Skill-Oriented and Performance-Driven Adaptive Curricula for Training in Robot-Assisted Surgery Using Simulators: A Feasibility Study

Real-time motion force-feedback system with predictive-vision for improving motor accuracy

Many haptic guidance systems have been studied over the years; however, most of them have been limited to predefined guidance methods. Calculating guidance according to the operator's motion is important for efficient human motor adaptation and learning. In this study, we developed a system that haptically provides guidance trajectory by sequential weighting between the operator's trajectory and the ideal trajectory calculated from a predictive-vision system. We investigated whether motion completion with a predictive-vision system affects human motor accuracy and adaptation in time-constrained goal-directed reaching and ball-hitting tasks through subject experiments. The experiment was conducted with 12 healthy participants, and all participants performed ball-hitting tasks. Half of the participants get forceful guidance from the proposed system in the middle of the experiment. We found that the use of the proposed system improved the operator's motor performance. Furthermore, we observed a trend in which the improvement in motor performance using this system correlated with that after the washout of this system. These results suggest that the predictive-vision system effectively enhances motor accuracy to the target error in dynamic and time-constrained reaching and hitting tasks and may contribute to facilitating motor learning.

Curricula for teaching end-users to kinesthetically program collaborative robots

Non-expert users can now program robots using various end-user robot programming methods, which have widened the use of robots and lowered barriers preventing robot use by laypeople. Kinesthetic teaching is a common form of end-user robot programming, allowing users to forgo writing code by physically guiding the robot to demonstrate behaviors. Although it can be more accessible than writing code, kinesthetic teaching is difficult in practice because of users' unfamiliarity with kinematics or limitations of robots and programming interfaces. Developing good kinesthetic demonstrations requires physical and cognitive skills, such as the ability to plan effective grasps for different task objects and constraints, to overcome programming difficulties. How to help users learn these skills remains a largely unexplored question, with users conventionally learning through self-guided practice. Our study compares how self-guided practice compares with curriculum-based training in building users' programming proficiency. While we found no significant differences between study participants who learned through practice compared to participants who learned through our curriculum, our study reveals insights into factors contributing to end-user robot programmers' confidence and success during programming and how learning interventions may contribute to such factors. Our work paves the way for further research on how to best structure training interventions for end-user robot programmers.

Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum

Robot-assisted surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational stakeholders guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee. The study was conducted in four Phases: P1: a steering group was formed to review current literature and summarise the evidence, P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to the three round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. There was 100% response from all three rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of > 0.8. There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment. Using the Delphi methodology, we achieved multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC. This guidance will benefit from further validation following implementation.

Design and validation of looping assistance methods in robotic-assisted neonatal surgical suturing in a chest model

BACKGROUND

Neonate patients have a reduced thoracic cavity, making thoracoscopic procedures even more challenging than their adult counterparts.

METHODS

We evaluated five control strategies for robot-assisted thoracoscopic surgical looping in simulations and experiments with a physical robotic system in a neonate surgical phantom. The strategies are composed of state-of-the-art constrained optimization and a novel looping force feedback term.

RESULTS

All control strategies allowed users to successfully perform looping. A user study in simulation showed that the proposed strategy was superior in terms of Physical demand p < 0.05 $\left(p< 0.05\right)$ and task duration p < 0.05 $\left(p< 0.05\right)$ . The cumulative sum analysis of inexperienced users shows that the proposed looping force feedback can speed up the learning. Results with surgeons did not show a significant difference among control strategies.

CONCLUSIONS

Assistive strategies in looping show promise and further work is needed to extend these benefits to other subtasks in robot-aided surgical suturing.

Safe implementation of robotic distal gastrectomy performed by non-endoscopic surgical skill qualification system-qualified surgeons

PURPOSE

Robotic gastrectomy (RG) for gastric cancer (GC) was approved for national medical insurance coverage in April, 2018, since when its use has increased dramatically throughout Japan. However, the safety of RG performed by surgeons who are not Endoscopic Surgical Skill Qualification System (ESSQS)-qualified has yet to be established. We conducted this study to verify the short-term outcomes of the initial series of RG procedures performed by non-ESSQS-qualified surgeons.

METHODS

Between January, 2020 and December, 2021, 30 patients with clinical Stage I and II GC underwent RG performed by four non-ESSQS-qualified surgeons according to the Japan Society for Endoscopic Surgery guideline. We evaluated, retrospectively, the morbidity rates according to Clavien-Dindo (CD) classification grade II or higher.

RESULTS

Each operating surgeon completed all procedures without any serious intraoperative adverse events. The median operative time, console time, and estimated blood loss were 413 (308-547) min, 361 (264-482) min, and 25.5 (4-167) mL, respectively. No patient required conversion to laparoscopic or open surgery. Three (10%) patients suffered CD grade II complications postoperatively. The median postoperative hospitalization was 11 (8-51) days.

CONCLUSION

Non-ESSQS-qualified surgeons trained by expert RG surgeons could perform robotic distal gastrectomy safely for initial cases.

A systematic review of robotic surgery curricula using a contemporary educational framework

BACKGROUND

There has been a rising trend in robotic surgery. Thus, there is demand for a robotic surgery curriculum (RSC) for training surgical trainees and practicing surgeons. There are limited data available about current curricular designs and the extent to which they have incorporated educational frameworks. Our aim was to study the existing robotic surgery curricula using Kern's 6-step approach in curriculum development.

METHODS

A systematic review was conducted using PubMed, PubMed Central, Cochrane, Embase, and Scopus (we searched studies from 2001 to 2021). PRISMA Guidelines was used to guide the search. Curriculum designed for general surgery and its subspecialties were included. Urology and gynecology were excluded. The articles were reviewed by five reviewers.

RESULTS

Our review yielded 71 articles, including 39 curricula at 9 different settings. Using Kern's framework, we demonstrated that the majority of robotic surgery curricula contained all the elements of Kern's curricular design. However, there were significant deficiencies in important aspects of these curricula i.e., implementation, the quality of assessment tools for measurement of performance and evaluation of the educational value of these interventions. Most institutions used commercial virtual reality simulators (VRS) as the main component of their RSC and 23% of curricula only used VRS.

CONCLUSIONS

Although majority of these studies contained all the elements of Kern's framework, there are critical deficiencies in the components of existing curricula. Future curricula should be designed using established educational frameworks to improve the quality of robotic surgery training.

A Fault Diagnosis Approach for Electromechanical Actuators with Simulating Model under Small Experimental Data Sample Condition

Electromechanical actuators (EMAs) have shown a high efficiency in flight surface control with the development of more electric aircraft. In order to identify the abnormalities and potential failures of EMA, a methodology for fault diagnosis is developed. A simulating model of EMA is first built to perform different working states. Based on the modeling of EMA, the corresponding faults are then simulated to re-generate the fault data. Afterwards, a gated recurrent unit (GRU) and co-attention-based fault diagnosis approach is proposed to classify the working states of EMA. Experiments are conducted and a satisfying classification accuracy on simulated data is obtained. Furthermore, fault diagnosis on an actual working system is performed. The experimental results demonstrate that the proposed method has a high efficiency.

The safe performance of robotic gastrectomy by second-generation surgeons meeting the operating surgeon's criteria in the Japan Society for Endoscopic Surgery guidelines

BACKGROUND

Robotic gastrectomy (RG) for gastric cancer (GC) has gradually gained nationwide prominence following 2011 guidelines from the Japan Society for Endoscopic Surgery (JSES), including the surgeons' criteria and the proctor system. In this retrospective study, we examined the short-term outcomes of the initial series of RGs performed by second-generation operating surgeons trained within our institute.

METHODS

Between January 2017 and April 2020, five surgeons each performed RG in 20 patients with clinical stage III or lower GC in accordance with the JSES guidelines. We evaluated both the rate of Clavien-Dindo grade II or higher morbidities and the console time required to reach the learning plateau via cumulative summation (CUSUM) analysis.

RESULTS

We observed no mortality and 3% of morbidity following RG. Both the operative time (430 vs 387.5 min, P = 0.019) and console time (380 vs . 331.5 min, P = 0.009) were significantly shorter in the second 10 cases than in the initial 10 cases. We observed a remarkable trend in cases of distal gastrectomy (DG), in which the total operative time and console time were significantly shorter in the later cases. Our CUSUM analysis revealed that seven cases were required to achieve a learning plateau in RG when confined to DG.

CONCLUSIONS

Non-expert RG surgeons meeting the operating surgeon's criteria from the JSES who had trained under an expert RG surgeon safely performed RG in an initial 20 cases.