PURPOSE
1
PGY 4 Capsulorhexis Performance Metrics on the Sensimmer “Phaco Simulator" and During Phacoemulsification-A Paired Control Study PURPOSE To compare capsulorhexis performance metrics between the Sensimmer phaco simulator and live surgery performed by PGY 4 ophthalmology residents. METHODS • Twelve senior residents from 4 training programs, who had similar surgical experience between months 7 and 9 of their PGY 4 year, were recruited as study participants • Simulator testing • Simulator-naïve residents were given brief simulator training prior to testing in 2 to 4 trials before collecting metrics The following three performance metrics were developed: 1)time to complete capsulorhexis (recorded in seconds); 2)number of capsular grabs per completed capsulorhexis; 3)circularity of the capsulorhexis. Circularity index was defined as the average radius divided by the maximal radius in the capsulorhexis trajectory measured at 45 degree intervals. Live surgery video recording • Capsulorhexis performance metrics were extracted from 3 video recordings of non-complicated cataract surgery cases from each resident during month 7 and 9. • Simulator training and metrics was also collected in the same time frame • The results were compared for the three performance metrics: 1) duration, 2) number of forcep grabs per completed rhexis; and 3) circularity of the capsulorhexis. Averages, standard deviations and correlations using a two-sample t-test were calculated. P. P. Banerjee, PhD 1 , C. Bouchard, MD 2 , , P. Dray, MD 3 , P. Bryar, MD 4 , R. Ahuja, MD 3 , D. P. Edward, MD 5 1 Mechanical and Industrial Engineering; Computer Science; Bioengineering; Ophthalmology, University of Illinois at Chicago, Chicago, IL; 2 Ophthalmology, Loyola University, Maywood, IL; 3 Ophthalmology, Stroger Hospital of Cook County , Chicago, IL; 4 Ophthalmology, Northwestern University , Chicago, IL; 5 Ophthalmology, Summa Health Systems, Akron, OH METHODS RESULTS • The average time to complete the capsulorhexis on the simulator for all residents was 96.91 ± 44.23 sec and 94.42 ± 65.74 sec during surgery. • The mean number of grabs on the simulator was 10.66 ± 4.81 and during surgery it was 10.31 ± 5.23. • The circularity index of the capsulorhexis on the simulator was 0.92 ± 0.04 and in surgery it was 0.88 ± 0.04 . • Although the average values for the time to complete the capsulorhexis and the number of grabs on the simulator were comparable between the group in surgery and on the simulator, there was considerable variability between individual residents under the two test scenarios. • Surgeons who showed the greatest variability on the simulator for these two metrics appeared to show increased variability during surgery while those residents that demonstrated less variability on the simulator showed reduced variability during the actual surgical CONCLUSIONS 1.PGY4 residents who completed comparable numbers of surgical cases showed considerable variability during surgery in two metrics: duration of capsulorhexis and number of forceps grabs per completed rhexis. 2.2. The capsulorhexis simulator was able to identify this variability. Average performance measures of a group may be misleading and may not reflect surgical performance of an individual resident. 3.The metric measuring the capsulorhexis circularity with the simulator correlated best with surgical performance suggesting that this metric may be useful in assessment of surgical performance in residents. 4.Additional training tools and techniques were needed to try to reduce performance variability in residents- in- training. 