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Title: Context-aware Monitoring in Robotic Surgery
Robotic-assisted minimally invasive surgery (MIS) has enabled procedures with increased precision and dexterity, but surgical robots are still open loop and require surgeons to work with a tele-operation console providing only limited visual feedback. In this setting, mechanical failures, software faults, or human errors might lead to adverse events resulting in patient complications or fatalities. We argue that impending adverse events could be detected and mitigated by applying context-specific safety constraints on the motions of the robot. We present a context-aware safety monitoring system which segments a surgical task into subtasks using kinematics data and monitors safety constraints specific to each subtask. To test our hypothesis about context specificity of safety constraints, we analyze recorded demonstrations of dry-lab surgical tasks collected from the JIGSAWS database as well as from experiments we conducted on a Raven II surgical robot. Analysis of the trajectory data shows that each subtask of a given surgical procedure has consistent safety constraints across multiple demonstrations by different subjects. Our preliminary results show that violations of these safety constraints lead to unsafe events, and there is often sufficient time between the constraint violation and the safety-critical event to allow for a corrective action.  more » « less
Award ID(s):
1804603
NSF-PAR ID:
10110795
Author(s) / Creator(s):
; ;
Date Published:
Journal Name:
International Symposium on Medical Robotics
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
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     Materials and Methods

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     METHODS:

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    A total of 7251 patients met inclusion criteria, of which 2770 were held out in a validation dataset based on chronological occurrence. Using segmentation metrics and clinical consensus, 3 distinct phenotypes were created for each surgery. The main features used for segmentation included urgency of the procedure, preoperative LOS, age, and comorbidities. The most relevant characteristics varied for each of the 3 surgeries. Low-risk phenotype alpha was the most common (2039 of 2770, 74%), while high-risk phenotype gamma was the rarest (302 of 2770, 11%). Adverse outcomes progressively increased from phenotypes alpha to gamma, including 30-day mortality (0.3%, 2.1%, and 6.0%, respectively), in-hospital mortality (0.2%, 2.3%, and 7.3%), and prolonged hospital LOS (3.4%, 22.1%, and 25.8%). When combined with the ASA score, digital phenotypes achieved higher AUROC than the ASA score alone (hospital mortality: 0.91 vs 0.84; prolonged hospitalization: 0.80 vs 0.71).

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    For 3 frequently performed surgeries, we identified 3 digital phenotypes. The typical profiles of each phenotype were described and could be used to anticipate adverse postoperative events.

     
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