Introduction: Flexible ureteroscopy (fURS) is the most common surgical procedure for treatment of urolithiasis. Various surgical disciplines and subspecialties have examined surgeon kinematics to improve assessment and generate measures of skill. Despite frequency of utilization, there is no undisputed method for evaluating fURS skills. Our pilot study utilized kinematic evaluations of fURS simulation to determine whether specific surgeon movements, techniques, and strategies correlate with measures of ureteroscopic (URS) efficiency. Methods: A motion capture system and standard video camera were employed to characterize surgeon movement variables. A URS simulation box was used by practicing urologists at various skill levels to perform a series of simple and complex URS movement tasks. Two tasks were chosen for this initial pilot analysis. Body kinematics, time to task completion, and URS movements were analyzed. Task efficiency was defined as quicker time to task completion and smaller ureteroscope end effector travel distance. A combined performance efficiency score (PES) was calculated using the root sum square of these two measures. Results: Twelve practicing urologists were enlisted. Average urologist age was 37 years with an average of 10.1 years of training; 50% were women, 50% were residents; and 33% had completed an Endourology fellowship. For the simple task, no kinematic data correlated with PES; for the complex task, participant head and torso movement correlated with PES (r = 0.60, p = 0.04 for head; r = 0.65, p = 0.02 for torso), with decreased body movement associated with higher efficiency. Conclusion: Our findings suggest that movement economy measures are associated with efficient URS manipulation for complex tasks. Decreased head and torso movement were associated with higher efficiency, suggesting that excess body movement may signal extraneous or improper URS movements. Additional assessment of these variables, including analysis in a clinical setting, is warranted as this may serve as a basis for improvement in endoscopic training and evaluation.
Journal of endourology. 2022 Jun [Epub]
Marie-Therese Valovska, Gricelda Gomez, Richard Fineman, William Woltmann, Leia Stirling, Daniel A Wollin
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA., Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA., Industrial and Operations Engineering, Robotics Institute, University of Michigan, Ann Arbor, Michigan, USA.