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Chodzinski A, Wissing S, Tipold A, Geburek F. Evaluation of equine perineural anesthesia simulators with integrated success control for veterinary education. Front Vet Sci 2025; 11:1403794. [PMID: 39850585 PMCID: PMC11754189 DOI: 10.3389/fvets.2024.1403794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 12/11/2024] [Indexed: 01/25/2025] Open
Abstract
The skills necessary to perform diagnostic perineural anesthesia in equids belongs to one of the Day One Competences of a veterinarian, so every veterinary graduate should be able to perform them correctly. For logistical, hygienic and ethical reasons, practical exercises on cadaver limbs are not accessible to all students. Two equine distal limb simulators were developed and evaluated as an additional instructional tool to train the required skills. Both simulators were designed and built with an integrated success control, with Simulator I (S1) designed to be a simplified anatomical model and Simulator II (S2), a more realistic model. The simulators were tested by 68 students in the 5th year who were divided into two groups. Thirty-four students received a training session using the simplified anatomical model (S1) and the other 34 students one on cadaver limbs, the usual instructional tool. The practical learning success of both groups was validated using S2. Additionally, data on self-efficacy were collected. The results show that the two groups did not differ significantly in their practical learning success, whereas self-efficacy of both groups increased significantly after the sessions. An evaluation performed by 7 veterinarians and 49 students of the 5th year indicate that the simulators are suitable for teaching perineural anesthesia in the equine distal limb. However, S2 could be more realistic. The simulators will be used as a supplement to exercises on cadaver limbs to enable all students to practice perineural anesthesia.
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Affiliation(s)
- Anna Chodzinski
- Centre for E-Learning, Didactics and Educational Research, Clinical Skills Lab, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Sandra Wissing
- Centre for E-Learning, Didactics and Educational Research, Clinical Skills Lab, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Andrea Tipold
- Clinic for Small Animals, Department of Neurology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Florian Geburek
- Clinic for Horses, Department of Surgery and Orthopedics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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El-Mahrouk M, Jaradat D, Eichler T, Sucher R, Margreiter C, Lederer A, Karitnig R, Geisler A, Jahn N, Hau HM. "YouTube" for Surgical Training and Education in Donor Nephrectomy: Friend or Foe? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2025; 12:23821205241301552. [PMID: 40008117 PMCID: PMC11851798 DOI: 10.1177/23821205241301552] [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: 05/06/2024] [Accepted: 10/23/2024] [Indexed: 02/27/2025]
Abstract
Background The COVID-19 pandemic has accelerated the shift toward e-learning and online education in surgical training. With the increasing prevalence of end-stage chronic kidney disease, kidney transplantation is in high demand. Donor safety is crucial in nephrectomy procedures, highlighting the importance of effective training. This study evaluates the quality and effectiveness of YouTube videos focusing on laparoscopic and robotic donor nephrectomy for surgical education. Methods On October 24, 2023, searches on YouTube for "laparoscopic live donor nephrectomy" and "robotic live donor nephrectomy" returned 121 videos, with 63 included in the study. Popularity was evaluated using the Video Power Index (VPI), while reliability and quality were assessed using the LAP-VEGaS Video Assessment Tool and Journal of the American Medical Association (JAMA) benchmark criteria. Additionally, a structured descriptive tool called the "Live Donor Nephrectomy Completeness (LDNC)" was created to evaluate the completeness and educational value of procedural technical steps. Results Out of 63 videos reviewed, laparoscopic surgical procedures were depicted in 71.4% of them, while robotic approaches were shown in 28.6%. Academic backgrounds were associated with 54% of the videos, and individual physician backgrounds with 46%. Mean scores were LAP-VEGaS 9.79 ± 3.87, VPI 6.32 ± 3.31, and LDNC 9.68 ± 1.97. JAMA scores varied, with 34.9% receiving 1 point, 34.9% receiving 2 points, 17.5% receiving 3 points, and 12.7% receiving 4 points. Academic videos scored significantly higher in LAP-VEGaS and LDNC (all p < .01). While LAP-VEGaS, VPI, and LDNC scores correlated significantly (all p < .05), no correlation was found between JAMA score and other scoring systems. Videos with more clicks and likes showed significantly better scores across all measures (all p < .05). Conclusion Amidst the challenges posed by the pandemic on surgical education, YouTube has emerged as a valuable resource for learning about laparoscopic and robotic donor nephrectomy for living kidney donation. However, the quality and reliability of these videos vary greatly, and many lack thorough reviews, leading to incomplete information. To enhance their educational value, it's proposed that videos undergo professional evaluation before publication and adhere to standardized, structured, and validated scoring systems, ensuring logical structure and improved quality.
