Safety Instruction and Competency Assessment for Laparoscopy

描述(申请人提供)：重要的遗漏步骤，错误的顺序和过度的力量在腹腔镜手术中会导致不必要的痛苦和昂贵的诉讼。由于快速发展的技术、技术和工作时间限制，仅有一小部分完整的圈速程序和安全问题可以通过目前的基本灵巧性训练或通过在手术室进行的“见一做一”来解决。基于计算机的培训和力量反馈有望帮助填补这一空白。但商业产品专注于标准病例，不允许外科医生教育人员自己选择和微调解剖学、病理学和技术。 创新建议的创作环境将拓宽范围，加深专门性和 通过使外科医生-教育者(A)能够确定他们的重点，加快基于计算机的培训的创新 并通过手术步骤的结构化列表自动初始化模块组件；(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程序中增加丰富的可共享培训模块集合。目前还没有类似的方法。-建立在具有力反馈的交互式3D手术模拟的组织物理、GPU计算和图形挑战的最先进解决方案的基础上，这项建议还通过(A)自动实例化模块(说明页、VR-Scenario、测量)和(B)使外科医生能够微调情景，为模拟技术开辟了新的天地。 方法(1)针对阑尾切除、胆囊切除和胃切除的每种解剖/病理变体 分流手术，一名首席外科医生将起草，至少三名外科医生将进行批评，这是一个基于网络的循序渐进的列表 任务和安全问题。在极少数情况下，没有达成共识，就会产生相互竞争的清单和案例。住院医师、首席外科医生和模拟与医学教育的一名院长已经签约，将领导五所机构的工作。(2)产量高，产量高 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和VR场景。这一原始模块由首席作者微调，他还通过执行VR模拟设置了可接受的性能范围。由此产生的模块经历了同行审查周期。VR-SIMULATION利用模拟引擎和在R21资助下开发的解剖和手术工具的广泛数据库，在会议上发表和演示[35，37，34，14，57，58，79，56，44，36，76]。(3)通过在五个参与的医疗中心中的两个进行单独的小型随机、盲法研究来衡量每个发布的模块对OR中的安全意识的影响。(4)编写环境及其结果将在主要医学会议(AAMC、ACS CC、ACGME)上公布，其结构化代码库将根据GNU LGP许可证在网络上传播，以鼓励广泛共享，并使修改和持续分布式开发能够得到利益相关者的支持。

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.