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Automated task-level autonomy assessment in robotic surgery.

William D Gerull1, Adam Liebendorfer2, Michael M Awad2

  • 1Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO , 63110, USA. wgerull@wustl.edu.

Surgical Endoscopy
|August 7, 2024
PubMed
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This study quantifies trainee involvement in robotic hiatal hernia repair using active control time (ACT) per task. Findings show task-specific differences in resident and fellow participation, informing surgical training progression.

Area of Science:

  • Robotic Surgery
  • Surgical Education
  • Medical Simulation

Background:

  • Quantifying surgical trainee autonomy is challenging.
  • Active control time (ACT) offers a broad measure but lacks task-specific detail.
  • Objective metrics are needed to assess trainee involvement in robotic procedures.

Purpose of the Study:

  • To quantify trainee involvement in robotic-assisted hiatal hernia repair at a task-specific level.
  • To utilize AI-assisted annotation for objective performance assessment.
  • To provide data for a structured roadmap for surgical trainee progression.

Main Methods:

  • Retrospective review of robotic hiatal hernia repair cases.
  • AI-assisted annotation and human review to segment procedures into 5 key tasks.
Keywords:
AssessmentAutomated performance metricsAutonomyObjective performance indicatorsRobotic surgeryRobotic training

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  • Recording and comparison of resident and fellow active control time (ACT) per task.

    • Main Results:

    • Residents showed highest ACT in hiatal dissection (53%), gastric fundus mobilization (84%), and fundoplication (57%).
    • Fellows exceeded 80% ACT in all 5 tasks, notably gastric fundus mobilization (100%) and hiatal dissection (88%).
    • Significant differences in ACT between residents and fellows were observed during mediastinal dissection and cruroplasty.

    Conclusions:

    • Objective performance metrics and automated segmentation can quantify trainee participation in robotic surgery.
    • Robotic surgery platforms provide data for objective, automated trainee assessment.
    • Task-level data can inform resident progression and define pathways to surgical autonomy.