Satoshi Ieiri

Construct validity for eye-hand coordination skill on a virtual reality laparoscopic surgical simulator.

BackgroundThis study was carried out to investigate whether eye-hand coordination skill on a virtual reality laparoscopic surgical simulator (the LAP Mentor) was able to differentiate among subjects with different laparoscopic experience and thus confirm its construct validity.MethodsA total of 31 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: experienced surgeons (more than 50 laparoscopic procedures) and novice surgeons (fewer than 10 laparoscopic procedures). The subjects were tested using the eye-hand coordination task of the LAP Mentor, and performance was compared between the two groups. Assessment of the laparoscopic skills was based on parameters measured by the simulator.ResultsThe experienced surgeons completed the task significantly faster than the novice surgeons. The experienced surgeons also achieved a lower number of movements (NOM), better economy of movement (EOM) and faster average speed of the left instrument than the novice surgeons, whereas there were no significant differences between the two groups for the NOM, EOM and average speed of the right instrument.ConclusionsEye-hand coordination skill of the nondominant hand, but not the dominant hand, measured using the LAP Mentor was able to differentiate between subjects with different laparoscopic experience. This study also provides evidence of construct validity for eye-hand coordination skill on the LAP Mentor.

Objective assessment of laparoscopic suturing skills using a motion-tracking system

BackgroundLaparoscopic suturing skills are important for advanced laparoscopic surgery. However, objective assessment of these skills has not yet been established. The aim of this study was to assess the laparoscopic suturing skills of novice and experienced surgeons using an electromagnetic motion-tracking system.MethodsA total of 18 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: 9 novice surgeons (fewer than 10 laparoscopic procedures) and 9 experienced surgeons (more than 50 laparoscopic procedures). The subjects performed an intracorporeal suturing task in an inanimate box laparoscopic trainer while the movements of their forceps were evaluated using an electromagnetic motion-tracking system. Their laparoscopic skills were assessed on the basis of the time, path length, and average speed of the forceps in each hand.ResultsExperienced surgeons completed the suturing task significantly faster than novice surgeons did. The left path length was significantly shorter for experienced surgeons than for novice surgeons, whereas the right path lengths did not differ. The right average speed of knot tying was significantly faster for experienced surgeons than for novice surgeons, whereas the left average speeds did not differ.ConclusionsEvaluation of psychomotor skills in laparoscopic suturing using an electromagnetic motion-tracking system revealed better results for experienced surgeons than for novice surgeons in terms of the time taken, left path length, and right speed of knot-tying. Furthermore, surgical proficiency due to experience can affect surgical dexterity of each hand differently. The present study also demonstrates the efficacy of this system for objective evaluation of laparoscopic suturing skills.

A remote surgery experiment between Japan and Thailand over Internet using a low latency CODEC system

Remote surgery is one of the most desired applications in the context of recent advanced medical technologies. For a future expansion of remote surgery, it is important to use conventional network infrastructures such as Internet. However, using such conventional network infrastructures, we are confronting time-delay problems of data transmission. In this paper, a remote surgery experiment between Japan and Thailand using a research and development Internet is presented. In the experiment, the image and audio information was transmitted by a newly developed low latency CODEC system to shorten the time-delay. By introducing the low latency CODEC system, the time-delay was shortened compared with the past remote surgery experiments despite the longer distance. We also conducted several network measurements such as a comparison between TCP/IP and UDP/IP about the control signal transmission.

Interventional navigation for abdominal therapy based on simultaneous use of MRI and ultrasound

An interventional navigation system designed for percutaneous abdominal therapies was proposed, and a pilot study was carried out to assess the proposed system. Integration of US to MRI-based segmentation and 3D display of tumours can help physicians deal with instabilities such as respiratory motion and soft tissue shift that are inherent in abdominal interventions. In addition to the 3D display of the needle and tumours, we adapted the system for the abdominal applications and incorporated a process to correct the mismatch in needle path between MRI and US. The preliminary results of phantom and animal experiments indicated that the proposed method could combine the advantages of both MRI and US. The time required to determine the optimal needle insertion path by using this system was significantly less than that required when either US or MRI guidance alone was employed. The developed system was applied in two patients who underwent PEIT therapy, and its clinical feasibility was partially confirmed.

