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Savage M, Spence A, Turbitt L. The educational impact of technology-enhanced learning in regional anaesthesia: a scoping review. Br J Anaesth 2024; 133:400-415. [PMID: 38824073 DOI: 10.1016/j.bja.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Effective training in regional anaesthesia (RA) is paramount to ensuring widespread competence. Technology-based learning has assisted other specialties in achieving more rapid procedural skill acquisition. If applicable to RA, technology-enhanced training has the potential to provide an effective learning experience and to overcome barriers to RA training. We review the current evidence base for use of innovative technologies in assisting learning of RA. METHODS Using scoping review methodology, three databases (MEDLINE, Embase, and Web of Science) were searched, identifying 158 relevant citations. Citations were screened against defined eligibility criteria with 27 studies selected for inclusion. Data relating to study details, technological learning interventions, and impact on learner experience were extracted and analysed. RESULTS Seven different technologies were used to train learners in RA: artificial intelligence, immersive virtual reality, desktop virtual reality, needle guidance technology, robotics, augmented reality, and haptic feedback devices. Of 27 studies, 26 reported a positive impact of technology-enhanced RA training, with different technologies offering benefits for differing components of RA training. Artificial intelligence improved sonoanatomical knowledge and ultrasound skills for RA, whereas needle guidance technologies enhanced confidence and improved needling performance, particularly in novices. Immersive virtual reality allowed more rapid acquisition of needling skills, but its functionality was limited when combined with haptic feedback technology. User friendly technologies enhanced participant experience and improved confidence in RA; however, limitations in technology-assisted RA training restrict its widespread use. CONCLUSIONS Technology-enhanced RA training can provide a positive and effective learning experience, with potential to reduce the steep learning curve associated with gaining RA proficiency. A combined approach to RA education, using both technological and traditional approaches, should be maintained as no single method has been shown to provide comprehensive RA training.
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Affiliation(s)
- Mairead Savage
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK.
| | - Andrew Spence
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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2
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Finseth TT, Smith B, Van Steenis AL, Glahn DC, Johnson M, Ruttle P, Shirtcliff BA, Shirtcliff EA. When virtual reality becomes psychoneuroendocrine reality: A stress(or) review. Psychoneuroendocrinology 2024; 166:107061. [PMID: 38701607 DOI: 10.1016/j.psyneuen.2024.107061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.
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Affiliation(s)
| | - Brandon Smith
- Center for Translational Neuroscience, University of Oregon, USA
| | | | - David C Glahn
- Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, USA
| | - Megan Johnson
- Center for Translational Neuroscience, University of Oregon, USA
| | - Paula Ruttle
- Center for Translational Neuroscience, University of Oregon, USA
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Riaziat ND, Erin O, Krieger A, Brown JD. Investigating Haptic Feedback in Vision-Deficient Millirobot Telemanipulation. IEEE Robot Autom Lett 2024; 9:6178-6185. [PMID: 38948904 PMCID: PMC11210683 DOI: 10.1109/lra.2024.3397529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The evolution of magnetically actuated millirobots gives rise to unique teleoperation challenges due to their non-traditional kinematic and dynamic architectures, as well as their frequent use of suboptimal imaging modalities. Recent investigations into haptic interfaces for millirobots have shown promise but lack the clinically motivated task scenarios necessary to justify future development. In this work, we investigate the utility of haptic feedback on bilateral teleoperation of a magnetically actuated millirobot in visually deficient conditions. We conducted an N=23 user study in an aneurysm coiling inspired procedure, which required participants to navigate the robot through a maze in near total darkness to manipulate beads to a target under simulated fluoroscopy. We hypothesized that users will be better able to complete the telemanipulation task with haptic feedback while reducing excess forces on their surroundings compared to the no feedback conditions. Our results showed an over 40% improvement in participants' bead scoring, a nearly 10% reduction in mean force, and 13% reduction in maximum force with haptic feedback, as well as significant improvements in other metrics. Results highlight that benefits of haptic feedback are retained when haptic feedback is removed. These findings suggest that haptic feedback has the potential to significantly improve millirobot telemanipulation and control in traditionally vision deficient tasks.
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Affiliation(s)
- Naveed D Riaziat
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland, USA
| | - Onder Erin
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland, USA. He is now with Johnson and Johnson, 5490 Great America Parkway, Santa Clara, California, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland, USA
| | - Jeremy D Brown
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland, USA
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4
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Erbaş İ, Güçlü B. Real-time vibrotactile pattern generation and identification using discrete event-driven feedback. Somatosens Mot Res 2024; 41:77-89. [PMID: 36751096 DOI: 10.1080/08990220.2023.2175811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
This study assesses human identification of vibrotactile patterns by using real-time discrete event-driven feedback. Previously acquired force and bend sensor data from a robotic hand were used to predict movement-type (stationary, flexion, contact, extension, release) and object-type (no object, hard object, soft object) states by using decision tree (DT) algorithms implemented in a field-programmable gate array (FPGA). Six able-bodied humans performed a 2- and 3-step sequential pattern recognition task in which state transitions were signaled as vibrotactile feedback. The stimuli were generated according to predicted classes represented by two frequencies (F1: 80 Hz, F2: 180 Hz) and two magnitudes (M1: low, M2: high) calibrated psychophysically for each participant; and they were applied by two actuators (Haptuators) placed on upper arms. A soft/hard object was mapped to F1/F2; and manipulating it with low/high force was assigned to M1/M2 in the left actuator. On the other hand, flexion/extension movement was mapped to F1/F2 in the right actuator, with movement in air as M1 and during object manipulation as M2. DT algorithm performed better for the object-type (97%) than the movement-type (88%) classification in real time. Participants could recognize feedback associated with 14 discrete-event sequences with low-to-medium accuracy. The performance was higher (76 ± 9% recall, 76 ± 17% precision, 78 ± 4% accuracy) for recognizing any one event in the sequences. The results show that FPGA implementation of classification for discrete event-driven vibrotactile feedback can be feasible in haptic devices with additional cues in the physical context.
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Affiliation(s)
- İsmail Erbaş
- Biomedical Engineering Department, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Burak Güçlü
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Turkey
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5
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Guo X, McFall F, Jiang P, Liu J, Lepora N, Zhang D. A Lightweight and Affordable Wearable Haptic Controller for Robot-Assisted Microsurgery. SENSORS (BASEL, SWITZERLAND) 2024; 24:2676. [PMID: 38732782 PMCID: PMC11085189 DOI: 10.3390/s24092676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/06/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
In robot-assisted microsurgery (RAMS), surgeons often face the challenge of operating with minimal feedback, particularly lacking in haptic feedback. However, most traditional desktop haptic devices have restricted operational areas and limited dexterity. This report describes a novel, lightweight, and low-budget wearable haptic controller for teleoperated microsurgical robotic systems. We designed a wearable haptic interface entirely made using off-the-shelf material-PolyJet Photopolymer, fabricated using liquid and solid hybrid 3D co-printing technology. This interface was designed to resemble human soft tissues and can be wrapped around the fingertips, offering direct contact feedback to the operator. We also demonstrated that the device can be easily integrated with our motion tracking system for remote microsurgery. Two motion tracking methods, marker-based and marker-less, were compared in trajectory-tracking experiments at different depths to find the most effective motion tracking method for our RAMS system. The results indicate that within the 4 to 8 cm tracking range, the marker-based method achieved exceptional detection rates. Furthermore, the performance of three fusion algorithms was compared to establish the unscented Kalman filter as the most accurate and reliable. The effectiveness of the wearable haptic controller was evaluated through user studies focusing on the usefulness of haptic feedback. The results revealed that haptic feedback significantly enhances depth perception for operators during teleoperated RAMS.
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Affiliation(s)
- Xiaoqing Guo
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Finn McFall
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Peiyang Jiang
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Jindong Liu
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Nathan Lepora
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Dandan Zhang
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
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6
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Ratschat AL, van Rooij BM, Luijten J, Marchal-Crespo L. Evaluating tactile feedback in addition to kinesthetic feedback for haptic shape rendering: a pilot study. Front Robot AI 2024; 11:1298537. [PMID: 38660067 PMCID: PMC11039957 DOI: 10.3389/frobt.2024.1298537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
In current virtual reality settings for motor skill training, only visual information is usually provided regarding the virtual objects the trainee interacts with. However, information gathered through cutaneous (tactile feedback) and muscle mechanoreceptors (kinesthetic feedback) regarding, e.g., object shape, is crucial to successfully interact with those objects. To provide this essential information, previous haptic interfaces have targeted to render either tactile or kinesthetic feedback while the effectiveness of multimodal tactile and kinesthetic feedback on the perception of the characteristics of virtual objects still remains largely unexplored. Here, we present the results from an experiment we conducted with sixteen participants to evaluate the effectiveness of multimodal tactile and kinesthetic feedback on shape perception. Using a within-subject design, participants were asked to reproduce virtual shapes after exploring them without visual feedback and with either congruent tactile and kinesthetic feedback or with only kinesthetic feedback. Tactile feedback was provided with a cable-driven platform mounted on the fingertip, while kinesthetic feedback was provided using a haptic glove. To measure the participants' ability to perceive and reproduce the rendered shapes, we measured the time participants spent exploring and reproducing the shapes and the error between the rendered and reproduced shapes after exploration. Furthermore, we assessed the participants' workload and motivation using well-established questionnaires. We found that concurrent tactile and kinesthetic feedback during shape exploration resulted in lower reproduction errors and longer reproduction times. The longer reproduction times for the combined condition may indicate that participants could learn the shapes better and, thus, were more careful when reproducing them. We did not find differences between conditions in the time spent exploring the shapes or the participants' workload and motivation. The lack of differences in workload between conditions could be attributed to the reported minimal-to-intermediate workload levels, suggesting that there was little room to further reduce the workload. Our work highlights the potential advantages of multimodal congruent tactile and kinesthetic feedback when interacting with tangible virtual objects with applications in virtual simulators for hands-on training applications.
