Feasibility of a Low-Cost Instrumented Trocar for Universal Surgical Procedure Analyses1

Abstract

The current path to become a surgeon follows the Halstedjan model of apprentice-style training, in which a resident remains under the shadow of a senior surgeon [1,2]. The resident starts by observing the surgeon and then gradually moves on to assist him. Though the process provides immediate mentor feedback through one-on-one interaction, it fails to carry out a systematic and consistent evaluation. All of the assessment is based on a senior surgeon’s subjective appraisal. Moreover, the requirement of performing a real procedure under the supervision of an experienced surgeon puts extra financial pressure on the medical school curriculum [2]. The advent and advancement of minimally invasive surgery (MIS) have made mastering such skills even more difficult, particularly psychomotor. Due to the increased complexity in required surgical skills and due to a need for a more consistent and systematic evaluation, there has been an increasing demand for an objective assessment of surgical skill. Studies in the past have examined motion analyses of surgeon’s hands and tool with a structured checklist to conclude that the motion analyses can serve as one of the measures for objectively assessing surgical skill [3]. A considerable amount of work has been done in the past to develop systems for tracking minimally invasive surgical tools. However, there does not exist a system that can be easily deployed to all three environments, i.e., virtual reality, physical benchtop, and operating room (OR). Most of these systems are only applicable to either virtual reality or physical benchtop training environment. There is only one system, Waseda bioinstrumentation 3, that can be applied in the OR. However, even that system is not validated yet and has an intrusive setup. Moreover, these systems can be very expensive with the average price ranging from $20,000 to $30,000. Hence, there is a strong need for a low-cost, noninvasive means to quantitatively discriminate surgical skill in a manner universally applicable to all environments and various surgical modalities like robotic, laparoscopic and endoscopic surgeries. This work presents the feasibility of such a system. Notably, we evaluate the feasibility of jerk cost as a low-cost alternative to skill evaluation. We hypothesize it can discriminate skill without expensive position tracking. 2 Methods