2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH POSTER ABSTRACTS
the greater curvature. The ERCP was then performed performed
and the gastrotomy was closed.
3.Preliminary Results:
The common bile duct stones were successfully removed via
ERCP. The patient tolerated the procedure well and went home
on post-operative day three.
4.Conclusions/Future Directions:
Laparoscopic assisted ERCP is a safe and effective method to
treat choledocholithiasis in patients who have undergone previous
roux-en-y gastric bypass.
TP032
REMOTE PRESENCE PROCTORING USING WIRELESS
REMOTE CONTROL VIDEOCONFERENCING SYSTEM, C Daniel
Smith MD, Kyle W Peterson PhD, Emory University School of
Medicine
OBJECTIVES: Remote presence in an operating room to allow
an experienced surgeon to proctor a surgeon has been promised
through robotics and telesurgery. While several such systems
have been developed and commercialized, little progress
has been made using telesurgery for anything more than live
demonstrations of surgery. This pilot project explored the use
of a new videoconferencing capability to determine if it offers
advantages over existing systems. METHODS: The video conferencing
system used is a PC based system with a flat screen
monitor and an attached camera that is then mounted on a
remotely controlled platform (Figure 1). This device is controlled
from a remotel PC-based videoconferencing system
computer outfitted with a joystick. Using the public internet
and a wireless router at the client site a surgeon at the control
station can manipulate the videoconferencing system. Controls
include navigating the unit around the room and moving the
flat screen/camera like a head looking up/down and right/left.
This system (InTouch Medical, Santa Barbara, CA) was used to
proctor 1st year medical students during an anatomy class
human dissection. The ability to effectively monitor the
student?s dissection and direct their activities was assessed
subjectively by students and surgeon. RESULTS: This device
was very effective at providing a controllable and interactive
presence in the anatomy lab. Students felt they were interacting
with a person rather than a video screen and quickly forgot
that the surgeon was not in the room. The ability to move the
device within the environment rather than just observe the
environment from multiple fixed camera angles gave the surgeon
a similar feel of true presence. CONCLUSION: A remote
controlled videoconferencing system provides a more real
experience for both student and proctor. Future development
of such a device could greatly facilitate progress in implementation
of remote presence protoring.
TP033
Augmented reality interface for laparoscopic skills training
Gerard Lacey, Derek Young, Derek Cassidy, Fiona Slevin,
Donncha Ryan
Haptica Ltd, Dublin, Ireland.
Purpose
The surgical community have developed a range of simple but
effective training scenarios for laparoscopic surgical skills.
These “box trainers” allow surgeons to practice surgically relevant
tasks safely. The skills taught in box trainers have been
shown to transfer to live operative performance [1] and the
surgeon’s hand movements have been shown to correlate well
with surgical skill [2]. This abstract describes ProMIS an
Augmented Reality (AR) training system that improves box
trainer tasks by adding both objective assessment and interactive
graphics to the training tasks.
Method
One method of providing objective assessment of surgical skill
is to capture and analyse the movement patterns of the surgeon’s
instruments while completing a standardised task. This
tests both the surgeons dexterity and their familiarity with the
instruments and by analysing the movement patterns the efficiency
of motion can be determined.
ProMIS achieves objective surgical skills assessment by capturing
the 3D movement of commercial laparoscopic instruments
while completing a standardised task. The surgeon’s
view of training tasks is provided by a digital camera mounted
within the bodyform. The position information is gathered
using cameras thus a reliable and accurate non-contact measurement
system is achieved.
The main performance metrics are time taken, total path
length swept by each instrument tip and the smoothness(efficiency)
of the surgeons movement. Additionally task specific
metrics are calculated to measure performance associated
with different regions on and above the task plate. This is
achieved because ProMIS has an accurate 3D model of the
standard task and regions in space. A software tool called
ProMIS LessonMaker allows a non-technical user to create
these regions and their associated metrics as part of creating
customised instructional materials.
Augmented Reality in Training Tasks
In addition to the capability to provide measurement ProMIS
Lesson Maker uses advanced multi-media technology to allow
the creation of Augmented Reality training materials. This is
the combination of 3D interactive graphics with live video.
This technology is normally associated with movie industry or
fighter pilot displays is used to add additional instruction,
interactive psychomotor challenges or proximal feedback on
errors during the completion of a “standard box trainer task”
Figure 1 Superimposed graphics interacting with instruments
during live video trainer task.
Results
The construct validity of the ProMIS system has been
demonstrated in 3 studies in Emory, Imperial College, London,
UK and AMNCH, Dublin, Ireland [3, 4]. Interactive augmented
reality content has been merged with the live video to improve
the training content and efficacy. A number centres are conducting
so called “VR-OR” studies to validate the transfer of
skills developed in ProMIS transfer to the OR.
Conclusions
In the ProMIS system Augmented Reality has been shown to
provide a clinically validated, flexible and engaging platform
for training and objectively assessing the skills of laparoscopic
surgery. Because the system uses non contact sensing, real
surgical instruments and runs on a standard PC it is a very
robust and cost effective method of surgical training.
References
[1] Datta, V. Bann, S. Beard, J. Mandalia, M. Darzi, A.
Comparison of bench test evaluations of surgical skill with live
operating performance assessments. J Am Coll Surg 2004
volume 199 issue 4 pp. 603-6
[2] Smith SG, Torkington J, Brown TJ, Taffinder NJ, Darzi A.
Motion Analysis, Surg Endosc. 2002 Apr;16(4):640-5
[3] D.A.M. McClusky K. Van Sickle, A.G. Gallagher Relationship
Between Motion Analysis, Time, Accuracy, and Errors During
Performance of a Laparoscopic Suturing Task on an
Augmented Reality Simulator EAES 2004
[4] D. Broe, P.F. Ridgway, S. Johnson, C. Tierney, K.C. Conlon,
Validation of a Novel Hybrid Surgical Simulator, EAES 2004
TP034
PRELIMINARY EXPERIENCE WITH A NEW MECHANICAL
MANIPULATOR: THE RADIUS SURGICAL SYSTEM
Nicola Di Lorenzo MD, Giorgio Coscarella MD, Luca Faraci MD,
Iwona Gacek MD, Fabrizio S Altorio MD, Achille L Gaspari,
UNIVERSITA’ DI ROMA TOR VERGATA ITALY
Objective of the device:
Improvement of the four degrees of freedom (DOF) that limit
conventional instruments in their range of movement: till now,
only electronic robotic effectors have mimicked the human
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