VIRTUAL PELVIC SURGERY SIMULATOR FOR THE PREVENTION OF SURGICAL ERRORS

用于预防手术错误的虚拟骨盆手术模拟器

基本信息

批准号：
10004033
负责人：
Gary Sutkin
金额：
$ 22.85万
依托单位：
UNIVERSITY OF MISSOURI KANSAS CITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-14 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10004033
关键词：
3-Dimensional 3D Print Address Aging Anatomy Awareness Biomechanics Biomedical Engineering Bladder Blood Transfusion Blood Vessels Catheters Cessation of life Characteristics Chronic Client satisfaction Cognitive Collaborations Colostomy Procedure Competence Complex Computer Models Computer software Data Developed Countries Diagnosis Distress Elbow Excision Exhibits Feedback Female Hand Health Care Costs Hospitals Human Incontinence Individual Injury Intestines Intratracheal Intubation Joints Judgment Knowledge Lead Litigation Magnetic Resonance Imaging Materials Testing Mathematics Measures Methods Minor Surgical Procedures Mission Modeling Morphologic artifacts Motion Motor Movement Operative Surgical Procedures Outcome Patients Pattern Pelvis Perforation Population Prevention Prevention strategy Procedures Process Publishing Quality of life Repeat Surgery Reproducibility Research Residencies Sepsis Shoulder Steel Stress Urinary Incontinence Structure Surgeon Surgical Error Surgical Injuries Surgical Instruments Surgical Models System Technology Testing Training Trocars United States Venous anxious apprenticeship arm base blind bone cost dexterity disability experience external iliac vein high risk human model human tissue improved instrument kinematics mathematical model models and simulation mortality multidisciplinary older women physical model prevent programs reconstruction sensor severe injury simulation spatiotemporal success surgery outcome three-dimensional modeling virtual virtual model wrist motion

项目摘要

Project Summary Surgical errors are commonplace and can have devastating consequences. More than 200 million surgeries occur annually worldwide and, in industrialized countries, preventable complications occur in up to 22% of cases for some procedures. Consequent permanent disability or mortality rates range between 0.4% and 0.8%. Errors can have numerous origins, including cognitive errors of judgment, missing a surgical step, performing them in the wrong order, or simply committing an error in technical execution. These can lead to poor surgical outcomes, poor patient satisfaction, reoperation, and litigation. Most surgeons are well aware of the high-risk steps in a given procedure, yet for most there is no widespread and reliable technology to prevent errors. We propose groundbreaking research in surgical error prevention by developing simulation technology, based on mathematical reconstructions of human tissue that can be utilized for our overall mission, to create a system to identify, model, and prevent surgical errors. To accomplish this, we will use motion analysis and high-fidelity 3-D models to simulate and measure surgical errors. We will analyze errors in a complex, high-risk step of one particular surgery, the midurethral sling (MUS) procedure. This surgery is an ideal choice for modeling individual surgeon error. Approximately 170,000 MUS surgeries are performed annually in the United States, a number that will likely increase given the aging US population. In performing the MUS, the surgeon is tasked with blindly guiding a sharp steel trocar past the bladder, bowel, and major blood vessels, so the surgeon must exhibit excellent bimanual dexterity and the ability to envision a blind 3-D space. If the trocar is not guided properly, complications can turn an elective minor surgery into a costly, protracted hospital course that may involve blood transfusions, a bowel resection, a colostomy, even sepsis and death. Novices are understandably anxious about performing this on a patient. We hypothesize that surgical error from trocar passage in the MUS surgery can be predicted, and thus avoided, by discrete changes in the kinematics of the surgeon’s shoulder, arm, and hand and by the spatio-temporal characteristics of trocar passage. We will create a 3-D pelvic simulator and use motion analysis with sensors to identify and prevent surgical errors during this complex, high-risk step. We will test the hypothesis with the following Aims: Aim 1: Create a high-fidelity pelvic simulator capable of identifying surgical errors involved in one surgery, the midurethral sling. Aim 2: Identify the kinematics of surgeon gross motor movements and of the surgical instrument during simulated trocar passage. Aim 3: Develop virtual surgical feedback software that when added to a printed pelvic simulation model will further reduce novice errors in the Midurethral Sling surgery. Our high-impact research and multi- disciplinary team is revolutionary in its approach to surgical error prevention. Our methods can be applied subsequently to a multitude of high-risk steps in numerous surgeries, and thus has the potential to prevent surgical injury for many patients.

