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Frati RMC, Maltez RG, Neto VJFDA, Porto BC, Passerotti CC, Sardenberg RADS, Artifon EL, Otoch JP, da Cruz JAS. Impact of Preoperative Warm-Up on Surgical Performance of Resident Physicians: A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2025; 82:103501. [PMID: 40184830 DOI: 10.1016/j.jsurg.2025.103501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/18/2024] [Accepted: 02/23/2025] [Indexed: 04/07/2025]
Abstract
INTRODUCTION Surgical learning is a complex process that involves resident characteristics, instructional methods, and technological tools. As surgical residency programs become more diverse, there is a growing need for adaptable training methods that align with various learning styles and backgrounds. Manual dexterity and self-assessment skills are essential for residents, and recent studies highlight those residents with refined manual skills perform better in surgery. Preoperative warm-up is emerging as a potential strategy to improve immediate surgical performance. The study aimed to analyze whether preoperative warm-up in low-cost surgical simulators (training boxes) is related to an immediate improvement in the intraoperative performance of general surgery residents inexperienced in laparoscopy. METHODS The study used a swine model for surgical simulations in a controlled training environment. 105 first-year general surgery residents were divided into 2 groups: the control group (performed procedures without warm-up) and the intervention group (performed a 10-minute preoperative warm-up using a training box). RESULTS The Intervention group demonstrated improved efficiency in cholecystectomy (2.97 ± 0.4 vs 2.41 ± 0.91, p = 0.03), with reductions of 41.5% in cholecystectomy dissection time (4.82 ± 4.94 vs 8.23 ± 5.15 minutes, p = 0.02) and 15.6% in left radical nephrectomy dissection time (13.03 ± 4.49 vs 16.77 ± 3.90 minutes, p = 0.012). CONCLUSIONS Preoperative warm-up using a training box significantly improved the qualitative and quantitative surgical performance of general surgery residents with no prior laparoscopic experience, particularly by increasing efficiency in cholecystectomy and reducing dissection times in both cholecystectomy and left radical nephrectomy.
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Affiliation(s)
- Rodrigo Marcus Cunha Frati
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil; Universidade Nove de Julho, Surgery Department, Sao Bernardo do Campos (SP), São Paulo, Brazil
| | - Rafael Guisalberte Maltez
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil; Universidade Nove de Julho, Surgery Department, Sao Bernardo do Campos (SP), São Paulo, Brazil
| | | | - Breno Cordeiro Porto
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil
| | - Carlo Camargo Passerotti
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil
| | - Rodrigo Afonso da Silva Sardenberg
- Universidade Nove de Julho, Surgery Department, Sao Bernardo do Campos (SP), São Paulo, Brazil; International Teaching and Research Institute, Hapvida NotreDame Intermédica, São Paulo, Brazil
| | - Everson Luiz Artifon
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil
| | - José Pinhata Otoch
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil
| | - José Arnaldo Shiomi da Cruz
- Universidade de São Paulo, School of Medicine, Surgical Technique and Experimental Surgery, São Paulo, Brazil; Universidade Nove de Julho, Surgery Department, Sao Bernardo do Campos (SP), São Paulo, Brazil; International Teaching and Research Institute, Hapvida NotreDame Intermédica, São Paulo, Brazil.
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Vannaprathip N, Haddawy P, Schultheis H, Suebnukarn S. SDMentor: A virtual reality-based intelligent tutoring system for surgical decision making in dentistry. Artif Intell Med 2025; 162:103092. [PMID: 40015210 DOI: 10.1016/j.artmed.2025.103092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/15/2025] [Accepted: 02/18/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND While VR simulation has already had a significant impact on training of psychomotor surgical skills, there is still a lack of work on the use of VR simulation to teach surgical decision making. Since surgical decision making is a cognitive process, a simulation for teaching it must be able to not only accurately simulate the surgical environment but to also represent and reason about the cognitive aspects involved. MATERIALS AND METHODS This paper presents and evaluates SDMentor, a virtual training environment that integrates high-fidelity VR simulation with an intelligent tutoring system for teaching surgical decision making in dentistry. SDMentor provides a virtual dental operating room with 3D stereoscopic graphics and with haptic feedback to realistically render the interaction of dental tools with the patient teeth. The intelligent tutor evaluates the student's actions and generates a variety of tutorial feedback. To evaluate the teaching effectiveness of the system, we carried out a randomized controlled trial in the domain of root canal treatment. RESULTS In all three aspects of scores: situation awareness ability, procedural knowledge, and overall performance; the post-test scores showed significant improvement over the pre-test scores of students in the same group (P < .05). The students from the experimental group had significantly higher learning gains than the students in the control group (P < .05). CONCLUSIONS The integration of high-fidelity VR simulation with intelligent tutoring is a promising approach to teaching surgical decision making and could be useful for teaching decision making in other high-precision psychomotor tasks.
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Affiliation(s)
- Narumol Vannaprathip
- Faculty of Information Communication and Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Peter Haddawy
- Faculty of Information Communication and Technology, Mahidol University, Nakhon Pathom, Thailand; Bremen Spatial Cognition Center, University of Bremen, Bremen, Germany.
| | - Holger Schultheis
- Bremen Spatial Cognition Center, University of Bremen, Bremen, Germany.
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Gonçalves MR, Marinho R, Reis SG, Viveiros R, Teixeira MM, Andrade AK, do Carmo Girão M, Rodrigues PPV, Castelo-Branco Sousa M. LapAppendectomy4all: validation of a new methodology for laparoscopic appendectomy simulation and training. Updates Surg 2025:10.1007/s13304-025-02127-y. [PMID: 39922944 DOI: 10.1007/s13304-025-02127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 01/26/2025] [Indexed: 02/10/2025]
Abstract
Appendectomy, whether open or minimally invasive (MIS) is one of the most frequent procedures performed by young residents. We designed and tested a new methodology and a new inexpensive silicone model for Laparoscopic Appendectomy (LA) simulation. This study aimed to assess their fidelity, usefulness and educational value in an introduction to laparoscopy course. The course was open to first-year general surgery residents. The group was divided in two and one of the groups watched a video of the procedure before the simulation. Individual performances were assessed directly on the models, using a specific assessment scale. Participants answered a questionnaire at the end of the course for evaluation. Thirty-five residents participated in this study. Execution, quality, and global performance were higher in the group that had more experience with the model. Thirty-two trainees (91%) answered the questionnaire. There was a strong agreement that the model was adequate for this type of course and face and content validity was considered high/very high. Participants strongly agreed that this model gives more confidence to perform a real LA and almost 97% (n = 31) considered they have learned solid foundations about LA. This study shows face, content and construct validation and also educational value for this new low-cost, laparoscopic appendectomy model. The integration of this model in an introduction to laparoscopy course showed good results in regard to an increase of confidence among first-year surgery residents. It can be a valuable tool for learning and training laparoscopic appendectomy.
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Affiliation(s)
- Mário Rui Gonçalves
- Centro Académico Clínico das Beiras (Academic Clinical Center of Beiras), Faculty of Health Sciences, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.
| | - Ricardo Marinho
- Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
| | - Sofia Gaspar Reis
- Centro Hospitalar Barreiro Montijo, Avenida Movimento das Forças Armadas, 2830-003, Barreiro, Portugal
| | - Ricardo Viveiros
- Hospital Central do Funchal, Avenida Luís de Camões nº 57, 9004-514, Funchal, Portugal
| | - Manuel Moutinho Teixeira
- Serviço de Cirurgia Geral, Unidade Local de Saúde de Castelo Branco, Hospital Amato Lusitano, Av. Pedro Alvares Cabral 3, 6000-085, Castelo Branco, Portugal
| | - Ana Kam Andrade
- Serviço de Cirurgia Geral, Unidade Local de Saúde de São José, Lisbon, Portugal
| | - Maria do Carmo Girão
- Serviço de Cirurgia Geral, Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | | | - Miguel Castelo-Branco Sousa
- Centro Académico Clínico das Beiras (Academic Clinical Center of Beiras), Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
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Punjabi K, Almohtadi A, Singh A, Singh I, Salha A, Seyedzenouzi G. Does early exposure to cardiothoracic surgery increase interest in the specialty? Perfusion 2025; 40:132-139. [PMID: 38112186 DOI: 10.1177/02676591231223076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The number of applications for cardiothoracic surgery has been steadily dropping over the past decades. We aim to assess whether a 1-day cardiothoracic surgical skills conference could increase interest into the speciality. METHODS Participants included in the study had to be medical students or junior doctors. Out of 57 delegates that attended the conference, 52 were enrolled in the study, and completed the pre-conference and post-conference questionnaires. Three introductory lectures were delivered by consultants in cardiothoracic surgery or cardiology in the morning, followed by three practical surgical workshops. We assessed demographics, confidence in and knowledge of procedures, and the change in participants' interest in the speciality pre- and post-conference. This study was conducted at St George's University of London. RESULTS The interest to pursue a career in cardiothoracic surgery increased by 23% post-conference (p = .035). Confidence and knowledge in all procedures taught improved significantly after the conference (p < .05), with the highest increase seen in anastomosis of vessels (p < .0001). Preclinical students made up 57.7% of participants, majority of whom had not seen more than three surgical procedures. CONCLUSION Our conference has shown to increase interest in cardiothoracic surgery and improve exposure to surgical skills, especially to those in early years of medical school. The surgical workshops improved student confidence and knowledge in procedures used within the field and the use of animal tissue improved participant experience. Further research is needed at other medical schools to assess whether a change in surgical skills teaching should be made to medical school curriculums.
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Affiliation(s)
- Karan Punjabi
- Centre for Medical Education, Insitute of Health Sciences Education, Queen Mary University of London, London, UK
| | | | | | - Ishan Singh
- University of Buckingham Medical School, Buckingham, UK
| | - Ahmad Salha
- St George's University of London, London, UK
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Favier A, Jaafar E, L’Hote R, Gauthier P, Avellino I, Canlorbe G. Impacts of immersive 3D videos on students' surgical learning compared to 2D videos: a randomized controlled trial. Int J Surg 2024; 110:7832-7839. [PMID: 39806743 PMCID: PMC11634195 DOI: 10.1097/js9.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 11/07/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Unlike other medical specialties, surgery is primarily learned through apprenticeship, by observing surgeons in action during operations. However, the increasing number of medical students and work-hour restrictions limit opportunities for learning in the operating room (OR). These circumstances call for novel technologies, such as immersive video. The objective of this study is to compare knowledge retention, preparedness, and content engagement for surgical learning when watching a surgical video in 3D through a Head-Mounted Display (HMD) versus in 2D video on a conventional screen. MATERIEL AND METHODS This randomized controlled trial includes 231 fourth-year medical students. Participants watched the same 12 min surgical video, narrated by an expert, presented either in immersive 3D form through an HMD, or in 2D form through a conventional screen. The students completed three questionnaires (previewing, postviewing, and 1 month later), which included questions on knowledge retention, expected preparedness, content engagement, tool engagement, and self-assessment. Statistical analyses were adjusted by including the confounding factors. RESULTS Immediately after the video, the 3D immersive video group showed a significantly lower knowledge retention score compared to the classic video group (P<0.01). Nonetheless, the 3D immersive video group demonstrated better-expected preparedness as a future resident (P=0.019), greater satisfaction (P=0.033), better stimulation (P<0.001), higher involvement (P<0.001), and a greater perceived ability to identify anatomical structures (P<0.001). After 1 month, participants in the immersive video group reported feeling more prepared (P=0.016), more self-confident (P=0.020), more at ease (P=0.023), and less overwhelmed (P<0.01) than those in the 2D video group. CONCLUSION Our results showed that 3D surgical immersive video vs. 2D surgical video, enhances the sense of stimulation, satisfaction, involvement, and the perception of having better identified anatomical structures. For early medical school students where access to the OR is limited, this tool appears to a significant step forward in surgical pedagogy. However, the precise understanding of its pedagogical value required further investigation and refinement.
