Methods for laparoscopic instrument tracking and motion analysis for objective assessment of surgical technical skills

Tesis Doctoral / Disertación , 2014 , 208 Páginas , Calificación: Excellent "cum laude"

Medicina - Ingeniería biomédica

Minimally invasive surgery (MIS) has become in many surgical specialties and procedures the gold-standard choice due to its efficiency and benefits towards patient safety. However, the introduction of laparoscopic surgery has led to the need of developing new surgical skills different to those required for open surgery, with a significant learning curve to perform a safe laparoscopic surgery. Traditional subjective assessment methods of trainees are no longer adequate for surgical training. Reduced working hours as well as demands from surgeons and associations mean that more objective assessment tools that can accredit surgeons as technically competent are required.
Evidence exists to validate motion analysis for laparoscopic technical skills assessment. Motion analysis of the laparoscopic instruments seeks to determine aspects that indicate the difference between surgeon's level of surgical dexterity. However, at the moment there is not an extended method to be used with current available training systems used in training laboratories as well as for the OR.
The purpose of this book is to present the design, development and validation of three novel motion analysis methods focused on the use of real laparoscopic instruments during laparoscopic performance. These methods are based on computer vision techniques attempting to not interfere with the surgical practice. They are introduced in an evolutionary way from methods for exclusive use in a box trainer to solutions with the potential of being used in actual OR setting.
Overall, this work corroborates the research hypothesis regarding the use of three different video-based tracking technologies for motion analysis of laparoscopic instruments, the use of instrument motion analysis for MIS technical skills assessment and the relationship between motion-related assessment metrics and quality of technical performance in laparoscopic training. These presented methods provide a tool to objectively assess MIS technical performance and a support to train novice surgeons in MIS techniques. The findings of this work encourage us to continue researching in improving these methods to be introduced as part of an actual laparoscopic training program, both inside and outside the OR.

Inhaltsverzeichnis (Table of Contents)

• SUMMARY
• RESUMEN
• I. Introduction
  • I.1. Essentials of laparoscopic surgery
  • 1.2. Psychomotor challenges
  • 1.3. Skills to be a proficient surgeon
  • I.4. Evolution of surgical education
    • I.4.1. Traditional surgical learning
    • I.4.2. New surgical learning approaches
  • I.5. Objective assessment methods
    • I.5.1. Structured rating systems for objective evaluation
      • I.5.1.1. Rating scales
      • I.5.1.2. Assessment programmes
    • I.5.2. Instrument motion analysis
    • I.5.3. A good assessment tool
• II. Research hypotheses and objectives
  • 1.6. Problem statement and aim of this thesis
  • I.7. Thesis outline
  • II.1. Research hypotheses
    • II.1.1. First instrument motion analysis method
    • II.1.2. Second instrument motion analysis method
    • II.1.3. Third instrument motion analysis method
  • II.2. Objectives
    • II.2.1. General objective
    • II.2.2. Specific objectives
• III. State of the art
  • III.1. Introduction
  • III.2. Surgical simulators
    • III.2.1. Physical simulators or box trainers
    • III.2.2. Virtual simulators
    • III.2. 3. Hybrid simulators
  • III.3. Objective assessment methods based on motion analysis
    • III.3.1. Extracorporeal methods
    • III.3.2. Intracorporeal methods
• Chapter IV: Laparoscopic hybrid simulator with stereoscopic tracking system
  • IV.1. Introduction
  • IV.2. Material and methods
    • IV.2.1. System description
    • IV.2.2. Stereo vision system
      • IV.2.2.1. System calibration
        • Image distortion
        • Stereo calibration
      • IV.2.2.2. Stereo alignment
      • IV.2.2.3. Three-dimensional correspondence
    • IV.2.3. Laparoscopic instrument tracking
    • IV.2.4. Technical validation

Zielsetzung und Themenschwerpunkte (Objectives and Key Themes)

This thesis presents a comprehensive study on the development and validation of novel methods for laparoscopic instrument tracking and motion analysis. The primary objective is to contribute to the advancement of objective assessment tools for surgical technical skills in laparoscopic surgery. The research focuses on developing and evaluating three distinct instrument motion analysis methods, each utilizing different technologies and approaches. The study aims to provide a robust and reliable framework for assessing surgical performance, ultimately contributing to the improvement of surgical training and patient safety.

• Development of novel methods for laparoscopic instrument tracking and motion analysis
• Objective assessment of surgical technical skills in laparoscopic surgery
• Validation of instrument motion analysis methods for surgical skill assessment
• Contribution to the advancement of surgical training and patient safety
• Exploration of the potential of hybrid simulators for surgical skill training and assessment

Zusammenfassung der Kapitel (Chapter Summaries)

The introduction provides a comprehensive overview of laparoscopic surgery, highlighting its advantages and challenges. It delves into the importance of psychomotor skills for proficient surgeons and explores the evolution of surgical education, including traditional and new learning approaches. The chapter also discusses the limitations of subjective assessment methods and the need for objective tools, particularly instrument motion analysis. The research hypotheses and objectives are outlined, emphasizing the development and validation of three distinct instrument motion analysis methods. The state-of-the-art section reviews existing surgical simulators and objective assessment methods based on motion analysis, providing a context for the proposed research. Chapter IV presents a detailed description of a laparoscopic hybrid simulator with a stereoscopic tracking system, outlining its design, calibration, and technical validation. The chapter focuses on the development of the first instrument motion analysis method, utilizing a stereo vision system for tracking instrument movements. The subsequent chapters delve into the development and validation of the remaining two instrument motion analysis methods, exploring different technologies and approaches. The thesis concludes with a discussion of the findings, implications for surgical training and assessment, and future research directions.

Schlüsselwörter (Keywords)

The keywords and focus themes of the text include laparoscopic surgery, surgical skills, instrument tracking, motion analysis, objective assessment, surgical simulators, hybrid simulators, stereo vision, technical validation, surgical training, and patient safety. The research explores the development and validation of novel methods for laparoscopic instrument tracking and motion analysis, aiming to contribute to the advancement of objective assessment tools for surgical technical skills. The study focuses on the use of hybrid simulators and different technologies, including stereo vision, for tracking instrument movements and evaluating surgical performance.

• Calificación: Excellent "cum laude"
• Autores: Juan A. Sánchez-Margallo (Autor), Francisco M. Sánchez-Margallo (Autor), José Moreno del Pozo (Autor), Enrique J. Gómez Aguilera (Autor)
• Año de publicación: 2014
• Páginas: 208
• No. de catálogo: V286604
• ISBN (Ebook): 9783656922681
• ISBN (Libro): 9783656922698
• Idioma: Inglés
• Etiqueta: laparoscopic instrument tracking, motion analysis, assessment surgical skills, methods, medicine, information science, surgery