Movement Of Forceps Research Articles

Developing an Effective Off-the-job Training Model and an Automated Evaluation System for Thoracoscopic Esophageal Atresia Surgery

BackgroundPediatric minimally invasive surgery requires advanced technical skills. Off-the-job training (OJT), especially when using disease-specific models, is an effective method of acquiring surgical skills. To achieve effective OJT, it is necessary to provide objective and appropriate skill assessment feedback to trainees. We aimed to construct a system that automatically evaluates surgical skills based on forceps movement using deep learning (DL). MethodsUsing our original esophageal atresia OJT model, participants were tasked with performing esophageal anastomosis. All tasks were recorded for image analysis. Based on manual objective skill assessments, each participant's surgical skills were categorized into two groups: good and poor. The motion of the forceps in both groups was used as training data. Employing this training data, we constructed an automated system that recognized the movement of forceps and determined the quality of the surgical technique. ResultsThirteen participants were assigned to the good skill group and 32 to the poor skill group. These cases were validated using an automated skill assessment system. This system showed a precision of 75%, a specificity of 94%, and an area under the receiver operating characteristic curve of 0.81. ConclusionsWe constructed a system that automatically evaluated the quality of surgical techniques based on the movement of forceps using DL. Artificial intelligence diagnostics further revealed the procedures important for suture manipulation. Levels of EvidenceLevel IV

Validate robot-assisted total laparoscopic hysterectomy with four equally-spaced ports without an assistant port.

To evaluate the usefulness of robot-assisted total laparoscopic hysterectomy with four equally-spaced ports (RA-TLH/4e) without an assistant port. In RA-TLH/4e, four da Vinci ports were placed horizontally at a height of 4cm above the umbilicus with 8cm equal spacing. Poor development of the surgical field or difficult forceps manipulations were handled with the endoscope and forceps movement (port-hopping). Patient background, surgical outcomes, complications, port-hopping frequency were compared in three groups: RA-TLH/4e, RA-TLH with four unequally-spaced ports (RA-TLH/4u), and conventional RA-TLH with five ports (RA-TLH/5). There were no significant differences in patient background or surgical outcomes among the three groups except for age, preparation time, and hospital stay, and no cases of laparotomy conversion or serious complications. RA-TLH/4e had fewer port-hoppings than RA-TLH/4u. The minimum abdominal width showed a weak negative correlation with port-hopping frequency in RA-TLH/4u, but not in RA-TLH/4e. RA-TLH/4e allowed for a reduction in personnel and costs compared to RA-TLH/5. The equal placement of four ports allowed sufficient port spacing even for patients with narrow abdominal widths. In addition, the port-hopping technique was able to fully compensate for the lack of an assistant port. RA-TLH/4e is a highly useful technique that not only excels in safety but also reduces costs.

Coupling Effect Suppressed Compact Surgical Robot with 7-Axis Multi-Joint Using Wire-Driven Method

Currently, the most prevalent surgical treatment method is laparoscopic surgery. Robotic surgery has many advantages over laparoscopic surgery. Therefore, robotic surgery technology is currently constantly evolving. The advantages of robotic surgery are that it can minimize incision, bleeding, and sequelae. Other advantages of robotic surgery are that it can reduce hospitalization, recovery period, and side effects. The appeal of robotic surgery is that it requires fewer surgical personnel compared to laparoscopic surgery. This paper proposes an ultra-compact 7-axis vertical multi-joint robot that employs the wire-driven method for minimally invasive surgery. The proposed robot analyzes the degree of freedom and motion coupling for control. The robot joint is composed of a total of seven joints, and among them, the 7-axis joint operates the forceps. At this time, the forceps joint (#7 axis) can only operate open and close functions, while the link is bent and rotatable, regardless of position change. This phenomenon can be analyzed by Forward Kinematics. Also, when the DOF rotates, the passing wires become twisted, and the wire is generated through length change and coupling phenomenon. The maximum rotation angle of DOF is 90° and the rotating passing wire is wound by the rotation of the wire pulley. If the DOF is rotated to the full range of 120°, the second DOF will be rotated to 90°, and at this time, the coupling phenomenon caused by the first DOF rotation can be eliminated. The length change and the robot joint angle change related to the motor drive, based on the surgical robot control using the wire-driven method, are correlated, and the values for the position and direction of the end effector of the robot can be obtained through a forward kinematic analysis. The coupling problem occurring in the wire connecting the robot driving part can be solved through a kinematic analysis. Therefore, it was possible to test the position of the slave robot and the performance of the surgical forceps movement using the master system.

Evaluation of minimally invasive surgical skills training: comparing a neonatal esophageal atresia/tracheoesophageal fistula model with a dry box.