5.The study suggests that metrics on simulators should be carefully assessed and developed. It is important that the ophthalmic community move forward in developing standards for simulation in cataract surgery and other ophthalmic procedures. Author Disclosure Information: P.P. Banerjee, ImmersiveTouch-Sensimmer, I; ImmersiveTouch- Sensimmer, P;; C. Bouchard, None; P. Dray, None. P. Bryar, None; R. Ahuja, None; D.P. Edward, Sensimmer, P; Support : NIH NEI grant 3R41EY018965-01S1; Perritt Charitable Foundation, Loyola University and University of Illinois at Chicago. References 1: Selvander M, Asman P. Virtual reality cataract surgery training: learning curves and concurrent validity. Acta Ophthalmol. 2010 Nov 1755-3768 [Epub ahead of print] PubMed PMID: 21054818. 2: Privett B, Greenlee E, Rogers G, Oetting TA. Construct validity of a surgical simulator as a valid model for capsulorhexis training. J Cataract Refract Surg. 2010;36(11):1835-8.PubMed PMID: 21029889. 3: Waqar S, Park J, Kersey TL, Modi N, Ong C, Sleep TJ. Assessment of fatigue in intraocular surgery: analysis using a virtual reality simulator. Graefes Arch Clin Exp Ophthalmol. 2011 Jan;249(1):77-81. PubMed PMID: 20890612. 4: Ament CS, Henderson BA. Optimizing resident education in cataract surgery.Curr Opin Ophthalmol. 2010 Nov 23. [Epub ahead of print] PubMed PMID: 21107259.  For additional information please contact: Dr. P. Pat Banerjee University of Illinois at Chicago [email protected] • Physi cs • Mesh Loading • Hapti cs • Force feedback • Position &Orienta tion • Integra tion • Graph ics • Stereo Renderin g • Log 1 2 3 4 5 6 7 8 0 50 100 150 200 250 300 350 400 Duration on Real Surgery(seconds) Duration on Simulator(second s) 1 2 3 4 0 0.2 0.4 0.6 0.8 1 Circularity on Real Surgery Circularity on Simulator 1 2 3 4 5 6 7 8 0 2 4 6 8 10 12 14 16 Grab times on Real Surgery Grab times on Simulator
description
Position &Orientation. Force feedback. PGY 4 Capsulorhexis Performance Metrics on the Sensimmer “ Phaco Simulator" and During Phacoemulsification -A Paired Control Study. . - PowerPoint PPT Presentation
Transcript of PURPOSE
PGY 4 Capsulorhexis Performance Metrics on the Sensimmer “Phaco Simulator" and During Phacoemulsification-A Paired Control Study
PURPOSE
To compare capsulorhexis performance metrics between the Sensimmer phaco simulator and live surgery performed by PGY 4 ophthalmology residents.
METHODS• Twelve senior residents from 4 training programs, who
had similar surgical experience between months 7 and 9 of their PGY 4 year, were recruited as study participants
• Simulator testing• Simulator-naïve residents were given brief simulator
training prior to testing in 2 to 4 trials before collecting metrics
The following three performance metrics were developed:
1) time to complete capsulorhexis (recorded in seconds);
2) number of capsular grabs per completed capsulorhexis;
3) circularity of the capsulorhexis. Circularity index was defined as the average radius divided by the maximal radius in the capsulorhexis trajectory measured at 45 degree intervals.
Live surgery video recording• Capsulorhexis performance metrics were extracted
from 3 video recordings of non-complicated cataract surgery cases from each resident during month 7 and 9.
• Simulator training and metrics was also collected in the same time frame
• The results were compared for the three performance metrics: 1) duration, 2) number of forcep grabs per completed rhexis; and 3) circularity of the capsulorhexis. Averages, standard deviations and correlations using a two-sample t-test were calculated.
P. P. Banerjee, PhD1, C. Bouchard, MD2,, P. Dray, MD3, P. Bryar, MD4, R. Ahuja, MD3, D. P. Edward, MD5
1Mechanical and Industrial Engineering; Computer Science; Bioengineering; Ophthalmology, University of Illinois at Chicago, Chicago, IL; 2Ophthalmology, Loyola University, Maywood, IL; 3Ophthalmology, Stroger Hospital of Cook County , Chicago, IL; 4Ophthalmology, Northwestern University , Chicago, IL; 5Ophthalmology,
Summa Health Systems, Akron, OH
METHODS RESULTS
• The average time to complete the capsulorhexis on the simulator for all residents was 96.91 ± 44.23 sec and 94.42 ± 65.74 sec during surgery.
