Skip to main content
Log in

A virtual pointer to support the adoption of professional vision in laparoscopic training

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

To assess a virtual pointer in supporting surgical trainees’ development of professional vision in laparoscopic surgery.

Methods

We developed a virtual pointing and telestration system utilizing the Microsoft Kinect movement sensor as an overlay for any imagine system. Training with the application was compared to a standard condition, i.e., verbal instruction with un-mediated gestures, in a laparoscopic training environment. Seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. Trainee performance was subjectively assessed by the trainee and trainer, and objectively measured by number of errors, time to task completion, and economy of movement.

Results

No significant differences in errors and time to task completion were obtained between virtual pointer and standard conditions. Economy of movement in the non-dominant hand was significantly improved when using virtual pointer (\(p = 0.012\)). The trainers perceived a significant improvement in trainee performance in virtual pointer condition (\(p < 0.001\)), while the trainees perceived no difference. The trainers’ perception of economy of movement was similar between the two conditions in the initial three runs and became significantly improved in virtual pointer condition in the fourth run (\(p = 0.017\)).

Conclusions

Results show that the virtual pointer system improves the trainer’s perception of trainee’s performance and this is reflected in the objective performance measures in the third and fourth training runs. The benefit of a virtual pointing and telestration system may be perceived by the trainers early on in training, but this is not evident in objective trainee performance until further mastery has been attained. In addition, the performance improvement of economy of motion specifically shows that the virtual pointer improves the adoption of professional vision— improved ability to see and use laparoscopic video results in more direct instrument movement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Lengyel J, Morrison C, Sagar PM (2010) Trends towards increased use of the laparoscopic approach in colorectal surgery. Colorectal Dis 12:1007–1012. https://doi.org/10.1111/j.1463-1318.2009.01937.x

    Article  PubMed  CAS  Google Scholar 

  2. Salvilla SA, Thusu S, Panesar SS (2012) Analysing the benefits of laparoscopic hernia repair compared to open repair: a meta-analysis of observational studies. J Minim Access Surg 8(4):111–117. https://doi.org/10.4103/0972-9941.103107

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mentis HM, Chellali A, Schwaitzberg S (2014) Learning to see the body: supporting instructional practices in laparoscopic surgical procedures. In: Proceedings of the 32nd annual ACM conference on Human factors in computing systems. ACM, pp 2113–2122. https://doi.org/10.1145/2556288.2557387

  4. Cope AC, Mavroveli S, Bezemer J, Hanna GB, Kneebone R (2015) Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room. Acad Med 90(8):1125–31. https://doi.org/10.1097/ACM.0000000000000740

    Article  PubMed  Google Scholar 

  5. Feng Y, Mentis HM (2016) Supporting common ground development in the operating room through information display systems. AMIA Annu Symp Proc 2016:1774–1783

    PubMed  Google Scholar 

  6. Fried G, Feldman L (2008) Objective assessment of technical performance. World J Surg 32(2):156–60. https://doi.org/10.1007/s00268-007-9143-y

    Article  PubMed  Google Scholar 

  7. Koschmann T, LeBaron C, Goodwin C, Feltovich P (2011) "Can you see the cystic artery yet?" A simple matter of trust. J Pragmat 43(2):521–41. https://doi.org/10.1016/j.pragma.2009.09.009

    Article  Google Scholar 

  8. Law B, Atkins MS, Kirkpatrick AE, Lomax AJ (2004) Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment. In: Proceedings of the 2004 symposium on Eye tracking research and applications, pp 41–48. https://doi.org/10.1145/968363.968370

  9. Richstone L, Schwartz MJ, Seideman C, Cadeddu J, Marshall S, Kavoussi LR (2010) Eye metrics as an objective assessment of surgical skill. Ann Surg 252(1):177–82. https://doi.org/10.1097/SLA.0b013e3181e464fb

    Article  PubMed  Google Scholar 

  10. Wilson MR, Vine SJ, Bright E, Masters RS, Defriend D, McGrath JS (2011) Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study. Surg Endosc 25(12):3731–9. https://doi.org/10.1007/s00464-011-1802-2

