Surgical Navigation System and Method Using Audio Feedback

Clinical robotic surgery systems do not currently provide haptic feedback because surgical instrument interactions are difficult to measure and display. Our laboratory recently developed a technology that allows surgeons to feel and/or hear the high-frequency vibrations of robotic instruments as they interact with patient tissue and other tools. Until now, this type of feedback had not been carefully evaluated by users. We conducted two human-subject studies to discover whether surgeons and non-surgeons value the addition of vibration feedback from surgical instruments during robotic surgery. In the first experiment, 10 surgeons and 10 non-surgeons (n = 20) used an augmented Intuitive da Vinci Standard robot to repeatedly perform up to four dry-lab tasks both with and without haptic and audio feedback. In the second experiment, 68 surgeons and 26 non-surgeons (n = 94) tested the same robot at a surgical conference: each participant spent approximately 5 min performing one or two tasks. Almost all subjects in both experiments (95 and 98 %, respectively) preferred receiving feedback of tool vibrations, and all subjects in the second experiment thought it would be useful for surgeons to have the option of such feedback. About half of the subjects (50, 60 %) preferred haptic and audio feedback together, and almost all the rest (45, 35 %) preferred haptic feedback alone. Subjects stated that the feedback made them more aware of tool contacts and did not interfere with use of the robot. There were no significant differences between the responses of different subject populations for any questions in either experiment. This study illustrates that both surgeons and non-surgeons prefer instrument vibration feedback during robotic surgery. Some participants found audio feedback useful but most preferred haptic feedback overall. This strong preference for tool vibration feedback indicates that this technology provides valuable tactile information to the surgeon.

Improving Access to Electronic Resources (ER) Through Usability Testing

Laparoscopic surgery, a type of minimally invasive surgery, is used in a variety of clinical surgeries because it has a faster recovery rate and causes less pain. However, in general, the robotic system used in laparoscopic surgery can cause damage to the surgical instruments, organs, or tissues during surgery due to a narrow field of view and operating space, and insufficient tactile feedback. This study proposes real-time models for the detection of surgical instruments during laparoscopic surgery by using a CNN(Convolutional Neural Network). A dataset included information of the 7 surgical tools is used for learning CNN. To track surgical instruments in real time, unified architecture of YOLO apply to the models. So as to evaluate performance of the suggested models, degree of recall and precision is calculated and compared. Finally, we achieve 72.26% mean average precision over our dataset.

PurposeThis paper seeks to present a usability evaluation of the web site of the Main Library of the St Augustine Campus of the University of the West Indies (UWI) to get users and site visitors to identify the major strengths and weaknesses of the site and to incorporate the results and participant feedback into a redesign that reflects users' intuitions rather than those of the site developers and librarians.Design/methodology/approachA combination of experimental and respondent research strategies was used to evaluate usability. These included survey questionnaires, focus groups, formal usability testing and card sort. In addition, both usability heuristics and ISO guidelines were used to assess effectiveness, learnability, usefulness and user satisfaction. Respondent strategies used a sample size of 529 participants for the self‐completion questionnaires and 16 participants in the focus group sessions. Experimental strategies combined observation of 21 individual participants and three groups of participants in the usability tests. In the card sort protocol nine individual participants and three groups of participants were observed.FindingsThe findings identified challenges in the site's information architecture (labelling and organisation) and in the interface design.Research limitations/implicationsMore ethnographic approaches are needed to elicit distinctive Caribbean user behaviours.Practical implicationsThe study concludes that similar usability evaluations should be undertaken at the other UWI campus library web sites and that usability training should be incorporated into the culture of the library organisation. Critical next steps for the web designer are also suggested.Originality/valueThe paper presents issues of organisational change and the impact of technology on the relationship between systems and user services librarians.

This study explores alternative approaches to the display of drug alerts, and examines whether and how human-factors based interface design can be used to improve the prescriber's perception about drug alert presentation, signal detection from noisy alert data, and their comprehension of clinical decision support during electronic prescribing. We reviewed issues with presenting multiple drug alerts in electronic prescribing systems. User-centered design, consisting of iterative usability and prototype testing was applied. After an iterative design phase, we proposed several novel drug alert presentation interfaces; expert evaluation and formal usability testing were applied to access physician prescribers' perceptions of the tools. We mapped drug alert attributes to different interface constructs. We examined four different interfaces for presenting multiple drug alerts. A TreeDashboard View was better perceived than a text-based ScrollText View with respect to the ability to detect critical information, the ability to accomplish tasks, and the perceptional efficacy of finding information. A robust model for studying multiple drug-alert presentations was developed. Several drug alert presentation interfaces were proposed. The TreeDashboard View was better perceived than the text-based ScrollText View in delivering multiple drug alerts during a simulation of electronic prescribing.

