Advertisement

Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty

  • Narges AhmidiEmail author
  • Piyush Poddar
  • Jonathan D. Jones
  • S. Swaroop Vedula
  • Lisa Ishii
  • Gregory D. Hager
  • Masaru Ishii
Original Article

Abstract

Purpose

Previous work on surgical skill assessment using intraoperative tool motion has focused on highly structured surgical tasks such as cholecystectomy and used generic motion metrics such as time and number of movements. Other statistical methods such as hidden Markov models (HMM) and descriptive curve coding (DCC) have been successfully used to assess skill in structured activities on bench-top tasks. Methods to assess skill and provide effective feedback to trainees for unstructured surgical tasks in the operating room, such as tissue dissection in septoplasty, have yet to be developed.

Methods

We proposed a method that provides a descriptive structure for septoplasty by automatically segmenting it into higher-level meaningful activities called strokes. These activities characterize the surgeon’s tool motion pattern. We constructed a spatial graph from the sequence of strokes in each procedure and used its properties to train a classifier to distinguish between expert and novice surgeons. We compared the results from our method with those from HMM, DCC, and generic metric-based approaches.

Results

We showed that our method—with an average accuracy of 91 %—performs better or equal than these state-of-the-art methods, while simultaneously providing surgeons with an intuitive understanding of the procedure.

Conclusions

In this study, we developed and evaluated an automated approach to objectively assess surgical skill during unstructured task of tissue dissection in nasal septoplasty.

Keywords

Unstructured activities Partially observed time series Surgical skill assessment Feature extraction  Septoplasty Feedback 

Notes

Acknowledgments

We gratefully acknowledge support from NIH 5R21DE022656-02. We would also like to thank participating attending surgeons—Drs. Kofi Boahene, Patrick Byrne, Ira Papel, and Theda Kontis, and trainee surgeons—Drs. Sun Ahn, Amit Kocchar, Linda Lee, Ryan Li, Myriam Loyo, Sofia Lyford-Pike, Peter Revenaugh, David Smith, Babar Sultan, David Mener, Samuel Oyer, Daniel Sun, at the Johns Hopkins Medical Institutions.

References

  1. 1.
    Sugden C, Aggarwal R (2010) Assessment and feedback in the skills laboratory and operating room. Surg Clin North Am 90:519–533CrossRefPubMedGoogle Scholar
  2. 2.
    Champagne BJ (2013) Effective teaching and feedback strategies in the or and beyond. Clin Colon Rectal Surg 26:244–249CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Fettman N, Sanford T, Sindwani R (2009) Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am 42:241–253CrossRefPubMedGoogle Scholar
  4. 4.
    Hwang PH, McLaughlin RB, Lanza DC, Kennedy DW (1999) Endoscopic septoplasty: indications, technique, and results. Otolaryngol Head Neck Surg 120:78–82CrossRefGoogle Scholar
  5. 5.
    Bhattacharyya N (2006) Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Laryngoscope 120:635–638CrossRefGoogle Scholar
  6. 6.
    Stewart MG, Witsell DL, Smith DL, Weaver EM, Yueh B, Hannley MT (2014) Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130:157–163CrossRefGoogle Scholar
  7. 7.
    Mason JD, Ansell J, Warren N, Torkington J (2013) Is motion analysis a valid tool for assessing laparoscopic skill? Surg Endosc 27:1468–1477Google Scholar
  8. 8.
    Moorthy K, Munz Y, Sarkar SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327:1032–1037CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Van Hove PD, Tuijthof GJ, Verdaasdonk EG, Stassen LP, Dankelman J (2010) Objective assessment of technical surgical skills. Br J Surg 97:972–987CrossRefPubMedGoogle Scholar
  10. 10.
    Aggarwal R, Grantcharov T, Moorthy K, Milland T, Papasavas P, Dosis A, Bello F, Darzi A (2007) An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room. Ann Surg 245:992–999CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Dosis A, Aggarwal R, Bello F, Moorthy K, Munz Y, Gillies D, Darzi A (2005) Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 140:293–299CrossRefPubMedGoogle Scholar
  12. 12.
    Oropesa I, Sanchez-Gonzalez P, Lamat P, Chmarra MK, Pagador JB, Sanchez-Margallo JA, Sanchez-Margallo FM, Gmez EJ (2011) Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery. J Surg Res 171:e81–e95CrossRefPubMedGoogle Scholar
  13. 13.
    Reiley CE, Lin HC, Yuh DD, Hager GD (2011) Review of methods for objective surgical skill evaluation. Surg Endosc 25:356–366CrossRefPubMedGoogle Scholar
  14. 14.
    Varadarajan B, Reiley C, Lin H, Khudanpur S, Hager GD (2009) Data-derived models for segmentation with application to surgical assessment and training. Med Image Comput Comput Assist Interv 12:426–434PubMedGoogle Scholar
  15. 15.
    Tao L, Elhamifar E, Khudanpur S, Hager GD, Vidal R (2012) Sparse Hidden Markov Models for Surgical Gesture Classification and Skill Evaluation. IPCAI 2012. LNCS, vol 7330, Springer, Heidelberg, pp 167–177Google Scholar
  16. 16.
    Ahmidi N, Gao Y, Bejar B, Vedula SS, Khudanpur S, Vidal R, Hager GD (2013) String motif-based description of tool motion for detecting skill and gestures in robotic surgery. MICCAI 16:26–33Google Scholar
  17. 17.
    Ahmidi N, Hager GD, Ishii L, Gallia GL, Ishii M (2012) Robotic path planning for surgeon skill evaluation in minimally-invasive sinus surgery. Springer, BerlinCrossRefGoogle Scholar

Copyright information

© CARS 2015

Authors and Affiliations

  • Narges Ahmidi
    • 1
    Email author
  • Piyush Poddar
    • 3
  • Jonathan D. Jones
    • 4
  • S. Swaroop Vedula
    • 1
  • Lisa Ishii
    • 2
  • Gregory D. Hager
    • 1
  • Masaru Ishii
    • 2
  1. 1.Department of Computer ScienceJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Head and Neck Surgery-OtolaryngologyJohns Hopkins Medical InstitutesBaltimoreUSA
  3. 3.Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Electrical and Computer EngineeringJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations