Develop portable low-cost COTS-based simulators to enable ubiquitous training and presurgical warm-up in minimally invasive surgery¶

Strategy · All strategies
Evidence · 7 claims (7 for) · 2 studies (2 review), q2 · 0 of 2 report an effect size · 7 claims rest on one study

Description¶

The review recommends exploring COTS gesture-detection technology as the basis for portable, low-cost simulation for skills learning and training in minimally invasive surgery, motivated by the high cost of existing virtual and augmented reality simulators. The authors conclude that "COTS devices applied to hand and instrument gesture–based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up". The strategy builds on validity evidence that simulation in virtual reality environments is effective for motor skills learning in MIS.

Design Implications¶

Context¶

Requirements¶

• New COTS technologies that allow hand gestures and instrument movements to be detected
• Development and validation of new simulation models in virtual environments

Constraints¶

• The field was still in the exploratory phase in areas requiring touchless manipulation within environments that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms
• Most identified articles were proof-of-concept or prototype user testing and feasibility testing studies

Target Learners¶

• surgical residents
• novice and intermediate minimally invasive surgery trainees

Target Learning Goals¶

• motor skills learning in minimally invasive surgery
• presurgical warm-up

Affordances¶

• Cots Touchless Gesture Interfaces Surgery

Claims¶

• A Leap Motion Controller-based system discriminated expert from novice surgical knot-tying performance with 100% accuracy, supporting construct validity for objective dexterity assessment [+W]
• Microsoft Kinect and the Leap Motion Controller were the most widely used COTS gesture-detection devices in surgical research, appearing in 50% and 36% of the 86 included studies respectively [+W]
• The most common use of gesture-based COTS devices in surgery was image manipulation in interventional radiology environments or the operating room (42 studies), followed by virtual or augmented reality for educational or interventional purposes (16 studies) [+W]
• In a 42-participant field study, Microsoft Kinect was found more useful and easier to use than the Leap Motion Controller, while the Leap Motion Controller was more accurate for manipulating CT images [+W]
• Finger-motion sensor (Leap Motion Controller) operation of angiographic and radiological images was significantly faster than mouse-based operation in observational studies with radiologists and dental students [+W]
• A randomized controlled trial found immersive virtual reality surgery training improved the knowledge and self-confidence of surgical residents [+W]
• Significant patient-safety improvements were found in 80% of comparative virtual reality simulation studies for cataract surgery training [+W]

Related Strategies¶

• Integrate cost-effective simulation with structured, proficiency-based curricula into pediatric MIS training
• Develop and validate a reusable, cost-effective, high-fidelity training platform and build homogeneous assessment tools for aneurysm clipping simulation
• Strengthen vascular simulation research with modern validity frameworks, longer skill-retention follow-up, cost-effectiveness analysis, and more nontechnical-skills and cadaver models

Examples¶

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Key Sources¶

• Alvarez-Lopez F, Maina MF, Saigí-Rubió F. (2019). Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review. Journal of Medical Internet Research. https://doi.org/10.2196/11925