Laser excision of urethral mesh erosion: a 10-year experience.

PURPOSE: To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS). METHODS: Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6 months after the final laser excision procedure. RESULTS: From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%). CONCLUSION: UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.

Vaginoscopy With Laser Treatment of Symptomatic Upper Vaginal Mesh Exposure After Prior Mesh Sacrocolpopexy.

OBJECTIVE: To describe the technique of vaginoscopy with Holmium:YAG and Thulium laser treatment of upper vaginal mesh exposure after mesh sacrocolpopexy (MSC) as well as evaluate treatment efficacy. METHODS: Following IRB approval, a chart review of all patients who underwent laser treatment of upper vaginal mesh exposure during vaginoscopy at a single institution between 2013 and 2022 was performed. Demographic information, previous mesh placement history, presenting symptoms, physical examination and vaginoscopy findings, imaging, laser type and settings, operating time, complications, and follow-up including examination and office vaginoscopy findings were extracted from electronic medical records. RESULTS: Five patients and 6 surgical encounters were identified. All patients had a history of MSC and symptomatic mesh exposure at the vaginal apex, which was tented up and difficult to access by traditional transvaginal mesh excision. Five patients underwent vaginal mesh treatment with laser with no further vaginal mesh exposure on follow-up exam or vaginoscopy. One patient was found to have a small recurrence at 4 months and underwent a second treatment with negative findings on vaginoscopy 7.9 months post-operatively. There were no complications. CONCLUSION: Vaginoscopy using a rigid cystoscope and laser treatment of upper vaginal mesh exposure using a Holmium:YAG or Thulium laser is a safe and quick method which led to definitive symptom resolution.

Objective Assessments of Peyronie's Disease.

INTRODUCTION: Penile deformity is the most obvious manifestation of Peyronie's disease (PD) and key to determining the optimal method of treatment. Other aspects of PD to consider include plaque size, location, and density; amount of calcification; erection quality; disease progression; and penile anatomy. Few standards exist for the objective assessment of these parameters. AIM: To describe current options and new trends in the objective evaluation of PD with a focus on penile curvature and imaging modalities. METHODS: A literature review was performed through PubMed from 1990 to 2017 regarding objective parameters in PD, including imaging modalities, measurements of deformity, and serum markers. Non-English-language articles were excluded. MAIN OUTCOME MEASURES: We sought to assess various objective measurements obtained in patients with PD and to evaluate their usefulness in the evaluation, treatment, and counseling of patients with PD. RESULTS: Measurement of penile curvature is most accurately performed with in-office goniometric angle measurement of a pharmacologically induced erection. However, new methods of assessing penile curvature using 3-dimensional photography and smartphone and tablet applications can aid clinicians in describing and treating PD. Ultrasound and ultrasound adjuncts provide excellent plaque characterization and assessment of penile vasculature, which can be useful for treatment planning and research. Presence of inflammation can be evaluated using magnetic resonance imaging or nuclear scintigraphy. CONCLUSION: Current guidelines only recommend obtaining measurements of penile length and penile curvature in the erect state. However, many other options exist for the objective evaluation of PD. These options can have a role in treatment decision making and help standardize results in PD research. Chen JY, Hockenberry MS, Lipshultz LI. Objective Assessments of Peyronie's Disease. Sex Med Rev 2018;6:438-445.

Human-automation interaction for multiple robot control: the effect of varying automation assistance and individual differences on operator performance.

In a human-automation interaction study, automation assistance level (AL) was investigated for its effects on operator performance in a dynamic, multi-tasking environment. Participants supervised a convoy of manned and unmanned vehicles traversing a simulated environment in three AL conditions, while maintaining situation awareness and identifying targets. Operators' situation awareness, target detection performance, workload and individual differences were evaluated. Results show increasing AL generally improved task performance and decreased perceived workload, however, differential effects due to operator spatial ability and perceived attentional control were found. Eye-tracking measures were useful in parsing out individual differences that subjective measures did not detect. At the highest AL, participants demonstrated potentially complacent behaviour, indicating task disengagement. Practitioner Summary: The effect of varying automation assistance level (AL) on operator performance on multiple tasks were examined in a within-subjects experiment. Findings indicated a moderate AL improved performance, while higher levels encouraged complacent behaviour. Effects due to individual differences suggest that effective AL depends on the underlying characteristics of the operator.

