Ricardo Ordorica Flores

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

AbstractBackground The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons’ psychomotor skills.MethodsThirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand–eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach’s α test.ResultsOverall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels.ConclusionsEndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons.

Thirty-degree optical system for laparoscopic training

The training systems used by starting laparoscopic surgeons for visual and motor adaptation employ zero-degree optics. However, as new laparoscopic surgery techniques make such optics obsolete, there is a need to design training and adaptation tools with other optics.

Postural Mechatronic Assistant for Laparoscopic Solo Surgery (PMASS)

Laparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of the visual perspective. The system designed is an intuitive mechatronic system with three degrees of freedom and a single active articulation. The system uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone. The mechatronic system has been tested in a physical trainer, cutting and suturing chicken parts, as well as in laparoscopic ovariohysterectomies in dogs and pediatric surgeries. In all the procedures, surgeons were able to auto-navigate and there was no visual tremor while using the system. Surgeons performed visual approaches in real time and had both hands free to carry out the procedure. This new mechatronic system allows surgeons to perform solo surgery. Cleaning and positioning downtime are reduced, since it is the surgeon him/herself who handles the optics and selects the best visual perspective for the surgery.Background and purposeLaparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of the visual perspective.MethodsThe system designed is an intuitive mechatronic system with three degrees of freedom and a single active articulation. The system uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone.ResultsThe mechatronic system has been tested in a physical trainer, cutting and suturing chicken parts, as well as in laparoscopic ovariohysterectomies in dogs and pediatric surgeries. In all the procedures, surgeons were able to auto-navigate and there was no visual tremor while using the system. Surgeons performed visual approaches in real time and had both hands free to carry out the procedure.ConclusionThis new mechatronic system allows surgeons to perform solo surgery. Cleaning and positioning downtime are reduced, since it is the surgeon him/herself who handles the optics and selects the best visual perspective for the surgery.

Tonatiuh II: Assisting manipulator for laparoscopic surgery

In this article we show the design of the Tonatiuh II robotic manipulator. This robotic assistant has an original electromechanical configuration and respects the laparoscope center of insertion as an invariant point for navigation in the work space. The manipulator went through several stages before reaching its final version. Surgical trials have shown the robot to be useful in the operating room and as a training assistant in specialty microsurgery.

Laparoscopic Nissen solo surgery using PMAT (first experience)

This article describes the use of a Postural Mechatronic Assistant Trainer (PMAT) in pediatric Nissen surgery. This mechatronic system enables users to establish the logistical considerations for solo surgery and determine the advantages this new tool offers for the autonomous handling of optics.

Early experience in mechatronic-assisted laparoscopic Heller esophagomyotomy.

To the Editor: Heller esophageal myotomy performed laparoscopically to treat achalasia limits surgeons in instrument manipulation and visualization of surgical targets. Robotic systems have been introduced trying to eliminate these limitations [1], but they present disadvantages such as setup times, cumbersome, high costs [2,3] and the need of a group of surgeons and assistants well trained to carry it out [4,5]. New techniques and auxiliary equipment are constantly being designed to facilitate and expand the surgical procedures [6,7] and the equipment must be tested before becoming part of the surgical instrumentation. We evaluated a new mechatronic system that provides visual self-assistance by performing a Heller myotomy in two pediatric patients under the concept of solo surgery. The Postural Mechatronic Assistant for Solo Surgery consists of a harness placed on the chest and a mechanical arm connected to the harness. The arm is activated by floor pedals to make changes in the optical perspective. Likewise, the postural movements of the surgeon cause the laparoscope to move in and out of the work area, and the motion of the torso shifts the view left and right [8]. The patients admitted at the Children’s Hospital in Mexico City diagnosed with Achalasia of the esophagus were treated with an esophageal Heller myotomy through a doublecontrast esophagogastroduodenal series, endoscopy and esophageal manometry. The first procedure lasted 90 min and the second 120 min performed in a different day. No complications were reported during surgery. This first experience using the mechatronic system to visually self-assist the surgeon in conjunction with the laparoscope showed several advantages over robotic systems. The system provided visual self-assistance without limiting the use of hands besides the setup and pull apart time (5 min ea.) were negligible compared with the times of other technologies. Its mechanic structure allowed performing this surgery efficaciously by one surgeon alone. The training and testing times necessary in the use of complex robotic technologies were eliminated. With this new equipment, a surgeon always selects the best visual perspective in real time.This advantage is related to the fact that the surgeon adapts himself intuitively the movement of the optics. The surgeon practically forgets the system in considering the direction. Cleaning of the laparoscope is carried out in a standard way and the reinsertion of the laparoscope always corresponds to the last surgical target, eliminating dead times which is not possible with some of the current robotic systems. Sterilization of the equipment was performed in a conventional way. Surgical times were similar to those reported internationally for the same procedure. Additionally, adaptation to this new technology will become as necessary as advantages are gained in important procedures as Heller myotomy. These first experiences of visual self-assistance in Heller myotomy with a mechatronic assistant system reflectedaconsiderablecost reduction.Surgical results were similar in time and quality to those reported in literature. The inclusion of this new technology in the operating room will help surgeons to improve their performance inquality andwill reduce the overall time.