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Affiliation(s)
- Alexandre L. Ratschat
- Motor Learning and Neurorehabilitation Lab, Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bob M. van Rooij
- Motor Learning and Neurorehabilitation Lab, Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
| | | | - Laura Marchal-Crespo
- Motor Learning and Neurorehabilitation Lab, Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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7
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Iriarte N, Ezcurdia I, Elizondo S, Irisarri J, Hemmerling D, Ortiz A, Marzo A. Contactless Electrostatic Piloerection for Haptic Sensations. IEEE TRANSACTIONS ON HAPTICS 2024; 17:140-151. [PMID: 37097797 DOI: 10.1109/toh.2023.3269885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this project, we create artificial piloerection using contactless electrostatics to induce tactile sensations in a contactless way. Firstly, we design various high-voltage generators and evaluate them in terms of their static charge, safety and frequency response with different electrodes as well as grounding strategies. Secondly, a psychophysics user study revealed which parts of the upper body are more sensitive to electrostatic piloerection and what adjectives are associated with them. Finally, we combine an electrostatic generator to produce artificial piloerection on the nape with a head-mounted display, this device provides an augmented virtual experience related to fear. We hope that work encourages designers to explore contactless piloerection for enhancing experiences such as music, short movies, video games, or exhibitions.
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Ota M, Oki E, Nakanoko T, Tanaka Y, Toyota S, Hu Q, Nakaji Y, Nakanishi R, Ando K, Kimura Y, Hisamatsu Y, Mimori K, Takahashi Y, Morohashi H, Kanno T, Tadano K, Kawashima K, Takano H, Ebihara Y, Shiota M, Inokuchi J, Eto M, Yoshizumi T, Hakamada K, Hirano S, Mori M. Field experiment of a telesurgery system using a surgical robot with haptic feedback. Surg Today 2024; 54:375-381. [PMID: 37653350 DOI: 10.1007/s00595-023-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To verify the usefulness of haptic feedback in telesurgery and improve the safety of telerobotic surgery. METHODS The surgeon's console was installed at two sites (Fukuoka and Beppu; 140 km apart), and the patient cart was installed in Fukuoka. During the experiment, the surgeon was blinded to the haptic feedback levels and asked to grasp the intestinal tract in an animal model. The surgeon then performed the tasks at each location. RESULTS No marked differences in task accuracy or average grasping force were observed between the surgeon locations. However, the average task completion time was significantly longer, and the system usability scale (SUS) was significantly lower rating for remote operations than for local ones. No marked differences in task accuracy or task completion time were observed between the haptic feedback levels. However, with haptic feedback, the organ was grasped with a significantly weaker force than that without it. Furthermore, with haptic feedback, experienced surgeons in robotic surgery tended to perform an equivalent task with weaker grasping forces than inexperienced surgeons. CONCLUSION The haptic feedback function is a tool that allows the surgeon to perform surgery with an appropriate grasping force, both on site and remotely. Improved safety is necessary in telesurgery; haptic feedback will thus be an essential technology in robotic telesurgery going forward.
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Affiliation(s)
- Mitsuhiko Ota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan.
| | - Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasushi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Toyota
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Qingjiang Hu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yu Nakaji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Yoshiya Takahashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hajime Morohashi
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Kotaro Tadano
- RIVERFIELD Inc., Tokyo, Japan
- Laboratory for Future Interdisciplinary Research of Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Kenji Kawashima
- RIVERFIELD Inc., Tokyo, Japan
- Department of Information Physics and Computing School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hironobu Takano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuma Ebihara
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Shiota
- Department of Urology, Kyushu University, Fukuoka, Japan
| | | | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenichi Hakamada
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Hirano
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Mori
- Committee for Promotion of Remote Surgery Implementation, Japan Surgical Society, Tokyo, Japan
- Tokai University School of Medicine, Isehara, Japan
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Bhatia V, Fernandez N, Long C, Sturm R, Farhat W, O’Kelly F. Advancements in Hypospadias Management: Trends, Techniques, Training, and Patient-Centric Outcomes. UROLOGY RESEARCH & PRACTICE 2024; 50:94-101. [PMID: 39115355 PMCID: PMC11232038 DOI: 10.5152/tud.2024.23219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/04/2024] [Indexed: 08/11/2024]
Abstract
Hypospadias has drawn increasing attention due to its prevalence, complex etiology, and significant impacts on psychological and sexual quality of life. This comprehensive review delves into the facets of hypospadias management, exploring pivotal themes that shape present understanding and practice. We demonstrate potential explanatory factors for its incidence through an analysis of geographic, genetic, and environmental influences. We then contextualize care by exploring historical and evolving surgical techniques, and highlight that advances in surgical approaches employ a spectrum of repair strategies. Innovation in surgical training, with a focus on simulation-based methodologies, offers a bridge between didactic learning and real-world application, which is particularly relevant due to the demonstrated effect of personal experience with hypospadias repair outcomes. Considering the importance of mentorship, case exposure, and hands-on practice, a holistic understanding of expertise cultivation at each training stage is essential. Lastly, patient-centric outcomes research must take center stage, particularly as the impact of our interventions on children with hypospadias will be judged by them as adults. Shifting from solely surgeon-reported outcomes to patient-reported outcomes is emphasized in the review, allowing for a more comprehensive assessment of the influence of surgical interventions across the lifespan. Integrating patients' perspectives refines surgical decision-making to align with expectations, ultimately enhancing overall satisfaction. Our multi-pronged exploration of advancements in hypospadias underscores the symbiotic relationship between evolving surgical techniques, training methodologies, personal experience, and patientreported outcomes. As the field progresses, these insights will collectively contribute to optimizing hypospadias care, advancing both medical practice and patient well-being.
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Affiliation(s)
- Vinaya Bhatia
- Department of Urology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Nicolas Fernandez
- Department of Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Christopher Long
- Department of Pediatric Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Renea Sturm
- Division of Pediatric Urology, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA, USA
| | - Walid Farhat
- Department of Urology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Fardod O’Kelly
- Division of Pediatric Urology, Women and Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
- Division of Pediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland
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10
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Gamberini G, Maglio S, Mariani A, Mazzotta AD, Forgione A, Marescaux J, Melfi F, Tognarelli S, Menciassi A. Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation. Sci Rep 2024; 14:4779. [PMID: 38413654 PMCID: PMC10899586 DOI: 10.1038/s41598-024-55351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
The number of robot-assisted minimally invasive surgeries is increasing annually, together with the need for dedicated and effective training. Surgeons need to learn how to address the novel control modalities of surgical instruments and the loss of haptic feedback, which is a common feature of most surgical robots. High-fidelity physical simulation has proved to be a valid training tool, and it might help in fulfilling these learning needs. In this regard, a high-fidelity sensorized simulator of vascular structures was designed, fabricated and preliminarily validated. The main objective of the simulator is to train novices in robotic surgery to correctly perform vascular resection procedures without applying excessive strain to tissues. The vessel simulator was integrated with soft strain sensors to quantify and objectively assess manipulation skills and to provide real-time feedback to the trainee during a training session. Additionally, a portable and user-friendly training task board was produced to replicate anatomical constraints. The simulator was characterized in terms of its mechanical properties, demonstrating its realism with respect to human tissues. Its face, content and construct validity, together with its usability, were assessed by implementing a training scenario with 13 clinicians, and the results were generally positive.
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Affiliation(s)
- Giulia Gamberini
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Sabina Maglio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Mariani
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessandro Dario Mazzotta
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Surgery, Madre Giuseppina Vannini Hospital, Istituto Figlie Di San Camillo, Rome, Italy
| | - Antonello Forgione
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | - Jacques Marescaux
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | | | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arianna Menciassi
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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11
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Pavone G, Pacilli M, Gerundo A, Quazzico A, Ambrosi A, Tartaglia N. Can robotic gastric bypass be considered a valid alternative to laparoscopy? Our early experience and literature review. Front Surg 2024; 11:1303351. [PMID: 38375411 PMCID: PMC10875057 DOI: 10.3389/fsurg.2024.1303351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Background Robotic bariatric surgery serves as an alternative to laparoscopy. The technology provides the surgeon with an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the operating room. Hypothesis We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass to demonstrate its safety and feasibility. The aim of this study is to evaluate potential differences between the robotic and laparoscopic techniques. Materials and methods Our study retrospectively identified 153 consecutive obese patients who underwent either laparoscopic or robotic gastric bypass (RGB) procedures over a 2-year period at the Department of Medical and Surgical Sciences, University of Foggia. Data on demographics, operative time, conversion rate, length of hospital stay, and mortality were collected and compared between two groups of patients: 82 patients who underwent laparoscopic procedures and 71 who underwent robotic procedures. Results We analyzed 153 patients who underwent gastric bypass with a mean age of 42.58 years, of whom 74 were female; 71 were treated with a robotic approach and 82 with a laparoscopic approach. The mean operative time was 224.75 ± 10.4 min for RGB (including docking time) and 101.22 min for laparoscopic gastric bypass (LGB) (p < 0.05), which is statistically significant. The median length of stay was 4.1 days for the RGB group and 3.9 days for the LGB group (p = 0.89). There is only one conversion to laparoscopy in the RGB group. We observed only one case of postoperative complications, specifically one episode of endoluminal bleeding in the laparoscopic group, which was successfully managed with medical treatment. No mortality was observed in either group. Conclusion The statistical analysis shows to support the robotic approach that had a lower incidence of complications but a longer operative duration. Based on our experience, the laparoscopic approach remains a technique with more haptic feedback than the robotic approach, making surgeons feel more confident.This study has been registered on ClinicalTrial.gov Protocol Registration and Results System with this ID: NCT05746936 for the Organization UFoggia (https://clinicaltrials.gov/ct2/show/NCT05746936).