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Affiliation(s)
- Amelia Favier
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
- Sorbonne Université, Inserm, UMR 938, Centre de Recherche Saint Antoine, Equipe Instabilité des Microsatellites et Cancer, Paris, France
| | - Eya Jaafar
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
- Sorbonne Université, CNRS, INSERM, ISIR, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - Raphael L’Hote
- Sorbonne Université, Faculté de médecine, AP-HP, Groupement Hospitalier Pitié Salpêtrière, Centre National de Référence du Lupus Systémique, du syndrome des antiphospholipides et autres maladies auto-immunes, Service de Médecine Interne 2, Institut E3M, CIMI-Paris, Paris, France
| | - Philippe Gauthier
- Sorbonne Université, CNRS, INSERM, ISIR, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - Ignacio Avellino
- Sorbonne Université, CNRS, INSERM, ISIR, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
- Sorbonne University, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France
- University Institute of Cancer, Sorbonne University, Paris, France
- BOpA, Bloc Opératoire Augmenté, AP-HP, l’Institut Mines-Télécom et l’Université Paris-Saclay
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Magalhães R, Oliveira A, Terroso D, Vilaça A, Veloso R, Marques A, Pereira J, Coelho L. Mixed Reality in the Operating Room: A Systematic Review. J Med Syst 2024; 48:76. [PMID: 39145896 PMCID: PMC11327191 DOI: 10.1007/s10916-024-02095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
Mixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information. When integrated with voice control mechanisms, gestures and even iris movement, it becomes a valuable tool for medicine. These features are particularly appealing for the operating room and surgical learning, where access to information and freedom of hand operation are fundamental. This study examines the most significant research on mixed reality in the operating room over the past five years, to identify the trends, use cases, its applications and limitations. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the research questions established using the PICO (Population, Intervention, Comparator and Outcome) framework. Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes. The articles' conclusions highlight the potential benefits of these innovations in surgical practice while acknowledging the challenges that must be addressed. Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The need for more flexible approaches and comprehensive studies is underscored by the specificity of procedures and limited samples sizes. The integration of imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.
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Affiliation(s)
- Renato Magalhães
- LabRP-CIR, ESS, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Porto, Portugal.
| | - Ana Oliveira
- ISEP, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4249-015 Porto, Portugal
| | - David Terroso
- ISEP, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4249-015 Porto, Portugal
| | - Adélio Vilaça
- CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rita Veloso
- LabRP-CIR, ESS, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Executive Board Member, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - António Marques
- LabRP-CIR, ESS, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Javier Pereira
- Universidade da Coruña, CITIC Research Center, Talionis Research Group. A Coruña, La Coruña, Spain
| | - Luís Coelho
- ISEP, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 4249-015 Porto, Portugal
- INESC TEC , Institute for Systems and Computer Engineering Technology and Science, Porto, Portugal
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Zhang J, Luo Z, Zhang R, Ding Z, Fang Y, Han C, Wu W, Cen G, Qiu Z, Huang C. The transition of surgical simulation training and its learning curve: a bibliometric analysis from 2000 to 2023. Int J Surg 2024; 110:3326-3337. [PMID: 38729115 PMCID: PMC11175803 DOI: 10.1097/js9.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Proficient surgical skills are essential for surgeons, making surgical training an important part of surgical education. The development of technology promotes the diversification of surgical training types. This study analyzes the changes in surgical training patterns from the perspective of bibliometrics, and applies the learning curves as a measure to demonstrate their teaching ability. METHOD Related papers were searched in the Web of Science database using the following formula: TS=[(training OR simulation) AND (learning curve) AND (surgical)]. Two researchers browsed the papers to ensure that the topics of articles were focused on the impact of surgical simulation training on the learning curve. CiteSpace, VOSviewer, and R packages were applied to analyze the publication trends, countries, authors, keywords, and references of selected articles. RESULT Ultimately, 2461 documents were screened and analyzed. The USA is the most productive and influential country in this field. Surgical endoscopy and other interventional techniques publish the most articles, while surgical endoscopy and other interventional techniques is the most cited journal. Aggarwal Rajesh is the most productive and influential author. Keyword and reference analyses reveal that laparoscopic surgery, robotic surgery, virtue reality, and artificial intelligence were the hotspots in the field. CONCLUSION This study provided a global overview of the current state and future trend in the surgical education field. The study surmised the applicability of different surgical simulation types by comparing and analyzing the learning curves, which is helpful for the development of this field.
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Affiliation(s)
- Jun Zhang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Zai Luo
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Renchao Zhang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Zehao Ding
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
- The Affiliated Chuzhou Hospital of Anhui Medical University, Anhui, the People's Republic of China
| | - Yuan Fang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Chao Han
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Weidong Wu
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Gang Cen
- The Affiliated Chuzhou Hospital of Anhui Medical University, Anhui, the People's Republic of China
| | - Zhengjun Qiu
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
| | - Chen Huang
- Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, the People’s Republic of China
- The Affiliated Chuzhou Hospital of Anhui Medical University, Anhui, the People's Republic of China
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Reinhold M, Asal C, Driesen T, Roch J, Jäckle K, Borgmann S, Lehmann W. Learning effectiveness of clinical anatomy and practical spine surgery skills using a new VR-based training platform. BRAIN & SPINE 2024; 4:102826. [PMID: 39823068 PMCID: PMC11735924 DOI: 10.1016/j.bas.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/14/2024] [Accepted: 05/03/2024] [Indexed: 01/19/2025]
Abstract
Introduction As medical education becomes more complex, the demand for advanced teaching and training methods has grown. Technological advancements have opened up new possibilities, particularly in the realm of virtual reality (VR) simulations for training. Research Question Our prospective, randomized pilot study aims to assess whether a novel VR-based 3D training platform can effectively teach the knowledge and skills needed for complex spinal surgery, specifically pedicle screw placement. Material and MethodsWe enrolled 25 participants who received either a traditional lecture (control group, n=11) or a VR lecture with identical content featuring 3D/VR anatomical models (VR group, n=14). The VR group also underwent VR simulation for pedicle screw placement. We evaluated their learning through a quiz, a practical skills test, and selfassessment questionnaires. Results In the theory multiple-choice test, the contral group scored an average of 69% (range 53-87%, SD 0.10), while the VR group scored 66% (range 47-87%, SD 0.11) (p=0.692, independent sample t-test).For the practical DOPS test (pedicle screw placement), the average score was 2.4 points (n=25; range 1-4). The VR group on average scored 2.9 points compared to the control (2 points) (p=0.134). Discussion and Conclusion Our study indicates that teaching with a new 3D VR training tool yields results comparable to traditional methods in terms of knowledge retention. This research supports the platform's effectiveness as an educational resource. Importantly, trainees can apply VR-acquired knowledge to real surgical procedures, which are well-received.
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Affiliation(s)
- Maximilian Reinhold
- Goettingen Medical University, Department of Trauma Surgery, Orthopedics and Plastic Surgery, Robert-Koch-Str. 40, D-37099, Goettingen, Germany
| | - Can Asal
- NonNocere, Sorauer Str. 14, D-10997, Berlin, Germany
| | - Tobias Driesen
- Goettingen Medical University, Department of Trauma Surgery, Orthopedics and Plastic Surgery, Robert-Koch-Str. 40, D-37099, Goettingen, Germany
| | - Jonathan Roch
- Goettingen Medical University, Department of Trauma Surgery, Orthopedics and Plastic Surgery, Robert-Koch-Str. 40, D-37099, Goettingen, Germany
| | - Katharina Jäckle
- Goettingen Medical University, Department of Trauma Surgery, Orthopedics and Plastic Surgery, Robert-Koch-Str. 40, D-37099, Goettingen, Germany
| | - Susanne Borgmann
- Goettingen Medical University, G1-2 Office of the Dean of Studies/Medical Didactics, Humboldtallee 38, 37073, Goettingen, Germany
| | - Wolfgang Lehmann
- Goettingen Medical University, Department of Trauma Surgery, Orthopedics and Plastic Surgery, Robert-Koch-Str. 40, D-37099, Goettingen, Germany
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Ock J, Choi Y, Lee DG, Chung JW, Kim N. Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation. Sci Rep 2024; 14:7661. [PMID: 38561420 PMCID: PMC10984916 DOI: 10.1038/s41598-024-58359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Yeonjoo Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Dong-Gyu Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
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10
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Foresti R, Fornasari A, Bianchini Massoni C, Mersanne A, Martini C, Cabrini E, Freyrie A, Perini P. Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training. Bioengineering (Basel) 2024; 11:197. [PMID: 38391683 PMCID: PMC10886183 DOI: 10.3390/bioengineering11020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.
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Affiliation(s)
- Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Arianna Mersanne
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Diagnostic Department, University-Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
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11
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Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Brain-behavior analysis of transcranial direct current stimulation effects on a complex surgical motor task. FRONTIERS IN NEUROERGONOMICS 2024; 4:1135729. [PMID: 38234492 PMCID: PMC10790853 DOI: 10.3389/fnrgo.2023.1135729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
Transcranial Direct Current Stimulation (tDCS) has demonstrated its potential in enhancing surgical training and performance compared to sham tDCS. However, optimizing its efficacy requires the selection of appropriate brain targets informed by neuroimaging and mechanistic understanding. Previous studies have established the feasibility of using portable brain imaging, combining functional near-infrared spectroscopy (fNIRS) with tDCS during Fundamentals of Laparoscopic Surgery (FLS) tasks. This allows concurrent monitoring of cortical activations. Building on these foundations, our study aimed to explore the multi-modal imaging of the brain response using fNIRS and electroencephalogram (EEG) to tDCS targeting the right cerebellar (CER) and left ventrolateral prefrontal cortex (PFC) during a challenging FLS suturing with intracorporeal knot tying task. Involving twelve novices with a medical/premedical background (age: 22-28 years, two males, 10 females with one female with left-hand dominance), our investigation sought mechanistic insights into tDCS effects on brain areas related to error-based learning, a fundamental skill acquisition mechanism. The results revealed that right CER tDCS applied to the posterior lobe elicited a statistically significant (q < 0.05) brain response in bilateral prefrontal areas at the onset of the FLS task, surpassing the response seen with sham tDCS. Additionally, right CER tDCS led to a significant (p < 0.05) improvement in FLS scores compared to sham tDCS. Conversely, the left PFC tDCS did not yield a statistically significant brain response or improvement in FLS performance. In conclusion, right CER tDCS demonstrated the activation of bilateral prefrontal brain areas, providing valuable mechanistic insights into the effects of CER tDCS on FLS peformance. These insights motivate future investigations into the effects of CER tDCS on error-related perception-action coupling through directed functional connectivity studies.
