A Survey on the Current Status and Future Challenges Towards Objective Skills Assessment in Endovascular Surgery

Abstract

Minimally invasive endovascular interventions have evolved rapidly over the past decade, facilitated by breakthroughs in medical imaging and sensing, instrumentation and most recently robotics. Catheter-based operations are potentially safer and applicable to a wider patient population due to the reduced comorbidity. As a result endovascular surgery has become the preferred treatment option for conditions previously treated with open surgery and as such the number of patients undergoing endovascular interventions is increasing every year. This fact coupled with a proclivity for reduced working hours results in a requirement for efficient training and assessment of new surgeons, that deviates from the “see one, do one, teach one” model introduced by William Halsted, so that trainees obtain operational expertise in a shorter period. Developing more objective assessment tools based on quantitative metrics is now a recognized need in interventional training and this manuscript reports the current literature for endovascular skills assessment and the associated emerging technologies. A systematic search was performed on PubMed (MEDLINE), Google Scholar, IEEXplore and known journals using the keywords, “endovascular surgery”, “surgical skills”, “endovascular skills”, “surgical training endovascular” and “catheter skills”. Focusing explicitly on endovascular surgical skills, we group related works into three categories based on the metrics used; structured scales and checklists, simulation-based and motion-based metrics. This review highlights the key findings in each category and also provides suggestions for new research opportunities towards fully objective and automated surgical assessment solutions.

Computer Vision in the Surgical Operating Room

“…This further facilitates the current trend in MIS practice towards establishing standardized protocols for surgical workflow and guidelines for task execution, describing optimal tool positioning with respect to the anatomy, setting performance benchmarks, and ensuring operational safety and complication-free, cost-effective procedures [10, 11]. The ability to objectively quantify surgical performance could impact many aspects of the user and patient experience, like a reduced mental/physical load, increased safety, and more efficient training and planning [12, 13]. Intraoperative video is the main sensory cue for surgical operators and provides a wealth of information about the workflow and quality of the procedure.…”

A haptic guidance system for simulated catheter navigation with different kinaesthetic feedback profiles

“…The most commonly used metrics in endovascular surgical studies is total intervention time (T tot ), 58 which is evaluated in this study. The entire navigation can take an extra 30–40 s, a statistically insignificant difference.…”

Cognitive AutonomouS CAtheters Operating in Dynamic Environments

“…Hereto, a detailed analysis of the state-of-theart in endovascular surgical skills evaluation methods has been conducted. 96 Expert endovascular surgeons operate instruments in a smooth, steady way without jerky and unnecessary movements. 96 For autonomous operation, the robotic system must emulate the performance of an expert endovascular surgeon to deal with the challenges and risks of TAVI as outlined in SubSec.…”