Simulation based surgical training for high risk low resourced procedures using a novel simulator with smart mentoring

摘要 腹腔镜胆囊切除术医源性并发症的一个重要来源是胆道损伤。 对胆囊管和动脉的错误识别。在每年进行的约750,000例LC中，胆管损伤 发病率高达0.15%，伴随死亡率为20.8%。其中约30%发生在手术过程中 由经验丰富的外科医生进行，他们已经完成了200多例LC手术。的批判观 安全性(CVS)，由美国胃肠道和内窥镜外科医生协会(SAGS)任务建立 FORCE，列出了在LC期间避免胆道损伤的具体程序步骤。关于虚拟现实(VR)的初步数据 在英国和瑞典对CVS的培训表明，它可以减少手术失误。在这 研究我们建议在便携式相机辅助原型上开发和验证VR CVS课程 模拟器(PortCAS)，使用基于Web的交互式、虚拟、智能指导培训协议。这项研究将 由两个具体目标组成。第一个目标是开发PortCAS硬件、软件、虚拟仿真、 以及基于云的交互式智能辅导培训环境。第二个目标是测试 由经验丰富的外科医生虚拟和真实获取CVS的PortCAS培训平台。 利用计算机视觉跟踪腹腔镜术的运动，将功能和低成本结合在一起 工具，弥合低技术模拟器(低保真、无反馈、低成本)和高科技之间的差距 模拟器(高保真、分析最少的一些反馈、高成本)。PortCAS的愿景是提供 自动评估手动或动作模拟(向受训者提供反馈)的成本最低的方法是- 基于任务的。除了腹腔镜手术外，PortCAS还可以扩展到其他许多培训学科。 PortCAS的小尺寸和可移植性使其可用于有指导的智能培训 无论是忙碌的外科医生，还是处于学习曲线任何阶段的实习生，都可以随时随地使用。摄像机跟踪是 在客户端进行，以最大限度地减少延迟，而智能训练算法将位于云中。 这允许远程访问训练方案，并降低了对 客户级别。这一策略是创新的，因为它降低了成本，使轻便的便携式训练设备成为可能 并将学习范例和个人绩效以及量身定制的智能指导集中在云中 服务器。培训将评估在实践中的技术掌握和专家判断方面的进展 外科医生使用手术中的血管痉挛图像。与培训工具箱或视频培训师不同，基于VR的 模拟器将学员暴露在罕见的不良事件中，允许根据个人需求进行定制，允许 对学员表现的细微衡量，并提供非常详细和客观的实时反馈 时间，独立于监狱长。我们期望有效地培训外科医生在术中达到 CVS，使用正常和不寻常的血管胆管解剖模拟，将减少发病率和 医源性胆道损伤造成的死亡率。

ABSTRACT A significant source of iatrogenic complication in laparoscopic cholecystectomy (LC) is biliary injury due to misidentification of the cystic duct and artery. Of the ~750,000 LCs performed annually, bile duct injury occurs in up to 0.15% of cases, with a concomitant mortality rate of 20.8%. Of these ~30% occur in procedures performed by experienced surgeons, who have completed more than 200 LC surgeries. The Critical View of Safety (CVS), established by a Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) task force, lays out specific procedural steps to avoid biliary injury during LC. Preliminary data on virtual reality (VR) training of CVS in the United Kingdom and Sweden have indicated that it results in fewer surgical errors. In this study we propose to develop and validate a VR CVS curriculum on a prototype portable camera aided simulator (PortCAS) using a web-based interactive, virtual, smart mentored training protocol. The study will consist of two specific aims. The first aim is to develop the PortCAS hardware, software, the virtual simulation, and an interactive cloud-based smart mentoring training environment. The second aim is to test the efficacy of the PortCAS training platform on virtual and real obtainment of the CVS by experienced surgeons. PortCAS combines function and low cost by using computer vision to track the motion of laparoscopic tools, bridging the gap between low-tech simulators (low fidelity, no feedback, low cost) and high-tech simulators (high fidelity, some feedback with minimal analytics, high cost). The vision for PortCAS is to provide the least expensive way to automate assessment of simulation (feedback to the trainee) for manual or motion- based tasks. PortCAS can be extended across many other training disciplines besides laparoscopic surgery. The small size and portability of PortCAS makes it available for mentored smart training anywhere/anytime for busy surgeons, and for trainees at any step of the learning curve. Camera tracking is conducted at the client side to minimize latency while the smart training algorithms will be located in the cloud. This allows training regimens to be accessed remotely and reduces the requirements for complexity at the client level. This strategy is innovative in that it reduces the cost, enables a lightweight portable training device and centralizes the learning paradigms and individual performance and tailored smart mentoring in the cloud server. The training will evaluate progress in both technical mastery and expert judgement in practicing surgeons using intra-surgical images of the CVS. Unlike training toolboxes or video trainers, VR-based simulators expose trainees to rare adverse events, allow customization based on individual needs, allow for subtle measurement of the trainee's performance, and provide very detailed and objective feedback in real time, independent of a proctor. We expect that effectively training surgeons in intra-operative attainment of CVS, using both normal and unusual vasculobiliary anatomy simulations, will reduce the incidence and mortality caused by iatrogenic biliary injury.