This paper reports on collaborative work with an SME, developing a system for data acquisition in health care organisations, providing mobile data support. We briefly introduce the ICF and the ICD classification scheme from the WHO as a foundation for our mobile application. A two-staged usability evaluation in a very early stage of development allows us to integrate user-centred design in the mobile application development process. Our procedure comprises interviews and usability tests with a limited number of users and thus can even be performed within a resource-constrained setting as it is typically found in smaller software development teams. We discuss the consolidated results of the usability tests quantitatively and qualitatively. From these results we deduce recommendations (and open issues) concerning the user interface design of the mobile application.

Throughout the 3000 years of the ancient Egyptian history, medicine itself, its treatments, and options changed slowly in each era. From the period of the New Kingdom the Edwin Smith papyrus written down latest around 1600-1550 BC, describes the surgical interventions of the time in a highly rational way. Doctors practised this type of medicine on a scientific basis, while magical spells were also recommended for some ailments. The Ebers papyrus,written nearly at the same time is one of the earliest records of drug therapy as conservative treatment with sketchy prescriptions, but also contains some surgical protocols. They are fundamental in medical history. Even after the decline of the pharaonic culture, the knowledge and tools of ancient Egyptian surgeons lived on in Greek and Roman medicine. Surgery is a manual activity. However, a skilled hand needs good tools to be effective. From the Neolithic onwards and up until the 19 th century, healing persons were forced to make their own surgical instruments, similar to household utensils, partly from materials found in nature and partly from materials that they have transformed. The oldest extant Egyptian instrument- depiction is the relief on the wall of the double temple of Haroeris and Sobek at Kom Ombo, built in the Ptolemaic period. In the Roman reliefs, we can see that ancient Egyptian doctors used knives, scalpels, forceps, scissors, saws, probes, trepan as direct instruments for surgical interventions, while cupping vessels, incense burners, beaked cups and vessels, bags, amulets, scales, herbal vessels, or sponges are represented as accessory tools in the patients’ perioperative actions. Their shape has remained essentially unchanged for hundreds of years In this article we investigate the ancient Egyptian roots by collecting and investigating the few occurrences of pharaonic surgical instruments as objects or mentioned in texts, considering the functions used nowadays. Based on practical viewpoint we are also working on the identification of the possible ways extant tools could be used, looking among them especially for those, which were made of vegetable material, or for those, which may have originated from plants. We thus describe “target tools” and operating instruments that were among the first to be developed and used for various surgical tasks and movements.

Generalized Framework for Control of Redundant Manipulators in Robot-Assisted Minimally Invasive Surgery

Stimulated by regulations and standards as well as commercial imperatives, medical device manufacturers are striving to make medical devices safer by decreasing the potential for harmful use errors. Accordingly, manufacturers are observing and interviewing intended users about their interactions with devices en route to developing user interface requirements; applying human factors engineering (HFE) principles when designing user interfaces; and conducting formative and summative usability tests to improve and validate their devices’ interactive quality. This has represented significant work for manufacturers, particularly the majority who started with little HFE knowledge and experience. Today, the “awakening” to HFE in medical device development is essentially over—an established manufacturer who is just now discovering HFE has been out of touch. After all, the U.S. Food and Drug Administration (FDA) and AAMI conducted their first joint conference on HFE in 1995 when they previewed HFE expectations related to recent changes in quality system regulation (QSR). So, it has been 17 years since HFE entered the medical industry’s zeitgeist. HFE specialists working in the medical industry used to focus on making devices more usable (i.e., user friendly). Since the QSR change, use safety has become the primary focus, resulting in user interfaces that are less vulnerable to harmful use errors. It is rather obvious how HFE affects the safety of some medical devices. In the design of a surgical instrument, for example, HFE’s aim would be to reduce the chance of cutting anything other than the intended target. This goal could be accomplished by including a blade guard and a mechanical interlock that requires more than one deliberate action to enable cutting.

Endonasal Skull Base Surgery has some advantages over conventional methods; however, some issues such as the need to replace the endoscope due to the fixed view, and possible invasiveness during insertion make the procedure difficult. To solve these problems, this paper proposes an active endoscope mechanism with several benefits. First, its variable direction of view can cover the wide ranges. Second, it provides a forward view, lessening the danger of damaging critical tissues while the endoscope is being inserted. Third, it can change the direction of view within a very small radius of 6.5 mm, so it can be used in a small cavity and work together with other surgical tools. We have designed the endoscope, which has 4 mm diameter. It is a simple tilting and rotation mechanism of 2-degree of freedom (DOF). It implements kinematics control to make it intuitive to operate. The image sensor attached to the distal end is fixed mechanically so that the image orientation is preserved in the direction of gravity. The experiments showed the user could intuitively control the endoscope with the master device and observe the target without swapping the endoscope. Future tests will examine clinical aspects and combination work with surgical instruments.

