Objective assessment in residency-based training for transoral robotic surgery.

OBJECTIVES/HYPOTHESIS: To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. STUDY DESIGN: Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. METHODS: Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. RESULTS: Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing) and trainees (average OSATS, 15.9; SD, 3.9; week 1) are well separated at the beginning of the training, and the separation reduces significantly (expert average OSATS, 27.6; SD, 2.7; trainee average OSATS, 24.2; SD, 6.8; module 3) at the conclusion of the training. Learning curves in each of the three stages show diminishing differences between the experts and trainees, which is also consistent with expert assessment. Subjective assessment by experts verified the clinical utility of the module 3 surgical environment, and a survey of trainees consistently rated the curriculum as very useful in progression to human operating room assistance. CONCLUSIONS: Structured curricular robotic surgery training with objective assessment promises to reduce the overhead for mentors, allow detailed assessment of human-machine interface skills, and create customized training models for individualized training. This preliminary study verifies the utility of such training in improving human-machine operations skills (module 1), and operating room and surgical skills (modules 2 and 3). In contrast to current coarse measures of total operating time and subjective assessment of error for short mass training sessions, these methods may allow individual tasks to be removed from the trainee regimen when skill levels are within the standard deviation of the experts for these tasks, which can greatly enhance overall efficiency of the training regimen and allow time for additional and more complex training to be incorporated in the same time frame.

A robotic assistant for trans-oral surgery: the robotic endo-laryngeal flexible (Robo-ELF) scope.

This paper describes the continued development of the Robotic EndoLaryngeal (Robo-ELF) Scope System, a simple clinically usable robot for manipulating flexible endoscopes, particularly in laryngeal surgery. The system includes a robot with three active and two passive degrees of freedom, a five degree of freedom passive positioning arm, a malleable scope shaft support, and a custom joystick controller. The Robo-ELF Scope allows a surgeon to control a flexible endoscope with only one hand and also to release the controls and perform bimanual surgery if desired. We have evaluated the Robo-ELF Scope system in both phantom and cadaver studies and found it superior to hand manipulation of flexible endoscopes and conventional rigid endoscopes.

Robotic endolaryngeal flexible (Robo-ELF) scope: a preclinical feasibility study.

OBJECTIVES/HYPOTHESIS: This article presents a novel robotic endolaryngeal flexible (Robo-ELF) scope driver for minimally invasive laryngeal surgery. The Robo-ELF consists of a simple, robust robotic scope driver with three active and two passive degrees of freedom, allowing it to manipulate any standard flexible endoscope. The system is controlled by a joystick-like three dimensional mouse that interfaces with the scope driver via a laptop. Because the scope is supported and controlled by the robot, motor control and therefore visualization are enhanced. Additionally, because the robot remains stationary when the mouse is not being manipulated, the surgeon can position it and operate bimanually. METHODS: The system was validated by performing visualization and biopsy procedures on two human cadavers with the Robo-ELF and comparing this with standard rigid endoscopes with three different angles. RESULTS: The Robo-ELF outperformed the rigid scopes in both image quality and range of motion, overcoming line of site constraints, and allowing visualization of otherwise hidden anatomy. The system also demonstrated a rapid learning curve and enhanced motor control over a manually operated flexible endoscope. CONCLUSIONS: The Robo-ELF is a novel robot to assist in driving a flexible endoscope for surgery of the upper aerodigestive tract.

Icon identification in context: the changing role of icon characteristics with user experience.

OBJECTIVE: This research examined the relative importance of icon characteristics in determining the speed and accuracy of icon identification. BACKGROUND: Studies to date have focused on the role of one or two icon characteristics when users first experience an icon set. This means that little is known about the relative importance of icon characteristics or how the role of icon characteristics might change as users gain experience with icons. METHODS: Thirty participants carried out an icon identification task over a long series of trials to simulate learning through experience. Icon characteristics investigated included semantic distance, concreteness, familiarity, and visual complexity. RESULTS: Icon characteristics were major determinants of performance, accounting for up to 69% of the variance observed in performance. However, the importance of icon characteristics changed with experience: Semantic distance is crucial initially while icon-function relationships are learned, but familiarity is important later because it has lasting effects on access to long-term memory representations. CONCLUSION: These findings suggest that icon concreteness may not be of primary importance when identifying icons and that semantic distance and familiarity may be more important. APPLICATION: Designers need to take into account icon characteristics other than concreteness when creating icons, particularly semantic distance and familiarity. The precise importance of the latter characteristics will vary depending on whether icons are rarely encountered or frequently used.