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[166] Citation: J. Rosen, L. Chang, J. D. Brown, B. Hannaford, M. Sinanan, R. Satava,
'Minimally Invasive Surgery Task Decomposition - Etymology of EndoscopicSuturing,'
Studies in Health Technology and Informatics - Medicine Meets Virtual Reality, vol. 94, pp. 295-301, IOS Press, Newport Beach, CA, January 2003.
Abstract
The analogy between Minimally Invasive Surgery (MIS) and the human language
inspires the decomposition of a surgical task into its primary
elements. The frequency of different elements or "words" and their sequential
associations or "grammar" both hold critical information about
the process and outcome of the procedure. Modeling these sequential element
expressions using a multi finite states model (Markov model)
reveals the grammatical structure of the surgical task and is utilized as one of
the key steps in objectively assessing surgical
performance. The experimental protocol included 30 surgeons at different levels
of training (5xR1,R2,R3,R4,R5, and experts) performing
Laparoscopic suturing on an animal model (pig). The kinematics and dynamics of
left and right endoscopic tools along with the visual view of
the surgical scene were acquired by the Blue DRAGON system. The methodology of
decomposing the surgical task is based on a fully connected,finite-states
(30 states) Markov model (MM) where the left and right hands arerepresented
by 15 states each. In addition to the MM
objective analysis, a scoring protocol was used by an expert surgeon to
subjectively assess the subjects' technical performance. An
objective learning curve was defined based on measuring quantitative statistical
distance (similarity) between MM of experts and MM of
residents at different levels of training. The objective learning curve
(e.g.statistical distance between MM) was similar to that of the
subjective performance analysis. The MM proved to be a powerful and compact
mathematical model for decomposing a complex task such as
laparoscopic suturing. Systems like surgical robots or virtual reality
simulators that inherently measure the kinematics and dynamics of the
surgical tool may benefit from inclusion of the proposed methodology for
analysis of efficacy and objective evaluation of surgical skills
during training.
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