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Assessing the efficacy of dissection gestures in robotic surgery

Inouye, Daniel A. and Ma, Runzhuo and Nguyen, Jessica H. and Laca, Jasper and Kocielnik, Rafal and Anandkumar, Anima and Hung, Andrew J. (2023) Assessing the efficacy of dissection gestures in robotic surgery. Journal of Robotic Surgery, 17 (2). pp. 597-603. ISSN 1863-2491. doi:10.1007/s11701-022-01458-x.

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Our group previously defined a dissection gesture classification system that deconstructs robotic tissue dissection into its most elemental yet meaningful movements. The purpose of this study was to expand upon this framework by adding an assessment of gesture efficacy (ineffective, effective, or erroneous) and analyze dissection patterns between groups of surgeons of varying experience. We defined three possible gesture efficacies as ineffective (no meaningful effect on the tissue), effective (intended effect on the tissue), and erroneous (unintended disruption of the tissue). Novices (0 prior robotic cases), intermediates (1–99 cases), and experts (≥ 100 cases) completed a robotic dissection task in a dry-lab training environment. Video recordings were reviewed to classify each gesture and determine its efficacy, then dissection patterns between groups were analyzed. 23 participants completed the task, with 9 novices, 8 intermediates with median caseload 60 (IQR 41–80), and 6 experts with median caseload 525 (IQR 413–900). For gesture selection, we found increasing experience associated with increasing proportion of overall dissection gestures (p = 0.009) and decreasing proportion of retraction gestures (p = 0.009). For gesture efficacy, novices performed the greatest proportion of ineffective gestures (9.8%, p < 0.001), intermediates commit the greatest proportion of erroneous gestures (26.8%, p < 0.001), and the three groups performed similar proportions of overall effective gestures, though experts performed the greatest proportion of effective retraction gestures (85.6%, p < 0.001). Between groups of experience, we found significant differences in gesture selection and gesture efficacy. These relationships may provide insight into further improving surgical training.

Item Type:Article
Related URLs:
URLURL TypeDescription
Inouye, Daniel A.0000-0001-7202-4800
Ma, Runzhuo0000-0001-6381-2661
Nguyen, Jessica H.0000-0003-0454-8463
Kocielnik, Rafal0000-0001-5602-6056
Anandkumar, Anima0000-0002-6974-6797
Hung, Andrew J.0000-0002-7201-6736
Additional Information:© 2023 Springer Nature. The authors declare that no support, financial or otherwise, were received for the preparation of this manuscript. Contributions. D Inouye: project development, data collection and management, data analysis, manuscript writing and editing. R Ma: project development, data management, data analysis, manuscript writing and editing. J Nguyen: project development, data analysis, manuscript writing and editing. J Laca: project development, data analysis. R Kocielnik: project development, data analysis. A Anandkumar: project development. A Hung: project development, data analysis, manuscript writing and editing. Ethics approval. This study was approved by the University of Southern California’s Institutional Review Board (protocol HS-16–00,318). Informed consent was obtained per Institutional Review Board protocol. Conflict of interest. Andrew J. Hung has financial disclosures with Intuitive Surgical, Inc.
Issue or Number:2
Record Number:CaltechAUTHORS:20220930-482429300.5
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Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:117191
Deposited By: Melissa Ray
Deposited On:04 Oct 2022 02:28
Last Modified:23 May 2023 21:26

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