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传感器与心理运动计量学:弥合手术流程与结果差距的独特契机。

Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes.

机构信息

Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States.

Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States.

出版信息

ACS Biomater Sci Eng. 2020 May 11;6(5):2630-2640. doi: 10.1021/acsbiomaterials.9b01019. Epub 2020 Mar 31.

Abstract

The surgical process remains elusive to many. This paper presents two independent empirical investigations where psychomotor skill metrics were used to quantify elements of the surgical process in a procedural context during surgical tasks in a simulated environment. The overarching goal of both investigations was to address the following hypothesis: Basic motion metrics can be used to quantify specific aspects of the surgical process including instrument autonomy, psychomotor efficiency, procedural readiness, and clinical errors. Electromagnetic motion tracking sensors were secured to surgical trainees' ( = 64) hands for both studies, and several motion metrics were investigated as a measure of surgical skill. The first study assessed performance during a bowel repair and laparoscopic ventral hernia (LVH) repair in comparison to a suturing board task. The second study assessed performance in a VR task in comparison to placement of a subclavian central line. The findings of the first study support our subhypothesis that motion metrics have a generalizable application to surgical skill by showing significant correlations in instrument autonomy and psychomotor efficiency during the suturing task and bowel repair (idle time: = 0.46, < 0.05; average velocity: = 0.57, < 0.05) and the suturing task and LVH repair (jerk magnitude: = 0.36, < 0.05; bimanual dexterity: = 0.35, < 0.05). In the second study, performance in VR (steering and jerkiness) correlated to clinical errors ( = 0.58, < 0.05) and insertion time ( = 0.55, < 0.05) in placement of a subclavian central line. Both gross (dexterity) and fine motor skills (steering) were found to be important as well as efficiency (i.e., idle time, duration, velocity) when seeking to understand the quality of surgical performance. Both studies support our hypotheses that basic motion metrics can be used to quantify specific aspects of the surgical process and that the use of different technologies and metrics are important for comprehensive investigations of surgical skill.

摘要

许多人对手术过程仍然感到难以理解。本文介绍了两项独立的实证研究,这些研究在模拟环境下的手术任务中,使用运动技能指标来量化程序性手术过程的各个方面。这两项研究的总体目标都是为了验证以下假设:基本运动指标可以用于量化手术过程的特定方面,包括器械自主性、运动效率、程序准备和临床错误。在这两项研究中,都将电磁运动跟踪传感器固定在手术受训者(n=64)的手上,并研究了几个运动指标作为手术技能的衡量标准。第一项研究比较了肠修复和腹腔镜腹疝(LVH)修复与缝合板任务的表现。第二项研究比较了 VR 任务与锁骨下中央线放置的表现。第一项研究的结果支持我们的子假设,即运动指标具有普遍适用性的手术技能,因为在缝合任务和肠修复(空闲时间:r=0.46,p<0.05;平均速度:r=0.57,p<0.05)以及缝合任务和 LVH 修复(急动幅度:r=0.36,p<0.05;双手灵巧性:r=0.35,p<0.05)中,仪器自主性和运动效率存在显著相关性。在第二项研究中,VR 中的表现(转向和抖动)与锁骨下中央线放置中的临床错误(r=0.58,p<0.05)和插入时间(r=0.55,p<0.05)相关。在寻求理解手术表现质量时,发现粗大运动技能(灵巧性)和精细运动技能(转向)以及效率(即空闲时间、持续时间、速度)都很重要。这两项研究都支持我们的假设,即基本运动指标可以用于量化手术过程的特定方面,并且使用不同的技术和指标对于全面研究手术技能非常重要。

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