Title
Force-based assessment of tissue handling skills in simulation training for robot-assisted surgery
Author
Rahimi, A. Masie (Amsterdam UMC; Amsterdam Skills Centre for Health Sciences; Cancer Center Amsterdam)
Hardon, S.F. (TU Delft Medical Instruments & Bio-Inspired Technology; Amsterdam UMC) 
Willuth, E. (University of Heidelberg)
Lang, F. (University of Heidelberg)
Haney, Caelan M. (University of Heidelberg)
Felinska, Eleni A. (University of Heidelberg)
Kowalewski, Karl Friedrich (University of Heidelberg)
Müller-Stich, Beat P. (University of Heidelberg)
Horeman, T. (TU Delft Medical Instruments & Bio-Inspired Technology)
Nickel, F. (University of Heidelberg)
Daams, Freek (Amsterdam UMC)
Date
2023
Abstract
Introduction: Although robotic-assisted surgery is increasingly performed, objective assessment of technical skills is lacking. The aim of this study is to provide validity evidence for objective assessment of technical skills for robotic-assisted surgery. Methods: An international multicenter study was conducted with participants from the academic hospitals Heidelberg University Hospital (Germany, Heidelberg) and the Amsterdam University Medical Centers (The Netherlands, Amsterdam). Trainees with distinctly different levels of robotic surgery experience were divided into three groups (novice, intermediate, expert) and enrolled in a training curriculum. Each trainee performed six trials of a standardized suturing task using the da Vinci Surgical System. Using the ForceSense system, five force-based parameters were analyzed, for objective assessment of tissue handling skills. Mann–Whitney U test and linear regression were used to analyze performance differences and the Wilcoxon signed-rank test to analyze skills progression. Results: A total of 360 trials, performed by 60 participants, were analyzed. Significant differences between the novices, intermediates and experts were observed regarding the total completion time (41 s vs 29 s vs 22 s p = 0.003), mean non zero force (29 N vs 33 N vs 19 N p = 0.032), maximum impulse (40 Ns vs 31 Ns vs 20 Ns p = 0.001) and force volume (38 N3 vs 32 N3 vs 22 N3p = 0.018). Furthermore, the experts showed better results in mean non-zero force (22 N vs 13 N p = 0.015), maximum impulse (24 Ns vs 17 Ns p = 0.043) and force volume (25 N3 vs 16 N3p = 0.025) compared to the intermediates (p ≤ 0.05). Lastly, learning curve improvement was observed for the total task completion time, mean non-zero force, maximum impulse and force volume (p ≤ 0.05). Conclusion: Construct validity for force-based assessment of tissue handling skills in robot-assisted surgery is established. It is advised to incorporate objective assessment and feedback in robot-assisted surgery training programs to determine technical proficiency and, potentially, to prevent tissue trauma.
Subject
Force measurements
Objective assessment
Robot tissue manipulation
Robotic surgery training
Robotic-assisted surgery
Simulation training
To reference this document use:
http://resolver.tudelft.nl/uuid:a34236b8-ab61-475b-839a-9bd75816e4cf
DOI
https://doi.org/10.1007/s00464-023-09905-y
ISSN
0930-2794
Source
Surgical Endoscopy: surgical and interventional techniques (online), 37 (6), 4414-4420
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2023 A. Masie Rahimi, S.F. Hardon, E. Willuth, F. Lang, Caelan M. Haney, Eleni A. Felinska, Karl Friedrich Kowalewski, Beat P. Müller-Stich, T. Horeman, F. Nickel, Freek Daams