Measurement of Nontechnical Skills During Robotic-Assisted Surgery Using Sensor-Based Communication and Proximity Metrics.
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ABSTRACT:
SUBMITTER: Cha JS
PROVIDER: S-EPMC8564574 | biostudies-literature | 2021 Nov
REPOSITORIES: biostudies-literature
Publications
Measurement of Nontechnical Skills During Robotic-Assisted Surgery Using Sensor-Based Communication and Proximity Metrics.
Cha Jackie S JS Athanasiadis Dimitrios D Anton Nicholas E NE Stefanidis Dimitrios D Yu Denny D
JAMA network open 20211101 11
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Project description:IntroductionA surgeon's technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique opportunity to develop objective metrics using key elements of intraoperative surgeon behavior which can be captured unobtrusively, such as instrument positions and button presses. Recent studies have shown that objective metrics based on these data (referred to as objective performance indicators [OPIs]) correlate to select clinical outcomes during robotic-assisted radical prostatectomy. However, the current OPIs remain difficult to interpret directly and, therefore, to use within structured feedback to improve surgical efficiencies.MethodsWe analyzed kinematic and event data from da Vinci surgical systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to calculate values that can summarize the use of robotic instruments, referred to as OPIs. These indicators were mapped to broader technical skill categories of established training protocols. A data-driven approach was then applied to further sub-select OPIs that distinguish skill for each technical skill category within each training task. This subset of OPIs was used to build a set of logistic regression classifiers that predict the probability of expertise in that skill to identify targeted improvement and practice. The final, proposed feedback using OPIs was based on the coefficients of the logistic regression model to highlight specific actions that can be taken to improve.ResultsWe determine that for the majority of skills, only a small subset of OPIs (2-10) are required to achieve the highest model accuracies (80-95%) for estimating technical skills within clinical-like tasks on a porcine model. The majority of the skill models have similar accuracy as models predicting overall expertise for a task (80-98%). Skill models can divide a prediction into interpretable categories for simpler, targeted feedback.ConclusionWe define and validate a methodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.
| S-EPMC7768128 | biostudies-literature
Project description: Not available
| S-EPMC8317860 | biostudies-literature
Project description:BackgroundNon-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams' NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS.MethodologyStepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool-RAS-NOTECHS-was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations).ResultsOur scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement.ConclusionsRAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries.
| S-EPMC8505574 | biostudies-literature
Project description: Not available
| S-EPMC6482865 | biostudies-literature
Project description:BACKGROUND:Robotic surgery presents a challenge to effective teamwork and communication in the operating theatre (OR). Our objective was to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery. METHODS AND FINDINGS:A prospective controlled trial of team members participating in gynecologic and urologic robotic procedures between January and March 2015. In the first phase, all surgeries were performed without headsets (control), followed by the intervention phase where all team members used the wireless headsets. Noise levels were measured during both phases. After each case, all team members evaluated the quality of communication, performance, teamwork and mental load using a validated 14-point questionnaire graded on a 1-10 scale. Higher overall scores indicated better communication and efficiency. Clinical and surgical data of all patients in the study were retrieved, analyzed and correlated with the survey results. The study included 137 procedures, yielding 843 questionnaires with an overall response rate of 89% (843/943). Self-reported communication quality was better in cases where headsets were used (113.0 ± 1.6 vs. 101.4 ± 1.6; p < .001). Use of headsets reduced the percentage of time with a noise level above 70 dB at the console (8.2% ± 0.6 vs. 5.3% ± 0.6, p < .001), but had no significant effect on length of surgery nor postoperative complications. CONCLUSIONS:The use of wireless headset devices improved quality of communication between team members and reduced the peak noise level in the robotic OR.
| S-EPMC6953850 | biostudies-literature
Project description:Inductive proximity sensors (IPSs) present a unique no-contact advantage. They are widely preferred for displacement measurement in various industrial fields (e.g., aviation and aerospace), and they are improved continuously. When the inductance and resistance components of the IPS sensing core are separated, the influence of temperature drift on measurement can be eliminated. The complexity of online computation of component separation can be reduced using a two-dimensional look-up table method. However, this method exhibits disadvantages, such as large capacity of the look-up table, dependency on precision measurement of sensing core parameter, and nonlinear distribution of measurement resolution. This study aims to overcome these disadvantages by examining the nonlinear relationship between the response of the sensing core and the ambient temperature, and proposes a dimension-reduced measurement method. The proposed method extracts the characteristics of the response curves at two temperatures and calculates the characteristics of the response curves at any temperature using a linear approximation. The look-up table capacity is less than 0.37% of the two-dimensional look-up table capacity (condensed) under the same condition; dimension reduction enables the construction of a complete look-up table directly by calibration procedures and avoids precise measurement on sensing core parameters; the calibration procedures establish uniform mapping of the distribution of measurement resolution. The experiment shows that, when the measurement ranges are 0-6, 0-5, and 0-4 mm, the maximum measurement errors are 0.140, 0.065, and 0.040 mm, respectively, under temperature ranging from 20 ∘ C to 110 ∘ C. This study extends the measurement range from 0-5 mm to 0-7 mm and improves the measurement accuracy over 0.1 mm (50% at 5 mm) compared with the two-dimensional look-up table method. Therefore, the proposed method not only inherits the advantages of the original method but also achieves the above-mentioned expected capacity improvements effectively.
| S-EPMC5539794 | biostudies-other
Project description:Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.
| S-EPMC10818539 | biostudies-literature
Project description:ObjectiveThere is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).MethodsUsing a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.ResultsCorrelations with other competence rating scales were high (rs > 0.86-0.89). The intraclass correlations ranged between moderate and good [ICC(2,2) = 0.65-0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91-95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).ConclusionThe CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.
| S-EPMC9596765 | biostudies-literature
Project description:BackgroundThe aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery.MethodsWe reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH.ResultsWe found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033.ConclusionsRA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.
| S-EPMC7947528 | biostudies-literature
Project description: Not available
| S-EPMC8667107 | biostudies-literature