Pediatric surgeons require highly advanced minimally invasive surgical skills to perform rare and complex surgeries in a very vulnerable population. We developed a neonatal esophageal atresia (EA) model to improve thoracoscopic surgical skills. This study aimed to evaluate the concurrent validity of the model by undertaking pre- and post-training skills assessments in two groups of students with no prior experience performing minimally invasive surgery, using the EA model and a dry box (DB). A pilot study was performed. The participants were randomly divided into two groups: one trained using the DB and one trained using the EA model. Both groups practiced a minimally invasive surgical suture task. The task completion time, 29-point checklist score, modified suturing error sheet score, and three-dimensional forceps movement in both groups were compared pre-and post-training by video analysis. The EA model task was significantly more difficult than that of the DB. Both groups showed significant improvement in the task time, 29-point checklist score, and modified suturing error sheet score; however, the EA model training was more efficient in improving each error item. Regarding forceps movement, the EA model training significantly decreased wasted motion, whereas the DB was limited in this regard. Short-term training on the EA model, which was more technically demanding than the DB, decreased technical error and wasted motion, and allowed learners to acquire surgical skills more efficiently than training with the DB model. These facts revealed the concurrent validity of the EA model.

Estimating future forceps movement using deep learning for robotic camera control in laparoscopic surgery

Estimating future forceps movement using deep learning for robotic camera control in laparoscopic surgery

Estimating future forceps movement using deep learning for robotic camera control in laparoscopic surgery

Estimating future forceps movement using deep learning for robotic camera control in laparoscopic surgery

Three‐dimensional laparoscopic vision improves forceps motion more in the depth direction than in the horizontal direction: An analysis of data from prospective randomized controlled trials

Three-dimensional (3D) laparoscopic vision can improve depth perception. However, it is a question whether 3D vision can improve motion in the depth direction. The aim of this study was to compare the impact of 3D vision on forceps motion in the depth and horizontal directions. All data were obtained from our previous two studies, where, in total, 40 novices and 20 moderately experienced surgeons participated. A simple phantom task was performed in a training box. The participants were randomly assigned to two groups. Specifically, one group performed the task five times initially under a two-dimensional (2D) system, and the other group started under a 3D system. Both groups then performed the same task five times under the alternative system. Performances were recorded by an optical position tracker. We separately evaluated forceps motion in the x-, y-, and z-axis directions. Compared with the findings for 2D vision, the forceps path lengths were significantly decreased among novices and moderately experienced surgeons in almost all tasks under 3D vision. In a comparison of the path length ratio (3D/2D) in each direction, larger reduction was observed for the depth direction among novices, whereas no significant directional difference was noted among moderately experienced surgeons. For novices, 3D laparoscopic vision improves depth perception and may give shorter forceps movement in the depth direction even for simple tasks.

Impact and characteristics of two- and three-dimensional forceps manipulation using laparoscopic hepaticojejunostomy mimicking a disease-specific simulator: a comparison of pediatric surgeons with gastrointestinal surgeons

This study assessed the impact of 2D and 3D environments by comparing pediatric surgeons (PS) and gastrointestinal surgeons (GIS) using a laparoscopic hepaticojejunostomy simulator. We developed a high-fidelity simulator of laparoscopic hepaticojejunostomy. Thirty-five participants (19 PS and 16 GIS) performed hepaticojejunostomy in both 2D and 3D environments. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations using the para-axial port layout. Regarding the participants' characteristics, the performance history of laparoscopic hepaticojejunostomy differed significantly between PS and GIS. In PS, the 3D environment did not markedly affect compared with 2D. In GIS, however, the 3D environment affected the time and movement of the right forceps. There were no significant differences in the time between PS and GIS in either environment. In both environments, the right-hand movement of the PS group was shorter and slower than that of the GIS group, but the left-hand movement was the opposite. There were significant differences in forceps movement characteristics between the PS and GIS. The effects of a 3D environment could not be clarified in this study, because it may depend on the port layout used and the operative procedures.

Quantitative comparison of operative skill using 2- and 3-dimensional monitors during laparoscopic phantom tasks

The recent development of stereoscopic images using 3-dimensional monitors is expected to improve techniques for laparoscopic operation. Several studies have reported technical advantages in using 3-dimensional monitors with regard to operative accuracy and working speed, but there are few reports that analyze forceps motions by 3-dimensional optical tracking systems during standardized laparoscopic phantom tasks. We attempted to develop a 3-dimensional motion analysis system for assessing laparoscopic tasks and to clarify the efficacy of using stereoscopic images from a 3-dimensional monitor to track forceps movement during laparoscopy. Twenty surgeons performed 3 tasks (Task 1: a simple operation by the dominant hand, Task 2: a simple operation using both hands, Task 3: a complicated operation using both hands) under 2-dimensional and 3-dimensional systems. We tracked and recorded the motion of forceps tips with an optical marker captured by a 3-dimensional position tracker. We analyzed factors such as forceps path lengths, operation times, and technical errors for each task and compared the results of 2-dimensional and 3-dimensional monitors. Mean operation times and technical errors were improved significantly for all tasks performed under the 3-dimensional system compared with the 2-dimensional system; in addition, mean path lengths for the forceps tips were shorter for all tasks performed under the 3-dimensional system. We found that stereoscopic images using a 3-dimensional monitor improved operative techniques with regard to increased accuracy and shorter path lengths for forceps movement, which resulted in a shorter operation time for basic phantom laparoscopic tasks.

