內視鏡手術刀具移動控制模式及其學習效應之研究

The investigation of laparoscopic instrument movement control and learning effect

陳宏仁(Hung-Jen Chen)

指導教授 ： 林久翔

中原大學/電機資訊學院/工業與系統工程研究所/博士(2010年)

https://doi.org/10.6840/cycu200901609

摘要

內視鏡手術的進行是主刀者根據眼前螢幕所呈現的病患體內影像，由病患體外操作長達40 cm 的內視鏡刀具進行手術，除了必需克服手眼間的不協調外，最重要的是必需由二維平面的影像判斷患者體內三維環境下器官與刀頭的相對位置與距離。過去雖然有許多研究針對內視鏡訓練議題進行探討，然而刀具的基本 移動控制模式卻始終未進行深入探究，若對內視鏡手術環境下刀具移動控制模式有了充分的了解，對於外科醫師在訓練上必產生極大的助益。 本研究的目的在於透過Ftts’ Law 探討內視鏡手術環境下手術刀具的移動控制模式以及發展其移動時間預測模型，了解探討放大倍率、移動距離以及移動方向對刀具移動時間與資訊處理能力之影響，並透過學習曲線概念，比較此三種參數對移動時間與資訊處理能力學習率之影響，最後根據Fitts’ Law 發展其移動時間預測模型。 本研究結果發現，無論放大倍率、移動距離以及移動方向對刀具移動時間與資訊處理能力皆有顯著影響。然而，此三種參數對於移動時間與資訊處理能力學習率則無顯著影響。值得注意的是，並非所有移動角度皆能在移動時間與資訊處理能力上產生學習效應。因此本研究建議，當設計內視鏡訓練課程時，應對於移 動角度上的訓練加以強化。 最後，本研究以Fitts’ Law 為基礎發展內視鏡手術刀具移動時間預測模型，此模型可透過移動距離、目標寬度以及移動角度三種容易量測之參數對於內視鏡手術刀具移動時間進行預測，期望本研究成果可提供設計內視鏡手術訓練時之參考，進而增進操作績效與縮短訓練時程，降低醫療資源的浪費及增進醫療品質。

關鍵字

內視鏡手術 ； 移動控制模式 ； Fitts’ law ； 放大倍率 ； 移動距離 ； 移動角度

並列摘要

Laparoscopic surgery avoids large incisions for intrabdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has investigated in the essential movement characteristics such as magnification, amplitude, and angle.
For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts’ task and to develop an instrument movement time predict model. Ten right-handed subjects made discrete Fitts’ pointing tasks using a laparoscopic trainer. The factors were amplitude, magnification and angle. Movement time, throughput, and improve rate were recorded as dependent variables.
The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, according to the results of a Kruskal-Wallis test in medians of improve rate for movement time and throughput, there were no significant differences between the three factors.
As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts’ law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program and the predictive model can be used to establish standards in the training procedure.

並列關鍵字

movement control mode ； laparoscopic surgery ； Fitts’ law ； amplitude ； angle ； magnification

參考文獻

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