项目摘要手术错误很常见，可能会带来毁灭性的后果。超过2亿手术每年在全球范围内发生，在工业化国家中，可预防的并发症发生在多达22％某些程序的情况。因此的永久残疾或死亡率范围在0.4％至 0.8％。错误可能具有许多起源，包括判断的认知错误，缺少外科手术步骤，以错误的顺序执行它们，或者只是在技术执行中犯了错误。这些可以导致手术结果不佳，患者满意度不佳，重新手术和诉讼。大多数外科医生都知道在给定程序中的高风险步骤，但是对于大多数程序而言，没有宽度和可靠的技术来防止错误。我们通过开发模拟技术，提出了预防手术错误的开创性研究，基于可以用于我们整体任务的人体组织的数学重建，以创建一个识别，建模和预防手术错误的系统。为此，我们将使用运动分析和高保真3-D模型，以模拟和测量手术误差。我们将在复杂的高风险中分析错误一项特定手术的步骤，即尿道吊带（MUS）手术。该手术是理想的选择建模个人外科医生错误。美国每年进行大约170,000次MUS手术鉴于美国老龄化的人口，这一数字可能会增加。在执行MUS时，外科医生是盲目地指导尖锐的钢制套管，经过膀胱，排便和主要血管，所以外科医生必须表现出极好的双歧敏感性和设想盲3D空间的能力。如果套管卡是无法正确引导，并发症可以将选修课的小手术变成昂贵的旷日持久的医院课程这可能涉及输血，肠切除，结肠造成术，甚至败血症和死亡。新手是可以理解的是，要对患者进行此操作。我们假设Trocar的手术误差可以通过离散的运动学变化来预测MUS手术中的通过。外科医生的肩膀，手臂和手，以及套道球通道的时空特征。我们将创建 3-D骨盆模拟器并使用传感器使用运动分析来识别和预防手术错误。复杂的高风险步骤。我们将以以下目的测试假设：目标1：创建高保真骨盆能够识别一项手术中涉及的手术错误的模拟器，即尿道吊带。目标2：识别在模拟套管下，外科医生总运动运动和手术仪器的运动学通道。目标3：开发虚拟手术反馈软件，该软件将其添加到印刷骨盆仿真中时模型将进一步减少尿道吊索手术中的新错误。我们的高影响研究和多纪律团队在预防手术错误的方法方面具有革命性。我们的方法可以应用随后进行了许多手术中的多种高风险步骤，因此有潜力许多患者的手术损伤。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Cognitive models for mentally visualizing a sharp instrument in a blind procedure.

用于在盲法过程中在心理上想象锋利仪器的认知模型。

DOI：
10.1007/s44186-023-00153-1
发表时间：
2023
期刊：
Global surgical education : journal of the Association for Surgical Education
影响因子：
0
作者：
Mueller,Faith;Bachar,Austin;Arif,MdA;King,GregoryW;Stylianou,AntonisP;Sutkin,Gary
通讯作者：
Sutkin,Gary

Reoperation rates of stress incontinence surgery in rural vs urban hospitals.

DOI：
10.1016/j.xagr.2022.100059
发表时间：
2022-08
期刊：
AJOG global reports
影响因子：
0
作者：
Ablatt, Saniya;Wang, Xi;Sahil, Suman;Cheng, An-Lin;Shepherd, Jonathan P;Sutkin, Gary
通讯作者：
Sutkin, Gary

Risk Factors for Returning to the Operating Room for a Second Surgery After Midurethral Sling for Stress Urinary Incontinence.