Computer-controlled endoscopic performance assessment system.

We have devised an advanced computer-controlled system (ADEPT) for the objective evaluation of endoscopic task performance. The system's hardware consists of a dual gimbal mechanism that accepts a variety of 5.0-mm standard endoscopic instruments for manipulation in a precisely mapped and enclosed work space. The target object consists of a sprung base plate incorporating various tasks. It is covered by a sprung perforated transparent top plate that has to be moved and held in the correct position by the operator to gain access to the various tasks. Standard video endoscope equipment provides the visual interface between the operator and the target-instrument field. Different target modules can be used, and the level of task difficulty can be adjusted by varying the manipulation, elevation, and azimuth angles. The system's software is designed to (a) prompt the surgeon with the information necessary to perform the task, (b) collect and collate data on performance during execution of specified tasks, and (c) save the data for future analysis. The system was alpha and beta tested to ensure that all functions operated correctly.

Psychomotor skills for endoscopic manipulations: differing abilities between right and left-handed individuals.

OBJECTIVE: The objective of this study was to compare the psychomotor aptitudes relevant to endoscopic manipulations between right-handed and left-handed subjects. SUMMARY BACKGROUND DATA: There has been little research on the psychomotor performance in relation to minimal access surgery and there are no psychomotor tests to evaluate aspects of psychomotor abilities relevant to endoscopic manipulations. METHODS: A microprocessor-controlled psychomotor tester was developed for objective evaluation of endoscopic performance. The task involved negotiating ten target holes with a probe under videoscopic imaging. Subjects consisted of two groups of 10 medical students: right- and left-handed. After a prestudy familiarization session, each subject performed two test runs with one hand, followed by two runs with the other hand. These test runs were repeated 1 week later. The outcome measures were the total execution time, force on backplate, angular deviations, error rate, and first-time accuracy. RESULTS: A significant difference in the error rate and first time accuracy was observed between subjects (p < 0.001 and p < 0.001, respectively) and between the dominant and nondominant hands (p < 0.001 and p < 0.025, respectively), with no significant change with practice. Right-handed subjects performed better with either hand in terms of error rate (p < 0.001) and first time accuracy (p < 0.001). Practice improved the execution time (p < 0.001) and the degree of angular deviations (p < 0.02). CONCLUSIONS: Right-handed subjects perform less errors and exhibit better first time accuracy. The parameters that improve with practice reflect the positive effect of training, whereas others, such as errors rate and first time accuracy which do not, reflect innate abilities.

A microprocessor-controlled psychomotor tester for minimal access surgery.

BACKGROUND: There is little reported information on psychomotor performance in relation to minimal access surgery (MAS). METHODS: A microprocessor-controlled endoscopic psychomotor tester (the Dundee Endoscopic Psychomotor Tester-DEPT) has been developed to evaluate psychomotor aspects of MAS. Experiments were conducted on 20 medical undergraduates to evaluate accuracy and reliability of the tester. RESULTS: The study demonstrated a significant difference between subjects (p < 0.01). It also identified three individuals who enacted 16, 22, and 40 errors while the majority (85%) sustained less errors with a median of 4.5. CONCLUSIONS: DEPT provides a standard, reproducible, objective real-time scoring system. It identifies individuals who cannot adjust to endoscopic viewing and therefore manipulate from endoscopic images.