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Endosc Int Open 2018; 06(08): E1065-E1069
DOI: 10.1055/a-0640-3123
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Global Evaluative Assessment of Robotic Skills in Endoscopy (GEARS-E): objective assessment tool for master and slave transluminal endoscopic robot

Nobuyoshi Takeshita
1   Department of Medicine, National University of Singapore, Singapore
,
Soo Jay Phee
2   School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
,
Philip WaiYan Chiu
3   Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
,
Khek Yu Ho
4   National University Hospital, Singapore
› Author Affiliations
Further Information

Publication History

submitted 13 December 2017

accepted after revision 30 April 2018

Publication Date:
10 August 2018 (online)

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Abstract

Background and study aims The Master and Slave Transluminal Endoscopic Robot (MASTER) is a novel robotic endosurgical system with two operating arms that offer multiple degrees of freedom. We developed a new assessment tool, the Global Evaluative Assessment of Robotic Skills in Endoscopy (GEARS-E), derived from existing tools in laparoscopic and robotic surgery, and evaluated its utility in the performance of procedures using MASTER.

Methods This was a pilot study conducted in vivo and ex vivo on animals. Three operators (Novice-1, Novice-2 and Expert) performed a total of five endoscopic submucosal dissections (ESD) using MASTER. Novice operators had no MASTER experience and the expert had previously performed eight MASTER ESDs. Operator performance was assessed by four independent evaluators using GEARS-E, which has a maximum score of 25 for five domains representing various skill-related variables (depth perception, bimanual dexterity, efficiency, tissue handling and autonomy).

Results The mean global rating scores for Novice-1 first attempt, Novice-1 second attempt, Novice-2 first attempt, Novice-2 second attempt and Expertʼs cases were 13.0, 16.0, 13.3, 15.5, and 21.5, respectively. The mean scores of each of the five domains were statistically higher for the second attempts compared to the first attempts for both Novice-1 and Novice-2. The mean scores of each of the five domains for the Expertʼs case were consistently higher than those for the two novice operators in both their first and second attempts.

Conclusion Results using GEARS-E showed correlations between surgical experience and MASTER ESD. As an assessment tool for evaluation of surgical skills, GEARS-E has great potential for application in MASTER procedures.

 

  • References

  • 1 Ono H, Yao K, Fujishiro M. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 2016; 28: 3-15
    CrossrefPubMedGoogle Scholar
  • 2 Akutsu Y, Uesato M, Shuto K. et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg 2013; 257: 1032-1038
    CrossrefPubMedGoogle Scholar
  • 3 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
    CrossrefPubMedGoogle Scholar
  • 4 Phee SJ, Low SC, Huynh VA. et al. Master and slave transluminal endoscopic robot (MASTER) for natural orifice transluminal endoscopic surgery (NOTES). Conf Proc IEEE Eng Med Biol Soc 2009; 2009: 1192-1195
    PubMedGoogle Scholar
  • 5 Takeshita N, Ho KY, Phee SJ. et al. Feasibility of performing esophageal endoscopic submucosal dissection using master and slave transluminal endoscopic robot. Endoscopy 2017; 49: E27-28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Phee SJ, Reddy N, Chiu PW. et al. Robot-assisted endoscopic submucosal dissection is effective in treating patients with early-stage gastric neoplasia. Clin Gastroenterol Hepatol 2012; 10: 1117-1121
    CrossrefPubMedGoogle Scholar
  • 7 Ho KY, Phee SJ, Shabbir A. et al. Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER). Gastrointest Endosc 2010; 72: 593-599
    CrossrefPubMedGoogle Scholar
  • 8 Vassiliou MC, Feldman LS, Andrew CG. et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 2005; 190: 107-113
    CrossrefPubMedGoogle Scholar
  • 9 Aghazadeh MA, Jayaratna IS, Hung AJ. et al. External validation of Global Evaluative Assessment of Robotic Skills (GEARS). Surg Endosc 2015; 29: 3261-3266
    CrossrefPubMedGoogle Scholar
  • 10 Tekkis PP, Senagore AJ, Delaney CP. et al. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 2005; 242: 83-91
    CrossrefPubMedGoogle Scholar
  • 11 Yamamoto S, Uedo N, Ishihara R. et al. Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve. Endoscopy 2009; 41: 923-928
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Chiu PW, Phee SJ, Bhandari P. et al. Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope. Endosc Int Open 2015; 5: E439-E442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Goff BA, Lentz GM, Lee D. et al. Development of an objective structured assessment of technical skills for obstetric and gynecology residents. Obstet Gynecol 2000; 96: 146-150
    PubMedGoogle Scholar
  • 14 Vassiliou MC, Kaneva PA, Poulose BK. et al. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc 2010; 24: 1834-1841
    CrossrefPubMedGoogle Scholar