Assessment of Robotic Console Skills (ARCS): construct validity of a novel global rating scale for technical skills in robotically assisted surgery.

BACKGROUND: Skill assessment during robotically assisted surgery remains challenging. While the popularity of the Global Evaluative Assessment of Robotics Skills (GEARS) has grown, its lack of discrimination between independent console skills limits its usefulness. The purpose of this study was to evaluate construct validity and interrater reliability of a novel assessment designed to overcome this limitation. METHODS: We created the Assessment of Robotic Console Skills (ARCS), a global rating scale with six console skill domains. Fifteen volunteers who were console surgeons for 0 ("novice"), 1-100 ("intermediate"), or >100 ("experienced") robotically assisted procedures performed three standardized tasks. Three blinded raters scored the task videos using ARCS, with a 5-point Likert scale for each skill domain. Scores were analyzed for evidence of construct validity and interrater reliability. RESULTS: Group demographics were indistinguishable except for the number of robotically assisted procedures performed (p = 0.001). The mean scores of experienced subjects exceeded those of novices in dexterity (3.8 > 1.4, p < 0.001), field of view (4.1 > 1.8, p < 0.001), instrument visualization (3.9 > 2.2, p < 0.001), manipulator workspace (3.6 > 1.9, p = 0.001), and force sensitivity (4.3 > 2.6, p < 0.001). The mean scores of intermediate subjects exceeded those of novices in dexterity (2.8 > 1.4, p = 0.002), field of view (2.8 > 1.8, p = 0.021), instrument visualization (3.2 > 2.2, p = 0.045), manipulator workspace (3.1 > 1.9, p = 0.004), and force sensitivity (3.7 > 2.6, p = 0.033). The mean scores of experienced subjects exceeded those of intermediates in dexterity (3.8 > 2.8, p = 0.003), field of view (4.1 > 2.8, p < 0.001), and instrument visualization (3.9 > 3.2, p = 0.044). Rater agreement in each domain demonstrated statistically significant concordance (p < 0.05). CONCLUSIONS: We present strong evidence for construct validity and interrater reliability of ARCS. Our study shows that learning curves for some console skills plateau faster than others. Therefore, ARCS may be more useful than GEARS to evaluate distinct console skills. Future studies will examine why some domains did not adequately differentiate between subjects and applications for intraoperative use.

Design and implementation of a continuous microwave heating system for ballast water treatment.

A continuous microwave system to treat ballast water inoculated with different invasive species was designed and installed atthe Louisiana State University Agricultural Center. The effectiveness of the system to deliver the required heating loads to inactivate the organisms present was studied. The targeted organisms were microalgae (Nannochloropsis oculata), zooplankton at two different growth stages (newly hatched brine shrimp-Artemia nauplii and adult Artemia), and oyster larvae (Crassosstrea virginica). The system was tested at two different flow rates (1 and 2 liters per min) and power levels (2.5 and 4.5 kW). Temperature profiles indicate that, depending on the species present and the growth stage, the maximum temperature increase will vary from 11.8 to 64.9 degrees C. The continuous microwave heating system delivered uniform and near-instantaneous heating at the outlet proving its effectiveness. The power absorbed and power efficiency varied for the species present. More than 80% power utilization efficiency was obtained at all flow rate and microwave power combinations for microalgae, Artemia nauplii and adults. Test results indicated that microwave treatment can be an effective tool for ballast water treatment, and current high treatment costs notwithstanding, this technique can be added as supplemental technology to the palette of existing treatment methods.

A continuous microwave system for prevention of invasive species during de-ballasting operation--death kinetics.

A continuous microwave heating system was tested for its effectiveness at removing potentially invasive organisms during deballasting operations. Four different organisms, namely Nannochloropsis oculata (microalgae), Artemia nauplii, Artemia adults and Crassosstrea virginica (oyster larvae) normally found in ballast water were investigated in a controlled study to quantify their survival after continuous microwave heating of synthetic ballast water. The experiments were performed in the microwave system using a 2 x 2 factorial design with power (2.5 and 4.5 kW) and flow rate (1.0 and 2.0 lpm) and the organisms subsequently subjected to different holding times. The control treatment was performed in a water bath using the same temperatures and holding times as in the case of the microwave treatment. Overall, the results obtained indicated that the microwave system was more effective in eliminating the organisms when compared with the control treatment. In most cases there were no survivors present after the microwave treatment at holding times above 100 s, and temperatures as low as 50 degrees C particularly for oyster larvae and Artemia adults. The results are promising, indicating that this technology has the potential to be an effective tool in controlling/preventing the introduction of invasive species into native environments.