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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12
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Shafiei SB, Shadpour S, Sasangohar F, Mohler JL, Attwood K, Jing Z. Development of performance and learning rate evaluation models in robot-assisted surgery using electroencephalography and eye-tracking. NPJ SCIENCE OF LEARNING 2024; 9:3. [PMID: 38242909 PMCID: PMC10799032 DOI: 10.1038/s41539-024-00216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
The existing performance evaluation methods in robot-assisted surgery (RAS) are mainly subjective, costly, and affected by shortcomings such as the inconsistency of results and dependency on the raters' opinions. The aim of this study was to develop models for an objective evaluation of performance and rate of learning RAS skills while practicing surgical simulator tasks. The electroencephalogram (EEG) and eye-tracking data were recorded from 26 subjects while performing Tubes, Suture Sponge, and Dots and Needles tasks. Performance scores were generated by the simulator program. The functional brain networks were extracted using EEG data and coherence analysis. Then these networks, along with community detection analysis, facilitated the extraction of average search information and average temporal flexibility features at 21 Brodmann areas (BA) and four band frequencies. Twelve eye-tracking features were extracted and used to develop linear random intercept models for performance evaluation and multivariate linear regression models for the evaluation of the learning rate. Results showed that subject-wise standardization of features improved the R2 of the models. Average pupil diameter and rate of saccade were associated with performance in the Tubes task (multivariate analysis; p-value = 0.01 and p-value = 0.04, respectively). Entropy of pupil diameter was associated with performance in Dots and Needles task (multivariate analysis; p-value = 0.01). Average temporal flexibility and search information in several BAs and band frequencies were associated with performance and rate of learning. The models may be used to objectify performance and learning rate evaluation in RAS once validated with a broader sample size and tasks.
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Affiliation(s)
- Somayeh B Shafiei
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
| | - Saeed Shadpour
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Zhe Jing
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
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13
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Ueda Y, Miyahara S, Tokuishi K, Nakajima H, Waseda R, Shiraishi T, Sato T. Impact of a pneumatic surgical robot with haptic feedback function on surgical manipulation. Sci Rep 2023; 13:22615. [PMID: 38114613 PMCID: PMC10730604 DOI: 10.1038/s41598-023-49876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Although robotic-assisted surgery has the advantages of low patient burden and high precision without unsteady hand movements, the lack of tactile sensations may result in unexpected iatrogenic organ damage. The Saroa (Riverfield Inc., Tokyo, Japan) is a pneumatically driven robot that provides real-time haptic feedback to the surgeon. Using the Saroa robot, six examinees performed puffed rice transfer and four of them performed pig lung resection tasks with the feedback function turned on and off. The puffed rice transfer task consisted of transferring 20 grains of puffed rice from the left to the right compartment in the training box. The mean grasping forces during the puffed rice transfer task with the haptic feedback function turned off and on were 2.14 N and 0.63 N, respectively (P = 0.003). The mean grasping forces during the pig lung resection task were lower with the feedback turned on than turned off. The force that the forceps exerted on the grasping object was weaker in both tasks when the haptic feedback function was turned on, suggesting that the feedback function allows gentler handling of tissues, improving patient safety during robotic surgery.
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Affiliation(s)
- Yuichiro Ueda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - So Miyahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Keita Tokuishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroyasu Nakajima
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuichi Waseda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Toshihiko Sato
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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14
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Reddy K, Gharde P, Tayade H, Patil M, Reddy LS, Surya D. Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 2023; 15:e50415. [PMID: 38222213 PMCID: PMC10784205 DOI: 10.7759/cureus.50415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Robotic surgery, a groundbreaking advancement in medical technology, has redefined the landscape of surgical procedures. This comprehensive overview explores the multifaceted world of robotic surgery, encompassing its definition, historical development, current applications, clinical outcomes, benefits, emerging frontiers, challenges, and future implications. We delve into the fundamentals of robotic surgical systems, examining their components and advantages. From general and gynecological surgery to urology, cardiac surgery, orthopedics, and beyond, we highlight the diverse specialties where robotic surgery is making a significant impact. The many benefits discussed include improved patient outcomes, reduced complications, faster recovery times, cost-effectiveness, and enhanced surgeon experiences. The outlook reveals a healthcare landscape where robotic surgery is increasingly vital, enabling personalized medicine, bridging healthcare disparities, and advancing surgical precision. However, challenges such as cost, surgeon training, technical issues, ethical considerations, and patient acceptance remain relevant. In conclusion, robotic surgery is poised to continue shaping the future of health care, offering transformative possibilities while emphasizing the importance of collaboration, innovation, and ethical governance.
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Affiliation(s)
- Kavyanjali Reddy
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Tayade
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mihir Patil
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dheeraj Surya
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Bergholz M, Ferle M, Weber BM. The benefits of haptic feedback in robot assisted surgery and their moderators: a meta-analysis. Sci Rep 2023; 13:19215. [PMID: 37932393 PMCID: PMC10628231 DOI: 10.1038/s41598-023-46641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
Robot assisted surgery (RAS) provides medical practitioners with valuable tools, decreasing strain during surgery and leading to better patient outcomes. While the loss of haptic sensation is a commonly cited disadvantage of RAS, new systems aim to address this problem by providing artificial haptic feedback. N = 56 papers that compared robotic surgery systems with and without haptic feedback were analyzed to quantify the performance benefits of restoring the haptic modality. Additionally, this study identifies factors moderating the effect of restoring haptic sensation. Overall results showed haptic feedback was effective in reducing average forces (Hedges' g = 0.83) and peak forces (Hedges' g = 0.69) applied during surgery, as well as reducing the completion time (Hedges' g = 0.83). Haptic feedback has also been found to lead to higher accuracy (Hedges' g = 1.50) and success rates (Hedges' g = 0.80) during surgical tasks. Effect sizes on several measures varied between tasks, the type of provided feedback, and the subjects' levels of surgical expertise, with higher levels of expertise generally associated with smaller effect sizes. No significant differences were found between virtual fixtures and rendering contact forces. Implications for future research are discussed.
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Affiliation(s)
- Max Bergholz
- Department of Ergonomics, Technical University of Munich, 85748, Garching, Germany
- Institute of Robotics and Mechatronics, German Aerospace Center, 82234, Wessling, Germany
| | - Manuel Ferle
- Department of Ergonomics, Technical University of Munich, 85748, Garching, Germany.
| | - Bernhard M Weber
- Institute of Robotics and Mechatronics, German Aerospace Center, 82234, Wessling, Germany
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16
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Wong SW, Crowe P. Visualisation ergonomics and robotic surgery. J Robot Surg 2023; 17:1873-1878. [PMID: 37204648 PMCID: PMC10492791 DOI: 10.1007/s11701-023-01618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023]
Abstract
Stereopsis may be an advantage of robotic surgery. Perceived robotic ergonomic advantages in visualisation include better exposure, three-dimensional vision, surgeon camera control, and line of sight screen location. Other ergonomic factors relating to visualisation include stereo-acuity, vergence-accommodation mismatch, visual-perception mismatch, visual-vestibular mismatch, visuospatial ability, visual fatigue, and visual feedback to compensate for lack of haptic feedback. Visual fatigue symptoms may be related to dry eye or accommodative/binocular vision stress. Digital eye strain can be measured by questionnaires and objective tests. Management options include treatment of dry eye, correction of refractive error, and management of accommodation and vergence anomalies. Experienced robotic surgeons can use visual cues like tissue deformation and surgical tool information as surrogates for haptic feedback.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
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17
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Kim JS, Jonas N, Rizvi TZ, Lin Z, Plewa D, Ricard C, Cheah YL, Simon CJ, Wright V. Validation of a multidisciplinary virtual reality (VR) robotic surgical curriculum. J Robot Surg 2023; 17:2495-2502. [PMID: 37526810 DOI: 10.1007/s11701-023-01679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
The objective is to identify whether trainees demonstrate improvement in a standardized knot-tying task as assessed by Global Evaluative Assessment of Robotic Skills (GEARS) score after completion of a virtual reality (VR) robotic curriculum. An IRB-exempt prospective study was conducted with surgical trainees from August 2021 to February 2023. Participants initially performed a baseline robotic suturing task in which they were instructed to tie interrupted square knots in 10 min. Participants then completed a virtual reality simulation curriculum involving 23 exercises until they achieved 90% proficiency on all tasks. Participants then repeated the suturing task. Pre- and post-curriculum suturing tasks were recorded, de-identified, and scored by expert graders using a GEARS score. Trainees from three academic centers were invited to participate. Medical students (MS1-MS3) and surgical residents from gynecology, urology, and general surgery were invited to participate. Twenty-five trainees completed the pre-curriculum suturing task, the VR curriculum, and the post-curriculum suturing task. Trainees demonstrated significant improvement in their post-test GEARS score by 2.43 points (p < 0.05) and were able to tie three additional knots within 10 min after completion of the curriculum (p < 0.05). Trainees also demonstrated a faster time to complete first knot (114 s improvement, p < 0.05) after completion of the curriculum. All participants agreed or strongly agreed that completion of the robotic curriculum helped them feel more comfortable using the robotic console, and improved their robotic surgical skills. Surgical trainees and medical students with limited prior robotic surgical experience demonstrated objective improvement after completion of a standardized VR curriculum.
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Affiliation(s)
- Jessica S Kim
- Department of Gynecology, Beth Israel Lahey Health, 41 Burlington Mall Road, Burlington, MA, 01803, USA
| | - Nicholas Jonas
- Division of Surgical Simulation, Beth Israel Lahey Health, Burlington, MA, USA
- Department of General Surgery, New York-Presbyterian Queens, Flushing, New York, USA
| | - Tasneem Zaihra Rizvi
- Beth Israel Lahey Health, Burlington, MA, USA
- Department of General Surgery, Beth Israel Lahey Health, Burlington, MA, USA
| | - Zhibang Lin
- Beth Israel Lahey Health, Burlington, MA, USA
| | - Deanna Plewa
- Division of Surgical Simulation, Beth Israel Lahey Health, Burlington, MA, USA
- Department of General Surgery, Beth Israel Lahey Health, Burlington, MA, USA
| | - Caroline Ricard
- Division of Surgical Simulation, Beth Israel Lahey Health, Burlington, MA, USA
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | - Yee Lee Cheah
- Division of Transplantation, Department of Surgery, Beth Israel Lahey Health, Burlington, MA, USA
- Division of Transplant and Hepatobiliary Disease, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Caroline J Simon
- Division of Transplantation, Department of Surgery, Beth Israel Lahey Health, Burlington, MA, USA
- Division of Transplant and Hepatobiliary Disease, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Valena Wright
- Department of Gynecology, Beth Israel Lahey Health, 41 Burlington Mall Road, Burlington, MA, 01803, USA.
