A Prospective Randomized Assessment of a Spatial Orientation Device in Natural Orifice Translumenal Endoscopic Surgery (NOTES)
Bibliographic record
Abstract
Purpose: One of the challenges in natural orifice translumenal endoscopic surgery (NOTES) is spatial orientation. Compared to laparoscopic surgery, NOTES is complicated by the flexibility of the endoscope, making understanding the orientation of the distal tip difficult. Knowledge of the endoscopic tip orientation is important for safe and efficient navigation in the peritoneum. A method to improve spatial orientation must be technically feasible, reliable, easy to implement, and safe, with no added risk to the patient. The Queen's NOTES research group has devised a novel method of orientation using a magnetic orientation device which passes within an endoscope channel and allows for 3-dimensional imaging of the shape and orientation of the endoscope. This experiment was designed to assess the feasibility of this device in a pig model. Methods: The device was tested by six experienced endoscopists and six experienced laparoscopic surgeons. Starting from the gastrotomy site, the time to identify four targets was recorded. For the first iteration the targets were the spleen, gallbladder, bladder, and fallopian tube. For the second iteration participants were required to identify, and touch with a closed forceps, the gallbladder, fallopian tube, a clip on the abdominal wall, and liver edge. Use of the orientation device was randomized for each session in which all four targets were identified. Results: The first iteration experiments appeared too simple to adequately assess the effects of the device (longest average time to target 13.69 seconds). Participants thought the device was helpful, but may be of more use for complex tasks. A second iteration was therefore designed. During the second iteration the mean time to identify all four targets using the device was 75.08 ± 42.68 seconds compared to 100.20 ± 60.70 seconds without the device. Regardless of randomization order, both groups were faster when using the device. In order to account for potential learning from the first to second attempt, the mean change in time was analyzed. Participants who used the device first were 14.21 ± 74.53% slower the second time (when not using the device). Participants who used the device second were 33.60 ± 32.07% faster than the first session (p=0.179). Conclusion: The results of our study demonstrate a trend towards faster times for identification of targets within the peritoneum when using the Queen's orientation device. The small sample size and simplicity of the study tasks limits our ability to assess the full utility of the device. The usefulness of the device may not be measured in speed, but in the improvement in ease and accuracy of surgery. Consequently, these encouraging results warrant further study using more complex scenarios.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".