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J Neurol Surg B Skull Base 2017; 78(01): 099-104
DOI: 10.1055/s-0036-1588061
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Region-Specific Objective Signatures of Endoscopic Surgical Instrument Motion: A Cadaveric Exploratory Analysis

R. Alex Harbison
1   Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Angelique M. Berens
1   Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Yangming Li
2   Department of Electrical Engineering, University of Washington, Seattle, Washington, United States
,
Randall A. Bly
3   Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, United States
,
Blake Hannaford
2   Department of Electrical Engineering, University of Washington, Seattle, Washington, United States
,
Kris S. Moe
1   Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
4   Department of Neurosurgery, University of Washington, Seattle, Washington, United States
› Author Affiliations
Further Information

Publication History

22 May 2016

26 July 2016

Publication Date:
30 August 2016 (online)

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Abstract

Objectives The objective of this study was to evaluate region-specific surgical instrument kinematics among novice and experienced surgeons performing endoscopic endonasal skull base surgery.

Design Cadaveric experimental study.

Setting Tertiary academic center.

Participants Two novice and two experienced surgeons performed eight endoscopic total ethmoidectomies and sphenoidotomies using an optically tracked microdebrider.

Main Outcome Measures Time-stamped Euclidian coordinates were recorded. Cumulative instrument travel, mean linear velocity and acceleration, and mean angular velocities were calculated in the anterior ethmoid, posterior ethmoid, and sphenoid sinus regions.

Results Mean cumulative instrument travel (standard deviation) was highest in the posterior ethmoid region for both novice and experienced surgeons (9,795 mm [1,664] vs. 3,833 mm [1,080]). There was a trend in mean linear and angular velocities, and acceleration with increasing magnitudes for experienced surgeons compared with novices. Among experienced surgeons, we observed a trend of decreasing yaw velocity during the approach to the surgical target.

Conclusions We present a novel method of evaluating surgical instrument motion with respect to anatomical regions of the skull base during endoscopic endonasal skull base surgery. These data may be used in the development of surgical monitoring and training systems to optimize patient safety.

Keywords

surgical instrument motion - kinematics - skull base - surgical safety - surgical training
 

  • References

  • 1 Oropesa I, Sánchez-González P, Lamata P , et al. Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery. J Surg Res 2011; 171 (1) e81-e95
    CrossrefPubMedGoogle Scholar
  • 2 Ahmidi N, Poddar P, Jones JD , et al. Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty. Int J CARS 2015; 10 (6) 981-991
    CrossrefPubMedGoogle Scholar
  • 3 Birkmeyer JD, Finks JF, O'Reilly A , et al; Michigan Bariatric Surgery Collaborative. Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013; 369 (15) 1434-1442
    CrossrefPubMedGoogle Scholar
  • 4 Datta V, Mackay S, Mandalia M, Darzi A. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 2001; 193 (5) 479-485
    CrossrefPubMedGoogle Scholar
  • 5 Datta V, Mandalia M, Mackay S, Chang A, Cheshire N, Darzi A. Relationship between skill and outcome in the laboratory-based model. Surgery 2002; 131 (3) 318-323
    CrossrefPubMedGoogle Scholar
  • 6 Bann SD, Khan MS, Darzi AW. Measurement of surgical dexterity using motion analysis of simple bench tasks. World J Surg 2003; 27 (4) 390-394
    CrossrefPubMedGoogle Scholar
  • 7 Dosis A, Aggarwal R, Bello F , et al. Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 2005; 140 (3) 293-299
    CrossrefPubMedGoogle Scholar
  • 8 Aggarwal R, Grantcharov T, Moorthy K , et al. An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room. Ann Surg 2007; 245 (6) 992-999
    CrossrefPubMedGoogle Scholar
  • 9 Verner L, Oleynikov D, Holtmann S, Haider H, Zhukov L. Measurements of the level of surgical expertise using flight path analysis from da Vinci robotic surgical system. Stud Health Technol Inform 2003; 94: 373-378
    PubMedGoogle Scholar
  • 10 Lin HC, Shafran I, Yuh D, Hager GD. Towards automatic skill evaluation: detection and segmentation of robot-assisted surgical motions. Comput Aided Surg 2006; 11 (5) 220-230
    CrossrefPubMedGoogle Scholar
  • 11 Ahmidi N, Ishii M, Fichtinger G, Gallia GL, Hager GD. An objective and automated method for assessing surgical skill in endoscopic sinus surgery using eye-tracking and tool-motion data. Int Forum Allergy Rhinol 2012; 2 (6) 507-515
    CrossrefPubMedGoogle Scholar
  • 12 Rosen J, Brown JD, Barreca M, Chang L, Hannaford B, Sinanan M. The Blue DRAGON—a system for monitoring the kinematics and the dynamics of endoscopic tools in minimally invasive surgery for objective laparoscopic skill assessment. Stud Health Technol Inform 2002; 85: 412-418
    PubMedGoogle Scholar
  • 13 Rosen J, Solazzo M, Hannaford B, Sinanan M. Objective laparoscopic skills assessments of surgical residents using Hidden Markov Models based on haptic information and tool/tissue interactions. Stud Health Technol Inform 2001; 81: 417-423
    PubMedGoogle Scholar
  • 14 Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013; 84 (8) 843-849
    CrossrefPubMedGoogle Scholar
  • 15 Sunkaraneni VS, Yeh D, Qian H, Javer AR. Computer or not? Use of image guidance during endoscopic sinus surgery for chronic rhinosinusitis at St Paul's Hospital, Vancouver, and meta-analysis. J Laryngol Otol 2013; 127 (4) 368-377
    CrossrefPubMedGoogle Scholar
  • 16 Chin OY, Ghosh R, Fang CH, Baredes S, Liu JK, Eloy JA. Internal carotid artery injury in endoscopic endonasal surgery: a systematic review. Laryngoscope 2016; 126 (3) 582-590
    CrossrefPubMedGoogle Scholar