    Article  PubMed  PubMed Central  Google Scholar 

  11. O’Hara K, Gonzalez G, Penney G, Sellen A, Corish R, Mentis H, Varnavas A, Criminisi A, Rouncefield M, Dastur N, Carrell T (2014) Interactional order and constructed ways of seeing with touchless imaging systems in surgery. Comput Support Cooper Work (CSCW) 23(3):299–337. https://doi.org/10.1007/s10606-014-9203-4

    Article  Google Scholar 

  12. Mentis HM, O’Hara K, Gonzalez G, Sellen A, Corish R, Criminisi A, Trivedi R, Theodore P (2015) Voice or gesture in the operating room. In: Extended abstracts of the conference on human factors in computing systems (CHI). ACM, New York, pp 773–780. https://doi.org/10.1145/2702613.2702963

  13. Seagull FJ, George I, Ghaderi I, Vaillancourt M, Park A (2009) Surgical Abdominal Wall (SAW): a novel simulator for training in ventral hernia repair. Surg Innov 16(4):330–6. https://doi.org/10.1177/1553350609357057

    Article  PubMed  Google Scholar 

  14. Jarc AM, Stanley AA, Clifford T, Gill IS, Hung AJ (2017) Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study. World J Urol 35(6):957–965. https://doi.org/10.1007/s00345-016-1944-x

    Article  PubMed  Google Scholar 

  15. Winne PH, Marx RW (1977) Reconceptualizing research on teaching. J Educ Psychol 69(6):668. https://doi.org/10.1037/0022-0663.69.6.668

    Article  Google Scholar 

  16. Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84(2):273–8. https://doi.org/10.1046/j.1365-2168.1997.02502.x

    Article  PubMed  CAS  Google Scholar 

  17. Wilson M, McGrath J, Vine S, Brewer J, Defriend D, Masters R (2010) Psychomotor control in a virtual laparoscopic surgery training environment: gaze control parameters differentiate novices from experts. Surg Endosc 24(10):2458–2464. https://doi.org/10.1007/s00464-010-0986-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Koch GG (1982) Intraclass correlation coefficient. Encycl Stat Sci. https://doi.org/10.1002/0471667196.ess1275

  19. Joice P, Hanna GB, Cuschieri A (1998) Errors enacted during endoscopic surgery—a human reliability analysis. Appl Ergon 29:409–414. https://doi.org/10.1016/S0003-6870(98)00016-7

    Article  PubMed  CAS  Google Scholar 

  20. Richard Landis J, Koch Gary G (1997) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. https://doi.org/10.2307/2529310

    Article  Google Scholar 

  21. Marguet CG, Young MD, L’esperance JO, Tan YH, Ekeruo WO, Preminger GM, Albala DM (2004) Hand assisted laparoscopic training for postgraduate urologists: the role of mentoring. J Urol 172:286–9. https://doi.org/10.1097/01.ju.0000132158.84026.0e

    Article  PubMed  Google Scholar 

  22. Kaito A, Kinoshita T (2017) Educational system of laparoscopic gastrectomy for trainee-how to teach, how to learn. J Vis Surg. https://doi.org/10.21037/jovs.2016.12.13

Download references

Acknowledgements

The authors gratefully acknowledge the Anne Arundel Medical Center for the use of equipment and space in the Simulation to Advanced Innovation and Learning (SAIL) Center, and would like to thank Ms. Jordan Ramsey and Mr. Jatin Chhikara for their support in system development, and Ms. Katie Li and Ms. Jacqueline Mun for their support in data collection and analysis, as well as the participants who devoted their time to this study. This work was supported by National Science Foundation Grants IIS #1422671 and #1552837.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuanyuan Feng.

Ethics declarations

Conflict of interest

The following authors have no conflict of interest or financial ties to disclose: Yuanyuan Feng, Hannah McGowan, Azin Semsar, Hamid R. Zahiri, Ivan M. George, Timothy Turner, Adrian Park, Andrea Kleinsmith and Helena M. Mentis

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was IRB-approved from UMBC and AAMC.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, Y., McGowan, H., Semsar, A. et al. A virtual pointer to support the adoption of professional vision in laparoscopic training. Int J CARS 13, 1463–1472 (2018). https://doi.org/10.1007/s11548-018-1792-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-018-1792-9

Keywords

Navigation