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New training method helps surgeons evaluate their own minimally invasive surgery skills

January 13, 2009

Recent years have seen the rapid emergence of minimally invasive surgery procedures in operating theatres. However, the training of surgeons in this field still leaves much to be desired. Researcher Magdalena Chmarra has changed this state of affairs by developing a realistic training system which records and analyses the surgeon's movements. As a result there is now, for the first time, an objective benchmark for measuring a surgeon's basic skills in the field of minimally invasive surgery. Chmarra will receive her PhD for this research at Delft University of Technology in The Netherlands on Monday 12 January.

Recent years have seen the rapid emergence of minimally invasive surgery procedures in operating theatres. Despite its considerable advantages, this relatively recent surgical technique still has a number of drawbacks. One such disadvantage relates to the training of surgeons, which is still, for the most part, delivered in a rather unstructured manner and, moreover, without any objective benchmark with which to measure the progress made by trainee surgeons.

Training

Broadly speaking, there are currently two safe training methods for minimally invasive surgery. The first is the so-called box trainer, an enclosed rectangular box in which trainee surgeons can practise performing basic manipulative tasks with the surgical devices, such as picking up and moving objects. As they do this, they can be assessed by an experienced surgeon. Clearly, this is a somewhat subjective process. The other option is the virtual reality trainer, employing computer simulations, which allows for excellent recording and analysis of the surgeon's actions. However, this training method still has the major disadvantage that it lacks realism. For example, users feel no tactile response when performing surgical tasks.

TrEndo

Thus both of these training methods have their drawbacks. The Delft doctoral candidate Magdalena Chmarra has sought to change this situation by developing a training tool that is realistic for the surgeon and at the same time records and analyses the motion of the instruments manipulated by the surgeon. This is accomplished with an inexpensive and relatively simple tracking device known as the 'TrEndo'. A TrEndo incorporates three optical computer-mouse sensors which record the movements made by the surgeon in all directions.

The TrEndo has been extensively tested by medical staff at Leiden University Medical Centre, who rate the device highly. The movements that they performed with the TrEndo felt no different from those undertaken with the actual surgical devices. TrEndo is currently undergoing further fine-tuning at Delft University of Technology.

Benchmarking

The TrEndo helps to identify the key factors underlying the basic skills required by surgeons, thus paving the way for objective benchmarking of their competence in the field of minimally invasive surgery. By means of motion analysis, Chmarra has therefore succeeded in arranging the basic skills of the participating trainee surgeons into a classification system which ranks them as being either expert, intermediate or beginner.

Delft University of Technology