Markov Modeling of Minimally Invasive Surgery Based on Tool/Tissue Interaction and Force/Torque Signatures for Evaluating Surgical Skills

Rosen, J. and Hannaford, B. and Richards, C. and Sinanan, M. (2001) Markov Modeling of Minimally Invasive Surgery Based on Tool/Tissue Interaction and Force/Torque Signatures for Evaluating Surgical Skills. IEEE Transactions on Biomedical Engineering, 48 (5). pp. 579-591.

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Abstract

The best method of training for laparoscopic surgical skills is controversial. Some advocate observation in the operating room, while others promote animal and simulated models or a combination of surgery-related tasks. A crucial process in surgical education is to evaluate the level of surgical skills. For laparoscopic surgery, skill evaluation is traditionally performed subjectively by experts grading a video of a procedure performed by a student. By its nature, this process uses fuzzy criteria. The objective of the current study was to develop and assess a skill scale using Markov Models (MM). Ten surgeons (5 Novice Surgeons - NS; 5 Expert Surgeons - ES) performed a cholecystectomy and Nissen fundoplication in a porcine model. An instrumented laparoscopic grasper equiped with a three-axis force/torque sensor was used to measure the forces/torques (F/T) at the hand/tool interface synchronized with a video of the tool operative maneuvers. A synthesis of frame-by-frame video analysis and a vector quantization algorithm, allowed to define force/torque signatues associated with 14 different types of tool/tissue interactions. The magnitude of F/T applied by NS and ES were significantly different (p<0.05) and varied based on the task being performed. High F/T magnitudes were applied by NS compared to ES while performing tissue manipulation and vise versa in tasks involved tissue dissection. From each step of the surgical procedures, two MM were developed representing the performance of 3 surgeons out of the 5 in the ES and NS groups. The data obtained by the remaining 2 surgeons in each group were used for evaluating the performance scale. The final result was a surgical performance index which represented a ratio of statistical similarity between the examined surgeon's MM and the MM of NS and ES. The difference between the performance index value, for a surgeon under study, and the NS/ES boundary, indicated the level of expertise in the surgeon's own group. Using this index, 87.5 of the surgical procedures were correctly classified into the NS and ES groups. The 12.5 of the procedures that were misclassified were performed by the ES and classified as NS. However, in these cases the performance index values were very close to the NS/ES boundary. Preliminary data suggest that a performance index values were very close to the NS/ES boundary. Preliminary data suggest that a performance index based on MM and force/torque signatures provides an objective means of distinguishing NS from ES. In addition, this methodology can be furthere applied to evaluate haptic virtual reality surgical simulators for improving realism in surgical education.

Item Type: Article
Subjects: Z Other
Divisions: Department of Bioengineering
Depositing User: Mohammad Haghighipanah
Date Deposited: 30 Jul 2015 17:58
Last Modified: 30 Jul 2015 17:58
URI: http://brl.ee.washington.edu/eprints/id/eprint/230

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