Skills assessment using a virtual reality simulator, LapSim™, after training to develop fundamental skills for endoscopic surgery

Abstract Education and training to maintain medical safety are very important within clinical settings. We have established a training center for endoscopic surgery and we regularly hold a unique training course, which focuses on the development of fundamental skills. One hundred and ninety-four surgeons who participated in our training course were divided into four groups according to their experience in performing laparoscopic procedures. Group 1: 0–19 laparoscopic procedures (n=44). Group 2: 20–49 laparoscopic procedures (n=53). Group 3: 50–99 laparoscopic procedures (n=46). Group 4: more than 100 laparoscopic procedures (n=55). All subjects underwent evaluation for “Lifting & Grasping” using a virtual reality (VR) simulator, LapSim™, before and after the training course. The mean efficiency score, time to completion and tissue damage after training were significantly improved after the training as compared with before training. Before training, subjects with greater experience had better scores. However, the only significant difference in the score was between the low experience group and greatest experience group. After training, the score increased in all groups compared with that before training, and there was no significant difference between groups. This study demonstrates the feasibility of using a VR simulator to assess fundamental skills for endoscopic surgery after training. We found that the scores for the task were associated with the level of experience of the surgeons.

A surgical robot with vision field control for single port endoscopic surgery.

Robotic end‐effectors for single port endoscopic surgery (SPS) require a manual change of vision field that slows surgery and increases the degrees of freedom (DOFs) of the manipulator.

A remote surgery experiment between Japan-Korea using the minimally invasive surgical system

Several robotic surgical systems have been developed for MIS (minimally invasive surgery) including commercialized products such as da Vinci and ZEUS. We have developed a minimally invasive surgical system, which have carried out remote surgery experiments for five times at the writing time. In this paper, a remote surgery experiment, which was conducted between Japan and Korea by using the developed minimally invasive surgical system is described. Research & Development (R & D) Internet testbet, APII (Asia-Pacific Information Infrastructure), which consists of an optical submarine cable network KJCN (Korea-Japan Cable Network), was used. In the experiment, a laparoscopic cholecystectomy was successfully carried out on a pig. The network time-delays of control signal and images were 6.5 msec and 435.5 msec respectively. A comparison of remote surgery experiments using ISDN and the Internet was studied

Three-dimensional liver model based on preoperative CT images as a tool to assist in surgical planning for hepatoblastoma in a child

The patient is a 3-year-old female diagnosed with PRETEXT IV hepatoblastoma (HB). Although the tumor was decreased after the neoadjuvant chemotherapy, HB still located at the porta hepatis. The patient underwent extended left lobectomy successfully after surgical simulation using three-dimensional (3D) printing liver model based on preoperative CT.

Development of a robotic system with six-degrees-of-freedom robotic tool manipulators for single-port surgery.

Current robotic systems have limitations for single‐port surgery (SPS) because the instruments are large, the arms collide and the field of vision requires manual readjustment. We have developed an SPS robotic system that manipulates the vision field.

Total colonic aganglionosis with or without small bowel involvement: a 30-year retrospective nationwide survey in Japan

PURPOSE We conducted a nationwide survey in Japan, to identify recent trends in the diagnosis and treatment of patients who had total colonic aganglionosis with or without small bowel involvement (TCSA). These data were compared with 2 similar studies conducted within the last 30 years. METHODS Patient data were collected in 3 phases; phase I included 135 patients between 1978 and 1982; phase II, 107 patients between 1988 and 1992; and phase III, 101 patients between 1998 and 2002. RESULTS The incidence of TCSA was 1:59,059, 1:58,084, and 1:58,375, and the male-female ratios were 1.5:1, 1.5:1, and 2.2:1 in each phase, respectively. Patients with associated anomalies increased from 15.2% (phase I) to 22.8% (phase III). The incidence of preoperative enterocolitis decreased over time. For treatment, Duhamels procedure and ascending colon patch methods have increased over time, whereas Martins procedure has decreased. The mortality rate dropped from 40.9% to 15.8%; however, a high mortality rate persists in those cases with small bowel involvement (35.5%). CONCLUSIONS A marked decrease in the overall mortality rate was observed during the study period. However, further efforts are still required especially in cases involving aganglionosis extending orally to 75 cm from Treitzs band.