Doing More with LessFeasibility Study of the Low-Cost Motion Tracking System for Assessing Endoscope Holding Skills
Introduction
Holding an endoscope is a basic but important skill for endoscopic surgery, especially for a surgical assistant. The perfect hold and appropriate accommodation of various surgical instruments in a narrow space can provide a good field of vision for the operator and are crucial for a successful and timely operation.1
Various kinds of mechanical holding arms that provide good stability and antifatigue properties exist for an endoscopic operation.2 However, a machine cannot yet replace an assistant, especially in an emergency situation where one needs to rapidly adjust the operation field.
Owing to different regional developments, hospitals often use an endoscope assistant to perform an intraoperative operation. The assistant holds the endoscope for most of the time and thus allows for more flexible movements. In many developing countries, such as China, these expensive “manipulator holders” are not available. At present, there is no effective tool to evaluate the surgical assistant's ability to hold an endoscope.
Motion tracking can measure the instrument's movements, location, speed, and acceleration used by a surgeon.3, 4, 5, 6, 7, 8 Motion tracking technology can transform the motion and 3-dimensional coordinate information into objective digital information using dynamic tracking of an area of interest. There are several technologies (e.g., mechanical, optical, acoustic or electromagnetic) can collect data about the instrument's movements and the forces applied. However, these devices (e.g., the navigation system or the array camera system) are often expensive and require a higher degree of a prerequisite even when precise.3 Currently, augment or virtual reality simulator assessments are often conducted outside a clinical setting in a simulator, which is not very convenient. With the development of artificial intelligence, motion tracking based on a video is a simple method.9 Video-based motion tracking technology can be used for endoscopic surgery evaluation as it has a lower cost and is already used in general surgery by a box situation for surgery3,8,10, 11, 12, 13, however, which is very different from neurosurgery with a narrow area.
There are several methods to evaluate the operator's ability, but they do not include the assistant's requirements.10,14, 15, 16 Here, we developed a cost-effective system based on a printed mark and free software. Nine participants (6 novice and 3 experts) and a machine holder captured a stable video with the tool in order to distinguish the performance levels and skills for holding an endoscope.
Section snippets
Methods
The study was approved by the Binzhou Medical Hospital ethics committee and divided into 2 parts (Supplementary Figure S1). First, we printed a mark using an A4 paper and pasted it at the end of the endoscope port, created using a stainless-steel tube (Figure 1). The software used to extract the data was a free motion tracking software (Kinovea 0.8.15). Second, nine participants used a fixed arm (Aesculap “snake-type” holder, Center Valley, Pennsylvania, USA) to hold the endoscopic equipment
Video Acquisition and Motion Tracking Analysis
All participants held the endoscope for at least 3 minutes and captured the video successfully. For both 0' (Figure 4) and 30' (Figure 5) endoscopes, total distance, average speed, acceleration, and the total depth were significantly smaller for experts than the residents. Compared with the experts, residents had a longer and more disordered total distance path. The mechanical arm observed a slight increase in movement (almost imperceptible) due to gravity. Compared with the residents, experts
Discussion
In a traditional intracranial ventriculostomy to the skull base expansion approach, the risk of endoscopy surgery is significantly increased. Young doctors serve as endoscopic surgery assistants in order to observe and learn various surgical skills and gain anatomic knowledge. One of the most important tasks of the assistant is to provide the surgeon with a proper vision. An endoscope holder may provide a stable vision but still have many shortcomings, such as crude movements, downward drift,
Conclusion
Through a printed mark of the tube port and free video motion tracking software, a simple low-cost assessment system was built to assess the ability to hold an endoscope. It can objectively assess the skill of holding an endoscope, clearly discriminate between an expert and novice, and be used by clinical neurosurgeons to select a qualified assistant.
CRediT authorship contribution statement
Li Zhenzhu: Methodology, Writing - review & editing. Li Lu: Methodology, Writing - review & editing. Li Zhenzhi: Writing - original draft, Writing - review & editing. Li Xuzhi: Writing - original draft, Writing - review & editing. Li Yizhi: Writing - original draft, Writing - review & editing. Fan Gangxian: Investigation, Writing - review & editing. Wang Henglu: Investigation, Writing - review & editing. Ding Jinke: Writing - review & editing. Wang Qingbo: Investigation, Writing - review &
Acknowledgments
We would like to thank our colleagues at Shandong University and Binzhou Medical University.
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Supplementary digital content available online.
Conflict of interest statement: This study was supported by Natural Science Foundation of Shandong Province (ZR2018LH007) and Binzhou Medical University Project (BY2015KJ28).