Clark James, Orihuela-Espina Felipe, Sodergren Mikael, James David Rc, Karimyan Vahe, Teare Julian, Darzi Ara, Yang Guang-Zhong
Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
Minim Invasive Ther Allied Technol. 2013 Feb;22(1):17-25. doi: 10.3109/13645706.2012.691638. Epub 2012 Jun 4.
The drive to perform procedures with the least impact on the patient has meant that interest in natural orifice translumenal endoscopic surgery (NOTES) continues to proliferate. However, endoscope control within the extralumenal environment remains a significant challenge. This study aims to define a method to quantitatively assess endoscopic torque control as an indication of performance.
Fourteen endoscopists performed a ten-target navigational task within a simulated NOTES environment whilst wrist movements were tracked with an optical motion tracker. Patterns of wrist movements were translated to a binary form enabling differentiation of the specified movement from no movement. Three patterns were discernable suggesting the discrimination of purposeful over random manipulations. Three independent assessors scored 140 patterns on a scale of 1 to 3 determined by which pattern was the most appropriate fit.
Mean score for novices was 16 (± 3) and for clinicians 22 (± 7). Inter-rater reliability (kappa statistic function) between the assessors ranged from 0.637 to 0.751 p < 0.001 referred to as a substantial assessment tool. The internal consistency between all variables using Chronbach's alpha function was 0.948 (p < 0.001).
Pattern of movements extrapolated from the wrist can be used as a method of measuring endoscope torque control during a translumenal navigation task.
以对患者影响最小的方式实施手术的需求意味着，对自然腔道内镜手术（NOTES）的兴趣持续增长。然而，在腔外环境中控制内镜仍然是一项重大挑战。本研究旨在确定一种定量评估内镜扭矩控制的方法，以此作为性能的指标。
14名内镜医师在模拟NOTES环境中执行一项有10个目标的导航任务，同时用光学运动追踪器跟踪腕部动作。腕部动作模式被转化为二进制形式，以便区分特定动作与无动作。可识别出三种模式，表明能够区分有目的操作和随机操作。三名独立评估者根据最符合的模式，对140种模式进行1至3分的评分。
新手的平均得分为16（±3）分，临床医生为22（±7）分。评估者之间的评分者间信度（kappa统计函数）范围为0.637至0.751，p<0.001，被称为一种有效的评估工具。使用Chronbach's alpha函数计算的所有变量之间的内部一致性为0.948（p<0.001）。
从腕部推断出的动作模式可作为在腔道内导航任务中测量内镜扭矩控制的一种方法。
