Reed Amy M, Li Yizhou, Atoum Jumanh, Acar Ayberk, Henry Callahan, Wu Jie Ying, Kavoussi Nicholas
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Computer Science, Vanderbilt University, Nashville, Tennessee, USA.
J Endourol. 2024 Dec;38(12):1421-1426. doi: 10.1089/end.2024.0246. Epub 2024 Oct 10.
Optical tracking (OT) has shown potential in assessing surgical skill but has yet to be evaluated for endoscopic urologic surgery. We sought to evaluate the potential for OT to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS) for kidney stone treatment in both simulated and live surgical settings. We performed OT analysis of six surgeons performing stone localization during fURS in two settings. In the first setting, surgeons were tasked with fiducial localization in three separate kidney phantoms during fURS. In the second setting, surgeons performed stone localization via fURS in five separate patients. Surgeons were categorized as "expert" ( = 3, endourologist, average case volume of >100 fURS per year) or trainee ( = 3, trainee, <100 fURS per year). OT metrics were recorded for both settings using the Microsoft HoloLens 2© as the surgeons viewed the surgical monitor during fURS. Standard OT metrics of experts and trainees were compared, and included: area of eye gaze movement, gaze distance traveled, number of gaze fixation points, percentage of gaze fixation dwell time, and number of saccades. In the simulated setting, the average time for stone localization was greater for trainees compared to experts (318 seconds 52 seconds, < 0.01). Additionally, the mean area of eye gaze movements with area of interest (AOI) was greater for trainees compared to experts (1430 cm 1060 cm, < 0.01). The total gaze distance traveled was also greater for trainees compared to experts (1480 cm 730 cm, < 0.01). In the live surgical setting, average time for stone localization was similar for trainees and experts (74 seconds 51 seconds, = 0.05). The total area of eye gaze movements in AOI was greater for trainees compared to experts (700 cm 30 cm, < 0.01). Additionally, the total gaze distance traveled was greater for trainees compared to experts (14,000 cm 680 cm, < 0.01). This suggests more varied and less point specific concentration on the surgical screen by trainees. There was no difference in percentage of gaze fixation dwell time and number of saccades between experts and trainees in either setting. OT analysis can objectively distinguish surgical experience between experts and trainee surgeons performing fURS in both simulated and live surgical settings. These findings may play a role in future surgical training and skills assessment.
光学跟踪（OT）已显示出在评估手术技能方面的潜力，但尚未在内镜泌尿外科手术中得到评估。我们试图评估在模拟和实际手术环境中，OT在柔性输尿管镜检查（fURS）治疗肾结石过程中区分专家和实习外科医生的潜力。我们对六名外科医生在两种环境下进行fURS时的结石定位进行了OT分析。在第一种环境中，外科医生的任务是在fURS过程中在三个单独的肾脏模型中进行基准定位。在第二种环境中，外科医生通过fURS对五名单独的患者进行结石定位。外科医生被分为“专家”（n = 3，泌尿外科专家，每年平均病例量>100例fURS）或实习生（n = 3，实习生，每年<100例fURS）。在fURS过程中，当外科医生查看手术监视器时，使用Microsoft HoloLens 2©记录两种环境下的OT指标。比较了专家和实习生的标准OT指标，包括：眼动注视区域、注视移动距离、注视固定点数量、注视固定停留时间百分比和扫视次数。在模拟环境中，实习生的结石定位平均时间比专家长（318秒±52秒，P<0.01）。此外，实习生与感兴趣区域（AOI）相关的眼动注视平均面积比专家大（1430平方厘米±1060平方厘米，P<0.01）。实习生的总注视移动距离也比专家长（1480厘米±730厘米，P<0.01）。在实际手术环境中，实习生和专家的结石定位平均时间相似（74秒±51秒，P = 0.05）。实习生与AOI相关的眼动注视总面积比专家大（700平方厘米±30平方厘米，P<0.01）。此外，实习生的总注视移动距离比专家长（14000厘米±680厘米，P<0.01）。这表明实习生在手术屏幕上的注意力分布更分散，针对性更差。在两种环境下，专家和实习生在注视固定停留时间百分比和扫视次数方面没有差异。OT分析可以客观地区分在模拟和实际手术环境中进行fURS的专家和实习外科医生的手术经验。这些发现可能在未来的手术培训和技能评估中发挥作用。
