Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon
Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon
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DOI：
10.1007/s00464-016-5213-2
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发表时间：
2017-05-01
影响因子：
3.1
通讯作者：
Nickel, Felix
中科院分区：
文献类型：
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作者：
Kowalewski, Karl-Friedrich;Hendrie, Jonathan D.;Nickel, Felix
由于学习曲线陡峭，手术室外的培训和评估对于微创手术至关重要。因此，我们开发并验证了基于传感器和专家模型的腹腔镜训练系统iSurgeon。不同经验水平的参与者（新手，中级，专家）进行了四个标准化的腹腔镜结。仪器和外科医生的关节运动由NDI北极星相机和微软Kinect v1跟踪。通过逐帧图像分析，识别出缝合和打结的关键步骤，并与运动数据进行配准。分析构念效度、并发效度和重测信度。采用客观结构化技术技能评估（OSATS）作为并发效度的金标准。系统显示之间的歧视建构效度等参数经验层次的时间(新手= 442.9 + / - 238.5年代;中间= 190.1 + / - 50.3年代;专家= 115.1 + / - 29.1 s, p < 0.001),总路径长度(新手= 18817 + / - 10318毫米;中间= 9995 + / - 3286毫米;专家= 7265 + / - 2232毫米;p < 0.001),平均速度(新手= 42.9 + / - 8.3 mm / s;中间= 52.7 + / - 11.2 mm / s;专家= 63.6 + / - 12.9 mm / s, p < 0.001),角路径(新手= 20573 + / - 12611度;中间= 8652 +/- 2692A度；专家= 5654 +/- 1746A度；P < 0.001)，动作数（新手= 2197 +/- 1405，中级= 987 +/- 367，专家= 743 +/- 238,P < 0.001），每秒动作数（新手= 5.0 +/- 1.4，中级= 5.2 +/- 1.5，专家= 6.6 +/- 1.6,P = 0.025），关节角度范围（不同轴和关节均P < 0.001）。建立了OSATS和iSurgeon参数的并发有效性。给出了8个参数中的7个参数的重测信度。关键步骤“将线绕在仪器上”和“定位针”是最难学习的。验证了自主开发的基于传感器和专家模型的腹腔镜培训系统“iSurgeon”的有效性和可靠性。实验证明，使用多个参数比使用单一度量参数更可靠。针绕线包裹和针定位是腹腔镜缝合打结的关键难点。iSurgeon可以基于专家模型生成自动实时反馈，这可能会缩短腹腔镜任务的学习曲线。我们的下一步将是在实验模型中实施和评估全程序培训。
Training and assessment outside of the operating room is crucial for minimally invasive surgery due to steep learning curves. Thus, we have developed and validated the sensor- and expert model-based laparoscopic training system, the iSurgeon.Participants of different experience levels (novice, intermediate, expert) performed four standardized laparoscopic knots. Instruments and surgeons' joint motions were tracked with an NDI Polaris camera and Microsoft Kinect v1. With frame-by-frame image analysis, the key steps of suturing and knot tying were identified and registered with motion data. Construct validity, concurrent validity, and test-retest reliability were analyzed. The Objective Structured Assessment of Technical Skills (OSATS) was used as the gold standard for concurrent validity.The system showed construct validity by discrimination between experience levels by parameters such as time (novice = 442.9 +/- 238.5 s; intermediate = 190.1 +/- 50.3 s; expert = 115.1 +/- 29.1 s; p < 0.001), total path length (novice = 18,817 +/- 10318 mm; intermediate = 9995 +/- 3286 mm; expert = 7265 +/- 2232 mm; p < 0.001), average speed (novice = 42.9 +/- 8.3 mm/s; intermediate = 52.7 +/- 11.2 mm/s; expert = 63.6 +/- 12.9 mm/s; p < 0.001), angular path (novice = 20,573 +/- 12,611A degrees; intermediate = 8652 +/- 2692A degrees; expert = 5654 +/- 1746A degrees; p < 0.001), number of movements (novice = 2197 +/- 1405; intermediate = 987 +/- 367; expert = 743 +/- 238; p < 0.001), number of movements per second (novice = 5.0 +/- 1.4; intermediate = 5.2 +/- 1.5; expert = 6.6 +/- 1.6; p = 0.025), and joint angle range (for different axes and joints all p < 0.001). Concurrent validity of OSATS and iSurgeon parameters was established. Test-retest reliability was given for 7 out of 8 parameters. The key steps "wrapping the thread around the instrument" and "needle positioning" were most difficult to learn.Validity and reliability of the self-developed sensor-and expert model-based laparoscopic training system "iSurgeon" were established. Using multiple parameters proved more reliable than single metric parameters. Wrapping of the needle around the thread and needle positioning were identified as difficult key steps for laparoscopic suturing and knot tying. The iSurgeon could generate automated real-time feedback based on expert models which may result in shorter learning curves for laparoscopic tasks. Our next steps will be the implementation and evaluation of full procedural training in an experimental model.