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Affiliation(s)
- Pushpinder Walia
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Yaoyu Fu
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, United States
| | - Steven D. Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Xavier Intes
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Suvranu De
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
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12
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Wanderling C, Saxton A, Phan D, Sheppard L, Schuler N, Ghazi A. Recent Advances in Surgical Simulation For Resident Education. Curr Urol Rep 2023; 24:491-502. [PMID: 37736826 DOI: 10.1007/s11934-023-01178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE OF REVIEW Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks. RECENT FINDINGS Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations. Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.
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Affiliation(s)
| | - Aaron Saxton
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Dennis Phan
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Lauren Sheppard
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Nathan Schuler
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Ahmed Ghazi
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA.
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13
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Rodrigues ACLF, Shojaeian F, Thanawiboonchai T, Zevallos A, Greer J, Adrales GL. 3D versus 2D laparoscopic distal gastrectomy in patients with gastric cancer: a systematic review and meta-analysis. Surg Endosc 2023; 37:7914-7922. [PMID: 37430123 DOI: 10.1007/s00464-023-10271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND While laparoscopic gastrectomy is a prominent therapeutic approach for distal gastric cancer, the clinical benefits of 3D laparoscopy over 2D laparoscopy remain unclear. We aimed to compare the clinical outcomes of 3D laparoscopy and 2D laparoscopy for distal gastric cancer resection through a systematic review and meta-analysis. METHODS We searched PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published from inception through January 2023, according to the PRISMA guidelines. The MD or RR was used to compare 3D and 2D distal gastrectomy. Random-effects meta-analysis was estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous outcomes. RESULTS After reviewing 559 studies, 6 manuscripts met the inclusion criteria. The analysis included 689 patients, with 348 (50.5%) in the 3D group and 341 (49.5%) in the 2D group. 3D laparoscopic gastrectomy reduces the operative time (WMD - 28.57 min, 95% CI - 50.70 to - 6.44, p = 0.011), intraoperative blood loss (WMD - 6.69 mL, 95% CI - 8.09 to - 5.29, p < 0.001), and postoperative hospital stay (WMD - 0.92 days, 95% CI - 1.43 to - 0.42, p < 0.001). There were no significant differences in time to first postoperative flatus (WMD - 0.22 days, 95% CI - 0.50 to 0.05, p = 0.110), postoperative complications (Relative Risk 0.56, 95% CI 0.22 to 1.41, p = 0.217), and the number of retrieved lymph nodes (WMD 1.25, 95% CI - 0.54 to 3.03, p = 0.172) between 3 and 2D laparoscopic distal gastrectomy. CONCLUSION Our study highlights the potential advantages of 3D laparoscopy in distal gastrectomy, including shorter operative time, postoperative hospital stay, and decreased intraoperative blood loss.
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Affiliation(s)
- Amanda Cyntia Lima Fonseca Rodrigues
- Department of Medicine, Positivo University, Curitiba, Brazil
- Department of Statistics and Biostatistics, Anhembi Morumbi University, Curitiba, Brazil
| | - Fatemeh Shojaeian
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Theethawat Thanawiboonchai
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Alba Zevallos
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
- Universidad Científica del Sur, Lima, Peru
| | - Jonathan Greer
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA
| | - Gina L Adrales
- Department of Surgery, The Johns Hopkins University, 600 N. Wolfe St, Blalock 618, Baltimore, MD, 21093, USA.
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14
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Cardoso SA, Suyambu J, Iqbal J, Cortes Jaimes DC, Amin A, Sikto JT, Valderrama M, Aulakh SS, Ramana V, Shaukat B, Patel T. Exploring the Role of Simulation Training in Improving Surgical Skills Among Residents: A Narrative Review. Cureus 2023; 15:e44654. [PMID: 37799263 PMCID: PMC10549779 DOI: 10.7759/cureus.44654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
The role of simulation in medical education is crucial to the development of surgeons' skills. Surgical simulation can be used to improve surgical skills in a secure and risk-free environment. Animal models, simulated patients, virtual reality, and mannequins are some types of surgical simulation. As a result, feedback encourages students to reflect on their strengths and weaknesses, enabling them to focus on improvement. Healthcare simulation is a strong educational instrument, and the main goal of this is to give the students an opportunity to do a practical application of what they have learned through theory. Before taking it to the patients, they will already have certain tools they have previously acquired during the practice. This makes it easier for students to identify the knowledge gaps that they must fill to improve patient outcomes. Moreover, simulation brings a wonderful opportunity for students to acquire skills, gain confidence, and experience success before working with real patients, especially when their clinical exposure is limited. The use of simulation to teach technical skills to surgical trainees has become more prevalent. The cost of setting up a simulation lab ranges from $100,000 to $300,000. There are several ways to evaluate the effectiveness of simulation-based surgical training. Repetitive surgical simulation training can improve speed and fluidity in general surgical skills in comparison to conventional training. Few previous studies compared learners who received structured simulation training to a group of trainees who did not receive any simulation training in single-center randomized control research. Significantly faster and less time-consuming skill proficiency was noticeable in simulated trainees. Despite being anxious in the operating room for the first time, simulated trainees completed the surgery on time, demonstrating the effectiveness of surgical simulation training. Traditional surgical training involves senior-surgeon supervision in the operating room. In simulation-based training, the trainees have full control over clinical scenarios and settings; however, guidance and assessment are also crucial. Simulators allow users to practice tasks under conditions resembling real-life scenarios. Simulators can be compared with traditional surgical training methods for different reasons. For example, intraoperative bleeding may occasionally show up not only visibly on the screen but also by shaking the trocars erratically. Without haptics, training on virtual simulators can cause one's pulling and pushing forces, which are frequently greater than what the tissue needs, to be distorted. A good method of simulation training is using virtual reality simulators with haptics and simulated patients. The availability of these facilities is limited, though, and a typical session might include an exercise involving stacking sugar cubes and box trainers. The degree of expertise or competency is one area that needs clarification as medical education transitions to a competency-based paradigm. The article aims to provide an overview of simulation, methods of simulation training, and the key role and importance of surgical simulation in improving skills in surgical residents.
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Affiliation(s)
- Swizel Ann Cardoso
- Major Trauma Services, University Hospital Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Jenisha Suyambu
- Medical Education, Jonalta School of Medicine, University of Perpetual Help System Dalta, Laspinas City, PHL
| | | | - Diana Carolina Cortes Jaimes
- Epidemiology, Universidad Autónoma de Bucaramanga, Bucaramanga, COL
- Medicine, Pontificia Universidad Javeriana, Bogotá, COL
| | - Aamir Amin
- Cardiothoracic Surgery, Guy's and St Thomas National Health Service (NHS) Foundation Trust, London, GBR
| | - Jarin Tasnim Sikto
- College of Medicine, Jahurul Islam Medical College and Hospital, Kishoreganj, BGD
| | | | | | - Venkata Ramana
- Orthopedics, All India Institute of Medical Sciences, Mangalagiri, IND
| | | | - Tirath Patel
- College of Medicine, American University of Antigua, St. John, ATG
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15
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Bin Helayel H, Almazyad EM, Almazyad LM, Qadi R, Almubaiyd A, Al-Shahwan S. Evaluation of Surgical Requirements and Competencies of the Saudi Ophthalmology Training Program in a Tertiary Eye Specialist Hospital- A Cross-Sectional Study. Clin Ophthalmol 2023; 17:2373-2382. [PMID: 37605763 PMCID: PMC10440114 DOI: 10.2147/opth.s411239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
Purpose To evaluate the adequacy of a Saudi ophthalmology training programs in achieving the competencies outlined by the Saudi Commission for Health Specialties (SCFHS) and the Accreditation Council for Graduate Medical Education (ACGME) and to assess resident satisfaction with their training. Methods A cross-sectional survey was sent electronically to all trainees (n=50) enrolled in the King Khaled Eye Specialist Hospital (KKESH) ophthalmology training program by email and messaging app (Whatsapp). The survey was sent between January 20, 2021, and January 30, 2021. It evaluated the level of satisfaction with surgical training and skills. The surgical logbooks of all trainees were extracted, and identifiers were removed. Then they were compared with SCFHS and ACGME curriculums for ophthalmology training. Results Out of 50 invitees, 47 returned the questionnaire. All trainees were confident they could meet surgical requirements by the end of their training. Most trainees were satisfied (n=29, 61.7%) with their performance in core competency requirements. There was no difference between female and male trainees' comfort levels when performing surgical steps in core competency requirements (P=0.2). Senior trainees seem more satisfied with their performance, especially in core competency requirements (P=0.087). All trainees practice at the wet lab and a virtual reality simulator to improve their skills. Obstacles faced during training were highlighted, including low exposure in the operating theater (n=18, 37.50%), competition on cases (n=5, 10.42%), attending surgeons not willing to teach (n=5, 10.42%), COVID-19 pandemic (n=5, 10.42%), and complex cases (n=4, 8.33%). Conclusion The outcomes of the current study indicate that trainees at KKESH were adequately satisfied with their surgical training in general. Also, competencies outlined by both the SCFHS and the ACGME were adequately fulfilled.
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Affiliation(s)
- Halah Bin Helayel
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Enmar Mazyad Almazyad
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Laith Mazyad Almazyad
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ruba Qadi
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Ophthalmology Department, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Alhanoof Almubaiyd
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Ophthalmology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sami Al-Shahwan
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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16
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Palvia V, Huntly J, Seckin S, Ascher-Walsh C, Khalil S. Role of video self-assessment in laparoscopic simulation training: a randomized pilot trial. AJOG GLOBAL REPORTS 2023; 3:100224. [PMID: 37342469 PMCID: PMC10277594 DOI: 10.1016/j.xagr.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Residency programs have implemented simulation training to compensate for reduced operating room exposure. Video recording is an educational tool that can be utilized for coaching, telepresence, and self-assessment during simulation training. Data is limited on the utility of video recording and self-assessment for laparoscopic training in Ob/Gyn residency programs.. OBJECTIVE This study aimed to determine the role of video self-assessment as an educational tool in laparoscopic simulation training and to establish the feasibility of our study design for a larger randomized controlled trial. STUDY DESIGN This was a prospective pilot study with a parallel, randomized, trial design that occurred in the Department of Obstetrics and Gynecology at the Mount Sinai Hospital. Subject participation took place in a surgical simulation training room. A total of 23 subjects were recruited (7 medical students, 15 residents, 1 fellow) voluntarily. All participants completed the study. All the subjects completed a pretest survey. The surgical simulation room contained a single Fundamentals of Laparoscopic Surgery box trainer and video-recording station. For session #1, each participant performed 2 Fundamentals of Laparoscopic Surgery tasks (A, peg transfer; B, intracorporeal knot tie). Participants were video recorded during session #1 and were randomized to either receive or not receive their video recording. The video group (n=13) and control group (n=10) repeated the Fundamentals of Laparoscopic Surgery tasks 7 to 10 days later (session #2). The primary outcome was percentage change in completion time between sessions. Secondary outcomes were percentage change in peg and needle drops between sessions. RESULTS The participant characteristics (video vs control) were as follows: average training level (6.15 vs 4.90 years), self-assessment (1=poor, 10=excellent) of surgical skill (4.8 vs 3.7), and laparoscopic skill (4.4 vs 3.5). Training level was inversely correlated with completion time for tasks A and B (r, -0.79 and -0.87; P<.0001). Less experienced trainees required the maximum time allotted for each task in session #1 (A, 3; B, 13). Regarding the primary outcome, the video group improved less than the control group (A, 16.7% vs 28.3%; B, 14.4% vs 17.3%). After controlling for training level (residents only), the video group improved more in the primary outcome (A, 17% vs 7.4%; B, 20.9% vs 16.5%) and secondary outcomes (A, 0.0% vs -194.1%; B, 41.3% vs 37.6%). CONCLUSION Video self-assessment has a potential role in simulation training for obstetrics-gynecology residents. With key improvements, the feasibility of our study design was demonstrated in preparation for a future definitive trial.
