RESUMEN
MOTIVATION: The precise and formal specification of surgical interventions is a necessary requirement for many applications in surgery, including teaching and learning, quality assessment and evaluation, and computer-assisted surgery. Currently, surgical processes are modeled by following various approaches. This diversity lacks a commonly agreed-upon conceptual foundation and thus impedes the comparability, the interoperability, and the uniform interpretation of process data. OBJECTIVE: However, it would be beneficial if scientific models, in the same context, shared a coherent conceptual and formal mathematical basis. Such a uniform foundation would simplify the acquisition and exchange of data, the transition and interpretation of study results, and the transfer and adaptation of methods and tools. Therefore, we propose a generic, formal framework for specifying surgical processes, which is presented together with its design methodology. METHODS: The methodology follows a four-level translational approach and comprises an ontological foundation for the formal level that orients itself by linguistic theories. RESULTS: A unifying framework for modeling surgical processes that is ontologically founded and formally and mathematically precise was developed. The expressive power and the unifying capacity of the presented framework are demonstrated by applying it to four contemporary approaches for surgical process modeling by using the common underlying formalization. CONCLUSIONS: The presented four-level approach allows for capturing the knowledge of the surgical intervention formally. Natural language terms are consistently translated to an implementation level to support research fields where users express their expert knowledge about processes in natural language, but, in contrast to this, statistical analysis or data mining need to be performed based on mathematically formalized data sets. The availability of such a translational approach is a valuable extension for research regarding the operating room of the future.
Asunto(s)
Cirugía Asistida por Computador/métodos , Simulación por Computador , Humanos , Cirugía Asistida por Computador/educaciónRESUMEN
One objective of ophthalmological departments is the optimization of patient treatment services. A strategy for optimization is the identification of individual potential for advanced training of surgeons based on their daily working results. The objective of this feasibility study was the presentation and evaluation of a strategy for the computation of surgeon-individual treatment profiles (SiTPs). We observed experienced surgeons during their standard daily performance of cataract procedures in the Ophthalmological Department of the University Medical Center Leipzig, Germany. One hundred five cases of cataract procedures were measured as Surgical Process Models (SPMs) with a detailed-to-the-second resolution. The procedures were performed by three different surgeons during their daily work. Subsequently, SiTPs were computed and analyzed from the SPMs as statistical 'mean' treatment strategies for each of the surgeons. The feasibility study demonstrated that it is possible to identify differences in surgeon-individual treatment profiles beyond the resolution of cut-suture times. Surgeon-individual workflows, activity frequencies and average performance durations of surgical activities during cataract procedures were analyzed. Highly significant (p < 0.001) workflow differences were found between the treatment profiles of the three surgeons. Conclusively, the generation of SiTPs is a convenient strategy to identify surgeon-individual training potentials in cataract surgery. Concrete recommendations for further education can be derived from the profiles.