Mamunes Alexander P, Campisano Federico, Martin James, Scaglioni Bruno, Mazomenos Evangelos, Valdastri Pietro, Obstein Keith L
Division of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Mechanical Engineering Department, Vanderbilt University, Nashville, Tennessee, United States.
Endosc Int Open. 2021 Feb;9(2):E171-E180. doi: 10.1055/a-1314-9860. Epub 2021 Jan 25.
Colonoscopy is a technically challenging procedure that requires extensive training to minimize discomfort and avoid trauma due to its drive mechanism. Our academic team developed a magnetic flexible endoscope (MFE) actuated by magnetic coupling under supervisory robotic control to enable a front-pull maneuvering mechanism, with a motion controller user interface, to minimize colon wall stress and potentially reduce the learning curve. We aimed to evaluate this learning curve and understand the user experience. Five novices (no endoscopy experience), five experienced endoscopists, and five experienced MFE users each performed 40 trials on a model colon using 1:1 block randomization between a pediatric colonoscope (PCF) and the MFE. Cecal intubation (CI) success, time to cecum, and user experience (NASA task load index) were measured. Learning curves were determined by the number of trials needed to reach minimum and average proficiency-defined as the slowest average CI time by an experienced user and the average CI time by all experienced users, respectively. MFE minimum proficiency was achieved by all five novices (median 3.92 trials) and five experienced endoscopists (median 2.65 trials). MFE average proficiency was achieved by four novices (median 14.21 trials) and four experienced endoscopists (median 7.00 trials). PCF minimum and average proficiency levels were achieved by only one novice. Novices' perceived workload with the MFE significantly improved after obtaining minimum proficiency. The MFE has a short learning curve for users with no prior experience-requiring relatively few attempts to reach proficiency and at a reduced perceived workload.
结肠镜检查是一项技术要求较高的操作，由于其驱动机制，需要大量培训以尽量减少不适并避免创伤。我们的学术团队开发了一种在机器人监督控制下通过磁耦合驱动的磁性柔性内窥镜（MFE），以实现前拉式操纵机制，并配备运动控制器用户界面，以尽量减少结肠壁压力并可能缩短学习曲线。我们旨在评估这条学习曲线并了解用户体验。五名新手（无内窥镜检查经验）、五名经验丰富的内镜医师和五名经验丰富的MFE用户分别使用儿科结肠镜（PCF）和MFE在模拟结肠上进行了40次试验，采用1:1的区组随机化。测量了盲肠插管（CI）成功率、到达盲肠的时间和用户体验（NASA任务负荷指数）。学习曲线由达到最低熟练度和平均熟练度所需的试验次数确定，最低熟练度定义为经验丰富的用户最慢的平均CI时间，平均熟练度定义为所有经验丰富的用户的平均CI时间。所有五名新手（中位数3.92次试验）和五名经验丰富的内镜医师（中位数2.65次试验）都达到了MFE最低熟练度。四名新手（中位数14.21次试验）和四名经验丰富的内镜医师（中位数7.00次试验）达到了MFE平均熟练度。只有一名新手达到了PCF的最低和平均熟练度水平。新手在达到最低熟练度后，对MFE的感知工作量显著改善。对于没有经验的用户来说，MFE的学习曲线较短，达到熟练程度所需的尝试次数相对较少，且感知工作量降低。