Preoperative surgical simulation of laparoscopic adrenalectomy for neuroblastoma using a three-dimensional printed model based on preoperative CT images

BackgroundThree-dimensional (3D) printed models based on computed tomography (CT) images facilitate the visualization of complex structures and are useful for understanding the surgical anatomy preoperatively. We developed a preoperative surgical simulation method using a 3D printed model based on CT images obtained prior to laparoscopic adrenalectomy for adrenal neuroblastomas (NBs). Materials and methodsThe multi-detector CT images were transferred to a 3D workstation, and 3D volume data were obtained by reconstructing the sections. A model was made with a 3D printer using acrylic ultraviolet curable resin. The adrenal tumor, kidney, renal vein and artery, inferior vena cava, aorta, and outer body were fabricated. The pneumoperitoneum, insertion of trocars, and laparoscopic view were all attainable in this model. We used this model for three cases with adrenal NB. ResultsWe used this model to discuss the port layout before the operation and to simulate the laparoscopic view and range of forceps movement. All three cases with NB were completely resected without any surgical complications. ConclusionsThe surgical simulation using 3D printed models based on preoperative CT images for adrenal NB was very useful for understanding the patient’s surgical anatomy and for planning the surgical procedures, especially for determining the optimal port layout.

Measurement of the Physical Properties during Laparoscopic Surgery Performed on Pigs by Using Forceps with Pressure Sensors.

Objectives. Here we developed a unique training system, a patient specific virtual reality simulator, for laparoscopic renal surgery. To develop the simulator, it was important to first identify the physical properties of the organ. Methods. We recorded the force measured during laparoscopic surgery performed on pigs by using forceps with pressure sensors. Several sensors, including strain gauges, accelerometers, and a potentiometer, are attached to the forceps. Results. Throughout the experiment, we measured the reaction force in response to the forceps movement in real time. Conclusions. The experiment showed the possibility of digitizing these physical properties in humans as well.

Novel method of the double-loop slip-knot: preknotting on the laparoscopic forceps enables easy and secure intracorporeal ligation

Laparoscopic ligation is a difficult and advanced technique because of the limited movement of forceps under two-dimensional videoscopic view. Currently, single-port surgery is widely used and a simple method for intracorporeal ligation is required. We describe an intracorporeal slip-knot with a double-loop strand that can be used to provide security and present the experimental results obtained. A modified Eskimo bowline with a 4-0 absorbable monofilament was placed on a needle driver, and the forceps was used to grip both ends of the thread. Another forceps was used to pass the line under vessels in the abdominal cavity. The line was withdrawn from the gripping point through the preknot on the rod after it was gripped at the same point. The slip-knot was tightened, and a pushing forceps and a needle driver were used to push the knot and complete the ligation. The double-loop slip-knot has a high bursting pressure compatible with that of a conventional square-to-slip knot, which is significantly higher than that of any other slip-knot. In an experimental evaluation on animal laparoscopy, residents performed complete ligations of gastric and colonic arteries and veins within 30 s after a short explanation of the procedure. This novel slip-knot with a double-strand loop could provide easy and secure intracorporeal ligation. This type of slip-knot has great potential for wide use in open surgery using laparoscopy. Further evaluation is required to determine its clinical applicability.

ドーム型スクリーンを用いた内視鏡外科手術向け立体映像提示システムの開発と手術手技における有用性の評価

In endoscopic surgery, surgeons should be highly professional to do the operation precisely using a 2D display as the image lacks depth perception. We aim at developing an endoscopic surgery system that consists of intuitive depth perception, enabling effective forceps operations by 3D vision. In this paper, we propose the 3D dome-shaped display system for endoscopic surgery. Developed system has been evaluated with a simulated situation and the results show that our developed system increases the degree of freedom of the forceps movement in comparison with the conventional 2D display for novice surgeons, especially depth directional distance and axial rotation of forceps.

2A1-A28 内視鏡手術トレーニングシミュレータの開発

Endoscope operation need a doctor high technically. Therefore there are many medical accidents. In late years demand of an endoscope operations rises. From this, a doctor has to take appropriate training. Training observes only movement of the lecturer side , but minute movement of forceps is hard to understand it. By this study, the master robot which an experience-rich doctor operates reappear movement of forceps of a slave robot of the student side. I describe development of master robot mechanism in a slave system by this report.