A Meta-Analysis of Factors Influencing the Development of Trust in Automation: Implications for Understanding Autonomy in Future Systems.

OBJECTIVE: We used meta-analysis to assess research concerning human trust in automation to understand the foundation upon which future autonomous systems can be built. BACKGROUND: Trust is increasingly important in the growing need for synergistic human-machine teaming. Thus, we expand on our previous meta-analytic foundation in the field of human-robot interaction to include all of automation interaction. METHOD: We used meta-analysis to assess trust in automation. Thirty studies provided 164 pairwise effect sizes, and 16 studies provided 63 correlational effect sizes. RESULTS: The overall effect size of all factors on trust development was g = +0.48, and the correlational effect was [Formula: see text] = +0.34, each of which represented medium effects. Moderator effects were observed for the human-related (g = +0.49; [Formula: see text] = +0.16) and automation-related (g = +0.53; [Formula: see text] = +0.41) factors. Moderator effects specific to environmental factors proved insufficient in number to calculate at this time. CONCLUSION: Findings provide a quantitative representation of factors influencing the development of trust in automation as well as identify additional areas of needed empirical research. APPLICATION: This work has important implications to the enhancement of current and future human-automation interaction, especially in high-risk or extreme performance environments.

Intelligent Agent Transparency in Human-Agent Teaming for Multi-UxV Management.

OBJECTIVE: We investigated the effects of level of agent transparency on operator performance, trust, and workload in a context of human-agent teaming for multirobot management. BACKGROUND: Participants played the role of a heterogeneous unmanned vehicle (UxV) operator and were instructed to complete various missions by giving orders to UxVs through a computer interface. An intelligent agent (IA) assisted the participant by recommending two plans-a top recommendation and a secondary recommendation-for every mission. METHOD: A within-subjects design with three levels of agent transparency was employed in the present experiment. There were eight missions in each of three experimental blocks, grouped by level of transparency. During each experimental block, the IA was incorrect three out of eight times due to external information (e.g., commander's intent and intelligence). Operator performance, trust, workload, and usability data were collected. RESULTS: Results indicate that operator performance, trust, and perceived usability increased as a function of transparency level. Subjective and objective workload data indicate that participants' workload did not increase as a function of transparency. Furthermore, response time did not increase as a function of transparency. CONCLUSION: Unlike previous research, which showed that increased transparency resulted in increased performance and trust calibration at the cost of greater workload and longer response time, our results support the benefits of transparency for performance effectiveness without additional costs. APPLICATION: The current results will facilitate the implementation of IAs in military settings and will provide useful data to the design of heterogeneous UxV teams.

Utility of stereoscopic displays for indirect-vision driving and robot teleoperation.

The effectiveness of an active shutter-glasses stereoscopic display (SD) and a passive polarised SD was evaluated in a live robot-teleoperation task and a simulated indirect-vision driving task in various terrains. Overall, participants completed their tasks significantly faster with the SDs in three-dimensional (3D) mode than with the SDs in the baseline 2D mode. They also navigated more accurately with the SDs in 3D mode. When the effectiveness of the two types of SDs was examined separately, results showed that the active shutter-glasses SD resulted in faster responses and task completion times than the passive polarised SD, though most of the differences failed to reach statistical significance. Perceived workload when interacting with the two SD systems did not differ significantly between the active versus passive display types or between the 3D and 2D modes of operation; however, participants reported more severe discomfort after interacting with the passive polarised SD.

Supervisory control of multiple robots in dynamic tasking environments.

A military targeting environment was simulated to examine the effects of an intelligent route-planning agent RoboLeader, which could support dynamic robot re-tasking based on battlefield developments, on the performance of robotics operators. We manipulated the level of assistance (LOAs) provided by RoboLeader as well as the presence of a visualisation tool that provided feedback to the participants on their primary task (target encapsulation) performance. Results showed that the participants' primary task benefited from RoboLeader on all LOAs conditions compared to manual performance; however, visualisation had little effect. Frequent video gamers demonstrated significantly better situation awareness of the mission environment than did infrequent gamers. Those participants with higher spatial ability performed better on a secondary target detection task than did those with lower spatial ability. Finally, participants' workload assessments were significantly lower when they were assisted by RoboLeader than when they performed the target entrapment task manually. Practitioner Summary: This study demonstrated the utility of an intelligent agent for enhancing robotics operators' supervisory control performance as well as reducing their workload during a complex urban scenario involving moving targets. The results furthered the understanding of the interplay among level-of-autonomy, multitasking performance and individual differences in military tasking environments.

