Department of Gynaecology Obstetrics, Rennes University Hospital, Univ Rennes, INSERM, LTSI - UMR 1099, F35000, Rennes, France.
University Rennes, INSERM, LTSI - UMR 1099, F35000, Rennes, France.
Surg Endosc. 2022 Feb;36(2):853-870. doi: 10.1007/s00464-021-08792-5. Epub 2021 Nov 8.
INTRODUCTION: Robot-assisted laparoscopy is a safe surgical approach with several studies suggesting correlations between complication rates and the surgeon's technical skills. Surgical skills are usually assessed by questionnaires completed by an expert observer. With the advent of surgical robots, automated surgical performance metrics (APMs)-objective measures related to instrument movements-can be computed. The aim of this systematic review was thus to assess APMs use in robot-assisted laparoscopic procedures. The primary outcome was the assessment of surgical skills by APMs and the secondary outcomes were the association between APM and surgeon parameters and the prediction of clinical outcomes. METHODS: A systematic review following the PRISMA guidelines was conducted. PubMed and Scopus electronic databases were screened with the query "robot-assisted surgery OR robotic surgery AND performance metrics" between January 2010 and January 2021. The quality of the studies was assessed by the medical education research study quality instrument. The study settings, metrics, and applications were analysed. RESULTS: The initial search yielded 341 citations of which 16 studies were finally included. The study settings were either simulated virtual reality (VR) (4 studies) or real clinical environment (12 studies). Data to compute APMs were kinematics (motion tracking), and system and specific events data (actions from the robot console). APMs were used to differentiate expertise levels, and thus validate VR modules, predict outcomes, and integrate datasets for automatic recognition models. APMs were correlated with clinical outcomes for some studies. CONCLUSIONS: APMs constitute an objective approach for assessing technical skills. Evidence of associations between APMs and clinical outcomes remain to be confirmed by further studies, particularly, for non-urological procedures. Concurrent validation is also required.
简介:机器人辅助腹腔镜手术是一种安全的手术方法,多项研究表明,并发症发生率与外科医生的技术技能之间存在相关性。手术技能通常通过专家观察员完成的问卷进行评估。随着手术机器人的出现,与器械运动相关的自动手术性能指标(APM)——客观测量指标——可以被计算出来。因此,本系统评价旨在评估机器人辅助腹腔镜手术中 APM 的使用情况。主要结果是通过 APM 评估手术技能,次要结果是 APM 与外科医生参数之间的关联以及对临床结果的预测。
方法:按照 PRISMA 指南进行系统评价。在 2010 年 1 月至 2021 年 1 月期间,在 PubMed 和 Scopus 电子数据库中使用“机器人辅助手术或机器人手术和性能指标”进行检索。使用医学教育研究研究质量工具评估研究的质量。分析了研究设置、指标和应用。
结果:最初的搜索产生了 341 条引文,最终有 16 项研究被纳入。研究设置为模拟虚拟现实(VR)(4 项研究)或真实临床环境(12 项研究)。用于计算 APM 的数据是运动学(运动跟踪)以及系统和特定事件数据(来自机器人控制台的操作)。APM 用于区分专业水平,从而验证 VR 模块,预测结果,并集成自动识别模型的数据集。一些研究表明 APM 与临床结果相关。
结论:APM 是评估技术技能的一种客观方法。需要进一步的研究来证实 APM 与临床结果之间的关联,特别是对于非泌尿科手术。还需要进行同时验证。
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