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Affiliation(s)
- Vijay Palvia
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Manhattan, NY (Drs Palvia, Huntly, Seckin, Ascher-Walsh, and Khalil)
- Department of Obstetrics and Gynecology, Lincoln Hospital, Bronx, NY (Dr Palvia)
| | - Jaimie Huntly
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Manhattan, NY (Drs Palvia, Huntly, Seckin, Ascher-Walsh, and Khalil)
| | - Serin Seckin
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Manhattan, NY (Drs Palvia, Huntly, Seckin, Ascher-Walsh, and Khalil)
| | - Charles Ascher-Walsh
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Manhattan, NY (Drs Palvia, Huntly, Seckin, Ascher-Walsh, and Khalil)
| | - Susan Khalil
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Manhattan, NY (Drs Palvia, Huntly, Seckin, Ascher-Walsh, and Khalil)
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17
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Kiyasseh D, Laca J, Haque TF, Miles BJ, Wagner C, Donoho DA, Anandkumar A, Hung AJ. A multi-institutional study using artificial intelligence to provide reliable and fair feedback to surgeons. COMMUNICATIONS MEDICINE 2023; 3:42. [PMID: 36997578 PMCID: PMC10063640 DOI: 10.1038/s43856-023-00263-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/17/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Surgeons who receive reliable feedback on their performance quickly master the skills necessary for surgery. Such performance-based feedback can be provided by a recently-developed artificial intelligence (AI) system that assesses a surgeon's skills based on a surgical video while simultaneously highlighting aspects of the video most pertinent to the assessment. However, it remains an open question whether these highlights, or explanations, are equally reliable for all surgeons. METHODS Here, we systematically quantify the reliability of AI-based explanations on surgical videos from three hospitals across two continents by comparing them to explanations generated by humans experts. To improve the reliability of AI-based explanations, we propose the strategy of training with explanations -TWIX -which uses human explanations as supervision to explicitly teach an AI system to highlight important video frames. RESULTS We show that while AI-based explanations often align with human explanations, they are not equally reliable for different sub-cohorts of surgeons (e.g., novices vs. experts), a phenomenon we refer to as an explanation bias. We also show that TWIX enhances the reliability of AI-based explanations, mitigates the explanation bias, and improves the performance of AI systems across hospitals. These findings extend to a training environment where medical students can be provided with feedback today. CONCLUSIONS Our study informs the impending implementation of AI-augmented surgical training and surgeon credentialing programs, and contributes to the safe and fair democratization of surgery.
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Affiliation(s)
- Dani Kiyasseh
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena, CA, USA.
| | - Jasper Laca
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Taseen F Haque
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Uro-Oncology, Prostate Center Northwest, St. Antonius-Hospital, Gronau, Germany
| | - Daniel A Donoho
- Division of Neurosurgery, Center for Neuroscience, Children's National Hospital, Washington DC, USA
| | - Animashree Anandkumar
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
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18
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Patel S, Ouellet J, Driscoll M. Examining impact forces during posterior spinal fusion to implement in a novel physics-driven virtual reality surgical simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02819-w. [PMID: 36952119 DOI: 10.1007/s11517-023-02819-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
This study aims to understand the impact forces that surgeons apply to the human spine during a posterior spinal fusion procedure towards the development of a novel spine surgical simulator for training medical residents. The foci of this study are impact forces during graft placement and spinal interbody cage insertion. This study examined the lumbar intervertebral discs of two male cadaveric specimens. Impact forces were collected during graft and spinal cage insertion over multiple levels. An impulse hammer and a camera were used to collect impact forces and displacements, respectively. The results demonstrated a logarithmic relationship between impact forces and cumulative displacement during graft placement. This was also observed between cumulative displacement and number of impacts during spinal cage insertion. A linear relationship was observed for the impact forces and number of impacts during graft placement. Results suggest that surgeons rely on the feedback experienced from impact forces during graft insertion to gauge the amount of graft that was placed in a specific area of the disc. Impact forces during cage insertion provide information about any encountered obstacles. When developing surgical simulators, designing the force feedback system should require modelling these behaviors to effectively impart corresponding skills on a trainee.
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Affiliation(s)
- Sneha Patel
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - Jean Ouellet
- Orthopaedic Research Lab, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada.
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19
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Hincapié-Gutiérrez LC, Oviedo-Peñata CA, Rojas-Galvis MA, Riaño-Benavides CH, Maldonado-Estrada JG. Implementation of a Canine Ergonomic Abdominal Simulator for Training Basic Laparoscopic Skills in Veterinarians. Animals (Basel) 2023; 13:ani13071140. [PMID: 37048396 PMCID: PMC10093257 DOI: 10.3390/ani13071140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023] Open
Abstract
The validity of the CALMA Veterinary Lap-trainer simulator (CVLTS) for training basic veterinary laparoscopic skills was assessed and compared to a simple collapsible mobile box trainer. Ten veterinarian surgeons with no experience in laparoscopic surgery and four experts with at least two years of experience in minimally invasive surgery (MIS) were included. The training curriculum included object transfer, non-woven gauze cutting with curved scissors, and interrupted and continuous intracorporeal sutures, which were practiced on the CVLTS. The initial and final assessments were carried out in both the CVLTS and in a collapsible mobile simulator. These were video-recorded and evaluated by external experts using the Objective Structured Assessment of Technical Skills (OSATS) and a specific scale evaluation in a double-blinded schedule. The time, angular displacement, number, and movement smoothness were recorded using a hands movement assessment system (HMAS). Through a survey, the face validity and content were evaluated. The data were analyzed by a Pearson's proportions comparison or Mann Whitney U test and a bilateral Student's t-test. The experimental group OSATS, specific scores, and HMAS values, with the exception of the smoothness of movements, significantly improved after training, with no statistically significant differences compared to the expert group. No differences were found between the two simulators. The experts' and experimental participants' CVLTS mean score was 4.8. Our data support the CVLTS validations for laparoscopic surgery basic skills training.
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Affiliation(s)
- Luis C Hincapié-Gutiérrez
- OHVRI-Research Group, Faculty of Agrarian Sciences, University of Antioquia, Medellín 050034, Colombia
| | - Carlos A Oviedo-Peñata
- OHVRI-Research Group, Faculty of Agrarian Sciences, University of Antioquia, Medellín 050034, Colombia
- Tropical Animal Production Research Group, Faculty of Veterinary Medicine and Zootechny, University of Cordoba, Monteria 230002, Colombia
| | - Manuel A Rojas-Galvis
- Latin American Center for Research and Training in Minimally Invasive Surgery Foundation, Bogotá 251008, Colombia
| | - Carlos H Riaño-Benavides
- OHVRI-Research Group, Faculty of Agrarian Sciences, University of Antioquia, Medellín 050034, Colombia
| | - Juan G Maldonado-Estrada
- OHVRI-Research Group, Faculty of Agrarian Sciences, University of Antioquia, Medellín 050034, Colombia
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20
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An Innovative Comparative Analysis Approach for the Assessment of Laparoscopic Surgical Skills. SURGERIES 2023. [DOI: 10.3390/surgeries4010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Over the past few decades, surgeon training has changed dramatically. Surgical skills are now taught in a surgical skills laboratory instead of the operating room. Simulation-based training helps medical students improve their skills, but it has not revolutionized clinical education. One critical barrier to reaching such a desired goal is the lack of reliable, robust, and objective methods for assessing the effectiveness of training sessions and the development of students. In this paper, we will develop a new comparative analysis approach that employs network models as the central concept in establishing a new assessment tool for the evaluation of the surgical skills of trainees as well as the training processes. The model is populated using participants electromyography data while performing a simulation task. Furthermore, using NASA Task Load Index score, participants’ subjective overload levels are analyzed to examine the impact of participants’ perception of their mental demand, physical demand, temporal demand, performance, effort, and frustration on how participants perform each simulation task. Obtained results indicate that the proposed approach enables us to extract useful information from the raw data and provides an objective method for assessment the of surgical simulation tasks and how the participants’ perception of task impacts their performance.
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Imaizumi K, Ichikawa N, Homma S, Yamamoto K, Ishizuka C, Takahashi R, Fukasawa T, Hamada T, Hamada K, Matsui H, Miyaoka Y, Yoshida T, Taketomi A. Effect of Continuous Box-trainer Training on Laparoscopic Skills of Surgical Residents: A Prospective, Observational Study. In Vivo 2023; 37:476-482. [PMID: 36593060 PMCID: PMC9843792 DOI: 10.21873/invivo.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM As opportunities for hands-on surgical training during residency have decreased, off-the-job training before surgery is gaining importance. We developed a training program using a box-trainer for surgical residents. This study aimed to verify the effectiveness of the program. Using task-achievement time, we demonstrated the learning curve through continuous task training and verified the efficiency of our training tasks. In addition, we examined the circularity of the cut circle to evaluate the task accuracy and summarized the questionnaire results. PATIENTS AND METHODS A prospective, observational study was conducted at a single center with five trainees from April 2019 to March 2020. The training consisted of four tasks based on the Fundamentals of Laparoscopic Surgery module. The trainees had to achieve expert proficiency time targets. The task-achievement time and circularity of the cut circle were used for objective assessment; subjective evaluation was done using a questionnaire. RESULTS Although the learning curves of the task-achievement time seemed to reach a plateau between the third and the fifth skills lab, all the trainees achieved expert proficiency times for the three tasks. Circularity of the cut circle tended to be more accurate after training. All trainees perceived an improvement in their skills after the training program. The level of satisfaction of the training program was rated as 'very satisfied' or 'satisfied'. CONCLUSION Continuous box-trainer training for 1 year may be effective for improvement in preoperative laparoscopic surgical skills of surgical residents.
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Affiliation(s)
- Ken Imaizumi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keiichiro Yamamoto
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Chihiro Ishizuka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Takahashi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takumu Fukasawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takumi Hamada
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuya Hamada
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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22
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Human body donation and surgical training: a narrative review with global perspectives. Anat Sci Int 2023; 98:1-11. [PMID: 36227535 PMCID: PMC9845172 DOI: 10.1007/s12565-022-00689-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/06/2022] [Indexed: 02/01/2023]
Abstract
Utilization of human material in surgical simulation training has been well-established as an effective teaching method. Despite the value of donor-based surgical simulation training, its application may be hampered by difficulties regarding access to donated bodies. Therefore, the aim of this review is to assess body donation and body acquisition practices with regard to surgical simulation training programs around the world. The results of this review highlight discrepancies regarding body donation practices and surgical simulation programs among continents and countries. The utilization of donor bodies in surgical simulation appears to mirror body donation practices. In countries that rely mostly or exclusively upon unclaimed bodies or executed criminals, there are scant reports of donor-based surgical simulation programs. In countries where willed-body donation is the principal source of human material, there tend to be many surgical simulation programs that incorporate human material as part of surgical training. This review suggests that, in anatomical and surgical education, the utilization of active willed-body donation programs, as opposed to the utilization of unclaimed human bodies, positively corresponds with the development of beneficial donor-based surgical simulation programs. Likewise, donor-based surgical simulation training programs may have an influence on the perpetualization of willed-body donations.
