The role of hand motion connectivity in the performance of laparoscopic procedures on a virtual reality simulator
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ORIGINAL ARTICLE
The role of hand motion connectivity in the performance of laparoscopic procedures on a virtual reality simulator Constantinos Loukas • Constantinos Rouseas Evangelos Georgiou
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Received: 5 December 2012 / Accepted: 12 March 2013 / Published online: 30 March 2013 International Federation for Medical and Biological Engineering 2013
Abstract Assessment of surgical skills based on virtual reality (VR) technology has received major attention in recent years, with special focus placed on experience discrimination via hand motion analysis. Although successful, this approach is restricted from extracting additional important information about the trainee’s hand kinematics. In this study, we investigate the role of hand motion connectivity in the performance of a laparoscopic cholecystectomy on a VR simulator. Two groups were considered: experienced residents and beginners. The connectivity pattern of each subject was evaluated by analyzing their hand motion signals with multivariate autoregressive (MAR) models. Our analysis included the entire as well as key phases of the operation. The results revealed that experienced residents outperformed beginners in terms of the number, magnitude and covariation of the MAR weights. The magnitude of the coherence spectra between different combinations of hand signals was in favor of the experienced group. Yet, the more challenging (in terms of hand movement activity) an operational phase was, the more connections were generated, with experienced subjects performing more coordinated gestures per phase. The proposed approach provides a suitable basis for hand motion analysis of surgical trainees and could be utilized in future VR simulators for skill assessment. Keywords Laparoscopic surgery Multivariate autoregressive models (MAR) Surgical performance analysis Virtual reality simulator Hand motion connectivity C. Loukas (&) C. Rouseas E. Georgiou Medical Physics Lab-Simulation Center, School of Medicine, University of Athens, Mikras Asias 75 str, Athens 11527, Greece e-mail: [email protected]
1 Introduction Laparoscopic surgery (LS) is a widely established procedure in minimally invasive surgery that is indicated for an increasing number of surgical interventions [9, 13]. Compared to open surgery, LS provides a number of important benefits for the patients such as faster healing, shorter hospitals stays, and minimized risk of infection. However, there are a number of inherent particularities in the application of minimally invasive techniques in the domain of surgery, such as visual projection of the 3D space onto a 2D display, restricted mobility, reduced force feedback, and the fulcrum effect. As a consequence, a laparoscopic surgeon needs to demonstrate increased depth perception and advanced psychomotor skills (such as grasping, tracking and suturing), using long and thin surgical instruments inserted in the abdominal cavity via small incisions. Over the past decade virtually reality (VR) simulation has come to the foreground as a novel education
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