• The mean number of grabs on the simulator was 10.66 ± 4.81 and during surgery it was 10.31 ± 5.23.
• The circularity index of the capsulorhexis on the simulator was 0.92 ± 0.04 and in surgery it was 0.88 ± 0.04 .
• Although the average values for the time to complete the capsulorhexis and the number of grabs on the simulator were comparable between the group in surgery and on the simulator, there was considerable variability between individual residents under the two test scenarios.
• Surgeons who showed the greatest variability on the simulator for these two metrics appeared to show increased variability during surgery while those residents that demonstrated less variability on the simulator showed reduced variability during the actual surgical procedures.
• For all surgeons, there was a high correlation between the circularity index on the simulator and in surgery (p=0.0002) using a two-sample t-test.
CONCLUSIONS
1. PGY4 residents who completed comparable numbers of surgical cases showed considerable variability during surgery in two metrics: duration of capsulorhexis and number of forceps grabs per completed rhexis.
2. 2. The capsulorhexis simulator was able to identify this variability. Average performance measures of a group may be misleading and may not reflect surgical performance of an individual resident.
3. The metric measuring the capsulorhexis circularity with the simulator correlated best with surgical performance suggesting that this metric may be useful in assessment of surgical performance in residents.
4. Additional training tools and techniques were needed to try to reduce performance variability in residents- in- training.
5. The study suggests that metrics on simulators should be carefully assessed and developed. It is important that the ophthalmic community move forward in developing standards for simulation in cataract surgery and other ophthalmic procedures.
Author Disclosure Information: P.P. Banerjee, ImmersiveTouch-Sensimmer, I; ImmersiveTouch-Sensimmer, P;; C. Bouchard, None; P. Dray, None. P. Bryar, None; R. Ahuja, None; D.P. Edward, Sensimmer, P;
Support : NIH NEI grant 3R41EY018965-01S1; Perritt Charitable Foundation, Loyola University and University of Illinois at Chicago.
References1: Selvander M, Asman P. Virtual reality cataract surgery training: learning curves and concurrent validity. Acta Ophthalmol. 2010 Nov 1755-3768 [Epub ahead of print] PubMed PMID: 21054818.2: Privett B, Greenlee E, Rogers G, Oetting TA. Construct validity of a surgical simulator as a valid model for capsulorhexis training. J Cataract Refract Surg. 2010;36(11):1835-8.PubMed PMID: 21029889.3: Waqar S, Park J, Kersey TL, Modi N, Ong C, Sleep TJ. Assessment of fatigue in intraocular surgery: analysis using a virtual reality simulator. Graefes Arch Clin Exp Ophthalmol. 2011 Jan;249(1):77-81. PubMed PMID: 20890612.4: Ament CS, Henderson BA. Optimizing resident education in cataract surgery.Curr Opin Ophthalmol. 2010 Nov 23. [Epub ahead of print] PubMed PMID: 21107259.5: Liang S, Banerjee PP, Edward DP. Conf Proc IEEE Eng Med Biol Soc. 2009:5092-5. PubMed PMID: 19963878

For additional information please contact:
Dr. P. Pat BanerjeeUniversity of Illinois at Chicago
• Physics
• Mesh Loading
•
Haptics
• Force feedback
• Position &Orientation
• Integration
•
Graphics
• Stereo Rendering
•Log
1 2 3 4 5 6 7 80
50
100
150
200
250
300
350
400
Duration on Real Surgery(seconds)Duration on Simu-lator(seconds)
1 2 3 40
0.10.20.30.40.50.60.70.80.9
1
Circularity on Real SurgeryCircularity on Simulator
1 2 3 4 5 6 7 80
2
4
6
8
10
12
14
16
Grab times on Real SurgeryGrab times on Simulator