Supervisory control of multiple robots: effects of imperfect automation and individual differences.

OBJECTIVE: A military multitasking environment was simulated to examine the effects of an intelligent agent, RoboLeader, on the performance of robotics operators. BACKGROUND: The participants' task was to manage a team of ground robots with the assistance of RoboLeader, an intelligent agent capable of coordinating the robots and changing their routes on the basis of battlefield developments. METHOD: In the first experiment, RoboLeader was perfectly reliable; in the second experiment, RoboLeader's recommendations were manipulated to be either false-alarm prone or miss prone, with a reliability level of either 60% or 90%. The visual density of the targeting environment was manipulated by the presence or absence of friendly soldiers. RESULTS: RoboLeader, when perfectly reliable, was helpful in reducing the overall mission times.The type of RoboLeader imperfection (false-alarm vs. miss prone) affected operators' performance of tasks involving visual scanning (target detection, route editing, and situation awareness). There was a consistent effect of visual density (clutter of the visual scene) for multiple performance measures. Participants' attentional control and video gaming experience affected their overall multitasking performance. In both experiments, participants with greater spatial ability consistently outperformed their low-spatial-ability counterparts in tasks that required effective visual scanning. CONCLUSION: Intelligent agents, such as RoboLeader, can benefit the overall human-robot teaming performance. However, the effects of type of agent unreliability, tasking requirements, and individual differences have complex effects on human-agent interaction. APPLICATION: The current results will facilitate the implementation of robots in military settings and will provide useful data to designs of systems for multirobot control.

A meta-analysis of factors affecting trust in human-robot interaction.

OBJECTIVE: We evaluate and quantify the effects of human, robot, and environmental factors on perceived trust in human-robot interaction (HRI). BACKGROUND: To date, reviews of trust in HRI have been qualitative or descriptive. Our quantitative review provides a fundamental empirical foundation to advance both theory and practice. METHOD: Meta-analytic methods were applied to the available literature on trust and HRI. A total of 29 empirical studies were collected, of which 10 met the selection criteria for correlational analysis and 11 for experimental analysis. These studies provided 69 correlational and 47 experimental effect sizes. RESULTS: The overall correlational effect size for trust was r = +0.26,with an experimental effect size of d = +0.71. The effects of human, robot, and environmental characteristics were examined with an especial evaluation of the robot dimensions of performance and attribute-based factors. The robot performance and attributes were the largest contributors to the development of trust in HRI. Environmental factors played only a moderate role. CONCLUSION: Factors related to the robot itself, specifically, its performance, had the greatest current association with trust, and environmental factors were moderately associated. There was little evidence for effects of human-related factors. APPLICATION: The findings provide quantitative estimates of human, robot, and environmental factors influencing HRI trust. Specifically, the current summary provides effect size estimates that are useful in establishing design and training guidelines with reference to robot-related factors of HRI trust. Furthermore, results indicate that improper trust calibration may be mitigated by the manipulation of robot design. However, many future research needs are identified.

UAV-guided navigation for ground robot tele-operation in a military reconnaissance environment.

A military reconnaissance environment was simulated to examine the performance of ground robotics operators who were instructed to utilise streaming video from an unmanned aerial vehicle (UAV) to navigate his/her ground robot to the locations of the targets. The effects of participants' spatial ability on their performance and workload were also investigated. Results showed that participants' overall performance (speed and accuracy) was better when she/he had access to images from larger UAVs with fixed orientations, compared with other UAV conditions (baseline- no UAV, micro air vehicle and UAV with orbiting views). Participants experienced the highest workload when the UAV was orbiting. Those individuals with higher spatial ability performed significantly better and reported less workload than those with lower spatial ability. The results of the current study will further understanding of ground robot operators' target search performance based on streaming video from UAVs. The results will also facilitate the implementation of ground/air robots in military environments and will be useful to the future military system design and training community.