机器人手术教学培训中 GEARS评分与客观操作指标相关性的初步探索

Preliminary exploration of the correlation between GEARS score and objective operative metrics in robot-assisted surgical training

摘要

目的 探讨泌尿外科机器人辅助手术培训场景下，术中数字化操作指标与GEARS评分的相关性，筛选可用于手术技能评价的客观指标，为机器人手术规范化教学与技能评估提供参考。方法 纳入15名初次接受机器人手术培训的泌尿外科医师，通过视频图像识别与轨迹追踪技术提取器械空间位置、器械脱离视野、离合、镜头及切换操作等量化指标；采用7名专家双盲法完成GEARS评分。运用Spearman秩相关分析各指标与GEARS评分的关联，并进一步校正年龄、总腹腔镜手术量混杂因素开展偏相关分析。结果 未校正混杂因素时，共10项指标与GEARS评分显著相关；其中距离右侧中心点最近距离呈强正相关（r_s=0.760，Q=0.010），器械脱离视野、离合、镜头、器械切换相关频次、时长指标均呈显著负相关。仅校正年龄后，距离右侧中心点最近距离、器械脱离视野总次数、切换使用总时长、切换使用平均时间仍存在独立统计学关联，切换使用平均时间负相关性最强（r_s=-0.749，Q=0.020）；单独校正总腹腔镜手术量、联合校正两项混杂因素后，全部指标校正Q值均＞0.05，原有相关关系消失。结论 器械空间定位稳定性、术野维持、离合与器械切换相关数字化指标可作为GEARS主观评分的补充客观评价依据；既往腹腔镜手术经验是二者关联的重要混杂因素。本研究为小样本初步探索，结论有待大样本、多中心研究进一步验证，提取的客观指标可用于手术培训精细化反馈，精准定位学员操作缺陷。

Abstract

Objective To analyze correlations between intraoperative digital operative metrics and GEARS scores in robotic urological surgery training，and screen objective skill assessment indicators，so as to provide references for standardized robotic surgical training. Methods A total of 15 untrained urologists receiving robotic training were included.Instrument position，out-of-view，clutch，camera and switching metrics were extracted via video recognition and trajectory tracking.Seven experts conducted double-blind GEARS scoring.Spearman correlation and partial correlation analyses adjusted for age and total laparoscopic surgical volume were carried out. Results Ten metrics were significantly correlated with GEARS scores without adjustment.The minimum distance to the right central point was strongly positively correlated（r_s=0.760，Q=0.010），whereas metrics of instrument out-of-view，clutch，camera and switching frequency/duration showed negative correlations.After age adjustment，four metrics retained independent associations，and average switching time had the strongest negative correlation（r_s= -0.749，Q =0.020）.No significant correlations remained after adjusting for total laparoscopic volume alone or both confounders（all Q＞0.05）. Conclusion Metrics of instrument positioning，field maintenance，clutch and arm switching can supplement subjective GEARS scoring.Previous laparoscopic experience is a key confounder.This small-sample exploratory study requires large multicenter verification；the objective metrics offer targeted training feedback to identify trainees' operational weaknesses.

关键词

机器人辅助手术 / 手术培训 / GEARS评分 / 操作指标 / 相关性分析

Key words

robot-assisted surgery / surgical training / GEARS score / operative metrics / correlation analysis

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