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23
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Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Error-related brain state analysis using electroencephalography in conjunction with functional near-infrared spectroscopy during a complex surgical motor task. Brain Inform 2022; 9:29. [PMID: 36484977 PMCID: PMC9733771 DOI: 10.1186/s40708-022-00179-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Error-based learning is one of the basic skill acquisition mechanisms that can be modeled as a perception-action system and investigated based on brain-behavior analysis during skill training. Here, the error-related chain of mental processes is postulated to depend on the skill level leading to a difference in the contextual switching of the brain states on error commission. Therefore, the objective of this paper was to compare error-related brain states, measured with multi-modal portable brain imaging, between experts and novices during the Fundamentals of Laparoscopic Surgery (FLS) "suturing and intracorporeal knot-tying" task (FLS complex task)-the most difficult among the five psychomotor FLS tasks. The multi-modal portable brain imaging combined functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) for brain-behavior analysis in thirteen right-handed novice medical students and nine expert surgeons. The brain state changes were defined by quasi-stable EEG scalp topography (called microstates) changes using 32-channel EEG data acquired at 250 Hz. Six microstate prototypes were identified from the combined EEG data from experts and novices during the FLS complex task that explained 77.14% of the global variance. Analysis of variance (ANOVA) found that the proportion of the total time spent in different microstates during the 10-s error epoch was significantly affected by the skill level (p < 0.01), the microstate type (p < 0.01), and the interaction between the skill level and the microstate type (p < 0.01). Brain activation based on the slower oxyhemoglobin (HbO) changes corresponding to the EEG band power (1-40 Hz) changes were found using the regularized temporally embedded Canonical Correlation Analysis of the simultaneously acquired fNIRS-EEG signals. The HbO signal from the overlying the left inferior frontal gyrus-opercular part, left superior frontal gyrus-medial orbital, left postcentral gyrus, left superior temporal gyrus, right superior frontal gyrus-medial orbital cortical areas showed significant (p < 0.05) difference between experts and novices in the 10-s error epoch. We conclude that the difference in the error-related chain of mental processes was the activation of cognitive top-down attention-related brain areas, including left dorsolateral prefrontal/frontal eye field and left frontopolar brain regions, along with a 'focusing' effect of global suppression of hemodynamic activation in the experts, while the novices had a widespread stimulus(error)-driven hemodynamic activation without the 'focusing' effect.
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Affiliation(s)
- Pushpinder Walia
- grid.273335.30000 0004 1936 9887Neuroengineering and Informatics for Rehabilitation Laboratory, Department of Biomedical Engineering, University at Buffalo, Buffalo, USA
| | - Yaoyu Fu
- grid.273335.30000 0004 1936 9887Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, USA
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, USA
| | - Steven D. Schwaitzberg
- grid.273335.30000 0004 1936 9887University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Xavier Intes
- grid.33647.350000 0001 2160 9198Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY USA ,grid.33647.350000 0001 2160 9198Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, USA
| | - Suvranu De
- grid.33647.350000 0001 2160 9198Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY USA ,grid.33647.350000 0001 2160 9198Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, USA
| | - Lora Cavuoto
- grid.273335.30000 0004 1936 9887Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, USA
| | - Anirban Dutta
- grid.36511.300000 0004 0420 4262Neuroengineering and Informatics for Rehabilitation and Simulation-Based Learning, University of Lincoln, Lincoln, UK
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24
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Tjønnås MS, Guzmán-García C, Sánchez-González P, Gómez EJ, Oropesa I, Våpenstad C. Stress in surgical educational environments: a systematic review. BMC MEDICAL EDUCATION 2022; 22:791. [PMID: 36380334 PMCID: PMC9667591 DOI: 10.1186/s12909-022-03841-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance. METHODS A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682). RESULTS Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance. CONCLUSIONS The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
- SINTEF Digital, Health Department, Trondheim, Norway.
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Enrique Javier Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Cecilie Våpenstad
- SINTEF Digital, Health Department, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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25
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Haque TF, Hui A, You J, Ma R, Nguyen JH, Lei X, Cen S, Aron M, Collins JW, Djaladat H, Ghazi A, Yates KA, Abreu AL, Daneshmand S, Desai MM, Goh AC, Hu JC, Lebastchi AH, Lendvay TS, Porter J, Schuckman AK, Sotelo R, Sundaram CP, Gill IS, Hung AJ. An Assessment Tool to Provide Targeted Feedback to Robotic Surgical Trainees: Development and Validation of the End-To-End Assessment of Suturing Expertise (EASE). UROLOGY PRACTICE 2022; 9:532-539. [PMID: 36844996 PMCID: PMC9948038 DOI: 10.1097/upj.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Purpose To create a suturing skills assessment tool that comprehensively defines criteria around relevant sub-skills of suturing and to confirm its validity. Materials and Methods 5 expert surgeons and an educational psychologist participated in a cognitive task analysis (CTA) to deconstruct robotic suturing into an exhaustive list of technical skill domains and sub-skill descriptions. Using the Delphi methodology, each CTA element was systematically reviewed by a multi-institutional panel of 16 surgical educators and implemented in the final product when content validity index (CVI) reached ≥0.80. In the subsequent validation phase, 3 blinded reviewers independently scored 8 training videos and 39 vesicourethral anastomoses (VUA) using EASE; 10 VUA were also scored using Robotic Anastomosis Competency Evaluation (RACE), a previously validated, but simplified suturing assessment tool. Inter-rater reliability was measured with intra-class correlation (ICC) for normally distributed values and prevalence-adjusted bias-adjusted Kappa (PABAK) for skewed distributions. Expert (≥100 prior robotic cases) and trainee (<100 cases) EASE scores from the non-training cases were compared using a generalized linear mixed model. Results After two rounds of Delphi process, panelists agreed on 7 domains, 18 sub-skills, and 57 detailed sub-skill descriptions with CVI ≥ 0.80. Inter-rater reliability was moderately high (ICC median: 0.69, range: 0.51-0.97; PABAK: 0.77, 0.62-0.97). Multiple EASE sub-skill scores were able to distinguish surgeon experience. The Spearman's rho correlation between overall EASE and RACE scores was 0.635 (p=0.003). Conclusions Through a rigorous CTA and Delphi process, we have developed EASE, whose suturing sub-skills can distinguish surgeon experience while maintaining rater reliability.
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Affiliation(s)
- Taseen F. Haque
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Alvin Hui
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Jonathan You
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Runzhuo Ma
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Jessica H. Nguyen
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Xiaomeng Lei
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Steven Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Monish Aron
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Justin W. Collins
- Division of Uro-oncology, University College London Hospital, London, UK
| | - Hooman Djaladat
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Ahmed Ghazi
- Urology Department, University of Rochester, Rochester, NY
| | - Kenneth A. Yates
- Rossier School of Education, University of Southern California, Los Angeles, CA
| | - Andre L. Abreu
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Siamak Daneshmand
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Mihir M. Desai
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Alvin C. Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Amir H. Lebastchi
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | | | | | - Anne K. Schuckman
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Rene Sotelo
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | | | - Inderbir S. Gill
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Andrew J. Hung
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
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de Sá VHLC, Pazin GS, Elias PE, Achar E, Pereira Filho GV. How to do it: Teaching surgical skills to medical undergraduates. Ann Med Surg (Lond) 2022; 82:104617. [PMID: 36268337 PMCID: PMC9577497 DOI: 10.1016/j.amsu.2022.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022] Open
Abstract
Medical students must be capable of performing clinical and surgical procedures in outpatient care and initial emergency care in all stages of the biological cycle. Here, we describe the surgical skills schedule with different animal models fulfilled at the Municipal University of São Caetano do Sul (USCS) Medical School, São Caetano do Sul, SP, Brazil, during the surgical abilities module. We retrospectively reviewed the surgical abilities module schedule provided at the USCS Medical School from 2015 until 2020; in this paper, we describe the use of different animal models. The activities were developed for two semesters during medical school and included an ox tongue, cylindrical Styrofoam, chicken leg and neck, live rabbits, and pigs. Practical surgical teaching starts with sutures using the ox tongue, after which students are taught to perform tenorrhaphy using cylindrical Styrofoam and chicken legs, followed by vascular anastomosis using the chicken trachea and esophagus. Rabbits are appropriate for training a variety of procedures such as cystostomy, gastrostomy, and appendectomy. Pigs allow for the simulation of several types of procedures such as chest drainage. Surgical training for medical undergraduates was demonstrated with an evolutionary intent, starting with simple sutures and ending up with basic emergency room surgical procedures.
There is no standard of how to teach surgical skills for medical undergraduates. Many articles have been presented discussing different materials. Surgical skills should be taught in an evolutionary way – from simple to complex. We start simple and finish with surgical procedures in live animals.
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Affiliation(s)
- Victor Hugo Lara Cardoso de Sá
- Plastic Surgery Department of ABC Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
- Surgical Abilities Module of USCS Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
- Corresponding author. 1341 Tabapua street, apt 122, Itaim Bibi, São Paulo, SP, 04533014, Brazil.
| | - Giovanna Savoy Pazin
- General Surgery Resident at PUC-Sorocaba Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
| | - Pablo Eduardo Elias
- Plastic Surgery Department of ABC Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
- Surgical Abilities Module of USCS Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
| | - Eduardo Achar
- Surgical Abilities Module of USCS Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
- Surgical Abilities Module of UNICID Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
| | - Gerson Vilhena Pereira Filho
- Plastic Surgery Department of ABC Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
- Surgical Abilities Module of USCS Medical School, University of São Caetano do Sul (USCS) Medical School, 50 Santo Antonio Street, São Caetano do Sul, SP, Brazil
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Kamat A, Makled B, Norfleet J, Schwaitzberg SD, Intes X, De S, Dutta A. Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology. NPJ SCIENCE OF LEARNING 2022; 7:19. [PMID: 36008451 PMCID: PMC9411170 DOI: 10.1038/s41539-022-00138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/04/2022] [Indexed: 05/11/2023]
Abstract
Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.
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Affiliation(s)
- Anil Kamat
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Basiel Makled
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | - Jack Norfleet
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | | | - Xavier Intes
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
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McCormick ME. Trends in Subglottic Stenosis Management: Resource Utilization and Pediatric Otolaryngology Training. Laryngoscope 2022; 132 Suppl 5:S1-S9. [DOI: 10.1002/lary.28927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Michael E. McCormick
- Department of Otolaryngology Medical College of Wisconsin Milwaukee Wisconsin U.S.A
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Gotfryd AO, Paula FCD, Sauma ML, Iutaka AS, Rodrigues LMR, Meyer GPC, Teivelis MP, Poetscher AW, Del Curto D, Kang DWW, Cintra L, Gregores GB, Lenza M, Ferretti M. Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations. EINSTEIN-SAO PAULO 2022; 20:eAO6318. [PMID: 35195190 PMCID: PMC8809647 DOI: 10.31744/einstein_journal/2022ao6318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/14/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.
