The kinematics and the dynamics of Minimally Invasive surgery - Objective assessment of surgical Performance Using Markov Models

Abstract

Minimally invasive surgery (MIS) involves a multi-dimensional series of tasks requiring a synthesis between visual information and the kinematics and dynamics of the surgical tools. Analysis of these sources of information is a key step in mastering MIS surgery but may also be used to define objective criteria for characterizing surgical performance. The BlueDRAGON is a new system for acquiring the kinematics and the dynamics of two endoscopic tools along with the visual view of the surgical scene. It includes two four-bar mechanisms equipped with position and force torque sensors for measuring the positions and the orientations (P/O) of two endoscopic tools along with the forces and torques (F/T) applied by the surgeon's hands. The methodology of decomposing the surgical task is based on a fully connected, finite-states (28 states) Markov model where each states corresponded to a fundamental tool/tissue interaction based on the tool kinematics and associated with unique F/T signatures. The experimental protocol included seven MIS tasks performed on an animal model (pig) by 30 surgeons at different levels of their residency training. Preliminary analysis of these data showed that major differences between residents at different skill levels were: (i) the types of tool/tissue interactions being used, (ii) the transitions between tool/tissue interactions being applied by each hand, (iii) time spent while performing each tool/tissue interaction, (iv) the overall completion time, and (v) the variable F/T magnitudes being applied by the subjects through the endoscopic tools. Systems like surgical robots or virtual reality simulators that inherently measure the kinematics and the 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

The BlueDRAGON system integration into a minimally invasive surgery setup

The BlueDRAGON system integration into a minimally invasive surgery setup -Overview
MPG Video Clip (2.5M)

The BlueDRAGON graphical user interface incorporating real-time data with the visual view of the endoscope
MPG Video Clip (5.2M)

The BlueDRAGON CAD rendering
MPG Video Clip (7.8M)

Instrumented Endoscopic Tool (IET)

BlueDRAGON

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Rosen J., J. D. Brown, L. Chang, M. Sinanan B. Hannaford, Generalized Approach for Modeling Minimally Invasive Surgery as a Stochastic Process Using a Discrete Markov Model, IEEE Transactions on Biomedical Engineering Vol. 53, No. 3, March 2006, pp. 399 - 413

[155]
J. Rosen, J.D. Brown, M. Barreca, L. Chang, B. Hannaford, M. Sinanan, 'The Blue DRAGON - A system for Monitoring the Kinematics and Dynamics of Endoscopic Tools in Minimally Invasive Surgery for Objective Laparoscopic Skill Assessment,' Studies in Health Technology and Informatics - Medicine Meets Virtual Reality, vol. 85, pp. 412-418, IOS Press, Newport Beach, CA, January 2002.

[157]
J. Rosen, J.D. Brown, L. Chang, M. Barreca, M. Sinanan, B. Hannaford, 'The BlueDRAGON - A System for Measuring the Kinematics and the Dynamics of Minimally Invasive Surgical Tools In Vivo,' Proc. Intl. Conf. on Robotics and Automation ICRA-2002, pp. 1876-1881, Arlington VA, May, 2002.