Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Abstract

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentortrainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software Solutions has allowed for the expansión of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentáis of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as 1 To whom correspondence and reprint requests should be addressed at Bioengineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM). Avda Complutense, 30, 28040, Madrid, Spain. E-mail: ioropesa@gbt.tfo. upm.es. well as optimize their already overloaded training schedules.

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“…These techniques forgo the traditional approach of open interventions, allowing surgeons to perform surgeries through minimal incisions in the patient's body. MIS interventions are less painful for the patient; have fewer post-operative complications associated, and can shorten hospital stays [4].…”

“…Moreover, educational processes are gradually being adapted from mentor-apprentice-based approaches towards structured, objective training and assessment programs, where direct involvement of residents in real surgeries is delayed until becoming proficient in the required skills. Several motivators can be identified behind this: social awareness on medical errors, the need to reduce costs in hospitals, or the overloaded schedules of surgeons [4].…”

TELMA: Technology-enhanced learning environment for minimally invasive surgery

“…A growingbody of research has demonstrated that professional networking is one of the central elements in collaborative learning environments [21][22][23]. Researchers have confirmed that these networks also play instrumental roles in learning environments as a conduit of resource and knowledge exchange [24] and as a source of support and socialization for distributed learners [23].…”

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

“…Principalmente, estos sistemas se clasifican en 2 grandes grupos: sistemas virtuales y físicos 6 . En este trabajo nos centraremos en los sistemas físicos de formación y evaluación quirúrgica por su mayor realismo en el uso del instrumental, así como en la interacción con el entorno de trabajo 7,8 .…”

“…El análisis de los movimientos del instrumental es un método efectivo para la evaluación objetiva de las habilidades psicomotoras del cirujano 6,9,10 . Durante el aprendizaje de una tarea, el sujeto ejecuta movimientos más eficientes cuando llega a dominar esta tarea 11 .…”