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Affiliation(s)
- Mohamed El-Mahrouk
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Derar Jaradat
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Tim Eichler
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert Sucher
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christian Margreiter
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Andri Lederer
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert Karitnig
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Antonia Geisler
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Hans Michael Hau
- Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Abelleyra Lastoria DA, Rehman S, Ahmed F, Jasionowska S, Salibi A, Cavale N, Dasgupta P, Aydin A. A Systematic Review of Simulation-Based Training Tools in Plastic Surgery. JOURNAL OF SURGICAL EDUCATION 2025; 82:103320. [PMID: 39615161 DOI: 10.1016/j.jsurg.2024.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 10/01/2024] [Accepted: 10/19/2024] [Indexed: 12/11/2024]
Abstract
OBJECTIVES The recent shift from traditional surgical teaching to the incorporation of simulation training in plastic surgery has resulted in the development of a variety of simulation models and tools. We aimed to assess the validity and establish the effectiveness of all currently available simulators and tools for plastic surgery. DESIGN Systematic review. METHODS The PRISMA 2020 checklist was followed. The review protocol was prospectively registered in PROSPERO (CRD42021231546). Published and unpublished literature databases were searched to the 29th of October 2023. Each model was appraised in accordance with the Messick validity framework, and a rating was given for each section. To determine the effectiveness of each model, the McGaghie model of translational outcomes was used. RESULTS On screening 1794 articles, 116 were identified to discuss validity and effectiveness of simulation models in plastic surgery. These were hand surgery (6 studies), breast surgery (12 studies), facial surgery (25 studies), cleft lip and palate surgery (29 studies), rhinoplasty (4 studies), hair transplant surgery (1 study), surgery for burns (10 studies), and general skills in plastic surgery (29 studies). Only 1 model achieved an effectiveness level > 3, and no model had a rating > 2 in all aspects of the Messick validity framework. CONCLUSION There are limited models enabling the transfer of skills to clinical practice. No models achieved reductions in surgical complications or costs. There must be more validity studies conducted using updated validity frameworks, with an increased emphasis on the applicability of these simulators to improve patient outcomes and surgical technique. More training tools evaluating both technical and non-technical surgical skills are recommended.
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Affiliation(s)
| | - Sehrish Rehman
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Farah Ahmed
- St George's, University of London, London, United Kingdom
| | - Sara Jasionowska
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Andrej Salibi
- Department of Plastic Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Naveen Cavale
- Departments of Plastic Surgery, King's College Hospital NHS Foundation Trust and Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
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Unal YC, Adanas C, Kaya S, Ozkan S, Ismailov U. Virtual reality headset versus traditional training in orthopedic surgery: A comparative study on real surgical performance in total knee arthroplasty. Medicine (Baltimore) 2024; 103:e40615. [PMID: 39809210 PMCID: PMC11596432 DOI: 10.1097/md.0000000000040615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 11/01/2024] [Indexed: 01/16/2025] Open
Abstract
Is it possible for a low-volume surgeon to enhance their surgical skills without performing actual surgeries by utilizing virtual reality headsets and emerging technologies? It has been observed that the time spent by surgical assistants in the operating room decreased after the post-shift leave regulation. In the literature, the use of virtual reality simulations as a support tool in surgical training is recommended. Although the efficacy of virtual reality surgical simulations in surgeries such as arthroscopy and laparoscopy has been proven, there are limited studies on their effect in open surgeries. In this study, 20 orthopedic and traumatology residents with no experience in primary total knee arthroplasty were divided into 2 groups. One group was prepared for surgery using surgical simulation with virtual reality headsets, while the other group was prepared for surgery with traditional methods. The actual surgical performance of the participants was evaluated with the Objective Structured Scale of Technical Skills (OSATS) surgical skills scale. It was observed that the virtual reality group was more successful in the "Time and Motion" and "Surgical Functioning and Fluency" criteria. Virtual reality surgical simulations are useful tool in surgical training and can contribute to the development of surgeons' skills. However, more research is needed on how to integrate these simulations into training programs and in which areas they are most effective.
