Virtual Pelvic Surgery Simulator for the Prevention of Surgical Errors
Abstract
Recent data suggests that over 200 million surgeries are performed annually worldwide
and about 3 to 22% of these surgeries involve some sort of complications. Surgical errors
can be caused by both technical errors and cognitive errors which may happen to even an
experienced surgeon. Resident surgeons are more prone to surgical errors as they start their
surgical career with less experience and skills. In order to quantify the surgical errors and
accelerate the learning experience of surgeons, a novel method has been proposed that can
identify, model and describe surgical errors by using biomechanical motion analysis and a
high-fidelity 3-D surgery simulator. This analysis has been done for a complex, common
and high-risk surgery, the midurethral sling (MUS) procedure for stress urinary
incontinence. The experimental protocol allowed for monitoring of the surgeon’s full body
kinematics during the procedure and accurate tracking of the trocar inside the body.
Surgeon kinematics and position of the trocar relative to anatomical structures were tracked
for both successful (continuous contact with the pubis) and error trials (lateral deviation
and cephalad deviation). The kinematics of the wrist, elbow, and shoulder joints
demonstrate major differences between the three different passage conditions. Cephalad
deviation of the trocar entered the peritoneal cavity, but during lateral deviation, trocar
remains within the anterior side of the pelvic bone without making any contact with the
external iliac vein. Off plane rotations of the shoulder, elbow and wrist joints, i.e.
abduction-adduction, and internal-external rotations, incurred large errors due to the
marker set used in the experiment. The model demonstrated good fidelity except for gel
thickness and transparency. Based on the expert surgeon, the physical model replicated the
feeling of performing the procedure on a live subject. Differences in the elbow, wrist and
shoulder joint kinematics between the three different passage conditions indicate that it is
possible to identify errors based on kinematics. Since the kinematics between the different
trials seem to be different, there is potential in training novice surgeons on proper
kinematics to ensure successful passages of the trocar.
Table of Contents
Introduction -- Literature review -- Background -- Methods -- Results -- Discussion -- Appendix
Degree
M.S. (Master of Science)