Irene H. Suh

The impact of environmental noise on robot-assisted laparoscopic surgical performance

BACKGROUND An operating room is a noisy environment. How noise affects performance during robotic surgery remains unknown. We investigated whether noise during training with the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) would affect the performance of simple operative tasks by the surgeon. METHODS Twelve medical students performed 3 inanimate operative tasks (bimanual carrying, suture tying, and mesh alignment) on the da Vinci Surgical System with or without the presence of noise. Prerecorded noise from an actual operating room was used. The kinematics of the robotic surgical instrument tips and the muscle activation patterns of the subjects were evaluated. RESULTS We found noise effects for all 3 tasks with increases in the time to task completion (23%; P=.046), the total distance traveled (8%; P=.011) of the surgical instrument tips, and the muscle activation volume (87%; P=.015) with the presence of noise. We confirmed that the mesh alignment task was the most difficult task with the greatest time to task completion and the greatest muscle activation volume, whereas the suture tying task and the bimanual carrying could be considered the intermediate and the least difficult task, respectively. The noise effects were significantly greater while performing more difficult tasks. CONCLUSION Our findings demonstrated that noise degraded robotic surgical performance; however, the impact of noise on robotic surgery will depend on the level of difficulty of the task. Subsequent research is required to identify how different types of noise, such as random or rhythmic sounds, affect the performance of operative tasks using robots such as the da Vinci.

The Effect of Music on Robot-Assisted Laparoscopic Surgical Performance

Music is often played in the operating room to increase the surgeon’s concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

Training program for fundamental surgical skill in robotic laparoscopic surgery

Although the use of robotic laparoscopic surgery has increased in popularity, training protocols for gaining proficiency in robotic surgical skills are not well established. The purpose of this study was to examine a fundamental training program that provides an effective approach to evaluate and improve robotic surgical skills performance using the da Vinci™ Surgical System.

Accuracy and speed trade-off in robot-assisted surgery

Controlling surgical task speed and maintaining accuracy are vital components of robotic surgical skills. This study was designed to investigate the relationship between accuracy and speed for robot‐assisted surgical skills.

The negative effect of distraction on performance of robot‐assisted surgical skills in medical students and residents

Modern surgical practice often requires multitasking in operating rooms, generally full of distractions. The purpose of this research was to investigate the effect of distraction on robot‐assisted surgical skill performance in medical students and residents.

Enhancing Fundamental Robot-Assisted Surgical Proficiency by Using a Portable Virtual Simulator

Background. The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation. Methods. Here, 14 medical students performed 2 fundamental surgical tasks—bimanual carrying (BC) and peg transfer (PT)—in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined. Results. Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P < .001) tasks. The time to task completion and the total distance traveled were significantly decreased in both surgical tasks in the VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining. Conclusions. Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game.

Examination of muscle effort and fatigue during virtual and actual laparoscopic surgical skills practice.

This study determined the muscle effort and fatigue of the upper extremity while performing fundamental surgical skills training tasks. Ten novices performed three tasks (precision cutting, needle passing, and peg transfer) using either a virtual simulator or a laparoscopic box-trainer. Their electromyography (EMG) activities in both proximal and distal parts of upper extremity were measured. Significantly more muscle effort were required to complete tasks with the box-trainer, whereas similar muscle fatigue levels between tasks were found in both training environments. These EMG results demonstrated how the virtual trainer could provide meaningful physiological value to the surgeon training in laparoscopic surgery.

Modeling surgical skill learning with cognitive simulation.

We used a cognitive architecture (ACT-R) to explore the procedural learning of surgical tasks and then to understand the process of perceptual motor learning and skill decay in surgical skill performance. The ACT-R cognitive model simulates declarative memory processes during motor learning. In this ongoing study, four surgical tasks (bimanual carrying, peg transfer, needle passing, and suture tying) were performed using the da Vinci© surgical system. Preliminary results revealed that an ACT-R model produced similar learning effects. Cognitive simulation can be used to demonstrate and optimize the perceptual motor learning and skill decay in surgical skill training.

Innovative effector design for simulation training in robotic surgery

Feasibility and effectiveness of minimally invasive surgery have made the use of robotic surgical system a rising prevalence with a wide range of applications. However, as a remarkable result, how to adroitly and precisely manipulate the sophisticated robotic surgery instruments is of fundamental importance to new surgeons. In order to provide the robotic surgical skill training for surgeons, we designed and built a training simulator with virtual reality equipped with two new hardware interfaces (effectors) which can emulate the operating process of the actual manipulators in the robotic surgical system. By using our designed framework, medical trainees can use the simulator to practice the fundamental technique of the surgical operation. To develop training platform and analyze performance, personal real time operating data, such like space position, moving speed and acceleration parameters of the virtual robotic instruments, can be collected by the sensors on the effectors and transmitted through wireless communication to the PC terminal for surgical skill performance analysis.

Consistency of performance of robot-assisted surgical tasks in virtual reality.

The purpose of this study was to investigate consistency of performance of robot-assisted surgical tasks in a virtual reality environment. Eight subjects performed two surgical tasks, bimanual carrying and needle passing, with both the da Vinci surgical robot and a virtual reality equivalent environment. Nonlinear analysis was utilized to evaluate consistency of performance by calculating the regularity and the amount of divergence in the movement trajectories of the surgical instrument tips. Our results revealed that movement patterns for both training tasks were statistically similar between the two environments. Consistency of performance as measured by nonlinear analysis could be an appropriate methodology to evaluate the complexity of the training tasks between actual and virtual environments and assist in developing better surgical training programs.