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Affiliation(s)
- Yunus Can Unal
- Department of Orthopedics and Traumatology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Cihan Adanas
- Department of Orthopedics and Traumatology, Faculty of Medicine Van Yuzuncu Yil University, Van, Turkey
| | - Sehmuz Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine Van Yuzuncu Yil University, Van, Turkey
| | - Sezai Ozkan
- Department of Orthopedics and Traumatology, Faculty of Medicine Van Yuzuncu Yil University, Van, Turkey
| | - Ulan Ismailov
- Department of Orthopedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
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Jafarabadi M, Gorginzadeh M, Rezayof E. The Effect of a Short Training Course of Hysteroscopic Myoma Resection on the Non-Technical Skills of Gynecologic Surgeons. J Family Reprod Health 2024; 18:80-84. [PMID: 39011407 PMCID: PMC11246738 DOI: 10.18502/jfrh.v18i2.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Objective To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0-4.0) to 7 (IQR, 5.0- 8.0) [bootstrap p<0.0001] for each of the randomly chosen pairings. The majority of candidates showed significantly improved cognitive skills after the HMR course despite their poor cognitive skills before the course. According to further analysis, there were significant enhancements in grades for all topics, especially regarding the basic principles of the procedure and management of complications (bootstrap p<0.0001). The odds ratio for the pre- versus post-course mean test results was 5.23. Due to the confidentiality stipulation, the pre- and post-course scores were not matched. Conclusion A two-day continuing medical educational course could be efficient in improving the nontechnical (cognitive) skills for HMR.
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Affiliation(s)
- Mina Jafarabadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elahe Rezayof
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Muehlberg J, Tipold A, Heppelmann M, Wissing S. Simulator-Assisted Training of Abomasal Surgery-A Pilot Study Using Blended Learning and Face-to-Face Teaching. Animals (Basel) 2023; 13:3822. [PMID: 38136859 PMCID: PMC10740769 DOI: 10.3390/ani13243822] [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: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Two stimulators were developed, one simplified and one realistic, in the present study for learning abomasal surgery for veterinary students. The simulators were tested in a pilot study: The upcoming blended learning format was compared with traditional face-to-face teaching. A total of 21 5th-year students participated in the study. While one group learned the surgical technique in traditional face-to-face simulator training, the second group completed interactive video training asynchronously. Afterwards, skills were examined in person. The results showed that the different groups did not lead to different performance results. Participation in the study increased self-assessment of skills by an average of about 7 of 36 points, as well as the learning success and motivation of students in both groups. The simulators developed were well liked by the students and rated as appropriate by 12 practicing bovine veterinarians. The pilot study indicates that blended learning could be a suitable alternative to traditional face-to-face teaching. This should be followed by further research to support the use of blended learning in the veterinary education of clinical skills.
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Affiliation(s)
- Julia Muehlberg
- Clinical Skills Lab, Centre for E-Learning, Didactics and Training Research, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
| | - Andrea Tipold
- Clinic for Small Animals, Neurology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany;
| | - Maike Heppelmann
- Clinic for Cattle, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
| | - Sandra Wissing
- Clinical Skills Lab, Centre for E-Learning, Didactics and Training Research, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [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: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Bhullar PK, Venkateswaran N. Ophthalmology Residency in the United States: The Case for a National Curriculum. Semin Ophthalmol 2023; 38:167-177. [PMID: 36653736 DOI: 10.1080/08820538.2022.2152713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.
