Nobuki Oshima

Towards understanding the suture/ligature skills during the training process using WKS-2RII

ObjectNowadays, most of the surgical training programs follow a duration-based format that focuses on improving technical skills of trainees for a fixed amount of time before declaring their proficiency. More recently, different approaches have been proposed for the skills assessment; such as the objective structured clinical examination (OSCE). The OSCE consists of different stations in which trainees are required to perform practical exams while their performance is evaluated by examiners. However, their performance cannot be easily assessed by the simple observation of the task. As a result, no standard evaluation criteria can be conceived.MethodsThanks to the recent advances in Robot Technology (RT); more efficient training systems can be conceived. In particular, authors believe in the importance of developing automated training devices designed to provide training progress quantitative information of trainees. For this reason, at Waseda University, since 2004, we have proposed as a long-term research goal, the development of a Patient Robot which nearly reproduces the human body anatomy and physiology by embedding sensors and actuators into a human model. Due to the complexity of patient robot development, as a first approach, we have proposed the development of a Suture/Ligature Training System. In this paper, the details of Waseda-Kyotokagaku Suture No. 2 Refined II (WKS-2RII) are presented. The WKS-2RII has been designed to reproduce the task conditions of the suture and ligature as well as to provide quantitative information of artificial skin movement, and the physical properties of the suture. From such collected data, we have proposed an Evaluation Function that integrates all the proposed evaluation parameters.ResultsIn order to verify the effectiveness of the WKS-2RII, a set of experiments were proposed to analyze the performance of subjects while performing the task with the WKS-2RII. The experiments were designed to determine if the proposed system may provide more detailed information of the task in a quantitative way. From the experimental results, we have confirmed that the WKS-2RII is capable of providing quantitative assessment of the task. In contrast to the conventional training methods (i.e., OSCE, etc.), the WKS-2RII can provide more detailed information of the task performance, so that the proposed system can detect the differences among different level of expertise (five surgeons, five medical students and five unskilled persons) as well as detect improvements of trainees by plotting the learning curve.ConclusionsIn this paper, we have presented the improvements on the WKS-2RII and a unique evaluation function has been proposed. Regarding the weighting coefficients, the discriminant analysis method was used to determine the optimal values of the weighting coefficients.

Quantitative assessment of the surgical training methods with the suture/ligature training system WKS-2RII

The emerging field of medical robotics is aiming in introducing intelligent tools to perform medical procedures. In particular, robotic researchers have been proposed advanced medical training systems to enhance motor dexterities of trainees. An efficient medical training system should be designed to simulate real-world conditions and to assure their effectiveness as the representation of the motor skills often differs among trainees. Up to now, several training simulators have been developed by medical companies designed to reproduce with high fidelity the human body. However, such devices are not designed to provide any information to trainees. Therefore, we have proposed the development of a Patient Robot which embeds sensors and actuators into a conventional human model. Due to its complexity, as a first approach; we are presenting the development of a suture training system designed to simulate the real-world task conditions as well as providing quantitative assessments. In particular; the Waseda-Kyotokagaku Suture No.2 Refined II is presented, which includes a new evaluation function to provide more detailed information of the task. A set of experiments were proposed to analyze the performance of trainees. From the experimental results, we could confirm its effectiveness to detect differences of the performance of trainees.

Development of a sensor system towards the acquisition of quantitative information of the training progress of surgical skills

Up to now, there is no widely accepted assessment of surgical skills. Nowadays, an objective structured clinical examination (OSCE) has been proposed as a modern type of examination often used in medicine to test skills. The assessment of skills is realized by practical exams, in which students are evaluated by experienced examiner using a check list. However, the examiner lacks of information which cannot be obtained through the simple observation of the task. Therefore, at Waseda University, we have proposed the development of a patient robot as an advanced evaluation tool to provide more detailed information of the task. As a first approach of our long-term research target, we have proposed the development of a suture/ligature training system which provides quantitative information of the movement of a dummy skin as well as information of the quality of task. Therefore in this paper, we are presenting the Waseda Kyotokagaku Suture No. 2 Refined II (WKS-2RII). The WKS-2RII has been designed to provide more detailed information of the task performance. Experiments were proposed to confirm the effectiveness of the proposed evaluation parameters to distinguish the differences among different training methods.

Integration of an evaluation function into the suture/ligature training system WKS-2R

Up to now, there is no widely accepted quantitative evaluation scheme. Nowadays, an objective structured clinical examination has been proposed as a modern type of examination often used in medicine to test skills such as medical procedures, etc. The assessment of skills is realized by practical exams, in which students are evaluated by experienced examiner using a check list. However, the examiner lacks of information which cannot be obtained trough the simple observation of the task. Thanks to the advances in robot technology in embedded systems, etc.; more advanced evaluation tools can be conceived. For this reason, at Waseda University, we have proposed the development of a patient robot as an advanced evaluation tool to provide more detailed information of the task. As a first approach of our long-term research target, we have proposed the development of a suture/ligature training system which provides quantitative information of the movement of a dummy skin as well as information of the quality of task. In this paper; we describe the functionalities of the newest version, the Waseda-KyotoKagaku Skin No.2 Refined (WKS-2R), which has been designed to provide quantitative information of the task. In addition, we are proposing a new evaluation function which includes performance indexes and weighting coefficients. As a first approach, the weighting coefficients were determined by using the discriminant analysis. A set of experiments were proposed to confirm the effectiveness of the proposed evaluation function. From the preliminary results, the evaluation function was useful in detecting differences among different levels of expertise as well as detecting improvements during the training process by computing the learning curve.

Development of the suture/ligature training system WKS-2 designed to provide more detailed information of the task performance

Authors have proposed as a long-term goal, since 2004, the development of a patient robot which could serve for both training purposes as well as an evaluation tool of medical procedures. As a first approach, we have developed last year a suture and ligature training system named Waseda Kyotokagaku Suture No. 1 (WKS-1), which is composed by a commercial skin dummy with arrays of embedded sensors designed to acquire quantitative data of the task. The WKS-1 was designed to reproduce realistically the task conditions as well as providing objective assessment of the task performance. In particular, the proposed evaluation function considered the following performance indexes: time, displacement and force levels. By performing experiments with medical doctors and unskilled persons, we confirmed the effectiveness of WKS-1 to provide objective assessments of the task performance. However, the functionalities of WKS-1 were too restricted as few automatic procedures were implemented for the acquisition and processing of the collected data. Therefore; in this paper, we are presenting the Waseda Kyotokagaku Suture No. 2 (WKS-2). The WKS-2 has been designed to provide more detailed information of the task performance as well as improving its portability, connectivity, and usability. In addition, thanks to the design improvements on the WKS-2, we have proposed additional evaluation parameters to measure the quality of the suture (after the task has been completed). For this purpose, we proposed a image processing algorithm to automatically measure the width of sutures, the distance among them and the wound area. Preliminary experiments were carried out to verify its effectiveness.