Neis Felix, Brucker Sara Yvonne, Bauer Armin, Shields Mallory, Purvis Lilia, Liu Xi, Ershad Marzieh, Walter Christina Barbara, Dijkstra Tjeerd, Reisenauer Christl, Kraemer Bernhard
Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany.
Intuitive Surgical Inc., Sunnyvale, CA, United States.
Front Med (Lausanne). 2024 Aug 16;11:1382609. doi: 10.3389/fmed.2024.1382609. eCollection 2024.
The curriculum for a da Vinci surgeon in gynecology requires special training before a surgeon performs their first independent case, but standardized, objective assessments of a trainee's workflow or skills learned during clinical cases are lacking. This pilot study presents a methodology to evaluate intraoperative surgeon behavior in hysterectomy cases through standardized surgical step segmentation paired with objective performance indicators (OPIs) calculated directly from robotic data streams. This method can provide individual case analysis in a truly objective capacity.
Surgical data from six robot-assisted total laparoscopic hysterectomies (rTLH) performed by two experienced surgeons was collected prospectively using an Intuitive Data Recorder. Each rTLH video was annotated and segmented into specific, functional surgical steps based on the recorded video. Once annotated, OPIs were compared through workflow analysis and across surgeons during two critical surgical steps: colpotomy and vaginal cuff closure.
Through visualization of the individual steps over time, we observe workflow consistencies and variabilities across individual surgeons of a similar experience level at the same hospital, creating unique surgeon behavior signatures across each surgical case. OPI differences across surgeons were observed for both the colpotomy and vaginal cuff closure steps, specifically reflecting camera movement, energy usage and clutching behaviors. Comparing colpotomy and vaginal cuff closure time needed for the step and the events of energy use were significantly different ( < 0.001). For the comparison between the two surgeons only the event count for camera movement during colpotomy showed significant differences ( = 0.03).
This pilot study presents a novel methodology to analyze and compare individual rTLH procedures with truly objective measurements. Through collection of robotic data streams and standardized segmentation, OPI measurements for specific rTLH surgery steps can be reliably calculated and compared to those of other surgeons. This provides opportunity for critical standardization to the gynecology field, which can be integrated into individualized training plans in the future. However, more studies are needed to establish context surrounding these metrics in gynecology.
达芬奇妇科手术医生的课程要求外科医生在进行首例独立手术前接受特殊培训，但目前缺乏对学员临床病例中工作流程或所学技能的标准化、客观评估。这项初步研究提出了一种方法，通过标准化手术步骤分割以及直接从机器人数据流计算得出的客观性能指标（OPI）来评估子宫切除病例中的术中外科医生行为。该方法能够以真正客观的方式提供个案分析。
前瞻性地使用直观数据记录器收集了由两位经验丰富的外科医生进行的六例机器人辅助全腹腔镜子宫切除术（rTLH）的手术数据。根据录制的视频，对每个rTLH视频进行注释并分割为特定的功能性手术步骤。注释完成后，通过工作流程分析并在两个关键手术步骤（阴道切开术和阴道断端闭合）中对不同外科医生的OPI进行比较。
通过对各个步骤随时间的可视化，我们观察到同一医院中经验水平相似的不同外科医生之间工作流程的一致性和变异性，在每个手术病例中形成了独特的外科医生行为特征。在阴道切开术和阴道断端闭合步骤中均观察到不同外科医生之间的OPI差异，具体反映在摄像头移动、能量使用和抓持行为上。比较该步骤所需的阴道切开术和阴道断端闭合时间以及能量使用事件存在显著差异（<0.001）。仅在两位外科医生之间进行比较时，阴道切开术期间摄像头移动的事件计数显示出显著差异（=0.03）。
这项初步研究提出了一种新颖的方法，以真正客观的测量来分析和比较个体rTLH手术过程。通过收集机器人数据流和标准化分割，可以可靠地计算特定rTLH手术步骤的OPI测量值，并与其他外科医生的测量值进行比较。这为妇科领域的关键标准化提供了机会，未来可将其纳入个性化培训计划。然而, 需要更多研究来确定这些指标在妇科领域的相关背景情况。
