An Instrumented Glove to Assess Manual Dexterity in Simulation-Based Neurosurgical Education

The traditional neurosurgical apprenticeship scheme includes the assessment of trainee’s manual skills carried out by experienced surgeons. However, the introduction of surgical simulation technology presents a new paradigm where residents can refine surgical techniques on a simulator before putting them into practice in real patients. Unfortunately, in this new scheme, an experienced surgeon will not always be available to evaluate trainee’s performance. For this reason, it is necessary to develop automatic mechanisms to estimate metrics for assessing manual dexterity in a quantitative way. Authors have proposed some hardware-software approaches to evaluate manual dexterity on surgical simulators. This paper presents IGlove, a wearable device that uses inertial sensors embedded on an elastic glove to capture hand movements. Metrics to assess manual dexterity are estimated from sensors signals using data processing and information analysis algorithms. It has been designed to be used with a neurosurgical simulator called Daubara NS Trainer, but can be easily adapted to another benchtop- and manikin-based medical simulators. The system was tested with a sample of 14 volunteers who performed a test that was designed to simultaneously evaluate their fine motor skills and the IGlove’s functionalities. Metrics obtained by each of the participants are presented as results in this work; it is also shown how these metrics are used to automatically evaluate the level of manual dexterity of each volunteer.

[1]  Kanav Kahol,et al.  High-fidelity, low-cost, automated method to assess laparoscopic skills objectively. , 2012, Journal of surgical education.

[2]  Anthony G Gallagher,et al.  Metric-based simulation training to proficiency in medical education:- What it is and how to do it , 2012, The Ulster medical journal.

[3]  Robert J. Wood,et al.  Printing Strain Gauges on Surgical Instruments for Force Measurement , 2014 .

[4]  Joseph Classen,et al.  Development and evaluation of a low-cost sensor glove for assessment of human finger movements in neurophysiological settings , 2009, Journal of Neuroscience Methods.

[5]  Alexander Winkler-Schwartz,et al.  Neurosurgical Assessment of Metrics Including Judgment and Dexterity Using the Virtual Reality Simulator NeuroTouch (NAJD Metrics) , 2015, Surgical innovation.

[6]  Akio Morita,et al.  Assessing Microneurosurgical Skill with Medico-Engineering Technology. , 2015, World neurosurgery.

[7]  Saso Tomazic,et al.  Early Improper Motion Detection in Golf Swings Using Wearable Motion Sensors: The First Approach , 2013, Sensors.

[8]  Sebastian Madgwick,et al.  Estimation of IMU and MARG orientation using a gradient descent algorithm , 2011, 2011 IEEE International Conference on Rehabilitation Robotics.

[9]  Constantinos G. Loukas,et al.  Multivariate Autoregressive Modeling of Hand Kinematics for Laparoscopic Skills Assessment of Surgical Trainees , 2011, IEEE Transactions on Biomedical Engineering.

[10]  Alher Mauricio Hernández,et al.  Instrumented glove for in-hand movement tracking in neurosurgical simulation , 2014, 2014 21st IEEE International Conference on Electronics, Circuits and Systems (ICECS).

[11]  Nicholas Gélinas-Phaneuf,et al.  Surgical Expertise in Neurosurgery: Integrating Theory Into Practice. , 2013, Neurosurgery.

[12]  E. Kuhry,et al.  Limitations of haptic feedback devices on construct validity of the LapSim® virtual reality simulator , 2013, Surgical Endoscopy.

[13]  Alberto Olivares,et al.  Detection of (In)activity Periods in Human Body Motion Using Inertial Sensors: A Comparative Study , 2012, Sensors.

[14]  Paolo Dario,et al.  A Survey of Glove-Based Systems and Their Applications , 2008, IEEE Transactions on Systems, Man, and Cybernetics, Part C (Applications and Reviews).

[15]  Dinchen A Jardine,et al.  Evaluation of Surgical Dexterity During the Interview Day: Another Factor for Consideration. , 2015, Journal of graduate medical education.

[16]  R. Del Maestro,et al.  Assessing Bimanual Performance in Brain Tumor Resection With NeuroTouch, a Virtual Reality Simulator , 2015, Neurosurgery.

