）和描述曲线编码（DCC）已经成功地用于评估在台式任务中结构化活动的技能。在手术室的非结构化手术任务中，如鼻中隔成形术中的组织剥离，评估技能并为受训者提供有效反馈的方法尚未开发。我们提出了一种方法，通过自动将鼻中隔成形术分割为更高层次的有意义的活动，即中风，为鼻中隔成形术提供描述性结构。这些活动表征了外科医生的工具运动模式。我们从每个手术的笔画序列中构建了一个空间图，并利用其属性来训练分类器来区分专家和新手外科医生。我们将我们的方法与HMM、DCC和基于度量的通用方法的结果进行了比较。我们表明，我们的方法——平均准确率为91%——比这些最先进的方法表现得更好或相同，同时为外科医生提供了对手术过程的直观理解。在本研究中，我们开发并评估了一种自动化方法，以客观评估鼻中隔成形术中非结构化组织剥离任务中的手术技巧。
Previous work on surgical skill assessment using intraoperative tool motion has focused on highly structured surgical tasks such as cholecystectomy and used generic motion metrics such as time and number of movements. Other statistical methods such as hidden Markov models (HMM) and descriptive curve coding (DCC) have been successfully used to assess skill in structured activities on bench-top tasks. Methods to assess skill and provide effective feedback to trainees for unstructured surgical tasks in the operating room, such as tissue dissection in septoplasty, have yet to be developed.We proposed a method that provides a descriptive structure for septoplasty by automatically segmenting it into higher-level meaningful activities called strokes. These activities characterize the surgeon's tool motion pattern. We constructed a spatial graph from the sequence of strokes in each procedure and used its properties to train a classifier to distinguish between expert and novice surgeons. We compared the results from our method with those from HMM, DCC, and generic metric-based approaches.We showed that our method-with an average accuracy of 91 %-performs better or equal than these state-of-the-art methods, while simultaneously providing surgeons with an intuitive understanding of the procedure.In this study, we developed and evaluated an automated approach to objectively assess surgical skill during unstructured task of tissue dissection in nasal septoplasty.