Safety Instruction and Competency Assessment for Laparoscopy

腹腔镜安全指导和能力评估

• 批准号: 8436912
• 负责人: JORG PETERS
• 金额: $ 20万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-10 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8436912
• 关键词: Address; Advertising; Algorithms; Anatomy; Appendectomy; Awareness; Blinded; Cholecystectomy; Clinical; Code; Collection; Communication; Computer software; Computers; Congresses; Consensus; Critiques; Databases; Development; Devices; E-learning; Education; Educational Curriculum; Environment; Feedback; Funding; Gastric Bypass; Goals; Head; Hour; Institution; Instruction; Internet; Laparoscopic Surgical Procedures; Laparoscopy; Lead; Licensing; Litigation; Location; Measurement; Measures; Medical; Medical Education; Medical center; Modeling; Modification; Online Systems; Operative Surgical Procedures; Output; Pathology; Peer Review; Performance; Physics; Procedures; Published Comment; Publishing; Questionnaires; Randomized; Residencies; Safety; Simulate; Solutions; Specialist; Specificity; Speed; Stomach; Structure; Surgeon; Techniques; Technology; Testing; Time; Tissues; Training; Validation; Variant; Work; base; biliary tract; cohort; cost; empowered; experience; high risk; improved; innovation; insight; portability; scaffold; simulation; spelling; symposium; technology/technique; tool; virtual reality

DESCRIPTION (provided by applicant): Significance Omission of steps, wrong sequencing and excessive force in laparoscopic surgery lead to unnecessary suffering and costly litigation. Due to rapidly advancing techniques, technology and work hour restrictions, only a fraction of the full spectrum of lap procedures and safety concerns can be addressed by current basic dexterity training or by 'see-one-do-one' in the OR. Computer-based training with force-feedback promises to help fill the gap. But commercial products focus on standard cases and do not allow surgeon-educators themselves to select and fine-tune anatomy, pathology and technique. Innovation The proposed authoring environment will broaden the range, deepen the specificity and speed up innovation in computer-based training by enabling surgeon-educators (a) to define their focus and scope via a structured list of surgical steps from which module components are automatically initialized; (b) to fine-tune crucial details that convey surgical expertise, techniqe and insight. This enables growing a rich collection of sharable training modules across a variety of surgical procedures. No similar approach currently exists. - Building on state-of-the-art solutions of tissue physics, GPU-computing and graphics challenges of interactive 3D surgery simulation with force-feedback, this proposal additionally breaks new ground for simulation technology by (a) automatically instantiating modules (instruction pages, VR-scenario, measurement) and (b) enabling surgeons to fine-tune scenarios. Approach (1) For each anatomic/pathological variant of appendectomy, cholecystectomy and gastric bypass, a lead surgeon will draft, and at least three surgeons will critique, a web-based step-by-step list of task and safety issues. In the rare case when no consensus is reached, competing lists and cases are generated. Heads of residency, chief surgeons and a dean for Simulation and Medical Education have signed up to lead the efforts at five institutions. (2) The output, a highly structured list of task and safety issues, enables software to automatically initialize a training module's instructional pages and VR-scenario. This raw module is fine-tuned by the lead author who also sets acceptable performance ranges by executing the VR-simulation. The resulting modules undergo a peer-review cycle. VR-simulation leverages a simulation engine and an extensive database of anatomy and surgical tools developed under R21 funding, published and demonstrated at conferences [35, 37, 34, 14, 57, 58, 79, 56, 44, 36, 76]. (3) The impact of each released module on safety awareness in the OR is measured by a separate small randomized, blinded study at two of the five participating medical centers. (4) The authoring environment and its results will be advertised at major medical conferences (AAMC, ACS CC, ACGME) and its structured code base will be disseminated on the web under the GNU LGP License to encourage broad sharing and enable modification and continued distributed development supported by the stakeholders.

描述（由申请人提供）：腹腔镜手术中的步骤省略、错误顺序和过度用力会导致不必要的痛苦和昂贵的诉讼。由于快速发展的技术，技术和工作时间的限制，只有一小部分的全方位的腹腔镜手术和安全问题可以解决目前的基本灵活性培训或'看一做一'在手术室。基于计算机的力量反馈训练有望帮助填补这一差距。但是商业产品专注于标准病例，不允许外科医生教育者自己选择和微调解剖学、病理学和技术。 创新所提出的创作环境将扩大范围，深化具体性， 通过使外科医生-教育工作者能够（a）确定他们的重点， 和范围;（B）微调传达外科专业知识、技术和洞察力的关键细节。这使得能够在各种外科手术中增加丰富的可共享培训模块集合。目前没有类似的办法。- 基于组织物理学、GPU计算和具有力反馈的交互式3D手术模拟的图形挑战的最新解决方案，该提案通过（a）自动实例化模块（指令页面、VR场景、测量）和（B）使外科医生能够微调场景，为模拟技术开辟了新天地。 方法（1）对于阑尾切除术、胆囊切除术和胃切除术的每种解剖/病理变异 旁路手术时，一名主刀医生将起草一份基于网络的步骤列表，至少有三名外科医生将进行评论 任务和安全问题。在极少数情况下，当没有达成共识时，就会产生相互竞争的名单和案件。住院医师负责人、首席外科医生以及模拟和医学教育院长已签约领导五个机构的工作。(2)输出，一个高度 任务和安全问题的结构化列表，使软件能够自动初始化培训模块的指导页面和VR场景。该原始模块由主要作者进行微调，主要作者还通过执行VR模拟来设置可接受的性能范围。由此产生的模块经过一个同行审查周期。VR模拟利用了模拟引擎和在R21资助下开发的解剖结构和手术工具的广泛数据库，并在会议上发表和演示[35，37，34，14，57，58，79，56，44，36，76]。(3)通过在五个参与医疗中心中的两个进行的单独小型随机、设盲研究，测量每个发布模块对手术室安全意识的影响。(4)创作环境及其结果将在主要的医学会议（AAMC，ACS CC，ACGME）上进行宣传，其结构化代码库将在GNU LGP许可证下在Web上传播，以鼓励广泛共享，并在利益相关者的支持下进行修改和持续的分布式开发。