[17]  Robert A Watson,et al.  Hand motion patterns of Fundamentals of Laparoscopic Surgery certified and noncertified surgeons. , 2014, American journal of surgery.

[18]  Nick Sevdalis,et al.  The use of simulation in neurosurgical education and training. A systematic review. , 2014, Journal of neurosurgery.

[19]  C. Gog SURGICAL EXPERTS - BORN OR MADE? , 2011 .

[20]  Gregory D. Hager,et al.  Surgical gesture classification from video and kinematic data , 2013, Medical Image Anal..

[21]  Xin Liu,et al.  Markerless Human–Manipulator Interface Using Leap Motion With Interval Kalman Filter and Improved Particle Filter , 2016, IEEE Transactions on Industrial Informatics.

[22]  Robert J. Wood,et al.  Measurement System for the Characterization of Micro-Manipulation Motion and Force , 2013 .

[23]  E. Verdaasdonk,et al.  Objective assessment of technical surgical skills , 2010, The British journal of surgery.

[24]  Jhonatan Camacho Navarro,et al.  EMG-BASED SYSTEM FOR BASIC HAND MOVEMENT RECOGNITION , 2012 .

[25]  J. Norcini,et al.  Assessment, surgeon, and society. , 2009, International journal of surgery.

[26]  T. Ortmaier,et al.  The touch and feel in minimally invasive surgery , 2005, IEEE International Workshop on Haptic Audio Visual Environments and their Applications.

[27]  Ronglei Sun,et al.  Kinematic analysis and dexterity evaluation of upper extremity in activities of daily living. , 2010, Gait & posture.

[28]  Andrea N. Reinkensmeyer,et al.  Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training , 2014, Journal of NeuroEngineering and Rehabilitation.

[29]  Raymond Y. W. Lee,et al.  Feasibility of using inertial sensors to assess human movement. , 2010, Manual therapy.

[30]  Chin-Shyurng Fahn,et al.  Development of a data glove with reducing sensors based on magnetic induction , 2005, IEEE Transactions on Industrial Electronics.

[31]  S. Sessa,et al.  Objective skill analysis and assessment in neurosurgery by using an ultra-miniaturized inertial measurement unit WB-3 — Pilot tests — , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[32]  K. Chin,et al.  Hand Motion Analysis Using the Imperial College Surgical Assessment Device: Validation of a Novel and Objective Performance Measure in Ultrasound-Guided Peripheral Nerve Blockade , 2010, Regional Anesthesia & Pain Medicine.

[33]  Mark R. Wilson,et al.  A comparison of evaluation, time pressure, and multitasking as stressors of psychomotor operative performance. , 2011, Surgery.

[34]  Kang Li,et al.  Development of finger-motion capturing device based on optical linear encoder. , 2011, Journal of rehabilitation research and development.

[35]  R. Reznick,et al.  Testing technical skill via an innovative "bench station" examination. , 1997, American journal of surgery.

[36]  Paul H. Chappell,et al.  Validation and Application of a Computational Model for Wrist and Hand Movements Using Surface Markers , 2008, IEEE Transactions on Biomedical Engineering.

[37]  Joseph P. Giuffrida,et al.  Clinically deployable Kinesia™ technology for automated tremor assessment , 2009, Movement disorders : official journal of the Movement Disorder Society.

[38]  Mauro Loyo,et al.  Neurosurgery in Mexico and Latin-America , 2015 .

[39]  O. Selnes A Compendium of Neuropsychological Tests , 1991, Neurology.

[40]  Hans de Visser,et al.  Progress in virtual reality simulators for surgical training and certification , 2011, The Medical journal of Australia.

[41]  Robert Anthony Watson Quantification of Surgical Technique Using an Inertial Measurement Unit , 2013, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[42]  Mohsen Tavakol,et al.  Assessing the skills of surgical residents using simulation. , 2008, Journal of surgical education.

[43]  Hiroshi Iseki,et al.  Objective skill analysis and assessment of neurosurgery by using the waseda bioinstrumentation system WB-3 , 2009, 2009 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[44]  A Darzi,et al.  Selection of individuals for training in surgery. , 2005, American journal of surgery.

