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Analysis of surgical procedures by Surgical Process Modelling


General purpose

One of aspects of understanding the decision-making process in accomplishing a surgical procedure relies on its explicit description. Descriptions of the main surgical procedures (means of first excision techniques …), complemented by a multitude of items of technical notes from notice of experts or clinical cases can be find in many surgical books and journals. All of them were performed by manual review of cases. So, it seems there are no specific works for the creation of such generic procedure models created from patient-specific models which describe surgical cases. To get them, it is necessary to have formal and explicit descriptions of the procedures carried out including both the information available before the operation (predictive data) but also the various techniques used supplemented by the use of instruments (taking into account their role and their impact on the surgical place).


image4.jpg The Need

In recent years, due to the progress of medicine and computers, there has been an increased use of technologies in healthcare systems, from the hospital administration to the Operating Room (OR). In particular, the OR has undergone significant transformations to evolve into a highly complex and technologically rich environment. Computer technologies are now increasingly used throughout the intervention, from pre-operative planning and surgical performance to post-operative assessment. Computer-assisted-surgery (CAS) or Computer-assisted Intervention (CAI) has therefore a vital role in current surgeries performance. For instance, during surgical planning, CAS provides access to multimodal images and information about the patient and the possible simulation of parts of the surgical procedure. During surgery, it provides visualisation of pre- and intra-operative information on the patient with regards to the operative field, and passive or active support of surgery by means of tool localisation or robotics. Additionally, all computer-driven tools provide real improvements to the ergonomics of the OR that increase medical safety, optimise operating time and support decision making that give a significant advantage over conventional techniques.



In most current medical procedures and applications, the sequence of surgical steps and actions that are accomplished to perform a treatment follows a repetitive schema. This schema is usually called a workflow. Workflows structure the performance of the operation, from the first incision on the patient to the last suturing. In regular operations, patient and surgeon specificities influence the surgical steps in their details. Workflows can be described in medical books, formalized by protocols and learnt by the personnel during medical studies and training.


We use live recorded surgical procedures and preoperative informations to create surgical models. Each record contains every activities of the surgery. Each activity was coded by the association of an action, an instrument, and an anatomical structure defining a triplet.

With these recorded surgeries, we can

¤ use statistical methods to compare different populations : for example studying differences between juniors and seniors surgeons

¤ extract rules which can be represented by networks like the figure on the right (which represents one phase of a RCVA surgery)

Main Collaborators

inserm rennes1 ltsi