识别手术训练任务中与术中应激相关的运动标记。

Yi Zheng, Grey Leonard, Juan Tellez, Herbert Zeh, Ann Majewicz Fey
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引用次数: 2

摘要

在手术过程中,压力水平的增加会损害外科医生的表现和患者的安全。本研究的目的是通过分析运动学数据来研究短期应激源对腹腔镜手术性能的影响。在irb批准的研究中,30名受试者被随机分为两组。对照组被要求使用FLS训练器完成一个延长时间的peg转移任务(6分钟),同时听正常的模拟生命体征,同时由一个沉默的主持人观察。压力组完成了同样的任务,但听了一段时间逐渐恶化的模拟病人生命体征,以及主持人的批评性口头反馈,最终导致30秒的心脏骤停和模拟病人的死亡。所有受试者使用安装在腹腔镜仪器手柄上的电磁跟踪器记录视频和位置数据。对时间序列速度、加速度和加速度数据以及路径长度和体积经济性进行了统计分析。临床应激源导致速度、加速度、震动和路径长度显著增加,以及体积经济性降低。使用改进的OSATS技术进行客观评价得分,应激组也明显低于对照组。本研究显示了利用时间序列运动学数据近实时识别腹腔镜手术应激状态的潜在可行性和优势。这些数据可以用于未来机器人辅助算法的设计,以减少压力对手术性能的不良影响。
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Identifying Kinematic Markers Associated with Intraoperative Stress during Surgical Training Tasks.

Increased levels of stress can impair surgeon performance and patient safety during surgery. The aim of this study is to investigate the effect of short term stressors on laparoscopic performance through analysis of kinematic data. Thirty subjects were randomly assigned into two groups in this IRB-approved study. The control group was required to finish an extended-duration peg transfer task (6 minutes) using the FLS trainer while listening to normal simulated vital signs and while being observed by a silent moderator. The stressed group finished the same task but listened to a period of progressively deteriorating simulated patient vitals, as well as critical verbal feedback from the moderator, which culminated in 30 seconds of cardiac arrest and expiration of the simulated patient. For all subjects, video and position data using electromagnetic trackers mounted on the handles of the laparoscopic instruments were recorded. A statistical analysis comparing time-series velocity, acceleration, and jerk data, as well as path length and economy of volume was conducted. Clinical stressors lead to significantly higher velocity, acceleration, jerk, and path length as well as lower economy of volume. An objective evaluation score using a modified OSATS technique was also significantly worse for the stressed group than the control group. This study shows the potential feasibility and advantages of using the time-series kinematic data to identify the stressful conditions during laparoscopic surgery in near-real-time. This data could be useful in the design of future robot-assisted algorithms to reduce the unwanted effects of stress on surgical performance.

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