Tool sequence trends in minimally invasive surgery: Statistical analysis and implications for predictive control of multifunction instruments

This paper presents an analysis of 67 minimally invasive surgical procedures covering 11 different procedure types to determine patterns of tool use. A new graph-theoretic approach was taken to organize and analyze the data. Through grouping surgeries by type, trends of common tool changes were identified. Using the concept of signal/noise ratio, these trends were found to be statistically strong. The tool-use trends were used to generate tool placement patterns for modular (multi-tool, cartridge-type) surgical tool systems, and the same 67 surgeries were numerically simulated to determine the optimality of these tool arrangements. The results indicate that aggregated tool-use data (by procedure type) can be employed to predict tool-use sequences with good accuracy, and also indicate the potential for artificial intelligence as a means of preoperative and/or intraoperative planning. Furthermore, this suggests that the use of multifunction surgical tools can be optimized to streamline surgical workflow.