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Kong CY, Fogg QA, Allam M. A novel model for hands-on laparoscopic pelvic surgery training on Genelyn-embalmed body: an initial feasibility study. Anat Sci Int 2023; 98:89-98. [PMID: 35750974 DOI: 10.1007/s12565-022-00677-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/25/2022] [Indexed: 01/20/2023]
Abstract
The human donor body provides a well-accepted ex vivo model for laparoscopic surgical training. Unembalmed, or fresh-frozen, bodies comprise high-fidelity models. However, their short life span and high cost relatively limit the hands-on training benefits. In contrast, soft embalmed body of donors has a relatively longer usability without compromising tissue flexibility. This study reports the initial experience of the utility and feasibility of human donor Genelyn-embalmed body as a novel soft-embalmed cadaveric model for laparoscopic surgical training. An expert laparoscopic surgeon, who organised many fresh-frozen body donor courses, performed deep laparoscopic pelvic dissection and laparoscopic surgical tasks including suturing and electrosurgery on a single Genelyn-embalmed body. The three sessions were performed over a course of 3 weeks. The body was fully embalmed using the Genelyn technique. The technique consisted of a single-point closed arterial perfusion of embalming solution via the carotid artery with no further exposure to or immersion in embalming fluids thereafter. The donor's Genelyn-embalmed body provided a feasible model for laparoscopic surgical training. Initial experience shows evidence of this model being feasible and realistic. There was reproducibility of these qualities across a minimum of 3 weeks in this single-donor study. Initial experience shows that donor's Genelyn-embalmed body provides a novel model for laparoscopic surgical training, which possesses fidelity and is feasible for laparoscopic training. While further studies are needed to validate these findings, this technical note provides perspectives from an expert trainer regarding this model and provides a photographic and videographic atlas of this model's use in laparoscopy.
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Affiliation(s)
- Chia Yew Kong
- School of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow, G8 12QQ, Scotland, UK. .,Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, Glasgow, Scotland.
| | - Quentin A Fogg
- Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, Glasgow, Scotland.,Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Melbourne, Australia
| | - Mohamed Allam
- School of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow, G8 12QQ, Scotland, UK.,Department of Obstetrics and Gynaecology, University Hospitals, National Health Service Lanarkshire, Lanarkshire, Scotland
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Erözkan K, Culcu S, Tamam S, Unal AE. The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic. Medicine (Baltimore) 2022; 101:e31537. [PMID: 36451455 PMCID: PMC9704872 DOI: 10.1097/md.0000000000031537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is no standardization in videos uploaded to Youtube. Were the videos capable of contributing to adequate technical quality and surgical training? We are aiming to answer these questions in this paper. It is a cross-sectional study. In January 2022, we searched the Youtube platform using the keyword "distal pancreatectomy." The substantiality, transparency, reliability, quality, popularity and educational values of the video content were evaluated after exclusion criteria. These parameters were evaluated using we the modified Journal of American Medical Association benchmark criteria, Global Quality Score (GQS), Video Power Index, modified laparoscopic pancreatectomy scoring system. The videos uploaded after the pandemic had a statistically significant higher GQS score (P < .001). Video Power Index, like GQS, had a statistically significant difference before and after the pandemic. (P = .046). There was no significant difference in the evaluation of the reliability and substantiality. Until the development of Youtube videos is completed, peer-reviewed, more reliable and content-rich online education platforms should be preferred in the first place. Care should be taken to watch selected videos on Youtube videos.