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18
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Lei Y, Deng Y, Dong L, Li X, Li X, Su Z. A Novel Sensor Fusion Approach for Precise Hand Tracking in Virtual Reality-Based Human-Computer Interaction. Biomimetics (Basel) 2023; 8:326. [PMID: 37504214 PMCID: PMC10807483 DOI: 10.3390/biomimetics8030326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
The rapidly evolving field of Virtual Reality (VR)-based Human-Computer Interaction (HCI) presents a significant demand for robust and accurate hand tracking solutions. Current technologies, predominantly based on single-sensing modalities, fall short in providing comprehensive information capture due to susceptibility to occlusions and environmental factors. In this paper, we introduce a novel sensor fusion approach combined with a Long Short-Term Memory (LSTM)-based algorithm for enhanced hand tracking in VR-based HCI. Our system employs six Leap Motion controllers, two RealSense depth cameras, and two Myo armbands to yield a multi-modal data capture. This rich data set is then processed using LSTM, ensuring the accurate real-time tracking of complex hand movements. The proposed system provides a powerful tool for intuitive and immersive interactions in VR environments.
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Affiliation(s)
- Yu Lei
- College of Humanities and Arts, Hunan International Economics University, Changsha 410012, China;
| | - Yi Deng
- College of Physical Education, Hunan International Economics University, Changsha 410012, China
| | - Lin Dong
- Institute of Sports Artificial Intelligence, Capital University of Physical Education and Sports, Beijing 100091, China
| | - Xiaohui Li
- Department of Wushu and China, Songshan Shaolin Wushu College, Zhengzhou 452470, China
- Department of History and Pakistan, University of the Punjab, Lahore 54000, Pakistan
| | - Xiangnan Li
- Yantai Science and Technology Innovation Promotion Center, Yantai 264005, China
| | - Zhi Su
- Department of Information, School of Design and Art, Changsha University of Science and Technology, Changsha 410076, China;
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19
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Boehm JR, Fey NP, Majewicz Fey A. Shaping Human Movement via Bimanually-Dependent Haptic Force Feedback. WORLD HAPTICS CONFERENCE. WORLD HAPTICS CONFERENCE 2023; 2023:266-272. [PMID: 38222039 PMCID: PMC10786619 DOI: 10.1109/whc56415.2023.10224475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Haptic feedback can enhance training and performance of human operators; however, the design of haptic feedback for bimanual coordination in robot-assisted tasks (e.g., control of surgical robots) remains an open problem. In this study, we present four bimanually-dependent haptic force feedback conditions aimed at shaping bimanual movement according to geometric characteristics: the number of targets, direction, and symmetry. Haptic conditions include a virtual spring, damper, combination spring-damper, and dual springs placed between the hands. We evaluate the effects of these haptic conditions on trajectory shape, smoothness, and speed. We hypothesized that for subjects who perform worse with no haptic feedback (1) a spring will improve the shape of parallel trajectories, (2) a damper will improve the shape of point symmetric trajectories, (3) dual springs will improve the shape of trajectories with one target, and (4) a damper will improve smoothness for all trajectories. Hypotheses (1) and (2) were statistically supported at the p < 0.001 level, but hypotheses (3) and (4) were not supported. Moreover, bimanually-dependent haptic feedback tended to improve shape accuracy for movements that subjects performed worse on under no haptic condition. Thus, bimanual haptic feedback based on geometric trajectory characteristics shows promise to improve performance in robot-assisted motor tasks.
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Affiliation(s)
- Jacob R Boehm
- Dept. of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Nicholas P Fey
- Dept. of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Ann Majewicz Fey
- Dept. of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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Hardon SF, Willuth E, Rahimi AM, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, van der Peet DL, Daams F, Nickel F, Horeman T. Crossover-effects in technical skills between laparoscopy and robot-assisted surgery. Surg Endosc 2023:10.1007/s00464-023-10045-6. [PMID: 37097456 PMCID: PMC10338573 DOI: 10.1007/s00464-023-10045-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery. METHODS An international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated. RESULTS A total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery. CONCLUSION The crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - A Masie Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Caelan M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Eleni A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Gould J, Webb SS, Byrne C, Brace E, Cleary J, Dow L, Edwards E, Glyn-Jones E, Hunter T, Longton J, Tibble K, MacLellan J. Red flags for episiotomy in a midwife-led birth: Using co-production with midwives to capture clinical experience. Women Birth 2023; 36:217-223. [PMID: 35941059 DOI: 10.1016/j.wombi.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of four key points in the Obstetric Anal Sphincter Injury Care Bundle, first piloted in the UK in 2016, was the directive to perform episiotomy when clinically indicated. Midwives are the primary health care professional for straightforward births in the UK and there is very little published literature that relates to their practice in this area. AIM The aim of the study was to explore experienced midwives' decision-making processes in their assessments for episiotomy during birth. METHODS 43 midwives self-identifying as confident in performing episiotomy were sampled across 8 NHS Trusts in England and Wales. Data collection was via online focus groups and 1:1 interviews. Primary thematic analysis was undertaken by the research team. Preliminary themes were used to structure a co-production analysis workshop where eight experienced midwives undertook a secondary analysis of the data resulting in four overall themes. FINDINGS Four themes were identified, 'Optimising Perineal Function', 'Red Flags to Stimulate Decision-Making', 'The Midwives' Episiotomy' and 'Infiltration as a Catalyst for Birth'. DISCUSSION Midwives use a number of visual, auditory and touch cues to inform their assessments for episiotomy during birth. CONCLUSION This study provides valuable insight into the cues that guide experienced midwives' decision-making in relation to episiotomy and contributes evidence related to performing episiotomy when clinically indicated in spontaneous vaginal birth.
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Affiliation(s)
| | | | - Carmen Byrne
- Freelance visual artist and researcher (narrative specialist)
| | | | - Jane Cleary
- University Hospitals Sussex NHS Foundation Trust, UK
| | | | | | | | | | | | - Katie Tibble
- University Hospitals Sussex NHS Foundation Trust, UK
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22
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Öztürk Y, Ayazoğlu M, Öztürk Ç, Arabacı A, Solak N, Özsoy S. A new patient-specific overformed anatomical implant design method to reconstruct dysplastic femur trochlea. Sci Rep 2023; 13:3204. [PMID: 36828989 PMCID: PMC9958018 DOI: 10.1038/s41598-023-30341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Patellar luxation with condylar defect is a challenging situation for reconstruction in humans. Patella reluxation, cartilage damage and pain are the most common complications. This study aims to present a new patient specific method of overformed implant design and clinical implantation that prevents luxation of patella without damaging the cartilage in a dog. Design processes are Computer Tomography, Computer Assisted Design, rapid prototyping of the bone replica, creation of the implant with surgeon's haptic knowledge on the bone replica, 3D printing of the implant and clinical application. The implant was fully seated on the bone. Patella reluxation or implant-related bone problem was not observed 80 days after the operation. However, before the implant application, there were soft tissue problems due to previous surgeries. Three-point bending test and finite element analysis were performed to determine the biomechanical safety of the implant. The stress acting on the implant was below the biomechanical limits of the implant. More cases with long-term follow-up are needed to confirm the success of this method in patellar luxation. Compared with trochlear sulcoplasty and total knee replacement, there was no cartilage damage done by surgeons with this method, and the implant keeps the patella functionally in sulcus. This is a promising multidisciplinary method that can be applied to any part of the bone and can solve some orthopaedic problems with surgeon's haptic knowledge.
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Affiliation(s)
- Yetkin Öztürk
- Molecular Biology and Genetics Department, Science and Literature Faculty, Istanbul Technical University, Maslak, 34469, Istanbul, Turkey.
| | - Murat Ayazoğlu
- grid.10516.330000 0001 2174 543XFaculty of Manufacturing Engineering, Istanbul Technical University, Gumussuyu, 34437 Istanbul, Turkey
| | - Çağrı Öztürk
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Atakan Arabacı
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Nuri Solak
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Serhat Özsoy
- grid.506076.20000 0004 1797 5496Surgery Department, Veterinary Faculty, Istanbul University-Cerrahpasa, Buyukcekmece, 34500 Istanbul, Turkey
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Batty T, Ehrampoosh A, Shirinzadeh B, Zhong Y, Smith J. A Transparent Teleoperated Robotic Surgical System with Predictive Haptic Feedback and Force Modelling. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22249770. [PMID: 36560138 PMCID: PMC9780898 DOI: 10.3390/s22249770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 06/12/2023]
Abstract
In recent years, robotic minimally invasive surgery has transformed many types of surgical procedures and improved their outcomes. Implementing effective haptic feedback into a teleoperated robotic surgical system presents a significant challenge due to the trade-off between transparency and stability caused by system communication time delays. In this paper, these time delays are mitigated by implementing an environment estimation and force prediction methodology into an experimental robotic minimally invasive surgical system. At the slave, an exponentially weighted recursive least squares (EWRLS) algorithm estimates the respective parameters of the Kelvin-Voigt (KV) and Hunt-Crossley (HC) force models. The master then provides force feedback by interacting with a virtual environment via the estimated parameters. Palpation experiments were conducted with the slave in contact with polyurethane foam during human-in-the-loop teleoperation. The experimental results indicated that the prediction RMSE of error between predicted master force feedback and measured slave force was reduced to 0.076 N for the Hunt-Crossley virtual environment, compared to 0.356 N for the Kelvin-Voigt virtual environment and 0.560 N for the direct force feedback methodology. The results also demonstrated that the HC force model is well suited to provide accurate haptic feedback, particularly when there is a delay between the master and slave kinematics. Furthermore, a haptic feedback approach that incorporates environment estimation and force prediction improve transparency during teleoperation. In conclusion, the proposed bilateral master-slave robotic system has the potential to provide transparent and stable haptic feedback to the surgeon in surgical robotics procedures.
