title: A hierarchical task analysis of shoulder arthroscopy for a virtual arthroscopic tear diagnosis and evaluation platform (VATDEP).
abstract: BACKGROUND
  Shoulder arthroscopy is a minimally invasive surgical procedure for diagnosis and treatment of a shoulder pathology. The procedure is performed with a fiber optic camera, called arthroscope, and instruments inserted through very tiny incisions made around the shoulder. The confined shoulder space, unintuitive camera orientation and constrained instrument motions complicates the procedure. Therefore, surgical competence in arthroscopy entails extensive training especially for psychomotor skills development. Conventional arthroscopy training methods such as mannequins, cadavers or apprenticeship model have limited use attributed to their low-fidelity in realism, cost inefficiency or incurring high risk. However, virtual reality (VR) based surgical simulators offer a realistic, low cost, risk-free training and assessment platform where the trainees can repeatedly perform arthroscopy and receive quantitative feedback on their performances. Therefore, we are developing a VR based shoulder arthroscopy simulation specifically for the rotator cuff ailments that can quantify the surgery performance. Development of such a VR simulation requires a through task analysis that describes the steps and goals of the procedure, comprehensive metrics for quantitative and objective skills and surgical technique assessment.
  
  
  METHODS
  We analyzed shoulder arthroscopic rotator cuff surgeries and created a hierarchical task tree. We introduced a novel surgery metrics to reduce the subjectivity of the existing grading metrics and performed video analysis of 14 surgery recordings in the operating room (OR). We also analyzed our video analysis results with respect to the existing proposed metrics in the literature.
  
  
  RESULTS
  We used Pearson's correlation tests to find any correlations among the task times, scores and surgery specific information. We determined strong positive correlation between cleaning time vs difficulty in tying suture, cleaning time vs difficulty in passing suture, cleaning time vs scar tissue size, difficulty passing vs difficulty in tying suture, total time and difficulty of the surgery.
  
  
  CONCLUSIONS
  We have established a hierarchical task analysis and analyzed our performance metrics. We will further use our metrics in our VR simulator for quantitative assessment.
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.|Computer Science Department, University of Arkansas, Little Rock, Arkansas, USA.
authors.forename: Doga
authors.initials: D
authors.lastname: Demirel
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Yu
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Cooper-Baer
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Dendukuri
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.
authors.forename: Tansel
authors.initials: T
authors.lastname: Halic
authors.affiliation: Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.
authors.forename: Sinan
authors.initials: S
authors.lastname: Kockara
authors.affiliation: Department of Orthopedics and Traumatology, Erzincan University Medical School, Erzincan, Turkey.
authors.forename: Nizamettin
authors.initials: N
authors.lastname: Kockara
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Ahmadi
mesh_terms: D001182:Arthroscopy / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D006801:Humans; D008953:Models, Anatomic; D000070636:Rotator Cuff Injuries / Q000175:diagnosis / Q000601:surgery; D000070599:Shoulder Injuries / Q000175:diagnosis* / Q000601:surgery*; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D014741:Video Recording
keywords: arthroscopy; hierarchical task analysis and video analysis; rotator cuff; virtual surgical simulation