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)
- I. Introduction
- I.1. Essentials of laparoscopic surgery
- I.2. Psychomotor challenges
- I.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
- I.6. Problem statement and aim of this thesis
- I.7. Thesis outline
- II. Research hypotheses and objectives
- 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
- IV.2.2.2. Stereo alignment
- IV.2.2.3. Three-dimensional correspondence
- IV.2.3. Laparoscopic instrument tracking
- IV.2.4. Technical validation
- IV.3. Results
- IV.3.1. Relative position error
- IV.3.2. Accumulated distance error
- IV.3.3. Face validation
- VI.4. Discussion
- VI.4.1. Chapter conclusions
- Chapter V: Optical pose tracker for assessment of MIS technical skills
- V.1. Introduction
- V.2. Technical validation
- V.2.1. First design
- V.2.1.1. System description
- V.2.1.2. Evaluation tests
- V.2.1.3. Results
- V.2.2. Second design
- V.2.2.1. System description
- V.2.2.2. Evaluation tests
- V.2.2.3. Results
- V.3. Validation for MIS skills assessment
- V.3.1. Experimental validation
- V.3.1.1. Subjects
- V.3.1.2. Tasks
- V.3.2. MIS skills assessment
- V.3.3. Statistical analysis
- V.3.4. Results
- V.3.4.1. Face validation
- V.3.4.2. GOALS exploratory analysis
- V.3.4.3. Construct validation
- V.3.4.4. Correlation between suturing checklist and motion metrics
- V.4. Installing the motion assessment system inside an OR setting
- V.4.1. Analysis of the position of the camera system
- V.4.1.1. Materials and methods
- V.4.1.2. Results
- V.4.2. Feasibility study for the use of the motion analysis method in a OR setting
- V.4.2.1. Materials and methods
- V.4.2.2. Results
- V.5. Discussion
- V.5.1. Chapter conclusions
- Chapter VI: Video-based instrument tracking method
- VI.1. Introduction
- VI.2. Materials
- VI.3. Laparoscopic instrument tracking method
- VI.3.1. Materials and methods
- VI.3.1.1. Compilation of the training images
- VI.3.1.2. Create training sample
- VI.3.1.3. Train the classifier
- VI.3.1.4. Technical validation
- VI.3.2. Results
- VI.3.2.1. Test 1: Accuracy under different working conditions
- VI.3.2.2. Test 2: Accuracy in different training settings
- VI.4. Method to insert multimedia support content
- VI.4.1. Technical validation
- VI.4.2. Results
- VI.5. Discussion
- VI.5.1. Chapter conclusions
- Chapter VII: General discussion
- Chapter VIII: Conclusions and future works
- VIII.1. Research hypotheses’ verification
- VIII.1.1. General hypothesis
- VIII.1.2. First instrument motion analysis method
- VIII.1.3. Second instrument motion analysis method
- VIII.1.4. Third instrument motion analysis method
- VIII.2. Main contributions
- VIII.4. Future works
- VIII.4.1. Concerning the first method based on stereoscopic techniques
- VIII.4.2. Concerning the second method based on an optical pose tracker
- VIII.4.3. Concerning the third method based on a classifier
Zielsetzung und Themenschwerpunkte (Objectives and Key Themes)
The main goal of this PhD work is to develop and validate three new motion analysis methods for laparoscopic instruments, which can be used as a tool to objectively assess MIS technical skills. This is particularly important since traditional subjective assessment methods are no longer adequate for surgical training. The three methods are based on computer vision techniques and are designed to be as non-interfering as possible with the surgical practice. Key themes include:- Objective assessment of MIS technical skills
- Motion analysis of laparoscopic instruments
- Computer vision techniques for surgical applications
- Hybrid laparoscopic simulators
- Visual support for laparoscopic training
Zusammenfassung der Kapitel (Chapter Summaries)
- Chapter I: Introduction provides a foundation for the PhD research, discussing the challenges of training and assessing laparoscopic skills, particularly technical skills. It highlights the need for objective assessment tools to ensure safe and effective laparoscopic surgery. The chapter concludes by outlining the research goals and the structure of the thesis.
- Chapter II: Research hypotheses and objectives outlines the main hypotheses and objectives that drive the PhD research. The general hypothesis proposes that real-time motion analysis of laparoscopic instruments can be used as an assessment tool for MIS technical skills. Specific hypotheses focus on the validity and reliability of three different motion analysis methods, as well as their potential for use in various training settings.
- Chapter III: State of the art reviews the current literature and technological approaches used for the objective evaluation of MIS technical skills. The chapter provides an overview of different types of surgical simulators and discusses the main technologies used for motion analysis of laparoscopic instruments.
- Chapter IV: Laparoscopic hybrid simulator with stereoscopic tracking system presents the design and implementation of a hybrid surgical simulator consisting of a box trainer and a stereoscopic tracking system for laparoscopic instruments. This chapter demonstrates the system's accuracy and explores surgeons' feedback on its usability.
- Chapter V: Optical pose tracker for assessment of MIS technical skills describes the design and validation of a tracking method for laparoscopic instruments based on an optical pose tracker. This chapter analyzes the system's accuracy, construct validity, and concurrent validity, and explores the feasibility of using the system in an OR setting.
- Chapter VI: Video-based instrument tracking method presents a real-time video-based tracking method for laparoscopic instruments that uses only the endoscopic image as its source of information. This chapter describes the development and validation of the tracking method, as well as an assistance system for laparoscopic training that provides visual support content.
Schlüsselwörter (Keywords)
This thesis focuses on the development and evaluation of objective assessment tools for minimally invasive surgery (MIS). The primary keywords include: laparoscopic surgery, technical skills, motion analysis, computer vision, surgical simulators, augmented reality, and image-guided surgery. The work explores the potential of using three different video-based instrument tracking methods as a tool for objective assessment of MIS technical skills.- Arbeit zitieren
- Juan A. Sánchez-Margallo (Autor:in), Francisco M. Sánchez-Margallo (Autor:in), José Moreno del Pozo (Autor:in), Enrique J. Gómez Aguilera (Autor:in), 2014, Methods for laparoscopic instrument tracking and motion analysis for objective assessment of surgical technical skills, München, GRIN Verlag, https://www.grin.com/document/286604
