Automated Electro-Mechanical Assessment of Psychomotor Skill for High-Stakes Certification in Surgical Robotics

Abstract

In recent years, surgical robotic systems (SRS) have been employed to great effect in a wide range of minimally invasive procedures [1]. Yet despite the increasing use of these devices in clinical practice, there exists to date no definitive, objective system of measurement of the skill level of a surgeon using an SRS. Assessments of patient outcomes, surgical speed and instrument docking time have shown that improvement in skill using an SRS requires in-depth training, with exposure to as many as 20 cases of a given procedure to attain proficiency [2]. The model employed for the certification of a surgeon in the practice of minimally invasive laparoscopic surgery has addressed a parallel problem since its inception by establishing a set of exercises comprising what is now known as the fundamentals of laparoscopic surgery (FLS) assessment [3]. This high stakes examination tests the surgeon’s psychomotor skills in the crucial subtasks involved in the successful execution of laparoscopic surgery. The foundations of robotic surgery (FRS) project is an ongoing collaborative effort to create a similar, high-stakes assessment for surgical robotics undertaken by an international consortium of authoritative surgeons from multiple specialties. This consortium has conceptually identified and built consensus for the general system concept, subtasks, and objective performance metrics for robotic surgery, but does not intend to design or prototype working models [4]. We herein present an instrumented, electro-mechanical design and prototype of the overall system and two of the seven subtasks developed for eventual inclusion in the complete FRS high-stakes assessment [4]. The first subtask, the ring tower transfer, requires that the surgeon move a small ring positioned at the base of one tower to the base of another tower while avoiding contact between the ring and the tower along the way. The second subtask, knot tying, requires the test taker to use a provided silk suture to draw together two metal rings and secure them with a surgical knot. In both cases, our system provides automated, objective evaluation of the required performance metrics.