Hierarchical decomposition of laparoscopic surgery: a human factors approach to investigating the operating room environment

Abstract

Hierarchical decomposition of complex behaviour and systems is a valuable research methodology from human factors and information-processing psychology that can be applied to laparoscopic surgery. This article describes results of research on surgeons performing several different laparoscopic procedures, conducted in Vancouver, Canada 1995–98. Through top-down analyses of surgical procedures and bottom-up analyses of tool motions, results included detailed decomposition of the procedures through surgical steps, sub-steps, tasks, sub-tasks and tool motions. Analyses at all levels provided valuable information. In addition to specific surgeon- and technology-related observations, such as the effect of dividing the short gastrics on performance of Nissen fundoplication, gaze patterns of surgeons and factors related to patient safety were analysed. The hierarchical decomposition approach can be extended to other aspects of the complex system that consists of the surgeon and operating room team, the technologies and the operating room environment. Other frameworks for assessment are also considered.

Surgical data science, an emerging field of medicine

“…They employed a haptic interface to interact directly with the patient data, and robotically execute the planned trajectories, using a neurosurgical manipulator [9]. One of the main advantages to the top-down approach is that it is capable of identifying different granularity levels, and accurately describing the surgery with the required detail [10]. While this method is a natural way of representing general knowledge, and is easily understandable for human readers, as the procedure is usually captured by human observers, this representation rarely provide high-level detail about the individual surgeries.…”

Surgical models for computer-assisted neurosurgery

“…It has been previously discussed with regard to surgical simulation [Satava 1996, Taylor 1999, robotics systems [Munchenberg 2000] and minimally invasive surgery [MacKenzie 2001]. Until very recently, there have been few concrete initiatives.…”

“…The reporting-centered approaches have focused on nomenclature generation and translation [CEN 2001, Price 1998, Trombert-Paviot 2000. The operative approaches focused on optimizing human/device interfaces by modeling interactive aspects [Kragic 2003, Mansoux 2005, Trevisan 2003], on studying the surgical gesture to directly optimize surgical planning [MacKenzie 2001, Munchenberg 2000, or on studying surgeons' gestures for partial robotic assistance [Botturi 2005, Kragic 2003, Nageotte 2005. Finally, the need for perioperative surgical workflow optimization has recently emerged, especially regarding the specifications of the operating room of the future [Dickhaus 2004, Fischer 2005, Lemke 2004, Sandberg 2004.…”

Surgical Gesture Classification from Video Data

“…One of the most natural approaches is to decompose a surgical task into a series of pre-defined 'atomic' gestures or surgemes [1][2][3], such as 'insert a needle', 'grab a needle', 'position a needle', etc. (Fig.…”