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Minimally Invasive Surgery Task Decomposition - Etymology of Endoscopic Suturing

Minimally Invasive Surgery Task Decomposition - Etymology of Endoscopic Suturing. Jacob Rosen* Ph.D., Lily Chang** MD, Jeff Brown ***, Andy Isch** MD Blake Hannaford* Ph.D., Mika Sinanan** MD Ph.D., Richard Satava** MD * Department of Electrical Engineering ** Department of Surgery

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Minimally Invasive Surgery Task Decomposition - Etymology of Endoscopic Suturing

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  1. Minimally Invasive Surgery Task Decomposition - Etymology of Endoscopic Suturing Jacob Rosen* Ph.D., Lily Chang** MD, Jeff Brown ***, Andy Isch** MD Blake Hannaford* Ph.D., Mika Sinanan** MD Ph.D., Richard Satava** MD * Department of Electrical Engineering ** Department of Surgery *** Department of Bioengineering University of Washington Seattle, Washington

  2. Surgery - The Big Picture Human - Machine Interface Reality Tissue Tool Robot (master-slave) Surgeon Virtual Reality Haptic Device Tissue Tool

  3. Evaluation of Surgical Skill

  4. Surgery - The Hidden Language Metaphor Surgeon Resident Operator Language Language HMI Robot / Tool Tool Patient Target

  5. Surgery - The Hidden Language Elements

  6. Research Aim • Create new quantitative knowledge of the forces and torques (F/T) applied by surgeons to their instruments and the positions and orientations (P/O) of the endoscopic tools during minimally invasive surgery • Develop and evaluate an objective surgical skill scale based multi finite state models (Markov Model) incorporating information regarding the kinematics and the dynamics of the endoscopic tools

  7. Instrumented Endoscopic Grasper

  8. Blue DRAGON

  9. Blue DRAGON

  10. Blue DRAGON - Graphical User Interface

  11. Experimental System VCR (PIP Mode) Mixer PC (A/D) GUI Data Video Blue DRAGON Left Blue DRAGON Right Endoscope 13 (Channels) * 2 (Dragons) = 26 Channels

  12. Experimental Protocol • Surgical Tasks: • Task 1: Running the bowel, 10x3” (right to left) • Task 2: Running the bowel, 10x3” (left to right) • Task 3: Dissecting Mesenteric Vessels, 4x • Task 4: Passing a Suture, 5x • Task 5: Tying a Knot, 4x • Task 6: Suturing the Bowel and Tying a Knot • Task 7: Passing Stomach Fundus behind the Esophagus, 1x • Subjects: 5x (R1, R2, R3, R4, R5, E) - 30 Subjects

  13. Normalized Completion TimeLearning Curve of Surgical Residents

  14. Position (Path) - Raw Data Novice Expert

  15. Normalized Trajectory LengthLearning Curve of Surgical Residents

  16. Forces - Raw Data Novice Expert

  17. Torques - Raw Data Novice Expert

  18. Tool/Tissue-Object Interactions - Taxonomy

  19. F/T Clusters (GR-PS-SW)

  20. Generalized Markov Model of MIS Surgery - One Tool

  21. Generalized Markov Model of MIS Surgery - Two Tools Left Tool Right Tool

  22. Surgeon Non - Surgeon Laparoscopic CholecystectomyExposure of Cystic Duct

  23. Learning Curve - Markov Model Statistical Distance R1 R2 R3 E R5 R4

  24. Normalized Statistical DistanceLearning Curve of Surgical Residents

  25. Subjective Score (Video Analysis) - CriteriaSuturing the Bowel and Tying a Knot • Overall performance [1-5] • Economy of movement [1-5] • Tissue handling [1-5] • Numbers of errors [No.] • Drop needle • Drop suture • Lose suture loop • Break suture • Needle injury to adjacent tissue • Inability to puncture bowel with needle

  26. Normalized Subjective Score (Video Analysis)Learning Curve of Surgical Residents

  27. Correlation Between Subjective and ObjectiveAssessment of Surgical Skill

  28. Conclusions / Application • Analyzing Minimally Invasive Surgery requires a synthesis between visual and haptic information. • Differences between expert and novice surgeons can be defined in terms of: • Force / Torque / Velocity signatures • State transitions / combinations • Time spent in each state • Trajectory (tool tip) length • Good correlation (R2=0.86) between objective (Markov Model) and subjective (video analysis scoring) assessment of surgical skill • The objective methodology for surgical skill evaluation is a modality independent. It can be applied to: • In-vivo surgical conditions • Telerobotic systems • VR haptics simulators

  29. 10Q

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