The role of Da Vinci Xi robotic simulation curriculum in enhancing skills in robotic colorectal surgery

An online trajectory guidance framework via imitation learning and interactive feedback in robot-assisted surgery

Improving the manipulation performance of surgical instruments is important for novice surgeons, as it directly affects the safety and outcome of robot-assisted surgery. To reduce the difference between expert and novice surgeons, learning the instrument movement trajectories generated by experts is an effective approach for novices to foster their muscle memory and improve manipulation skills. In this work, we propose an online trajectory guidance framework to generate expert-like movement trajectories so that novice surgeons can receive intra-operative trajectory guidance to achieve a similar manipulation performance as experts. First, Dynamic Movement Primitives (DMP) based Imitation Learning (IL) is implemented to model the 3D trajectories demonstrated by experts for adaptive trajectory generation at different start and end points. To introduce the obstacle avoidance capability into IL, we propose a vision-based strategy involving stereo reconstruction, object detection and segmentation to recover the 3D information of obstacles so that they can be coupled into DMP as an obstacle avoidance term. Furthermore, we introduce Augmented Reality (AR) and Interactive Feedback (IF) including visual and force feedback to enhance the trajectory reproduction accuracy of novice surgeons during operation. The experiment was conducted based on a 3D peg-transfer task in two different scenes (with changed start and end points, and with the obstacle present) using a standard da Vinci Research Kit robot. Ten non-expert human subjects were invited to evaluate the online trajectory guidance framework by reproducing the expert-like manipulation trajectories, and the experimental results showed that the novices with the assistance of AR and IF achieved promising trajectory reproduction performance (the mean distance error Emean was reduced by 76.47% and 65.15% in two different intra-operative scenes, respectively), narrowing the manipulation gap with experts.

Assessment of the evolution of psychomotor skills in the robotic surgery simulation process

Robotic surgery is a rapidly expanding field, given the wide variety of new robotic platforms emerging. Looking at the training of surgeons in robotic surgery is of extreme necessity and urgency, considering the ongoing technological advancements. In this research, the performance during the virtual reality simulation phase of training for robotic surgery was analyzed. It was observed that, in addition to the lack of consensus among societies regarding the required simulation hours, there is no guidance on the best curriculum to be adopted. From the data in this study, it can be inferred that the more advanced skills have fewer proficient individuals, meaning that fewer surgeons in training have reached proficiency in all skill exercises. Even with differences in the number of exercises performed proficiently between groups that underwent varying amounts of simulation time, there is no statistically significant difference in the proportion between them.

Can Computerized Simulation be Used to Assess Surgical Proficiency in Laparoscopic Colorectal Surgeries? A Systematic Review

INTRODUCTION

Computerized simulation (CS) of surgery in virtual reality (VR), augmented reality (AR) and mixed reality (MR) settings are used to teach foundational skills, but its applicability in advanced training is to be determined. This review aims to summarize the types of CS available for laparoscopic colorectal surgery (CRS) and its utility in assessment of proficiency.

METHODS

A systematic review of CS in laparoscopic CRS was done on PubMed, Embase, Scopus and Cochrane Library databases.

RESULTS

Eleven relevant observational studies were identified. The most common procedure simulated was laparoscopic colectomy. Assessment using performance metrics measured by the simulator such as path length moved by laparoscopic tools, procedure time and number of discrete movements had the most consistent differentiating ability between expert and non-expert cohorts. Surgeons fared similarly in proficiency scores in assessment with CS compared to assessment with traditional cadaveric or porcine models.

CONCLUSION

CS of laparoscopic CRS may be used in assessment of proficiency using performance metrics measuring economy of movement. CS may be a viable assessment tool in advanced surgical training, but further studies should assess utility of incorporating it as a formal assessment tool in training programs.