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[135] Citation: Abstract
Laparoscopic surgical skills evaluation of surgery residents is usually a subjective process, carried out in the operating room by senior
surgeons. By its nature, this process is performed using fuzzy criteria.The objective of the current study was to develop and assess an objectivelaparoscopic
surgical skill scale using Hidden Markov Models (HMM) basedon haptic information, tool/tissue interactions and visual taskdecomposition. Methods: Eight subje
cts (six residents: first year
surgical residents 2xR1, third year surgical residents 2xR3, fifth year
surgical residents 2xR5; and two expert laparoscopic surgeons: 2xES)
performed laparoscopic cholecystectomy following a specific 7 step protocolon a pig. An instrumented laparoscopic grasper equipped with a three-axisforce/torq
ue sensor was used to measure the forces and torques at thehand/tool interface synchronized with a video of the tool operativemaneuvers. A synthesis of frame-
by-frame video analysis was used to define14 different types of tool/tissue interactions, each one associated withunique force/torque (F/T) signatures. HMMs w
ere developed for each subjectrepresenting the surgical skills in terms of haptic information andtool tissue interactions. The statistical distance between th
e HMMSrepresenting residents at different levels of their training and the HMMsof expert surgeons were calculated in order to evaluate the learning curveof sel
ected steps of laparoscopic cholecystectomy. Results: The objectivelaparoscopic surgical skill learning-curve showed significant differencesbetween all skill
levels. The major differences between skill levelswere: (i) magnitudes of F/T applied, (ii) types of tool/tissue interactionsused and with the transition be
tween them, and (iii) time intervalsspent in each tool/tissue interaction and the overall completion time.The HMM analysis showed that the greatest difference
in performance wasbetween R1 and R3 and then decreased as the level of expertise increased.The objective evidence for a learning curve indicates that the surgi
calresidents appear to acquire a major portion of their laparoscopic surgicalcapabilities between the first and the third years of their residency training.
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Updated: Tue Aug 19 09:16:09 2008
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