Analysis of Flexible Ureteroscopic Motion and Kinematic Efficiency: A Simulation-Based Pilot Study

Area of Science:

• Urology
• Surgical Simulation
• Medical Engineering

Background:

• Flexible ureteroscopy (fURS) is a primary treatment for urolithiasis.
• Assessing surgeon skill in fURS is challenging due to a lack of standardized methods.
• Kinematic analysis offers a potential objective measure for surgical skill evaluation.

Purpose of the Study:

• To investigate if surgeon kinematics correlate with efficiency during flexible ureteroscopy (fURS) simulation.
• To identify specific surgeon movements linked to improved ureteroscopic (URS) task performance.
• To explore the utility of movement economy as a metric for fURS skill assessment.

Main Methods:

• A motion capture system and video analysis were used to record surgeon movements during simulated URS tasks.
• Twelve urologists of varying experience performed simple and complex URS tasks in a simulation box.
• Task efficiency was quantified by time to completion and ureteroscope end effector travel distance, combined into a performance efficiency score (PES).

Main Results:

• For complex tasks, decreased head and torso movement significantly correlated with higher performance efficiency (r=0.60 for head, r=0.65 for torso).
• No kinematic correlations with efficiency were found for the simple URS task.
• Reduced extraneous body motion was associated with more efficient ureteroscope manipulation.

Conclusions:

• Movement economy, specifically reduced head and torso motion, is linked to efficient performance in complex flexible ureteroscopy (fURS) tasks.
• These findings suggest that minimizing unnecessary body movements may indicate optimized URS technique.
• Further research in clinical settings is recommended to validate these kinematic measures for endoscopic training and skill assessment.