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Affiliation(s)
- Taran Batty
- Australian Synchrotron, ANSTO, Melbourne, VIC 3168, Australia
| | - Armin Ehrampoosh
- Robotics and Mechatronics Research Laboratory (RMRL), Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC 3800, Australia
| | - Bijan Shirinzadeh
- Robotics and Mechatronics Research Laboratory (RMRL), Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC 3800, Australia
| | - Yongmin Zhong
- Department of Mechanical and Automotive Engineering, RMIT University, Melbourne, VIC 3083, Australia
| | - Julian Smith
- Department of Surgery, Monash University, Melbourne, VIC 3800, Australia
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Waters I, Jones D, Alazmani A, Culmer P. Encouraging and Detecting Preferential Incipient Slip for Use in Slip Prevention in Robot-Assisted Surgery. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22207956. [PMID: 36298309 PMCID: PMC9607044 DOI: 10.3390/s22207956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 05/27/2023]
Abstract
Robotic surgical platforms have helped to improve minimally invasive surgery; however, limitations in their force feedback and force control can result in undesirable tissue trauma or tissue slip events. In this paper, we investigate a sensing method for the early detection of slip events when grasping soft tissues, which would allow surgical robots to take mitigating action to prevent tissue slip and maintain stable grasp control while minimising the applied gripping force, reducing the probability of trauma. The developed sensing concept utilises a curved grasper face to create areas of high and low normal, and thus frictional, force. In the areas of low normal force, there is a higher probability that the grasper face will slip against the tissue. If the grasper face is separated into a series of independent movable islands, then by tracking their displacement it will be possible to identify when the areas of low normal force first start to slip while the remainder of the tissue is still held securely. The system was evaluated through the simulated grasping and retraction of tissue under conditions representative of surgical practice using silicone tissue simulants and porcine liver samples. It was able to successfully detect slip before gross slip occurred with a 100% and 77% success rate for the tissue simulant and porcine liver samples, respectively. This research demonstrates the efficacy of this sensing method and the associated sensor system for detecting the occurrence of tissue slip events during surgical grasping and retraction.
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Affiliation(s)
- Ian Waters
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Dominic Jones
- School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Ali Alazmani
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Peter Culmer
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
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Gani A, Pickering O, Ellis C, Sabri O, Pucher P. Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training. Ann Med Surg (Lond) 2022; 83:104734. [DOI: 10.1016/j.amsu.2022.104734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 10/14/2022] Open
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26
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Touching data with PropellerHand. J Vis (Tokyo) 2022. [DOI: 10.1007/s12650-022-00859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Abstract
Immersive analytics often takes place in virtual environments which promise the users immersion. To fulfill this promise, sensory feedback, such as haptics, is an important component, which is however not well supported yet. Existing haptic devices are often expensive, stationary, or occupy the user’s hand, preventing them from grasping objects or using a controller. We propose PropellerHand, an ungrounded hand-mounted haptic device with two rotatable propellers, that allows exerting forces on the hand without obstructing hand use. PropellerHand is able to simulate feedback such as weight and torque by generating thrust up to 11 N in 2-DOF and a torque of 1.87 Nm in 2-DOF. Its design builds on our experience from quantitative and qualitative experiments with different form factors and parts. We evaluated our prototype through a qualitative user study in various VR scenarios that required participants to manipulate virtual objects in different ways, while changing between torques and directional forces. Results show that PropellerHand improves users’ immersion in virtual reality. Additionally, we conducted a second user study in the field of immersive visualization to investigate the potential benefits of PropellerHand there.
Graphical abstract
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Abbass Y, Dosen S, Seminara L, Valle M. Full-hand electrotactile feedback using electronic skin and matrix electrodes for high-bandwidth human-machine interfacing. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20210017. [PMID: 35762222 DOI: 10.1098/rsta.2021.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/16/2022] [Indexed: 06/15/2023]
Abstract
Tactile feedback is relevant in a broad range of human-machine interaction systems (e.g. teleoperation, virtual reality and prosthetics). The available tactile feedback interfaces comprise few sensing and stimulation units, which limits the amount of information conveyed to the user. The present study describes a novel technology that relies on distributed sensing and stimulation to convey comprehensive tactile feedback to the user of a robotic end effector. The system comprises six flexible sensing arrays (57 sensors) integrated on the fingers and palm of a robotic hand, embedded electronics (64 recording channels), a multichannel stimulator and seven flexible electrodes (64 stimulation pads) placed on the volar side of the subject's hand. The system was tested in seven subjects asked to recognize contact positions and identify contact sliding on the electronic skin, using distributed anode configuration (DAC) and single dedicated anode configuration. The experiments demonstrated that DAC resulted in substantially better performance. Using DAC, the system successfully translated the contact patterns into electrotactile profiles that the subjects could recognize with satisfactory accuracy ([Formula: see text] for static and [Formula: see text] for dynamic patterns). The proposed system is an important step towards the development of a high-density human-machine interfacing between the user and a robotic hand. This article is part of the theme issue 'Advanced neurotechnologies: translating innovation for health and well-being'.
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Affiliation(s)
- Yahya Abbass
- Department of Electrical, Electronic, Telecommunications Engineering, and Naval Architecture (DITEN), University of Genoa, 16145 Genova, Italy
| | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lucia Seminara
- Department of Electrical, Electronic, Telecommunications Engineering, and Naval Architecture (DITEN), University of Genoa, 16145 Genova, Italy
| | - Maurizio Valle
- Department of Electrical, Electronic, Telecommunications Engineering, and Naval Architecture (DITEN), University of Genoa, 16145 Genova, Italy
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Personalized virtual reality simulation training system for percutaneous needle insertion and comparison of zSpace and vive. Comput Biol Med 2022; 146:105585. [DOI: 10.1016/j.compbiomed.2022.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
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Kourtesis P, Argelaguet F, Vizcay S, Marchal M, Pacchierotti C. Electrotactile Feedback Applications for Hand and Arm Interactions: A Systematic Review, Meta-Analysis, and Future Directions. IEEE TRANSACTIONS ON HAPTICS 2022; 15:479-496. [PMID: 35816531 DOI: 10.1109/toh.2022.3189866] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Haptic feedback is critical in a broad range of human-machine/computer-interaction applications. However, the high cost and low portability/wearability of haptic devices remain unresolved issues, severely limiting the adoption of this otherwise promising technology. Electrotactile interfaces have the advantage of being more portable and wearable due to their reduced actuators' size, as well as their lower power consumption and manufacturing cost. The applications of electrotactile feedback have been explored in human-computer interaction and human-machine-interaction for facilitating hand-based interactions in applications, such as prosthetics, virtual reality, robotic teleoperation, surface haptics, portable devices, and rehabilitation. This article presents a technological overview of electrotactile feedback, as well a systematic review and meta-analysis of its applications for hand-based interactions. We discuss the different electrotactile systems according to the type of application. We also discuss over a quantitative congregation of the findings, to offer a high-level overview into the state-of-art and suggest future directions. Electrotactile feedback systems showed increased portability/wearability, and they were successful in rendering and/or augmenting most tactile sensations, eliciting perceptual processes, and improving performance in many scenarios. However, knowledge gaps (e.g., embodiment), technical (e.g., recurrent calibration, electrodes' durability) and methodological (e.g., sample size) drawbacks were detected, which should be addressed in future studies.
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Lwin TM, Turner MA, Nishino H, Amirfakhri S, Hernot S, Hoffman RM, Bouvet M. Fluorescent Anti-CEA Nanobody for Rapid Tumor-Targeting and Imaging in Mouse Models of Pancreatic Cancer. Biomolecules 2022; 12:711. [PMID: 35625638 PMCID: PMC9138244 DOI: 10.3390/biom12050711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/16/2022] Open
Abstract
Tumor-specific targeting with fluorescent probes can enhance contrast for identification of cancer during surgical resection and visualize otherwise invisible tumor margins. Nanobodies are the smallest naturally-occurring antigen-binding molecules with rapid pharmacokinetics. The present work demonstrates the efficacy of a fluorescent anti-CEA nanobody conjugated to an IR800 dye to target and label patient derived pancreatic cancer xenografts. After intravenous administration, the probe rapidly localized to the pancreatic cancer tumors within an hour and had a tumor-to-background ratio of 2.0 by 3 h. The fluorescence signal was durable over a prolonged period of time. With the rapid kinetics afforded by fluorescent nanobodies, both targeting and imaging can be performed on the same day as surgery.
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Affiliation(s)
- Thinzar M. Lwin
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael A. Turner
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgery, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Hiroto Nishino
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgery, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Siamak Amirfakhri
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgery, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Sophie Hernot
- Laboratory for In vivo Cellular and Molecular Imaging, ICMI-BEFY/MIMA, Vrije Universiteit Brussel, B-1090 Brussels, Belgium;
| | - Robert M. Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgery, VA San Diego Healthcare System, San Diego, CA 92161, USA
- AntiCancer, Inc., San Diego, CA 92111, USA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, CA 92093, USA; (T.M.L.); (M.A.T.); (H.N.); (S.A.); (R.M.H.)
