Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Winship Cancer Institute, Emory University, Atlanta, Georgia.
J Surg Res. 2024 Oct;302:836-844. doi: 10.1016/j.jss.2024.07.103. Epub 2024 Sep 6.
Surgeon assessment tools are subjective and nonscalable. Objective performance indicators (OPIs), machine learning-enabled metrics recorded during robotic surgery, offer objective insights into surgeon movements and robotic arm kinematics. In this study, we identified OPIs that significantly differed across expert (EX), intermediate (IM), and novice (NV) surgeons during robotic right colectomy.
Endoscopic videos were annotated to delineate 461 surgical steps across 25 robotic right colectomies. OPIs were compared among two EX, two IM, and eight NV surgeons during mesenteric dissection, vascular pedicle ligation, right colon and hepatic flexure mobilization, and preparation of the proximal and distal bowel for transection.
Compared to NV's, EX's exhibited greater velocity, acceleration and jerk for camera, dominant, nondominant, and third arms across all steps. Compared to NV's, IM's exhibited more arm swaps and master clutch use, higher camera-related metrics (movement, path length, moving time, velocity, acceleration, and jerk), greater dominant wrist pitch and nondominant wrist articulations (roll, pitch, and yaw), longer dominant and nondominant arm path length, and higher velocity, acceleration and jerk for dominant, nondominant, and third arms across all steps. Compared to NV's, EX/IM surgeons utilized more arm swaps, higher camera-related metrics (movement, path length, velocity, acceleration, and jerk), longer nondominant arm path length, and greater velocity, acceleration and jerk for dominant, nondominant, and third arms across all steps.
We report OPIs that discriminate EX, IM, and NV surgeons during RRC. This study is the first to demonstrate feasibility of using OPIs as an objective, scalable way to classify surgeon skill during RRC steps.
外科医生评估工具具有主观性和不可扩展性。机器人手术过程中记录的客观绩效指标 (OPI) 及其机器学习算法，可提供有关外科医生动作和机器臂运动学的客观见解。本研究旨在确定在机器人右半结肠切除术 (RRC) 过程中，专家 (EX)、中级 (IM) 和新手 (NV) 外科医生之间存在显著差异的 OPI。
对 25 例机器人右半结肠切除术的内镜视频进行注释，以确定 461 个手术步骤。在肠系膜解剖、血管蒂结扎、右半结肠和肝曲游离、近端和远端肠准备横断等步骤中，比较了 2 名 EX、2 名 IM 和 8 名 NV 外科医生的 OPI。
与 NV 相比，EX 的相机、主导手、非主导手和第三臂在所有步骤中的速度、加速度和急动度均更大。与 NV 相比，IM 表现出更多的手臂交换和主离合器使用，更高的相机相关指标（运动、路径长度、移动时间、速度、加速度和急动度），更大的主导手腕关节俯仰和非主导手关节旋转（滚转、俯仰和偏航），更长的主导手和非主导手臂路径长度，以及更高的主导手、非主导手和第三臂在所有步骤中的速度、加速度和急动度。与 NV 相比，EX/IM 外科医生使用更多的手臂交换，更高的相机相关指标（运动、路径长度、速度、加速度和急动度），更长的非主导手臂路径长度，以及更高的主导手、非主导手和第三臂在所有步骤中的速度、加速度和急动度。
本研究报告了在 RRC 过程中区分 EX、IM 和 NV 外科医生的 OPI。这是首次证明使用 OPI 作为客观、可扩展的方法来分类 RRC 步骤中外科医生技能的可行性。
