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  4. It has been shown that intraoperative stress can have a negative effect on surgeon surgical skills during laparoscopic procedures. For novice surgeons, stressful conditions can lead to significantly higher velocity, acceleration, and jerk of the surgical instrument tips, resulting in faster but less smooth movements. However, it is still not clear which of these kinematic features (velocity, acceleration, or jerk) is the best marker for identifying the normal and stressed conditions. Therefore, in order to find the most significant kinematic feature that is affected by intraoperative stress, we implemented a spatial attention-based Long Short-Term Memory (LSTM) classifier. In a prior IRB approved experiment, we collected data from medical students performing an extended peg transfer task who were randomized into a control group and a group performing the task under external psychological stresses. In our prior work, we obtained “representative” normal or stressed movements from this dataset using kinematic data as the input. In this study, a spatial attention mechanism is used to describe the contribution of each kinematic feature to the classification of normal/stressed movements. We tested our classifier under Leave-One-User-Out (LOUO) cross-validation, and the classifier reached an overall accuracy of 77.11% for classifying “representative” normal and stressed movements usingmore »kinematic features as the input. More importantly, we also studied the spatial attention extracted from the proposed classifier. Velocity and acceleration on both sides had significantly higher attention for classifying a normal movement ([Formula: see text]); Velocity ([Formula: see text]) and jerk ([Formula: see text]) on nondominant hand had significant higher attention for classifying a stressed movement, and it is worthy noting that the attention of jerk on nondominant hand side had the largest increment when moving from describing normal movements to stressed movements ([Formula: see text]). In general, we found that the jerk on nondominant hand side can be used for characterizing the stressed movements for novice surgeons more effectively.« less
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  7. An important problem in designing human-robot systems is the integration of human intent and performance in the robotic control loop, especially in complex tasks. Bimanual coordination is a complex human behavior that is critical in many fine motor tasks, including robot-assisted surgery. To fully leverage the capabilities of the robot as an intelligent and assistive agent, online recognition of bimanual coordination could be important. Robotic assistance for a suturing task, for example, will be fundamentally different during phases when the suture is wrapped around the instrument (i.e., making a c- loop), than when the ends of the suture are pulled apart. In this study, we develop an online recognition method of bimanual coordination modes (i.e., the directions and symmetries of right and left hand movements) using geometric descriptors of hand motion. We (1) develop this framework based on ideal trajectories obtained during virtual 2D bimanual path following tasks performed by human subjects operating Geomagic Touch haptic devices, (2) test the offline recognition accuracy of bi- manual direction and symmetry from human subject movement trials, and (3) evalaute how the framework can be used to characterize 3D trajectories of the da Vinci Surgical System’s surgeon-side manipulators during bimanual surgical training tasks.more »In the human subject trials, our geometric bimanual movement classification accuracy was 92.3% for movement direction (i.e., hands moving together, parallel, or away) and 86.0% for symmetry (e.g., mirror or point symmetry). We also show that this approach can be used for online classification of different bimanual coordination modes during needle transfer, making a C loop, and suture pulling gestures on the da Vinci system, with results matching the expected modes. Finally, we discuss how these online estimates are sensitive to task environment factors and surgeon expertise, and thus inspire future work that could leverage adaptive control strategies to enhance user skill during robot-assisted surgery.« less
  8. Training for robotic surgery can be challenging due the complexity of the technology, as well as a high demand for the robotic systems that must be primarily used for clinical care. While robotic surgical skills are traditionally trained using the robotic hardware coupled with physical simulated tissue models and test-beds, there has been an increasing interest in using virtual reality simulators. Use of virtual reality (VR) comes with some advantages, such as the ability to record and track metrics associated with learning. However, evidence of skill transfer from virtual environments to physical robotic tasks has yet to be fully demonstrated. In this work, we evaluate the effect of virtual reality pre-training on performance during a standardized robotic dry-lab training curriculum, where trainees perform a set of tasks and are evaluated with a score based on completion time and errors made during the task. Results show that VR pre-training is weakly significant ([Formula: see text]) in reducing the number of repetitions required to achieve proficiency on the robotic task; however, it is not able to significantly improve performance in any robotic tasks. This suggests that important skills are learned during physical training with the surgical robotic system that cannot yet bemore »replaced with VR training.« less