- Department of Surgery, VA San Diego Healthcare System, San Diego, CA 92161, USA
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Wang Y, Sun J, Liu X, Li Y, Fan X, Zhou H. Robot-Assisted Orbital Fat Decompression Surgery: First in Human. Transl Vis Sci Technol 2022; 11:8. [PMID: 35536720 PMCID: PMC9100477 DOI: 10.1167/tvst.11.5.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the safety and feasibility of robot-assisted orbital fat decompression surgery. Methods Ten prospectively enrolled patients (18 eyes) with Graves’ ophthalmopathy underwent robot-assisted orbital fat decompression surgery with the da Vinci Xi surgical system. Intraoperative blood loss, operative time, and complications were recorded. For every patient, the exophthalmos of the operated eyes and Graves’ orbitopathy quality of life (GO-QoL) were measured both preoperatively and 3 months postoperatively to assess the surgical effect. Results All surgical procedures were successfully performed. The mean duration to complete the whole procedure was 124.3 ± 33.2 minutes (range, 60–188). The mean intraoperative blood loss was 17.8 ± 6.2 mL (range, 7.5–28). There were neither complications nor unexpected events in terms of either orbital decompression surgery or robot-assisted procedures. The mean exophthalmos was 20.2 ± 1.8 mm before surgery and 17.9 ± 1.4 mm postoperatively (P < 0.0001). The preoperative and postoperative GO-QoL on the visual function arm was 84.38 ± 20.04 and 93.75 ± 9.32, respectively. The preoperative and postoperative GO-QoL on the appearance arm was 42.50 ± 14.97 and 64.38 ± 21.46, respectively (P = 0.027). Conclusions The da Vinci Xi surgical system provided the stability, dexterity, and good visualization necessary for orbital fat decompression surgery, indicating the safety and feasibility of robot-assisted orbital fat decompression surgery. Translational Relevance Based on a literature search using EMBASE and MEDLINE databases, we believe that this study reports the first in-human results of the safety and effectiveness of da Vinci robot-assisted orbital fat decompression surgery.
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Affiliation(s)
- Yi Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Perry S, Bridges SM, Burrow MF. A conceptual model for clinical psychomotor skill development in an era of simulated and virtual reality. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:263-276. [PMID: 34047437 DOI: 10.1111/eje.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/25/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
Psychomotor skill development is central to a beginner practitioner's learning pathway. Curriculum constraints around time, access to facilities and resources in health professions education have prompted the growth in alternative approaches to clinical skill development in both simulation and direct patient care. Among these is the increased incorporation of virtual reality (VR) systems with haptic feedback alongside traditional, solid simulations. Given the rapid growth in the adoption of technological affordances to support skill development, it is cogent to pause and examine whether the underpinning concepts regarding psychomotor skill development that have driven much of the approaches to teach clinical skill acquisition in dentistry remain fit-for-purpose. This conceptual paper proposes a new taxonomy for clinical simulation psychomotor skill development in the era of increasing variety of simulation modalities.
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Affiliation(s)
- Suzanne Perry
- The Scottish Orthodontic Centre, East Kilbride, Scotland
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Aissaoui R, Gagnon D. Effect of Haptic Training During Manual Wheelchair Propulsion on Shoulder Joint Reaction Moments. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:827534. [PMID: 36188985 PMCID: PMC9397983 DOI: 10.3389/fresc.2022.827534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Background Manual wheelchair propulsion remains a very ineffective means of locomotion in terms of energy cost and mechanical efficiency, as more than half of the forces applied to the pushrim do not contribute to move the wheelchair forward. Manual wheelchair propulsion training using the haptic biofeedback has shown an increase in mechanical efficiency at the handrim level. However, no information is available about the impact of this training on the load at the shoulders. We hypothesized that increasing propulsion mechanical efficiency by 10% during propulsion would not yield clinically significant augmentation of the load sustained at the shoulders. Methods Eighteen long-term manual wheelchair users with a spinal cord injury propelled a manual wheelchair over a wheelchair simulator offering the haptic biofeedback. Participants were asked to propel without the Haptic Biofeedback (HB) and, thereafter, they were subjected to five training blocks BL1–BL5 of 3 min in a random order with the haptic biofeedback targeting a 10% increase in force effectiveness. The training blocs such as BL1, BL2 BL3, BL4, and BL5 correspond, respectively, to a resistant moment of 5, 10, 15, 20, and 25%. Pushrim kinetics, shoulder joint moments, and forces during the propulsive cycle of wheelchair propulsion were assessed for each condition. Results The tangential force component increases significantly by 74 and 87%, whereas value for the mechanical effective force increases by 9% between the pretraining and training blocks BL3. The haptic biofeedback resulted in a significant increase of the shoulder moments with 1–7 Nm. Conclusion Increases in shoulder loads were found for the corresponding training blocks but even though the percentage of the increase seems high, the amplitude of the joint moment remains under the values of wheelchair propulsion found in the literature. The use of the HB simulator is considered here as a safe approach to increase mechanical effectiveness. However, the longitudinal impact of this enhancement remains unknown for the impact on the shoulder joint. Future studies will be focused on this impact in terms of shoulder risk injury during manual wheelchair propulsion.
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Affiliation(s)
- Rachid Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Génie des systèmes, École de technologie supérieure (ETS), Montreal, QC, Canada
- *Correspondence: Rachid Aissaoui
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Pathokinesiology Laboratory (www.pathokin.ca), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Montreal, QC, Canada
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St Mart JP, Goh EL, Liew I, Shah Z, Sinha J. Artificial intelligence in orthopaedic surgery: transforming technological innovation in patient care and surgical training. Postgrad Med J 2022:postgradmedj-2022-141596. [PMID: 35379754 DOI: 10.1136/postgradmedj-2022-141596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/19/2022] [Indexed: 12/16/2022]
Abstract
Artificial intelligence (AI) is an exciting field combining computer science with robust data sets to facilitate problem-solving. It has the potential to transform education, practice and delivery of healthcare especially in orthopaedics. This review article outlines some of the already used AI pathways as well as recent technological advances in orthopaedics. Additionally, this article further explains how potentially these two entities could be combined in the future to improve surgical education, training and ultimately patient care and outcomes.
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Affiliation(s)
- Jean-Pierre St Mart
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - En Lin Goh
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford Trauma, Kadoorie Centre, University of Oxford, Oxford, UK
| | - Ignatius Liew
- Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Zameer Shah
- Trauma and Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joydeep Sinha
- Trauma and Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Isakovic M, Malesevic J, Kostic M, Dosen S, Strbac M. The Impact of Size and Position of Reference Electrode on the Localization of Biphasic Electrotactile Stimulation on the Fingertips. IEEE TRANSACTIONS ON HAPTICS 2022; 15:255-266. [PMID: 34995193 DOI: 10.1109/toh.2022.3141187] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Development of haptic interfaces to enrich augmented and virtual reality with the sense of touch is the next frontier for technological advancement of these systems. Among available technologies, electrotactile stimulation enables design of high-density interfaces that can provide natural-like sensation of touch in interaction with virtual objects. The present study investigates the human perception of electrotactile sensations on fingertips, focusing on the sensation localization in function of the size and position of reference electrode. Ten healthy subjects participated in the study, with the task to mark the sensations elicited by stimulating the index fingertip using an 8-pad electrode. The test systematically explored several configurations of the active (position) and reference (position and size) electrode pads. The results indicated that there was a spreading of perceived sensations across the fingertip, but that they were mostly localized below the active pad. The position and size of the reference electrode were shown to affect the location of the perceived sensations, which can potentially be exploited as an additional parameter to modulate the feedback. The present study demonstrates that the fingertip is a promising target for the delivery of high-resolution feedback.
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Kossowsky H, Farajian M, Nisky I. The Effect of Kinesthetic and Artificial Tactile Noise and Variability on Stiffness Perception. IEEE TRANSACTIONS ON HAPTICS 2022; 15:351-362. [PMID: 35271449 DOI: 10.1109/toh.2022.3158386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Robot-assisted minimally invasive surgeries (RAMIS) have many benefits. A disadvantage, however, is the lack of haptic feedback. Haptic feedback is comprised of kinesthetic and tactile information, and we use both to form stiffness perception. Applying both kinesthetic and tactile feedback can enable more precise feedback than kinesthetic feedback alone. However, during remote surgeries, haptic noises and variations can be present. Therefore, toward designing haptic feedback for RAMIS, it is important to understand the effect of haptic manipulations on stiffness perception. We assessed the effect of two manipulations using stiffness discrimination tasks in which participants received force feedback and artificial skin stretch. In Experiment 1, we added sinusoidal noise to the artificial tactile signal, and found that the noise did not affect participants' stiffness perception or uncertainty. In Experiment 2, we varied either the kinesthetic or the artificial tactile information between consecutive interactions with an object. We found that the both forms of variability did not affect stiffness perception, but kinesthetic variability increased participants' uncertainty. We show that haptic feedback, comprised of force feedback and artificial skin stretch, provides robust haptic information even in the presence of noise and variability, and hence can potentially be both beneficial and viable in RAMIS.
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Tang EM, El-Haddad MT, Patel SN, Tao YK. Automated instrument-tracking for 4D video-rate imaging of ophthalmic surgical maneuvers. BIOMEDICAL OPTICS EXPRESS 2022; 13:1471-1484. [PMID: 35414968 PMCID: PMC8973184 DOI: 10.1364/boe.450814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 05/11/2023]
Abstract
Intraoperative image-guidance provides enhanced feedback that facilitates surgical decision-making in a wide variety of medical fields and is especially useful when haptic feedback is limited. In these cases, automated instrument-tracking and localization are essential to guide surgical maneuvers and prevent damage to underlying tissue. However, instrument-tracking is challenging and often confounded by variations in the surgical environment, resulting in a trade-off between accuracy and speed. Ophthalmic microsurgery presents additional challenges due to the nonrigid relationship between instrument motion and instrument deformation inside the eye, image field distortion, image artifacts, and bulk motion due to patient movement and physiological tremor. We present an automated instrument-tracking method by leveraging multimodal imaging and deep-learning to dynamically detect surgical instrument positions and re-center imaging fields for 4D video-rate visualization of ophthalmic surgical maneuvers. We are able to achieve resolution-limited tracking accuracy at varying instrument orientations as well as at extreme instrument speeds and image defocus beyond typical use cases. As proof-of-concept, we perform automated instrument-tracking and 4D imaging of a mock surgical task. Here, we apply our methods for specific applications in ophthalmic microsurgery, but the proposed technologies are broadly applicable for intraoperative image-guidance with high speed and accuracy.
