Enhancing robotic head and neck surgical skills using stimulated simulation

使用刺激模拟增强机器人头颈手术技能

基本信息

批准号：
10586874
负责人：
Suvranu De
金额：
$ 61.86万
依托单位：
FLORIDA STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-05 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10586874
关键词：
3-Dimensional Acceleration Active Learning Address Adoption Anatomy Auditory Automobile Driving Aviation Benchmarking Benign Cerebral cortex Clinical Cognitive Complex Computer Models Computers Confined Spaces Control Groups Conventional Surgery Cues Depth Perception Development Devices Dissection Educational Curriculum Electrocoagulation Environment Excision Exposure to FDA approved Feedback Fellowship Fistula Future Goals Head and Neck Surgeon Head and Neck Surgery Hour Impaired healing Interdisciplinary Study Intuition Jaw Laryngeal neoplasm Larynx Learning Learning Skill Lesion Malignant - descriptor Malignant neoplasm of pharynx Medical Methodology Music Obstructive Sleep Apnea Operative Surgical Procedures Oral Oral cavity Oropharyngeal Osteoradionecrosis Otolaryngology Participant Patient-Focused Outcomes Patients Performance Pharyngeal structure Physics Physiological Procedures Recovery Research Research Personnel Research Project Grants Resected Residencies Resolution Risk Robotics Scalp structure Speed Sports Standardization Structure Surgeon Task Performances Techniques Technology Time Tissues Traction Training Treatment Cost Variant Vision Visual Work Wrist body cavity clinical training cognitive skill cost design experience experimental study functional disability functional outcomes head mounted display improved instrument lens malignant oropharynx neoplasm minimally invasive noninvasive brain stimulation novel open source patient safety platform-independent simulation simulation environment simulation software skill acquisition skills skills training success task analysis tongue root tool transcranial direct current stimulation transfer learning tumor virtual virtual reality virtual reality simulator wearable device wound

项目摘要

Enhancing robotic head and neck surgical skills using stimulated simulation Abstract We propose stimulated simulation as the next paradigm for accelerating simulator-based training of transoral robotic surgery (TORS) using noninvasive brain stimulation. TORS is a minimally invasive technology that is seeing rapid adoption in the field of otolaryngology - head and neck surgery to resect benign and malignant tumors of the pharynx and larynx as well as treat obstructive sleep apnea. As a relatively novel and complex procedure, surgeons are learning to perform TORS after their residency, mostly during a fellowship year. However, TORS has a steep learning curve, with a minimum of 20-35 cases needed to achieve basic proficiency. Without a structured curriculum or effective simulation platform, most novice surgeons currently reach the 20-35 case benchmark while operating on live patients. Consequently, positive margin (i.e., the tumor is not entirely removed) rates for oropharyngeal cancers in low-volume centers are twice that in high-volume facilities. Commercially available task trainers and virtual reality simulators for robotic surgery have four major deficiencies: (i) they do not prepare trainees to operate in the confined space of the oropharynx and do not provide the procedure-specific skills necessary for TORS, such as tissue manipulation, retraction, or dissection using electrocautery; (ii) they are platform-dependent – training basic robotic skills for the da Vinci platform (Intuitive Surgical, Sunnyvale, CA), though two platforms are currently FDA approved for TORS, and a third one is waiting for approval, (iii) they are costly, limiting their use to the most affluent centers and (iv) they offer no mechanism to accelerate skill acquisition beyond brute-force repeated practice. To address these limitations, we will design, develop, and validate the first Virtual Transoral Robotic Surgical (VTORS) simulator for training TORS procedures and use transcranial direct current stimulation (tDCS), a safe and effective, well-established, commercially available, wearable noninvasive brain stimulation technique that uses very low direct current (<4mA) applied to the scalp to modulate cortical excitability, to accelerate the surgical skill acquisition. We have assembled a highly interdisciplinary team of researchers to accomplish the two aims of the project: (SA1) Design, develop and validate a high-resolution, ultra-low-cost, versatile, and platform-independent Virtual Transoral Robotic Surgical (VTORS) simulator for TORS tongue base resection; and (SA2) Demonstrate the training efficiency with transcranial direct current stimulation (tDCS) (i.e., stimulated simulation) compared with sham stimulation. Based on the latest developments in off-the-shelf virtual reality (VR) and tDCS technology and open- source simulation software, stimulated simulation has the potential to become the preferred training paradigm – simultaneously improving skills and accelerating skill acquisition - for complex psychomotor skills, including surgery, aviation, driving, sports, and music.

使用刺激的模拟增强机器人头部和颈部手术技能抽象的我们建议刺激的模拟作为加速基于模拟器的训练的下一个范式使用非侵入性脑刺激的横向机器人手术（TOR）。 TOR是一种最少的侵入性在耳鼻喉科领域快速采用的技术 - 头颈外科手术咽部和Larrynx的良性和恶性肿瘤以及治疗阻塞性睡眠呼吸暂停。相对新颖而复杂的程序，外科医生正在学习在住所后进行TOR，主要是在奖学金年。但是，TOR具有钢制学习曲线，至少需要20-35例实现基本水平。没有结构化课程或有效的模拟平台，大多数新颖目前，外科医生在活着的患者手术时达到20-35个病例基准。因此，积极低量中心的口咽癌的边缘（即，肿瘤未完全去除）是在大批量设施中两次。机器人的市售任务培训师和虚拟现实模拟器手术有四个主要缺陷：（i）他们不准备在受训者的狭窄空间中运作口咽，不提供TOR所需的特定程序技能，例如组织操纵，撤回或使用电磁性解剖；（ii）它们是依赖平台的 - 培训基本机器人技能 Da Vinci平台（直觉手术，加利福尼亚州桑尼维尔），尽管目前有两个FDA批准了两个平台 TOR和第三个正在等待批准，（iii）它们的代价很高，将其使用限制为影响最大的中心（iv）他们没有提供任何机制，可以加快蛮力重复练习以外的技能获取。为了解决这些限制，我们将设计，开发和验证第一个虚拟横向机器人用于训练TORS程序的手术（VTOR）模拟器并使用trancranial Direct电流刺激（TDCS），一种安全有效，建立良好，可耐磨性的无创大脑刺激技术使用非常低的直流电流（<4mA）应用于头皮来调节皮质兴奋性，以加速手术技能。我们组建了一个高度跨学科的团队研究人员要完成该项目的两个目标：（SA1）设计，开发和验证高分辨率，超低成本，多功能和与平台无关的虚拟横向机器人手术（VTORS）模拟器 TOR舌底座切除；（SA2）证明了trancranial Direct电流的训练效率与假刺激相比，刺激（TDC）（即刺激模拟）。根据现成的虚拟现实（VR）和TDCS技术的最新发展以及开放源模拟软件，受刺激的模拟有可能成为首选训练范式 - 简单地提高技能和加速技能的获取 - 用于复杂的心理运动技能，包括手术，航空，驾驶，运动和音乐。