[45]  Michiko Nishiyama,et al.  Wearable Sensing Glove With Embedded Hetero-Core Fiber-Optic Nerves for Unconstrained Hand Motion Capture , 2009, IEEE Transactions on Instrumentation and Measurement.

[46]  A. Darzi,et al.  The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. , 2001, Journal of the American College of Surgeons.

[47]  P. Ackerman A theory of adult intellectual development: Process, personality, interests, and knowledge , 1996 .

[48]  M. Downes,et al.  Simulation in Neurosurgery: A Review of Computer-Based Simulation Environments and Their Surgical Applications , 2010, Neurosurgery.

[49]  J. O'Connor Objective assessment of technical skills in surgery , 2004, BMJ : British Medical Journal.

[50]  Dorin M. Popovici,et al.  A Survey of Visuo-Haptic Simulation in Surgical Training , 2011, ArXiv.

[51]  Ara Darzi,et al.  The surgical efficiency score: a feasible, reliable, and valid method of skills assessment. , 2006, American journal of surgery.

[52]  Fahad Alotaibi,et al.  Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection , 2015, International Journal of Computer Assisted Radiology and Surgery.

[53]  D. Stoyanov,et al.  A pilot study of video-motion analysis in endovascular surgery: development of real-time discriminatory skill metrics. , 2013, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[54]  Surapa Thiemjarus,et al.  Design of an Assistive Communication Glove Using Combined Sensory Channels , 2012, 2012 Ninth International Conference on Wearable and Implantable Body Sensor Networks.

[55]  Ethan D Grober,et al.  Visual-spatial ability correlates with efficiency of hand motion and successful surgical performance. , 2003, Surgery.

[56]  Volodymyr V. Kindratenko,et al.  A survey of electromagnetic position tracker calibration techniques , 2005, Virtual Reality.

[57]  Rajesh Aggarwal,et al.  Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator. , 2010, Journal of vascular surgery.

[58]  Henry C. Lin,et al.  Review of methods for objective surgical skill evaluation , 2011, Surgical Endoscopy.

[59]  Alher Mauricio Hernández,et al.  Instrumented glove for skills assessment in neurosurgical simulation , 2014, 2014 IEEE Biomedical Circuits and Systems Conference (BioCAS) Proceedings.

[60]  A. Darzi,et al.  Objective assessment of technical skills in surgery , 2003, BMJ : British Medical Journal.

[61]  Houde Dai,et al.  A Novel Glove Monitoring System Used to Quantify Neurological Symptoms During Deep-Brain Stimulation Surgery , 2013, IEEE Sensors Journal.

[62]  Anthony B. Costa,et al.  Operator experience determines performance in a simulated computer-based brain tumor resection task , 2015, International Journal of Computer Assisted Radiology and Surgery.

[63]  Woojin Ahn,et al.  Development and Validation of VBLaST-PT©: A Virtual Peg Transfer Simulator , 2013, MMVR.

[64]  Sohyung Cho,et al.  Analysis of surgical motions in minimally invasive surgery using complexity theory , 2015 .

[65]  J. D. Lemos,et al.  System for skills training and competency assessment in neurosurgery , 2013, 2013 Pan American Health Care Exchanges (PAHCE).

[66]  J. Hamdorf,et al.  Surgeons and cognitive processes , 2003, The British journal of surgery.

[67]  Ara Darzi,et al.  The relationship between motion analysis and surgical technical assessments. , 2002, American journal of surgery.

[68]  Martin Bauer,et al.  Inverse Kinematic Infrared Optical Finger Tracking , 2005 .

[69]  Makoto Hashizume,et al.  Analysis of hand motion differentiates expert and novice surgeons. , 2014, The Journal of surgical research.

[70]  Silvio H. R. Rizzi,et al.  Sensory and Motor Skill Testing in Neurosurgery Applicants: A Pilot Study Using a Virtual Reality Haptic Neurosurgical Simulator. , 2013, Neurosurgery.

[71]  Anupam Alur,et al.  Haptic Technology :-A Comprehensive Review of its Applications and Future Prospects , 2014 .