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.

使用刺激模拟增强机器人头颈手术技能抽象的我们提出刺激模拟作为加速基于模拟器的训练的下一个范例使用无创脑刺激的经口机器人手术 (TORS) 是一种微创手术。在耳鼻喉科领域迅速采用的技术 - 头颈手术切除咽和喉的良性和恶性肿瘤以及治疗阻塞性睡眠呼吸暂停。手术新颖且复杂，外科医生在住院医师实习结束后正在学习执行 TORS，主要是在住院期间然而，TORS 的学习曲线很陡，至少需要 20-35 个案例。如果没有结构化的课程或有效的模拟平台，大多数新手都无法达到基本的熟练程度。目前，外科医生在对活体检测呈阳性的患者进行手术时达到了 20-35 例病例基准。低容量中心口咽癌的边缘率（即肿瘤未完全切除）为是商用任务训练器和机器人虚拟现实模拟器的两倍。手术有四个主要缺陷：（i）它们没有让受训者做好在有限空间内进行手术的准备。口咽部，不提供 TORS 所需的特定手术技能，例如组织操作、使用电灼术进行牵开或解剖；（ii）它们依赖于平台 - 训练基本的机器人技能达芬奇平台（Intuitive Surgical，桑尼维尔，加利福尼亚州），尽管目前 FDA 批准了两个平台 TORS，第三个正在等待批准，(iii) 它们成本高昂，仅限于最富裕的中心使用 (iv) 除了强力重复练习之外，它们没有提供任何机制来加速技能获取。为了解决这些限制，我们将设计、开发和验证第一个虚拟经口机器人手术 (VTORS) 模拟器，用于训练 TORS 程序并使用经颅直流电刺激（tDCS），一种安全有效、成熟、可商用、可穿戴的非侵入性大脑使用非常低的直流电（<4mA）施加到头皮来调节皮质的刺激技术兴奋性，以加速手术技能的获得，我们组建了一支高度跨学科的团队。研究人员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、多功能且独立于平台的虚拟经口机器人手术 (VTORS) 模拟器 TORS 舌根切除术；以及 (SA2) 展示经颅直流电的训练效率刺激（tDCS）（即刺激模拟）与假刺激相比。基于现成虚拟现实 (VR) 和 tDCS 技术的最新发展以及开放式源码模拟软件，受激模拟有潜力成为培训首选范式 – 同时提高技能和加速技能获取 – 对于复杂的心理运动技能，包括外科、航空、驾驶、体育和音乐。