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Affiliation(s)
- Eric M. Tang
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Mohamed T. El-Haddad
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Shriji N. Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yuankai K. Tao
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
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Park YJ, Lee ES, Choi SB. A Cylindrical Grip Type of Tactile Device Using Magneto-Responsive Materials Integrated with Surgical Robot Console: Design and Analysis. SENSORS 2022; 22:s22031085. [PMID: 35161830 PMCID: PMC8839812 DOI: 10.3390/s22031085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/15/2023]
Abstract
This paper proposes a cylindrical grip type of tactile device that is effectively integrated to a surgical robot console so that a surgeon can easily touch and feel the same stiffness as the operating organs. This is possible since the yield stress (or stiffness) of magnetic-responsive materials can be tuned or controlled by the magnetic field intensity. The proposed tactile device consists of two main parts: a magnetorheological elastomer (MRE) layer and a magnetorheological fluid (MRF) core. The grip shape of the device to be positioned on the handle part of the master of the surgical robot is configured and its operating principle is discussed. Then, a couple of equations to calculate the stiffness from the gripping force and the field-dependent yield stress of MRF are derived and integrated using the finite element analysis (FEA) model. After simulating the stiffness of the proposed tactile device as a function of the magnetic field intensity (or current), the stiffnesses of various human organs, including the liver and heart, are calculated from known data of an elastic modulus. It is demonstrated from comparative data between calculated stiffness from human tissues and simulated stiffness from FEA that the proposed tactile device can generate sufficient stiffness with a low current level to recognize various human organs which are significantly required in the surgical robot system.
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Affiliation(s)
- Yu-Jin Park
- Korea Initiative for Fostering University of Research and Innovation, Department of Mechanical Engineering, Inha University, Incheon 21999, Korea;
| | - Eun-Sang Lee
- Korea Initiative for Fostering University of Research and Innovation, Department of Mechanical Engineering, Inha University, Incheon 21999, Korea;
- Correspondence: (E.-S.L.); (S.-B.C.)
| | - Seung-Bok Choi
- Department of Mechanical Engineering, The State University of New York, Korea, Incheon 21985, Korea
- Department of Mechanical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
- Correspondence: (E.-S.L.); (S.-B.C.)
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Şendir M, Kızıl H, Inangil D, Kabuk A, Türkoğlu İ. Effectiveness of haptic technology in teaching urinary catheterization skill: A randomized controlled study. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Juo YY, Pensa J, Sanaiha Y, Abiri A, Sun S, Tao A, Vogel SD, Kazanjian K, Dutson E, Grundfest W, Lin A. Reducing retraction forces with tactile feedback during robotic total mesorectal excision in a porcine model. J Robot Surg 2021; 16:1083-1090. [PMID: 34837593 DOI: 10.1007/s11701-021-01338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
Excessive tissue-instrument interaction forces during robotic surgery have the potential for causing iatrogenic tissue damages. The current in vivo study seeks to assess whether tactile feedback could reduce intraoperative tissue-instrument interaction forces during robotic-assisted total mesorectal excision. Five subjects, including three experts and two novices, used the da Vinci robot to perform total mesorectum excision in four pigs. The grip force in the left arm, used for retraction, and the pushing force in the right arm, used for blunt pelvic dissection around the rectum, were recorded. Tissue-instrument interaction forces were compared between trials done with and without tactile feedback. The mean force exerted on the tissue was consistently higher in the retracting arm than the dissecting arm (3.72 ± 1.19 vs 0.32 ± 0.36 N, p < 0.01). Tactile feedback brought about significant reductions in average retraction forces (3.69 ± 1.08 N vs 4.16 ± 1.12 N, p = 0.02), but dissection forces appeared unaffected (0.43 ± 0.42 vs 0.37 ± 0.28 N, p = 0.71). No significant differences were found between retraction and dissection forces exerted by novice and expert robotic surgeons. This in vivo animal study demonstrated the efficacy of tactile feedback in reducing retraction forces during total mesorectal excision. Further research is required to quantify the clinical impact of such force reduction.
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Affiliation(s)
- Yen-Yi Juo
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA.
| | - Jake Pensa
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yas Sanaiha
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Ahmad Abiri
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Songping Sun
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anna Tao
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sandra Duarte Vogel
- Division of Laboratory Animal Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kevork Kazanjian
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Erik Dutson
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Warren Grundfest
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anne Lin
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
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Braun D, Weik D, Elsner S, Hunger S, Werner M, Drossel WG. Position Control and Force Estimation Method for Surgical Forceps Using SMA Actuators and Sensors. MATERIALS 2021; 14:ma14175111. [PMID: 34501197 PMCID: PMC8434184 DOI: 10.3390/ma14175111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgery is increasingly used in many medical operations because of the benefits for the patients. However, for the surgeons, accessing the situs through a small incision or natural orifice comes with a reduction of the degrees of freedom of the instrument. Due to friction of the mechanical coupling, the haptic feedback lacks sensitivity that could lead to damage of the tissue. The approach of this work to overcome these problems is to develop a control concept for position control and force estimation with shape memory alloys (SMA) which could offer haptic feedback in a novel handheld instrument. The concept aims to bridge the gap between manually actuated laparoscopic instruments and surgical robots. Nickel-titanium shape memory alloys are used for actuation because of their high specific energy density. The work includes the manufacturing of a functional model as a proof of concept comprising the development of a suitable forceps mechanism and electronic circuit for position control and gripping force measurement, as well as designing an ergonomic user interface with haptic force feedback.
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Affiliation(s)
- Dennis Braun
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Correspondence:
| | - David Weik
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sophia Elsner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Professorship for Adaptronics and Lightweight Design in Production, Chemnitz University of Technology, Straße der Nationen 62, 09111 Chemnitz, Germany
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Survival of polymeric microstructures subjected to interrogatory touch. PLoS One 2021; 16:e0255980. [PMID: 34473714 PMCID: PMC8412302 DOI: 10.1371/journal.pone.0255980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
Polymeric arrays of microrelief structures have a range of potential applications. For example, to influence wettability, to act as biologically inspired adhesives, to resist biofouling, and to play a role in the “feel” of an object during tactile interaction. Here, we investigate the damage to micropillar arrays comprising pillars of different modulus, spacing, diameter, and aspect ratio due to the sliding of a silicone cast of a human finger. The goal is to determine the effect of these parameters on the types of damage observed, including adhesive failure and ploughing of material from the finger onto the array. Our experiments point to four principal conclusions [1]. Aspect ratio is the dominant parameter in determining survivability through its effect on the bending stiffness of micropillars [2]. All else equal, micropillars with larger diameter are less susceptible to breakage and collapse [3]. The spacing of pillars in the array largely determines which type of adhesive failure occurs in non-surviving arrays [4]. Elastic modulus plays an important role in survivability. Clear evidence of elastic recovery was seen in the more flexible polymer and this recovery led to more instances of pristine survivability where the stiffer polymer tended to ablate PDMS. We developed a simple model to describe the observed bending of micropillars, based on the quasi-static mechanics of beam-columns, that indicated they experience forces ranging from 10−4–10−7 N to deflect into adhesive contact. Taken together, results obtained using our framework should inform design considerations for microstructures intended to be handled by human users.
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ROBOT-ASSISTED VITREORETINAL SURGERY IMPROVES SURGICAL ACCURACY COMPARED WITH MANUAL SURGERY: A Randomized Trial in a Simulated Setting. Retina 2021; 40:2091-2098. [PMID: 31842191 PMCID: PMC7575030 DOI: 10.1097/iae.0000000000002720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Robot-assisted vitreoretinal surgery increases precision and limits tissue damage compared with manual surgery especially for the novice surgeon. The Eyesi Simulator is a feasible platform for investigating robot-assisted vitreoretinal surgery. Purpose: To compare manual and robot-assisted vitreoretinal surgery using a virtual-reality surgical simulator. Methods: Randomized controlled crossover study. Ten experienced vitreoretinal surgeons and 10 novice ophthalmic surgeons were included. The participants were randomized to start with either manual or robot-assisted surgery. Participants completed a test session consisting of three vitreoretinal modules on the Eyesi virtual-reality simulator. The automated metrics of performance supplied by the Eyesi simulator were used as outcome measures. Primary outcome measures were time with instruments inserted (seconds), instrument movement (mm), and tissue treatment (mm2). Results: Robot-assisted surgery was slower than manual surgery for both novices and vitreoretinal surgeons, 0.24 SD units (P = 0.024) and 0.73 SD units (P < 0.001), respectively. Robot-assisted surgery allowed for greater precision in novices and vitreoretinal surgeons, −0.96 SD units (P < 0.001) and −0.47 SD units (P < 0.001), respectively. Finally, novices using robot-assisted surgery inflicted less tissue damage when compared with that using manual surgery, −0.59 SD units (P = 0.009). Conclusion: At the cost of time, robot-assisted vitreoretinal surgery seems to improve precision and limit tissue damage compared with that of manual surgery. In particular, the performance of novice surgeons is enhanced with robot-assisted vitreoretinal surgery.
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Ly HH, Tanaka Y, Fujiwara M. SuP-Ring: A pneumatic tactile display with substitutional representation of contact force components using normal indentation. Int J Med Robot 2021; 17:e2325. [PMID: 34425041 DOI: 10.1002/rcs.2325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Shear force is important for tumour detection and can contribute to minimally invasive surgery (MIS). A popular method uses lateral skin stretch to produce shear force but has some limitations. METHODS We have developed a ring-type pneumatic tactile display that employs normal indentation substituted for lateral skin stretch to represent normal and shear feedback, called SuP-Ring. Psychophysical experiments were conducted to evaluate how users perceive the provided feedback and the effectiveness of SuP-Ring in tumour localisation. RESULTS The experimental results show that the participants could perceive the provided normal and shear feedback well. Shear feedback enables users to enhance their performance in localising the tumour and normal feedback could contribute to ensuring the safety requirements in MIS. CONCLUSIONS The proposed tactile display could be useful for intraoperative tumour localisation and has the potential to be used in a wide variety of applications.