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Heskin L, Simms C, Traynor O, Galvin R. Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees. BMC Surg 2021; 21:417. [PMID: 34911527 PMCID: PMC8672577 DOI: 10.1186/s12893-021-01417-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma. Methods Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis. Results Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement. Conclusion There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01417-7.
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Affiliation(s)
- L Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland.
| | - C Simms
- Trinity College Dublin, Dublin, Ireland
| | - O Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland
| | - R Galvin
- University of Limerick, Limerick, Ireland
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Gautam UC, Pydi YS, Selladurai S, Das CJ, Thittai AK, Roy S, Datla NV. A Poly-vinyl Alcohol (PVA)-based phantom and training tool for use in simulated Transrectal Ultrasound (TRUS) guided prostate needle biopsy procedures. Med Eng Phys 2021; 96:46-52. [PMID: 34565552 DOI: 10.1016/j.medengphy.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Trans-rectal ultrasound-guided needle biopsy is a well-established diagnosis technique for prostate cancer. To enhance the needle manoeuvring skills under ultrasound (US) guidance, it is preferable to train medical practitioners in needle biopsy on tissue-mimicking phantoms. This phantom should mimic the morphology as well as mechanical and acoustic properties of the human male pelvic region to provide a surgical experience and feedback. In this study, polyvinyl alcohol (PVA) was used and evaluated for prostate phantom development, that is stiffness tunable, US-compatible and durable phantom material. Three samples, each with 5%, 10%, and 15% concentration of PVA material, were prepared, and their mechanical and shrinkage characteristics were investigated. The anatomy of male pelvic region was used to develop an anatomically correct phantom. Later US-guided needle biopsy was performed on the phantom. The range of elastic moduli of the PVA samples was 2∼146 kPa. Their elastic moduli and volumes were found to remain statistically close from seventh to eighth freeze-thaw cycle (p>0.05). Initial US scans of the phantom resulted in satisfactory B-mode images, with a clear distinction between the prostate and its surrounding organs. This study demonstrated the applicability of PVA hydrogel as a phantom material for training in US-guided needle biopsy.
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Affiliation(s)
- Umesh C Gautam
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India; Department of Applied Mechanics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Yeswanth S Pydi
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | | | - Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Arun K Thittai
- Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai 600036, India
| | - Sitikantha Roy
- Department of Applied Mechanics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Naresh V Datla
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
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Gupta PC, Singh R, Khurana S, Behera RK, Thattaruthody F, Pandav SS, Ram J. Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India. Indian J Ophthalmol 2021; 69:1928-1932. [PMID: 34146058 PMCID: PMC8374778 DOI: 10.4103/ijo.ijo_566_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as ‘severe’ by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. Methods: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand–eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand–eye coordination of the residents. Results: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. Conclusion: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjan Kumar Behera
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faisal Thattaruthody
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nillahoot N, Patel S, Suthakorn J. A Technique for Mimicking Soft Tissue Manipulation from Experimental Data to a Wave Equation Model for a New Laparoscopic Virtual Reality Training System. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background:
The difficulty of laparoscopic procedures and the specific psychomotor skills required support the need for a training system for intensive and repetitive practice to acquire the specific skills. The present VR training systems have some limitations with respect to the soft tissue models in the training system. This is associated with the need for a real-time simulation, which requires a balance between computational cost and accuracy.
Objective:
The primary objective of the study is to develop a two dimensional wave equation model that closely mimics the soft tissue manipulation in a laparoscopic procedure for a VR training system.
Methods:
A novel mathematical model based on the wave equation is prepared to represent the interaction between the laparoscopic tool and the soft tissue. The parameters within the model are determined through experimental analysis of a soft tissue phantom. The experimental setup involves a linear actuator applying force to the soft tissue phantom to generate deformation. Data acquisition is conducted through a camera and a robotic force acquisition system which measures force, displacement of the linear actuator and records a video. Through image processing, the displacements of the markers on the phantom’s x-y plane during its deformation are determined and these parameters are used to develop the model, which finally is validated through a comparative analysis.
Results:
The results from the developed model are observed and compared statistically as well as graphically with the finite element model based on deformation data. The results show that the deformation data between the developed model and the available model is significantly similar.
Conclusion:
This study demonstrates the adaptability of the wave equation to meet the needs of the specific surgical procedure through modification of the model based on the experimental data. Moreover, the comparative analysis further corroborates the relevance and validity of the model for the surgical training system.
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Duboureau H, Renaud-Petel M, Klein C, Haraux E. Development and evaluation of a low-cost part-task trainer for laparoscopic repair of inguinal hernia in boys and the acquisition of basic laparoscopy skills. J Pediatr Surg 2021; 56:674-677. [PMID: 32631609 DOI: 10.1016/j.jpedsurg.2020.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/24/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine the fidelity of our model of laparoscopic inguinal hernia repair (LIHR) in boys and evaluate its value in resident training programs and the learning of basic laparoscopy skills. METHODS We created a simulation model with inexpensive, easy-to-obtain equipment. Study participants from 34 university hospital departments received a user manual and an evaluation questionnaire (11 items rated on a 5-point Likert scale). We considered that the evaluation was positive when the median overall score was 4 or over. We compared the results for residents (n=26) vs. expert surgeons (n=29) (t tests). RESULTS The duration of the procedure was significantly longer among the residents (30.0±16.8 min) than among the expert surgeons (20.5±11.7 min; p=0.01). In both groups, the participants rated the model favorably with regard to the overall impression (median score: 4.0±1.0), realism (4.0±0.9), ease of access to the required equipment (5.0±0.6), the quality of the user manual (5.0±0.6), ease of assembly (5.0±0.8), ease of the procedure (5.0±0.8), value in resident training programs (4.0±0.9), and value in learning basic laparoscopy skills (5.0±0.8)). The evaluation was positive (4.0±0.9). CONCLUSION Our low-cost model was an effective teaching and training tool for LIHR and basic laparoscopy skills. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hortense Duboureau
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France
| | | | - Céline Klein
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France
| | - Elodie Haraux
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France.
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Rastegari E, Orn D, Zahiri M, Nelson C, Ali H, Siu KC. Assessing Laparoscopic Surgical Skills Using Similarity Network Models: A Pilot Study. Surg Innov 2021; 28:600-610. [PMID: 33745371 DOI: 10.1177/15533506211002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Medical devices are becoming more complex, and doctors need to learn quickly how to use new medical tools. However, it is challenging to objectively assess the fundamental laparoscopic surgical skill level and determine skill readiness for advancement. There is a lack of objective models to compare performance between medical trainees and experienced doctors. Methods: This article discusses the use of similarity network models for individual tasks and a combination of tasks to show the level of similarity between residents and medical students while performing each task and their overall laparoscopic surgical skill level using a medical device (eg laparoscopic instruments). When a medical student is connected to most residents, that student is competent to the next training level. Performance of sixteen participants (5 residents and 11 students) while performing 3 tasks in 3 different training schedules is used in this study. Results: The promising result shows the general positive progression of students over 4 training sessions. Our results also indicate that students with different training schedules have different performance levels. Students' progress in performing a task is quicker if the training sessions are held more closely compared to when the training sessions are far apart in time. Conclusions: This study provides a graph-based framework for evaluating new learners' performance on medical devices and their readiness for advancement. This similarity network method could be used to classify students' performance using similarity thresholds, facilitating decision-making related to training and progression through curricula.
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Affiliation(s)
- Elham Rastegari
- Department of Business Intelligence and Analytics, 6216Creighton University, Omaha, NE, USA
| | - Donovan Orn
- College of Information Science and Technology, 14720University of Nebraska at Omaha, Omaha, NE, USA
| | - Mohsen Zahiri
- Senior Research Scientist, BioSensics LLC, Watertown, MA, USA
| | - Carl Nelson
- Department of Mechanical and Materials Engineering, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Hesham Ali
- College of Information Science and Technology, 14720University of Nebraska at Omaha, Omaha, NE, USA
| | - Ka-Chun Siu
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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Cruff J. Robotic Surgical Training at Home: A Low-Fidelity Simulation Method. JOURNAL OF SURGICAL EDUCATION 2021; 78:379-381. [PMID: 32747322 DOI: 10.1016/j.jsurg.2020.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Laparoscopic box simulators provide surgical residents a cost-effective and accessible learning tool to practice basic laparoscopic skills. Despite effective, high-fidelity simulators used in robotic surgery training, a similar low-fidelity alternative simulation method is not available. The objective of this report and accompanying video is to introduce a low-fidelity method to help those new to robotic-assisted surgery learn fundamental skills even before sitting at the console. METHOD Using 2 fine-point metal tweezers with Velco loops for finger slots, I developed a user-friendly way to practice basic needle handling and intracorporeal knot tying activities similar to those encountered on a high-fidelity robotic simulator. These simple tools mimic the controllers at the actual robot console. EXPERIENCE This teaching tool is meant to help surgical trainees and those new to robotic surgery develop the initial dexterity and economy of motion for performing basic tasks. I have greatly improved my own surgical confidence and experience anecdotally using these tools before I sat for actual cases. I hope a motivated trainee may discover the same benefit. CONCLUSIONS A low-fidelity simulation method may enhance a learner's initial proficiency in robotic-assisted surgery, but future performance studies using this method will be needed.
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Affiliation(s)
- Jason Cruff
- Advanced Urogynecology of Michigan, PC, Dearborn, Michigan; Beaumont Health, Wayne, Michigan.
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Skervin AL, Scott HJ. Mental rehearsal: A useful simulation adjunct to surgical training. Surgeon 2021; 19:e423-e429. [PMID: 33583688 DOI: 10.1016/j.surge.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Simulation is an effective adjunct to surgical training. There is increasing interest in the use of mental rehearsal as a form of cognitive simulation. The mental visualisation of a motor skill is recognised to enhance performance; a concept not novel to surgeons. Despite this, mental rehearsal has yet to be formally incorporated into surgical training. This study aims to assess the use of mental rehearsal amongst general surgical trainees and consultants. METHOD A six-item questionnaire was designed and electronically circulated to general surgical core trainees, registrars, fellows and consultants. Qualitative and quantitative analysis was independently performed. RESULTS 153 responses (consultants = 51.6%, trainees = 48.4%) were received over 3 weeks. 91.5% of surgeons mentally rehearse prior to operating. Its use predominates for complex cases only. There is no difference in case complexity and the surgeon's grade in regard to when mental rehearsal is performed (χ2 = 1.027, p = 0.31). Individual mental rehearsal is preferred. Consultants are more likely to mentally rehearse with others, although there was no statistical difference compared to trainees (χ2 = 0.239, p = 0.63). Clarification, confidence and anticipation of potential difficulties were the perceived benefits of mental rehearsal reported in 58.6% of responses. CONCLUSIONS Mental rehearsal prior to operating appears instinctive for general surgeons irrespective of seniority and case complexity. Whether the efficacy of mental rehearsal on training is sustained and continues as surgeons progress along the training curve are unknown. Alternative methods of surgical training are very much needed. We propose mental rehearsal.
