Sodergren Mikael H, Warren Alexander, Nehme Jean, Clark James, Gillen Sonja, Feussner Hubertus, Teare Julian, Darzi Ara, Yang Guang-Zhong
1Imperial College, South Kensington Campus, London, UK.
Surg Innov. 2014 Feb;21(1):74-9. doi: 10.1177/1553350613489187. Epub 2013 May 16.
Spatial orientation in natural orifice translumenal endoscopic surgery (NOTES) has been identified as a potential barrier to clinical application. We aim to evaluate a triaxial inertial sensor and software that automatically corrects any movements on the roll axis of the flexible endoscope, allowing for stabilization of the image horizon during NOTES operations in a randomized controlled trial.
A total of 18 participants (11 surgeons/7 gastroenterologists) performed a transgastric task in the ELITE simulator, which included navigation to the appendix and gallbladder, diathermy of the appendix base and gallbladder fossa, and clipping of the cystic duct using a single-channel gastroscope. Each participant performed the task twice with randomization to horizon stabilization occurring at the second attempt. The primary end point was change in overall performance (time taken and errors made) between the first and second attempt, and secondary end points were absolute performances in the second attempt and subjective evaluation.
Without horizon stabilization, there was a median improvement of 42.4% in time taken and 38% in number of errors made from the first to the second attempt; however, with the software turned on, there was a statistically significant deterioration of 4.9% (P = .038) in time taken and an increase in errors made of 183% (P = ns).
Although the software corrects the view to that preferred during surgery, the endoscopic control mechanism as well as the exit point of the instrument are altered in this process, leading to a deterioration of overall performance. Potential solutions include deploying intermittent horizon stabilization or using a robotic interface to achieve fully aligned perceptual-motor control.
自然腔道内镜手术（NOTES）中的空间定向已被视为临床应用的潜在障碍。我们旨在评估一种三轴惯性传感器及软件，该软件可自动校正柔性内镜横轴上的任何移动，从而在一项随机对照试验的NOTES手术过程中实现图像视野的稳定。
共有18名参与者（11名外科医生/7名胃肠病学家）在ELITE模拟器中执行了经胃任务，该任务包括导航至阑尾和胆囊、阑尾根部和胆囊窝的透热疗法，以及使用单通道胃镜夹闭胆囊管。每位参与者执行该任务两次，随机安排在第二次尝试时进行视野稳定。主要终点是第一次和第二次尝试之间总体表现（所用时间和所犯错误）的变化，次要终点是第二次尝试时的绝对表现和主观评估。
在没有视野稳定的情况下，从第一次尝试到第二次尝试，所用时间中位数改善了42.4%，所犯错误数量减少了38%；然而，在软件开启的情况下，所用时间有4.9%的统计学显著恶化（P = 0.038），所犯错误增加了183%（P = 无统计学意义）。
尽管该软件将视野校正为手术中偏好的视野，但在此过程中内镜控制机制以及器械的出口点发生了改变，导致总体表现恶化。潜在的解决方案包括采用间歇性视野稳定或使用机器人接口来实现完全对齐的感知 - 运动控制。
