Kumuthan Sriskandarajah

The first decade of robotic surgery in children

BACKGROUND Robotic surgery offers technological solutions to current challenges of minimal access surgery, particularly for delicate and dexterous procedures within spatially constrained operative workspaces in children. The first robotic surgical procedure in a child was reported in April 2001. This review aims to examine the literature for global case volumes, trends, and quality of evidence for the first decade of robotic surgery in children. METHODS A systematic literature search was performed for all reported cases of robotic surgery in children during the period of April 2001 to March 2012. RESULTS Following identification of 220 relevant articles, 137 articles were included, reporting 2393 procedures in 1840 patients. The most prevalent gastrointestinal, genitourinary, and thoracic procedures were fundoplication, pyeloplasty, and lobectomy, respectively. There was a progressive trend of increasing number of publications and case volumes over time. The net overall reported conversion rate was 2.5%. The rate of reported robot malfunctions or failures was 0.5%. CONCLUSIONS Robotic surgery is an expanding and diffusing innovation in pediatric surgery. Future evolution and evaluation should occur simultaneously, such that wider clinical uptake may be led by higher quality and level of evidence literature.

Eye tracking for skills assessment and training: a systematic review

BACKGROUND The development of quantitative objective tools is critical to the assessment of surgeon skill. Eye tracking is a novel tool, which has been proposed may provide suitable metrics for this task. The aim of this study was to review current evidence for the use of eye tracking in training and assessment. METHODS A systematic literature review was conducted in line with PRISMA guidelines. A search of EMBASE, OVID MEDLINE, Maternity and Infant Care, PsycINFO, and Transport databases was conducted, till March 2013. Studies describing the use of eye tracking in the execution, training or assessment of a task, or for skill acquisition were included in the review. RESULTS Initial search results returned 12,051 results. Twenty-four studies were included in the final qualitative synthesis. Sixteen studies were based on eye tracking in assessment and eight studies were on eye tacking in training. These demonstrated feasibility and validity in the use of eye tracking metrics and gaze tracking to differentiate between subjects of varying skill levels. Several training methods using gaze training and pattern recognition were also described. CONCLUSIONS Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to surgical training to improve performance. Eye tracking remains a promising area of research with the possibility of future implementation into surgical skill assessment.

Gaze contingent cartesian control of a robotic arm for laparoscopic surgery

This paper introduces a gaze contingent controlled robotic arm for laparoscopic surgery, based on gaze gestures. The method offers a natural and seamless communication channel between the surgeon and the robotic laparoscope. It offers several advantages in terms of reducing on-screen clutter and efficiently conveying visual intention. The proposed hands-free system enables the surgeon to be part of the robot control feedback loop, allowing user-friendly camera panning and zooming. The proposed platform avoids the limitations of using dwell-time camera control in previous gaze contingent camera control methods. The system represents a true hands-free setup without the need of obtrusive sensors mounted on the surgeon or the use of a foot pedal. Hidden Markov Models (HMMs) were used for real-time gaze gesture recognition. This method was evaluated with a cohort of 11 subjects by using the proposed system to complete a modified upper gastrointestinal staging laparoscopy and biopsy task on a phantom box trainer, with results demonstrating the potential clinical value of the proposed system.

EALab (Eye Activity Lab): a MATLAB Toolbox for Variable Extraction, Multivariate Analysis and Classification of Eye-Movement Data

Recent advances in the reliability of the eye-tracking methodology as well as the increasing availability of affordable non-intrusive technology have opened the door to new research opportunities in a variety of areas and applications. This has raised increasing interest within disciplines such as medicine, business and education for analysing human perceptual and psychological processes based on eye-tracking data. However, most of the currently available software requires programming skills and focuses on the analysis of a limited set of eye-movement measures (e.g., saccades and fixations), thus excluding other measures of interest to the classification of a determined state or condition. This paper describes ‘EALab’, a MATLAB toolbox aimed at easing the extraction, multivariate analysis and classification stages of eye-activity data collected from commercial and independent eye trackers. The processing implemented in this toolbox enables to evaluate variables extracted from a wide range of measures including saccades, fixations, blinks, pupil diameter and glissades. Using EALab does not require any programming and the analysis can be performed through a user-friendly graphical user interface (GUI) consisting of three processing modules: 1) eye-activity measure extraction interface, 2) variable selection and analysis interface, and 3) classification interface.

Looking towards objective quality evaluation in colonoscopy: Analysis of visual gaze patterns

There are currently limited training and assessment tools available to novice endoscopists. A potential tool for the objective assessment of endoscopist visual search strategy is eye‐tracking technology. The aim of this study is to assess whether eye‐tracking technology can be used to differentiate the visual gaze patterns (VGP) of experienced and novice endoscopists, and to characterize any differences arising between the two groups.