Motion analysis of flexible ureteroscopic techniques by urologic surgeons

Abstract

Urologic surgeons, in order to surgically remove kidney stones from patients who suffer from this painful condition, perform a common procedure known as flexible ureteroscopy. During this operation, the surgeon will utilize a 3mm-diameter flexible camera passed through the urinary tract to fragment, manipulate, and remove kidney stones. The flexible ureteroscope utilizes a non-intuitive control mechanism including a thumb-actuated lever and various wrist rotations to direct the end effector. Numerous methodologies exist to evaluate, understand, and train proper surgeon movement when operating this device, although the current literature suggests that urologists cannot sufficiently define correct or successful device interaction. In this study, we employed infrared motion capture in combination with standard video analysis to characterize surgeon movement variables in a simulated clinical scenario. A ureteroscopic simulation box was used by 12 practicing urologists at various skill levels to perform a number of ureteroscopic tasks. Demographic, motion, and task-specific data were recorded and analyzed to delineate associations between measures of ureteroscopic efficiency and success. This project suggests that certain surgeon movement data, including measures of economy of motion and wrist rotation, trend with efficient ureteroscopic manipulation and require additional study. These variables could potentially serve as a basis for improvement in device development and urologic surgical training and evaluation.