Introduction: Hand/instrument motion-tracking in surgical simulation can provide valuable data to improve psychomotor skills, and can also serve as a more formative evaluative tool. Although motion analysis has been well studied within laparoscopic surgery, it has been very poorly studied in endoscopic surgery. There are essentially no studies looking at surgeon hand/instrument motion tracking for flexible ureteroscopy (fURS), a surgical procedure that requires a significant amount of hand dexterity. In this study we aimed to develop a ureteroscopic surgery simulation platform that incorporates motion tracking capabilities.
Methods: Using the PolhemusTM system we designed a motion tracking platform for a benchtop ureteroscopy simulator. This system was designed to capture specific instrument/surgeon hand motions determined to be important during fURS. Motion data were captured for a specific defined task performed on the simulator. Using this data, motion analysis metrics for fURS were established. 25 volunteers were tested on this new platform and motion analysis parameters were recorded and analyzed.
Results: Using motion tracking software we analyzed three key motions during fURS: scope in-out motion, scope rotation, and scope tip flexion/extension. The target task was visualization of one upper, one inter-, and one lower pole calyx on a benchtop surgical simulator of the left kidney. Participants were asked to pause for 10 seconds when visualizing each papilla to help discriminate the motion data. 25 participants were tested (5 novices, 13 residents, 7 urologists). While scope in-out motion and scope tip flexion were significantly different between participants of different expertise level, the most discriminatory metric which differentiated experts from novices was scope rotation (Figure 1).
Conclusions: We were able to successfully create a flexible ureteroscopy simulation platform that captures instrument motion. Preliminary data suggests scope rotation is the most discriminatory motion parameter in fURS that discriminates between novice and expert surgeons. Source of
