Surgical training and simulation.
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Journal Article↗
Biomedical subjects
Jenny Dankelman
Publications and source records attributed to Jenny Dankelman.
Evaluation of voice control, touch panel control and assistant control during steering of an endoscope.
The increasing amount of equipment used in the Operating Room (OR) asks for ergonomical user interfaces. The aim of this study was to investigate in a pelvi-trainer setting the efficiency, reliability and user satisfaction of voice control, touch panel control and conventional manual control by an assistant. Ten subjects had to control the zoom and light intensity of an endoscope, using voice, a touch panel or an assistant. For each interface, the subject received nine tasks to control to a certain level, light, zoom or both. The experiment was repeated three times (three cycles) and the sequences of interfaces were varied per cycle. Experiments were recorded on video and off-line time needed per task and the number of wrongly interpreted tasks were measured. A questionnaire was used to investigate user satisfaction. Voice control was slower than assistant control and touch panel control (92.5 s, 80.2 s and 76.0 s, respectively, p<0.02). There was no significant difference between touch panel control and assistant control. With voice control, 3.1% of the commands were not interpreted and 1.7% were wrongly interpreted. 40% of the subjects experienced voice control as the quickest, 30% touch panel control and 30% assistant control. 48% of the subjects preferred voice control, 28% the touch panel and 24% assistant control. Voice control was less efficient than touch panel control and manual control by an assistant. The subjects experienced voice control as more efficient, however. In the future, voice control should be improved to overcome wrongly interpreted commands. Furthermore, experiments should be performed in a clinical setting in which the surgeon has to perform two-handed tasks to evaluate the effects on the surgeon's performance.
Journal Article↗
Identifying error pathways during elbow and knee replacements.
The aim of our study was to identify errors and error pathways during joint replacements and to propose improvements. A time-action and error analysis method was adapted for use during surgery. The error analysis consisted of identifying all possible errors, determining error paths presented in an error chart, quantifying errors, and determining the impact of errors. This method was used to evaluate joint replacements. We evaluated five knee and 11 elbow replacements done by two experienced surgeons. The main error for elbow replacements was caused by inadequate instruments. The main error for knee replacements was caused by inexperienced nurses being unfamiliar with guiding instruments. The time-action analysis showed a large variation in procedure duration. The main surgical limitations for both procedures were waiting caused by the cementing process and waiting caused by inexperienced scrub nurses. Our study identified errors and surgical limitations during joint replacements by using time-action and error analysis. Placement of both prostheses will benefit from new fixation techniques, a more experienced nursing staff, and more organized instrument tables.
Arthroplasty, Replacement↗
Factors influencing the surgical process during shoulder joint replacement: time-action analysis of five different prostheses and three different approaches.
BACKGROUND: To evaluate the per-operative process of shoulderjoint replacement, time-action analysis can be used. MATERIAL/METHODS: Forty procedures performed by 7 surgeons with different experience using 5 different prostheses and 3 different surgical approaches were analyzed. RESULTS: The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used. The surgical procedure was influenced by several factors, such as the prosthesis used, the surgical approach, the patient's condition, and the experience of the surgeon. Exposure of the glenoid was difficult and several retractors were needed, which were held by an extra assistant or clamped to the table or the surgeon. Two main limitations were seen in all procedures: repeated actions and waiting. Also, five errors could be identified. None of the alignment instruments was completely reliable and they allowed the surgeon to make major errors. CONCLUSIONS: Better alignment instruments, pre-operative planning techniques, and operation protocols are needed for shoulder prostheses. The training of resident surgeons should be focused on the exposure phase, the alignment of the humeral head, the exposure of the glenoid, and the alignment of the glenoid. Evaluating the surgical process using time-action analysis can be used to determine the limitations during surgical procedures. Furthermore, it shows the large variation in factors affecting surgical performance, indicating that a system approach is needed to improve surgical outcome.
Arthroplasty, Replacement↗
Balance between myogenic, flow-dependent, and metabolic flow control in coronary arterial tree: a model study.
Myogenic response, flow-dependent dilation, and direct metabolic control are important mechanisms controlling coronary flow. A model was developed to study how these control mechanisms interact at different locations in the arteriolar tree and to evaluate their contribution to autoregulatory and metabolic flow control. The model consists of 10 resistance compartments in series, each representing parallel vessel units, with their diameters determined by tone depending on either flow and pressure [flow-dependent tone reduction factor (TRF(flow)) x Tone(myo)] or directly on metabolic factors (Tone(meta)). The pressure-Tone(myo) and flow-TRF(flow) relations depend on the vessel size obtained from interpolation of data on isolated vessels. Flow-dependent dilation diminishes autoregulatory properties compared with pressure-flow lines obtained from vessels solely influenced by Tone(myo). By applying Tone(meta) to the four distal compartments, the autoregulatory properties are restored and tone is equally distributed over the compartments. Also, metabolic control and blockage of nitric oxide are simulated. We conclude that a balance is required between the flow-dependent properties upstream and the constrictive metabolic properties downstream. Myogenic response contributes significantly to flow regulation.
Algorithms↗
Evaluation of humeral head replacements using time-action analysis.
New surgical technologies are often introduced without objective evaluation of their efficiency. Commonly, their results are only related to surgical outcome and complication rate. In this study, time-action analysis was applied to evaluate the per-operative process and to measure surgical performance during 8 humeral head replacements. An overview of the operative theater and a detailed view were recorded on video simultaneously. The duration and number of actions grouped to functions, limitations, and repeated actions were determined. The duration and number of performed actions varied between procedures. The efficiency of the procedure, defined as the percentage of goal-oriented functions, was about 55%. Repeated actions were frequently observed during the alignment and insertion phase. We conclude that time-action analysis can be used to evaluate surgical performance objectively. Limitations of the surgical process that can be improved could be identified. These findings enable the evaluation of new operative techniques, protocols, and instruments.
Arthroplasty, Replacement↗
Engineering for patient safety: the clinically driven approach.
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Biomedical Engineering↗