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[161] Citation: Abstract
Objective: Evaluation of the laparoscopic surgical skills of surgical
residents is usually a subjective process carried out in the operating room by
senior surgeons. The two hypotheses of the
current study were: (1) haptic information and tool/tissue interactions
(types and transitions) performed
in laparoscopic surgery are skill-dependent, and (2) statistical models
(Hidden Markov Models, HMMs) incorporating these data are capable of objectively
evaluating laparoscopic surgical skills.
Materials and Methods: Eight subjects (six residentstwo first-year
(R1), two third-year (R3), and two fifth-year (R5)and two expert laparoscopic
surgeons) performed laparoscopic cholecystectomy
on pigs using an instrumented grasper equipped with force/torque (F/T)
sensors at the hand/tool interface, and F/T data was synchronized with video of
the operative maneuvers. Fourteen types of tool/tissue (T/T) interactions, each
associated with unique F/T
signatures, were defined from frame-by-frame video analysis. HMMs for each
subject and step of
the operation were compared to evaluate the statistical distance between expert
surgeons and
residents with different skill levels.
Results: The statistical distances between HMMs representing expert
surgeons and residents
were significantly different (alpha < 0.05). Major differences occurred
in: (1) F/T magnitudes; (2)
type of T/T interactions and transitions between them; and (3) time
intervals for each T/T interaction
and overall completion time. The greatest difference in performance was
between R1 (junior
trainee) and R3 (midlevel trainee). Smaller changes were seen as
expertise increased beyond the R3 level.
Conclusion: HMMs incorporating haptic and visual information provide an
objective tool for
evaluating surgical skills. Objective evidence for a learning curve
suggests that surgical residents
acquire a major portion of their laparoscopic skill between year 1 and
year 3 of training.
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Updated: Tue Jul 15 23:54:51 2008
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