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Affiliation(s)
- Hoang Hiep Ly
- Department of Electrical and Mechanical Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yoshihiro Tanaka
- Department of Electrical and Mechanical Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Michitaka Fujiwara
- Medical xR Center, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Winkler C, Strobl A, Schmal TJ, Hartl M, Burian M, Formanek M. [Role of Robotic Surgery in ENT]. Wien Med Wochenschr 2021; 172:20-30. [PMID: 34338906 DOI: 10.1007/s10354-021-00865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
Since the beginning of the 21st century, surgical robots have been used in the ENT-environment. They primarily support surgeons in minimal invasive transoral operations, especially in multidisciplinary treatment concepts of head and neck tumors, but also in snoring surgery the robot provides a complement to the established transoral laser surgery. In the meantime there is a large number of data that deals with the importance of oncological results, function maintenance, economics and future perspectives.Operation areas of the current robot devices are still limited in the ENT-environment. As the number of cases are small, efforts are being made to connect centres on a national and international level. Thus, uniform training standards, targeted knowledge and data exchange as well as further development of systems would be managed better. The creation of small and agile ENT-specific equipment could expand the possibilities as a next step for the future and finally lead to a wide scale of ENT-surgical applications.
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Affiliation(s)
- Christoph Winkler
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich. .,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich.
| | - Andreas Strobl
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich.
| | - Thomas J Schmal
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich.,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich
| | - Maximilian Hartl
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich
| | - Martin Burian
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich
| | - Michael Formanek
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich.,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich
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Battaglia E, Boehm J, Zheng Y, Jamieson AR, Gahan J, Majewicz Fey A. Rethinking Autonomous Surgery: Focusing on Enhancement over Autonomy. Eur Urol Focus 2021; 7:696-705. [PMID: 34246619 PMCID: PMC10394949 DOI: 10.1016/j.euf.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT As robot-assisted surgery is increasingly used in surgical care, the engineering research effort towards surgical automation has also increased significantly. Automation promises to enhance surgical outcomes, offload mundane or repetitive tasks, and improve workflow. However, we must ask an important question: should autonomous surgery be our long-term goal? OBJECTIVE To provide an overview of the engineering requirements for automating control systems, summarize technical challenges in automated robotic surgery, and review sensing and modeling techniques to capture real-time human behaviors for integration into the robotic control loop for enhanced shared or collaborative control. EVIDENCE ACQUISITION We performed a nonsystematic search of the English language literature up to March 25, 2021. We included original studies related to automation in robot-assisted laparoscopic surgery and human-centered sensing and modeling. EVIDENCE SYNTHESIS We identified four comprehensive review papers that present techniques for automating portions of surgical tasks. Sixteen studies relate to human-centered sensing technologies and 23 to computer vision and/or advanced artificial intelligence or machine learning methods for skill assessment. Twenty-two studies evaluate or review the role of haptic or adaptive guidance during some learning task, with only a few applied to robotic surgery. Finally, only three studies discuss the role of some form of training in patient outcomes and none evaluated the effects of full or semi-autonomy on patient outcomes. CONCLUSIONS Rather than focusing on autonomy, which eliminates the surgeon from the loop, research centered on more fully understanding the surgeon's behaviors, goals, and limitations could facilitate a superior class of collaborative surgical robots that could be more effective and intelligent than automation alone. PATIENT SUMMARY We reviewed the literature for studies on automation in surgical robotics and on modeling of human behavior in human-machine interaction. The main application is to enhance the ability of surgical robotic systems to collaborate more effectively and intelligently with human surgeon operators.
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Affiliation(s)
- Edoardo Battaglia
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Jacob Boehm
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Yi Zheng
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Andrew R Jamieson
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Gahan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA.
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Kossowsky H, Farajian M, Milstein A, Nisky I. The Effect of Variability in Stiffness on Perception and Grip Force Adjustment. IEEE TRANSACTIONS ON HAPTICS 2021; 14:513-525. [PMID: 33449879 DOI: 10.1109/toh.2021.3052136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Haptic information can be used to create our perception of the stiffness of objects and to regulate grip force. Introducing noise into sensory inputs can create uncertainty, yet a method of creating haptic uncertainty without distorting the haptic information has yet to be discovered. Toward this end, in this article, we investigated the effect of varying haptic information between consecutive interactions with an elastic force field on stiffness perception and grip force control. In a stiffness discrimination task, participants interacted with force fields multiple times. Low, medium, and high variability levels were created by drawing the stiffness level applied in each consecutive interaction within a trial from normal distributions. Perceptual haptic uncertainty was created only by the medium variability level. Moreover, all the variability levels affected the grip force control: the modulation of the grip force with the load force decreased with repeated interactions with the force field, whereas no change in the baseline grip force was observed. Additionally, we ascertained that participants formed their perceived stiffness by calculating a weighted average of the different stiffness levels applied by a given force field. We conclude that the medium variability level can be effective in inducing uncertainty in both perception and action.
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Nillahoot N, Patel S, Suthakorn J. A Technique for Mimicking Soft Tissue Manipulation from Experimental Data to a Wave Equation Model for a New Laparoscopic Virtual Reality Training System. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background:
The difficulty of laparoscopic procedures and the specific psychomotor skills required support the need for a training system for intensive and repetitive practice to acquire the specific skills. The present VR training systems have some limitations with respect to the soft tissue models in the training system. This is associated with the need for a real-time simulation, which requires a balance between computational cost and accuracy.
Objective:
The primary objective of the study is to develop a two dimensional wave equation model that closely mimics the soft tissue manipulation in a laparoscopic procedure for a VR training system.
Methods:
A novel mathematical model based on the wave equation is prepared to represent the interaction between the laparoscopic tool and the soft tissue. The parameters within the model are determined through experimental analysis of a soft tissue phantom. The experimental setup involves a linear actuator applying force to the soft tissue phantom to generate deformation. Data acquisition is conducted through a camera and a robotic force acquisition system which measures force, displacement of the linear actuator and records a video. Through image processing, the displacements of the markers on the phantom’s x-y plane during its deformation are determined and these parameters are used to develop the model, which finally is validated through a comparative analysis.
Results:
The results from the developed model are observed and compared statistically as well as graphically with the finite element model based on deformation data. The results show that the deformation data between the developed model and the available model is significantly similar.
Conclusion:
This study demonstrates the adaptability of the wave equation to meet the needs of the specific surgical procedure through modification of the model based on the experimental data. Moreover, the comparative analysis further corroborates the relevance and validity of the model for the surgical training system.
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Rondelli F, Sanguinetti A, Polistena A, Avenia S, Marcacci C, Ceccarelli G, Bugiantella W, De Rosa M. Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art. J Pers Med 2021; 11:jpm11060584. [PMID: 34205596 PMCID: PMC8233761 DOI: 10.3390/jpm11060584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Alessandro Sanguinetti
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Andrea Polistena
- Department of General and Laparoscopic Surgery–University Hospital, University of Rome, “Umberto I”, 00161 Rome, Italy;
| | - Stefano Avenia
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Claudio Marcacci
- Department of General Surgery and Surgical Specialties, University of Perugia, “S. Maria” Hospital, 05100 Terni, Italy; (F.R.); (A.S.); (S.A.); (C.M.)
| | - Graziano Ceccarelli
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Walter Bugiantella
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
| | - Michele De Rosa
- Department of General and Robotic Surgery, “San Giovanni Battista” Hospital, USL Umbria 2, 06034 Foligno, Italy; (G.C.); (W.B.)
- Correspondence:
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Hardon SF, van Gastel LA, Horeman T, Daams F. Assessment of technical skills based on learning curve analyses in laparoscopic surgery training. Surgery 2021; 170:831-840. [PMID: 34090675 DOI: 10.1016/j.surg.2021.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Objective force- and motion-based assessment is currently lacking in laparoscopic skills curricula. This study aimed to evaluate the added value of parameter-based assessment and feedback during training. METHODS Laparoscopy-naïve surgical residents that took part in a 3-week skills training curriculum were included. A box trainer equipped with the ForceSense system was used for assessment of tissue manipulation- (MaxForce) and instrument-handling skills (Path length and Time). Learning curves were established using linear regression tests. Pre- and post-course comparisons indicated the overall progression and were compared to predefined proficiency levels. A post-course survey was carried out to assess face validity. RESULTS In total, 4,268 trials, executed by 24 residents, were successfully assessed. Median (interquartile range) MaxForce outcomes improved from 2.7 Newton (interquartile range 1.9-3.8) to 1.8 Newton (interquartile range 1.2-2.4) between pre- and post-course assessment (P ≤ .009). Instrument Path length improved from 7,102.2 mm (interquartile range 5,255.2-9,025.9) to 3,545.3 mm (interquartile range 2,842.9-4,563.2) (P ≤.001). Time to execute the task improved from 159.8 seconds (interquartile range 119.8-219.0) to 60.7 seconds (interquartile range 46.0-79.5) (P ≤ .001). The learning curves revealed during what training phase the proficiency benchmarks were reached for each trainee. In the survey outcomes, trainees indicated that this curriculum should be part of a surgical residency program (mean visual analog scale score of 9.2 ± 0.9 standard deviation). CONCLUSION Force-, motion-, and time-parameters can be objectively measured during basic laparoscopic skills curricula and do indicate progression of skills over time. The ForceSense parameters enable curricula to be designed for specific proficiency-based training goals and offer the possibility for objective classification of the levels of expertise.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Leonie A van Gastel
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands. https://twitter.com/freekdaams
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