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Affiliation(s)
- A L Skervin
- Colorectal Surgical Department, St Peter's Hospital, Guildford Road, Chertsey, KT16 0PZ, UK.
| | - H J Scott
- Colorectal Surgical Department, St Peter's Hospital, Guildford Road, Chertsey, KT16 0PZ, UK
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Hanrahan JG, Sideris M, Pasha T, Dedeilia A, Papalois A, Papalois V. Postgraduate Assessment Approaches Across Surgical Specialties: A Systematic Review of the Published Evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:285-295. [PMID: 32889945 DOI: 10.1097/acm.0000000000003712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Ensuring competence for surgical trainees requires holistic assessment of the qualities and competencies necessary to practice safely and effectively. To determine the next steps toward achieving this aim, the authors conducted a systematic review to summarize and appraise the available evidence related to any assessment approach to postgraduate surgical training and to identify the dominant themes for assessment approaches across different specialties or countries. METHOD Medline and Embase were searched on January 10, 2019, without language or time restrictions. Any peer-reviewed study that described an assessment framework (in practice or novel) throughout postgraduate surgical training globally was included. An iterative review and thematic analysis were performed on full-text articles to determine assessment themes. Studies were then grouped by assessment themes. A tailored quality assessment of the studies included in the final analysis was conducted. Assessment themes and validity were compared across surgical specialties and countries. RESULTS From an initial 7,059 articles, 91 studies (evaluating 6,563 surgical trainees) were included in the final analysis. Ten defined assessment themes were extracted. Ten studies (11.0%) were deemed low risk of bias based on the quality assessment tool used and thus were determined to be high quality. Minor differences in assessment themes were observed between specialties and countries. Assessment themes neglected by individual surgical specialties and assessment themes that need validated assessment tools were identified. CONCLUSIONS This review highlights the low quality of evidence and fragmented efforts to develop and optimize surgical assessments. The minor differences observed demonstrate a common approach, globally and across specialties, related to surgical assessments. A paradigm shift in assessment approaches, which will require national and international collaboration, is required to optimize design and validation so that a comprehensive assessment of surgical competence can be implemented.
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Affiliation(s)
- John Gerrard Hanrahan
- J.G. Hanrahan is academic foundation doctor, Department of General Surgery, Lister Hospital, Stevenage, United Kingdom
| | - Michail Sideris
- M. Sideris is a specialty trainee in obstetrics and gynaecology, Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
| | - Terouz Pasha
- T. Pasha is a final-year medical student, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Aikaterini Dedeilia
- A. Dedeilia is a final-year medical student, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Papalois
- A. Papalois is director, ELPEN Research & Experimental Centre, Athens, Greece
| | - Vassilios Papalois
- V. Papalois is professor of transplant surgery, Department of Surgery and Cancer, Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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IMHOTEP: cross-professional evaluation of a three-dimensional virtual reality system for interactive surgical operation planning, tumor board discussion and immersive training for complex liver surgery in a head-mounted display. Surg Endosc 2021; 36:126-134. [PMID: 33475848 PMCID: PMC8741674 DOI: 10.1007/s00464-020-08246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Virtual reality (VR) with head-mounted displays (HMD) may improve medical training and patient care by improving display and integration of different types of information. The aim of this study was to evaluate among different healthcare professions the potential of an interactive and immersive VR environment for liver surgery that integrates all relevant patient data from different sources needed for planning and training of procedures. METHODS 3D-models of the liver, other abdominal organs, vessels, and tumors of a sample patient with multiple hepatic masses were created. 3D-models, clinical patient data, and other imaging data were visualized in a dedicated VR environment with an HMD (IMHOTEP). Users could interact with the data using head movements and a computer mouse. Structures of interest could be selected and viewed individually or grouped. IMHOTEP was evaluated in the context of preoperative planning and training of liver surgery and for the potential of broader surgical application. A standardized questionnaire was voluntarily answered by four groups (students, nurses, resident and attending surgeons). RESULTS In the evaluation by 158 participants (57 medical students, 35 resident surgeons, 13 attending surgeons and 53 nurses), 89.9% found the VR system agreeable to work with. Participants generally agreed that complex cases in particular could be assessed better (94.3%) and faster (84.8%) with VR than with traditional 2D display methods. The highest potential was seen in student training (87.3%), resident training (84.6%), and clinical routine use (80.3%). Least potential was seen in nursing training (54.8%). CONCLUSIONS The present study demonstrates that using VR with HMD to integrate all available patient data for the preoperative planning of hepatic resections is a viable concept. VR with HMD promises great potential to improve medical training and operation planning and thereby to achieve improvement in patient care.
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Mondal SB, Achilefu S. Virtual and Augmented Reality Technologies in Molecular and Anatomical Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Su Yin M, Haddawy P, Suebnukarn S, Kulapichitr F, Rhienmora P, Jatuwat V, Uthaipattanacheep N. Formative feedback generation in a VR-based dental surgical skill training simulator. J Biomed Inform 2020; 114:103659. [PMID: 33378704 DOI: 10.1016/j.jbi.2020.103659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/22/2023]
Abstract
Fine motor skill is indispensable for a dentist. As in many other medical fields of study, the traditional surgical master-apprentice model is widely adopted in dental education. Recently, virtual reality (VR) simulators have been employed as supplementary components to the traditional skill-training curriculum, and numerous dental VR systems have been developed academically and commercially. However, the full promise of such systems has yet to be realized due to the lack of sufficient support for formative feedback. Without such a mechanism, evaluation still demands dedicated time of experts in scarce supply. To fill the gap of formative assessment using VR simulators in skill training in dentistry, we present a framework to objectively assess the surgical skill and generate formative feedback automatically. VR simulators enable collecting detailed data on relevant metrics throughout a procedure. Our approach to formative feedback is to correlate procedure metrics with the procedure outcome to identify the portions of a procedure that need to be improved. Specifically, for the errors in the outcome, the responsible portions of the procedure are identified by using the location of the error. Tutoring formative feedback is provided using the video modality. The effectiveness of the feedback system is evaluated with dental students using randomized controlled trials. The findings show the feedback mechanisms to be effective and to have the potential to be used as valuable supplemental training resources.
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Affiliation(s)
- Myat Su Yin
- Faculty of ICT, Mahidol University, Nakhon Pathom, Thailand.
| | - Peter Haddawy
- Faculty of ICT, Mahidol University, Nakhon Pathom, Thailand.
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IJgosse WM, van Goor H, Rosman C, Luursema JM. The Fun Factor: Does Serious Gaming Affect the Volume of Voluntary Laparoscopic Skills Training? World J Surg 2020; 45:66-71. [PMID: 32989581 PMCID: PMC7752875 DOI: 10.1007/s00268-020-05800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
Background The availability of validated laparoscopic simulators has not resulted in sustainable high-volume training. We investigated whether the validated laparoscopic serious game Underground would increase voluntary training by residents. We hypothesized that by removing intrinsic barriers and extrinsic barriers, residents would spend more time on voluntary training with Underground compared to voluntary training with traditional simulators. Methods After 1 year, we compared amount of voluntary time spent on playing Underground to time spent on all other laparoscopic training modalities and to time spent on performing laparoscopic procedures in the OR for all surgical residents. These data were compared to resident’ time spent on laparoscopic activities over the prior year before the introduction of Underground. Results From March 2016 until March 2017, 63 residents spent on average 20 min on voluntary serious gaming, 17 min on voluntary simulator training, 2 h and 44 min on mandatory laparoscopic training courses, and 14 h and 49 min on laparoscopic procedures in the OR. Voluntary activities represented 3% of laparoscopic training activities which was similar in the prior year wherein fifty residents spent on average 33 min on voluntary simulator training, 3 h and 28 min on mandatory laparoscopic training courses, and 11 h and 19 min on laparoscopic procedures. Conclusion Serious gaming has not increased total voluntary training volume. Underground did not mitigate intrinsic and extrinsic barriers to voluntary training. Mandatory, scheduled training courses remain needed. Serious gaming is flexible and affordable and could be an important part of such training courses.
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Affiliation(s)
- Wouter Martijn IJgosse
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Radboud University Medical Center, PO Box 9101 (960), 6500 HB, Nijmegen, The Netherlands.
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan-Maarten Luursema
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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van Ginkel MPH, Schijven MP, van Grevenstein WMU, Schreuder HWR. Bimanual Fundamentals: Validation of a New Curriculum for Virtual Reality Training of Laparoscopic Skills. Surg Innov 2020; 27:523-533. [PMID: 32865136 PMCID: PMC8580384 DOI: 10.1177/1553350620953030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background. To determine face and construct validity for the new
Bimanual Fundamentals curriculum for the Simendo® Virtual Reality
Laparoscopy Simulator and prove its efficiency as a training and objective
assessment tool for surgical resident’s advanced psychomotor skills.
Methods. 49 participants were recruited: 17 medical
students (novices), 15 residents (intermediates), and 17 medical specialists
(experts) in the field of gynecology, general surgery, and urology in 3 tertiary
medical centers in the Netherlands. All participants performed the 5 exercises
of the curriculum for 3 consecutive times on the simulator. Intermediates and
experts filled in a questionnaire afterward, regarding the reality of the
simulator and training goals of each exercise. Statistical analysis of
performance was performed between novices, intermediates, and experts.
Parameters such as task time, collisions/displacements, and path length right
and left were compared between groups. Additionally, a total performance score
was calculated for each participant. Results. Face validity
scores regarding realism and training goals were overall positive (median scores
of 4 on a 5-point Likert scale). Participants felt that the curriculum was a
useful addition to the previous curricula and the used simulator would fit in
their residency programs. Construct validity results showed significant
differences on the great majority of measured parameters between groups. The
simulator is able to differentiate between performers with different levels of
laparoscopic experience. Conclusions. Face and construct
validity for the new Bimanual Fundamental curriculum for the Simendo virtual
reality simulator could be established. The curriculum is suitable to use in
resident’s training programs to improve and maintain advanced psychomotor
skills.
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Affiliation(s)
- Martijn P H van Ginkel
- Department of Obstetrics and Gynecology, 8124University Medical Center Utrecht, the Netherlands
| | | | | | - Henk W R Schreuder
- Department of Gynecologic Oncology, Cancer Center, 8124University Medical Center Utrecht, the Netherlands
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Laverdiere C, Harvey E, Schupbach J, Boily M, Burman M, Martineau PA. Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling. Orthop J Sports Med 2020; 8:2325967120905795. [PMID: 32201706 PMCID: PMC7068746 DOI: 10.1177/2325967120905795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Femoral tunnel positioning in anterior cruciate ligament reconstruction
(ACLR) is an intricate procedure that requires highly specific surgical
skills. Purpose: To report the ability of residents to identify femoral landmarks and the
native ACL footprint before and after a structured formal teaching session
as a reflection of overall surgical skill training for orthopaedic surgery
residents in Canada. Study Design: Controlled laboratory study. Methods: A total of 13 senior orthopaedic residents were asked to identify a femoral
landmark and an ACL footprint on ten 3-dimensional (3D)–printed knee models
before and after a teaching session during the fall of 2018. The 3D models
were made based on actual patients with different anatomic morphologic
features. ImageJ software was used to quantify the measurements, which were
then analyzed through use of descriptive statistics. Results: Before and after the teaching session, residents attempted to identify a
specific anatomic location (bifurcate and intercondylar ridge intersection)
with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to
12.13 mm in magnitude, respectively. Furthermore, before and after the
teaching session, residents identified the specific position to perform the
surgical procedure (ACL femoral footprint), with a mean error per
participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude,
respectively. The teaching session resulted in no significant improvement in
identification of either the intersection of the bifurcate and intercondylar
ridges (P = .9343 in the proximal-distal axis and
P = .8133 in the anteroposterior axis) or the center of
the femoral footprint (P = .7761 in the proximal-distal
axis and P = .9742 in the anteroposterior axis). Conclusion: Although a formal teaching session was combined with a hands-on session that
entailed real surgical instrumentation and fresh cadaveric specimens, the
intervention seemed to have no direct impact on senior residents’
performance or their ability to demonstrate the material taught. This puts
into question the format and efficacy of present teaching methods. Also, it
is possible that the 3D spatial perception required to perform these skills
is not something that can be taught effectively through a teaching session
or at all. Further investigation is required regarding the effectiveness and
application of surgical skill laboratories and simulations on the
competencies of orthopaedic residents.
