Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study.
OBJECTIVE
In this study, we examine three-dimensional (3D) proctoring tools (i.e., semitransparent ghost tools overlaid on the surgeon's field of view) on realistic surgical tasks. Additionally, we develop novel, quantitative measures of whether proctors exploit the additional capabilities offered by ghost tools.


METHODS
Seven proctor-trainee pairs completed realistic surgical tasks such as tissue dissection and suturing in a live porcine model using 3D ghost tools on the da Vinci Xi Surgical System. The usability and effectiveness of 3D ghost tools were evaluated using objective measures of proctor performance based on proctor hand movements and button presses, as well as post-study questionnaires.


RESULTS
Proctors exploited the capabilities of ghost tools, such as 3D hand movement (p < 0.001), wristedness (p < 0.001), finger pinch gestures (p < 0.001), and bimanual hand motions (p < 0.001). The median ghost tool excursion distances across proctors in the x-, y-, and z-directions were 57.6, 31.9, and 50.7, respectively. Proctors and trainees consistently evaluated the ghost tools as effective across multiple categories of mentoring. Trainees found ghost tools more helpful than proctors across all categories (p < 0.05).


CONCLUSIONS
Proctors exploit the augmented capabilities of 3D ghost tools during clinical-like training scenarios. Additionally, both proctors and trainees evaluated ghost tools as effective mentoring tools, thereby confirming previous studies on simple, inanimate tasks. Based on this preliminary work, advanced mentoring technologies, such as 3D ghost tools, stand to improve current telementoring and training technologies in robot-assisted minimally invasive surgery.
Intuitive Surgical, Inc., Norcross, GA, USA. anthony.jarc@gmail.com.
Anthony M
AM
Jarc
Intuitive Surgical, Inc., Sunnyvale, CA, USA.
Andrew A
AA
Stanley
Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Thomas
T
Clifford
Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Inderbir S
IS
Gill
Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Andrew J
AJ
Hung
D000818:Animals; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency / Q000379:methods*; D000071252:Mentoring / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D023421:Models, Animal; D065287:Robotic Surgical Procedures / Q000193:education* / Q000295:instrumentation; D000066908:Simulation Training / Q000379:methods*; D013552:Swine
Augmented reality; Ghost tools; Performance metrics; Proctor; Surgeon training; Telementoring
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