APIs are becoming the fundamental building block of modern software and their usability is crucial to programming efficiency and software quality. Yet API designers find it hard to gather and interpret user feedback on their APIs. To close the gap, we interviewed 23 API designers from 6 companies and 11 open-source projects to understand their practices and needs. The primary way of gathering user feedback is through bug reports and peer reviews, as formal usability testing is prohibitively expensive to conduct in practice. Participants expressed a strong desire to gather real-world use cases and understand users' mental models, but there was a lack of tool support for such needs. In particular, participants were curious about where users got stuck, their workarounds, common mistakes, and unanticipated corner cases. We highlight several opportunities to address those unmet needs, including developing new mechanisms that systematically elicit users' mental models, building mining frameworks that identify recurring patterns beyond shallow statistics about API usage, and exploring alternative design choices made in similar libraries.

The aim of this study was to evaluate usability of a prototype tablet PC-administered computerized adaptive test (CAT) of headache impact and patient feedback report, referred to as HEADACHE-CAT. Heuristic evaluation specialists (n = 2) formed a consensus opinion on the application's strengths and areas for improvement based on general usability principles and human factors research. Usability testing involved structured interviews with headache sufferers (n = 9) to assess how they interacted with and navigated through the application, and to gather input on the survey and report interface, content, visual design, navigation, instructions, and user preferences. Specialists identified the need for improved instructions and text formatting, increased font size, page setup that avoids scrolling, and simplified presentation of feedback reports. Participants found the tool useful, and indicated a willingness to complete it again and recommend it to their healthcare provider. However, some had difficulty using the onscreen keyboard and autoadvance option; understanding the difference between generic and headache-specific questions; and interpreting score reports. Heuristic evaluation and user testing can help identify usability problems in the early stages of application development, and improve the construct validity of electronic assessments such as the HEADACHE-CAT. An improved computerized HEADACHE-CAT measure can offer headache sufferers an efficient tool to increase patient self-awareness, monitor headaches over time, aid patient-provider communications, and improve quality of life.

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4–7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5–7), with no significant differences between experts and novices, p ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.

Computer-assisted surgery (CAS) allows clinicians to personalize treatments and surgical interventions and has therefore become an increasingly popular treatment modality in maxillofacial surgery. The current maxillofacial CAS consists of three main steps: (1) CT image reconstruction, (2) bone segmentation, and (3) surgical planning. However, each of these three steps can introduce errors that can heavily affect the treatment outcome. As a consequence, tedious and time-consuming manual post-processing is often necessary to ensure that each step is performed adequately. One way to overcome this issue is by developing and implementing neural networks (NNs) within the maxillofacial CAS workflow. These learning algorithms can be trained to perform specific tasks without the need for explicitly defined rules. In recent years, an extremely large number of novel NN approaches have been proposed for a wide variety of applications, which makes it a difficult task to keep up with all relevant developments. This study therefore aimed to summarize and review all relevant NN approaches applied for CT image reconstruction, bone segmentation, and surgical planning. After full text screening, 76 publications were identified: 32 focusing on CT image reconstruction, 33 focusing on bone segmentation and 11 focusing on surgical planning. Generally, convolutional NNs were most widely used in the identified studies, although the multilayer perceptron was most commonly applied in surgical planning tasks. Moreover, the drawbacks of current approaches and promising research avenues are discussed.

We developed and evaluated a visual compensation system that allows surgeons to visualize obscured regions in real time, such that the surgical instrument appears virtually transparent. The system consists of two endoscopes: a main endoscope to observe the surgical environment, and a supporting endoscope to render the region hidden from view by surgical instruments. The view captured by the supporting endoscope is transformed to simulate the view from the main endoscope, segmented to the shape of the hidden regions, and superimposed to the main endoscope image so that the surgical instruments look transparent. A prototype device was benchmarked for processing time and superimposition rendering error. Then, it was evaluated in a training environment with 22 participants performing a backhand needle driving task with needle exit point error as the criterion. Lastly, we conducted an in vivo study. In the benchmark, the mean processing time was 62.4ms, which was lower than the processing time accepted in remote surgeries. The mean superimposition error of the superimposed image was 1.4mm. In the training environment, needle exit point error with the system decreased significantly for experts compared with the condition without the system. This change was not significant for novices. In the in vivo study, our prototype enabled visualization of needle exit points during anastomosis. The benchmark suggests that the implemented system had an acceptable performance, and evaluation in the training environment demonstrated improved surgical task outcomes in expert surgeons. We will conduct a more comprehensive in vivo study in the future.