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Affiliation(s)
- Carl Laverdiere
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Eric Harvey
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Justin Schupbach
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Mathieu Boily
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Mark Burman
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Paul A Martineau
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
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Preoperative skill evaluation in transabdominal preperitoneal (TAPP) inguinal hernia repair using a three-dimensional printed TAPP repair simulator. Surg Endosc 2020; 35:270-274. [PMID: 31938926 DOI: 10.1007/s00464-020-07389-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP LIHR) is becoming increasingly more critical in the management of hernias, it has a long learning curve. The learning curve is often measured by a shortened operative time without mention of the quality of the procedure. This study was performed to evaluate the efficacy of a three-dimensional printed TAPP LIHR simulator to evaluate the surgeon's preoperative skill before entering the operative theater. METHODS Fifteen surgeons in our institution were enrolled in this study. They performed simulation TAPP LIHR while being video recorded. The TAPP LIHR simulator allows for the performance of all procedures required in TAPP LIHR. All participants were classified according to several background factors: postgraduate years (PGYs) (1-5, 6-10, or > 10), number of TAPP LIHR procedures performed (< 10, 11-49, or > 50), and number of laparoscopic surgeries performed (≤ 100 or > 100). The correlation among PGYs, the number of TAPP repairs performed, and the checklist score was evaluated. RESULTS The mean total score and time required to perform TAPP LIHR were significantly different among the three TAPP LIHR experience groups (< 10, 11-49, and > 50 procedures; P < 0.05). The checklist score and time required to perform TAPP LIHR were strongly correlated with the number of TAPP LIHR procedures performed (r = 0.74 and r = 0.69, respectively). However, the checklist score showed a weak correlation with PGY (r = 0.52). CONCLUSIONS Preoperative skill evaluation using a TAPP LIHR simulator and TAPP repair checklist supports the distinction between novices and experts. Both education systems are a valuable and affordable tool for evaluation and training of TAPP LIHR.
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Perrone KH, Blevins KS, Denend L, Fan R, Huelman J, Wall JK. Initial experiences with virtual reality as a tool for observation in needs-driven health technology innovation. ACTA ACUST UNITED AC 2020. [DOI: 10.1136/bmjinnov-2018-000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Stanford University Biodesign Innovation Fellowship teaches a needs-based methodology for the innovation of health technologies. This involves the direct observation of patient care in a variety of settings, ranging from the hospital to the home, to identify unmet needs that can be addressed via innovative new technology-based solutions. Expanding this model to educate a larger population of undergraduate and graduate students is limited by access to real clinical observations, partly due to hospital policies and patient privacy concerns. We hypothesise that the use of virtual reality (VR) can be an effective tool to provide students access to a variety of clinical scenarios for identifying needs for innovation. In this preliminary study, two undergraduate students observed clinical care live in the operating room (OR) and using VR headsets. The students identified needs in both settings and compared the two experiences with a short survey. While VR did not offer a complete replication of the OR experience, it served as a viable tool for learning how to make observations. VR merits further investigation as an educational tool for needs finding and as a proxy for live clinical observations.
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Zipper CT, Friedrich U, Backhaus J, König S, Mavroveli S, Wiegering A, Olbrecht S, Puppe F, Günster SA, Dietz UA. Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of the fatty triangle: validation and educational impact study. Hernia 2019; 24:1307-1315. [PMID: 31792801 DOI: 10.1007/s10029-019-02094-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Incisional hernia repair requires detailed anatomic knowledge. Regarding median subxiphoidal hernias, the proper preparation of the fatty triangle is challenging. To foster proficiency-based training, a cost-efficient model for open median retromuscular mesh repair resembling the human body was developed, including the main anatomical structures related to the procedure. The aim is to create and validate a high-fidelity model on open retromuscular mesh repair suitable for "training before doing". MATERIALS AND METHODS Different types of fabrics for imitation of connective tissue and 2-component silicones were used to construct the incisional hernia model. Sample size for validation of the model was determined by a triangular testing approach. Operations from six beginners and six experts were assessed by three blinded-raters. Reliability and construct-validity were evaluated on a behaviorally anchored rating scale (highest score: 4) for the criteria: "instrument use", "tissue handling", "near misses and errors", and "end-product quality". RESULTS The model authentically mimicked an open median retromuscular mesh repair. Participants considered the procedure realistic. Reliability was excellent, ranging from 0.811 to 0.974 for "end-product quality", and "tissue handling" respectively. Construct-validity was confirmed with experts significantly outperforming beginners in the "use of instruments" (Mbeg. = 2.33, Mexp. = 3.94, p < 0.001), "tissue handling" (Mbeg. = 2.11, Mexp. = 3.72, p < 0.001), "near misses and errors" (Mbeg. = 2.67, Mexp. = 3.67, p < 0.001), and "end-product quality" (Mbeg. = 2.78, Mexp. = 3.72, p < 0.001). Criterion-validity revealed a paradox effect: beginners performed significantly better than experts (p < 0.05) when preparing the fatty triangle. CONCLUSIONS The model covers all relevant aspects involved in median-open retromuscular incisional hernia mesh repair. Performance differences between beginners and experts confirm construct-validity and thereby realism of the model. It enables to efficiently improve and practice technical skills of the demanding surgery.
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Affiliation(s)
- C T Zipper
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - U Friedrich
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - J Backhaus
- Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany
| | - S König
- Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany
| | - S Mavroveli
- London General Surgical Skills Programme, Imperial College London, South Wharf Road, Paddington, London, W2 1BL, UK
| | - A Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - S Olbrecht
- Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - F Puppe
- Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany
| | - S A Günster
- Institut für Allgemeinmedizin, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Universitaetsstrasse 29, 91054, Erlangen, Germany
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. .,Department of General, Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Baselstrasse 150, 4600, Olten, Switzerland.
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Ko J, Lee JJ, Jang SW, Yun Y, Kang S, Shin DA, Kim YS. An Epiduroscopy Simulator Based on a Serious Game for Spatial Cognitive Training (EpiduroSIM): User-Centered Design Approach. JMIR Serious Games 2019; 7:e12678. [PMID: 31456580 PMCID: PMC6734856 DOI: 10.2196/12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/31/2019] [Accepted: 04/16/2019] [Indexed: 01/22/2023] Open
Abstract
Background Performing high-level surgeries with endoscopy is challenging, and hence, an efficient surgical training method or system is required. Serious game–based simulators can provide a trainee-centered educational environment unlike traditional teacher-centered education environments since serious games provide a high level of interaction (feedback that induces learning). Objective This study aimed to propose an epiduroscopy simulator, EpiduroSIM, based on a serious game for spatial cognitive training. Methods EpiduroSIM was designed based on a serious game. For spatial cognitive training, the virtual environment of EpiduroSIM was modeled based on a cognitive map. Results EpiduroSIM was developed considering user accessibility to provide various functions. The experiment for the validation of EpiduroSIM focused on psychological fidelity and repetitive training effects. The experiments were conducted by dividing 16 specialists into 2 groups of 8 surgeons. The group was divided into beginner and expert based on their epiduroscopy experience. The psychological fidelity of EpiduroSIM was confirmed through the training results of the expert group rather than the beginner group. In addition, the repetitive training effect of EpiduroSIM was confirmed by improving the training results in the beginner group. Conclusions EpiduroSIM may be useful for training beginner surgeons in epiduroscopy.
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Affiliation(s)
- Junho Ko
- BioComputing Lab, Institute for Bio-Engineering Application Technology, Korea University of Technology and Education, Cheonan, Republic of Korea
| | - Jong Joo Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Jang
- BioComputing Lab, Institute for Bio-Engineering Application Technology, Korea University of Technology and Education, Cheonan, Republic of Korea
| | - Yeomin Yun
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungchul Kang
- Robot Center, Samsung Research, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Sang Kim
- BioComputing Lab, Institute for Bio-Engineering Application Technology, Korea University of Technology and Education, Cheonan, Republic of Korea
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Validation and educational impact study of the NANEP high-fidelity simulation model for open preperitoneal mesh repair of umbilical hernia. Hernia 2019; 24:873-881. [PMID: 31325054 DOI: 10.1007/s10029-019-02004-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the study was to develop, validate and analyze the educational impact of a high-fidelity simulation model for open preperitoneal mesh repair of an umbilical hernia. The number of surgical simulators available for training residents is limited. Primary for ethical reasons and secondary for the emerging pay-per-quality policies, practicing-on simulators rather than patients is considered gold standard. Validated full-procedural surgical models will become more and more important in training residents. Such models may assure that evidence-based standards regarding technical aspects of the procedures become integral part of the curriculum. Furthermore, they can be employed as a quality control of residents' skills (Fonseca et al. in J Surg Educ 70:129-137, 2013). METHODS In a repeated measures design, medical students, residents in their last year of training and attending surgeons performed an open preperitoneal mesh repair on the NANEP model [NANEP stands for the German acronym Nabelhernien-Netzimplatation-Präperitonal (English: Umbilical hernia mesh implantation preperitoneal)]. Subjects were categorized as "Beginners" (internship students) or "Experts" (residents and surgeons). Content validity was analyzed by criteria of subject-matter-experts. Blinded raters assessed surgical skills by means of the Competency Assessment Tool (CAT) using the online platform "CATLIVE". Differential validity was measured by group differences. Proficiency gain was analyzed by monitoring the learning curve (Gallagher et al. in Ann Surg 241:364-372, 2005). Post-operative examination of the simulators shed light on criterion validity. RESULTS The NANEP model-proofed content and construct-valid significant Bonferroni-corrected differences were found between beginners and experts (p < 0.05). Beginners showed a significant learning increase from the first to the second surgery (p < 0.05). Post-operative examination data confirmed criterion validity. CONCLUSION The NANEP model is an inexpensive, simple and efficient simulation model. It has highly realistic features, it has been shown to be of high-fidelity, full-procedural and benchtop-model. The NANEP model meets the main needs of surgical educational courses at the beginning of residency.
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Two-dimensional versus three-dimensional laparoscopic gastrectomy in surgical efficacy for gastric cancer: a systematic review and meta-analysis. Clin Transl Oncol 2019; 22:122-129. [DOI: 10.1007/s12094-019-02116-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/11/2019] [Indexed: 01/04/2023]
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