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Affiliation(s)
- Kamil Erözkan
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
- * Correspondence: Kamil Erozkan, Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey (e-mail: )
| | - Serdar Culcu
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
| | - Selim Tamam
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Ekrem Unal
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
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Sivakumar J, Chen Q, Hii MW, Cullinan M, Choi J, Steven M, Crosthwaite G. Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression. Surg Endosc 2022; 37:2453-2475. [PMID: 36416945 DOI: 10.1007/s00464-022-09760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has a long learning curve. It can be a technically challenging procedure and initially presents an unfamiliar view of inguinal anatomy. The aim of this review was to evaluate published literature relating to the learning curve of laparoscopic inguinal hernia repair and identify the number of cases required for proficiency. The secondary aim was to compare outcomes between surgeons before and after this learning curve threshold had been attained. METHODS A systematic literature search was conducted in databases of PubMed, Medline, Embase, Web of Science, and Cochrane Library, to identify studies that evaluated the learning curve of laparoscopic inguinal hernia repair. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase of the curve. RESULTS Twenty-two studies were included in this review, with 19 studies included in the meta-regression analysis, and 11 studies included in the meta-analysis. Mixed-effects Poisson regression demonstrated that there was a non-linear trend in the number of cases required to achieve surgical proficiency, with a 2.7% year-on-year decrease. The predicted number of cases to achieve surgical proficiency in 2020 was 32.5 (p < 0.01). The meta-analysis determined that surgeons in their learning phase may experience a higher rate of conversions to open (OR 4.43, 95% CI 1.65, 11.88), postoperative complications (OR 1.61, 95% CI 1.07, 2.42), and recurrences (OR 1.32, 95% CI 0.40, 4.30). CONCLUSION Laparoscopic inguinal hernia repair has a well-defined learning curve. While learning surgeons demonstrated reasonable outcomes, supervision during this period may be appropriate given the increased risk of conversion to open surgery. These data may benefit learning surgeons in the skill development of minimally invasive inguinal hernia repairs.
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Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia.
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Australia.
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Qianyu Chen
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Michael W Hii
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Cullinan
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Choi
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Western Health, Melbourne, Australia
| | - Mark Steven
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
| | - Gary Crosthwaite
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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Kaur K, Gurnani B, Venkatesh D, Sinha A, Tejaswini A, Niharika J, Morya AK. Commentary: Changing era of modern cataract surgery - The role of virtual reality-based simulators in manual small-incision cataract surgery training modules. Indian J Ophthalmol 2022; 70:4016-4017. [PMID: 36308147 PMCID: PMC9907297 DOI: 10.4103/ijo.ijo_2233_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kirandeep Kaur
- Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Bharat Gurnani
- Consultant Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Dharavath Venkatesh
- Department of Ophthalmology, Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Aprajita Sinha
- Specialty Doctor Ophthalmology, Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, United Kingdom
| | - Antarvedi Tejaswini
- Department of Ophthalmology, Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Jella Niharika
- Department of Ophthalmology, Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Arvind K Morya
- Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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13
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Nagayo Y, Saito T, Oyama H. Augmented reality self-training system for suturing in open surgery: A randomized controlled trial. Int J Surg 2022; 102:106650. [PMID: 35525415 DOI: 10.1016/j.ijsu.2022.106650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Existing self-training materials are insufficient to learn open surgical procedures, and a new self-training system that provides three-dimensional procedural information is needed. The effectiveness and usability of a self-training system providing three-dimensional information by augmented reality (AR) were compared to those of an existing self-training system, instructional video, in self-learning of suturing in open surgery. MATERIALS AND METHODS This was a prospective, evaluator-blinded, randomized, controlled study. Medical students who were suturing novices were randomized into 2 groups: practice with the AR training system (AR group) or an instructional video (video group). Participants were instructed in subcuticular interrupted suture and each training system and watched the instructional video once. They then completed a pretest performing the suture on a skin pad. Participants in each group practiced the procedure 10 times using each training system, followed by a posttest. The pretest and posttest were video-recorded and graded by blinded evaluators using a validated scoring form composed of global rating (GR) and task-specific (TS) subscales. Students completed a post-study questionnaire assessing system usability, each system's usefulness, and their confidence and interest in surgery. RESULTS Nineteen participants in each group completed the trial. No significant difference was found between the AR and video groups on the improvement of the scores from pretest to posttest (GR: p = 0.54, TS: p = 0.91). The posttest scores of both GR and TS improved significantly from pretest in both groups (GR: both p < 0.001, TS: both p < 0.001). There was no significant difference between the groups in the system usability scale scores (p = 0.38). The motion provided in the AR system was more helpful for manipulating surgical instruments than the video (p = 0.02). CONCLUSION The AR system was considered as understandable and easy to use as the instructional video in learning suture technique in open surgery for novices.
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Affiliation(s)
- Yuri Nagayo
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Toki Saito
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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Luo H, Fu Y, Ding N, Dong C, Zhang Y, Wang D. Hap-pulse: A Wearable Vibrotactile Glove for Medical Pulse Wave Rendering. IEEE TRANSACTIONS ON HAPTICS 2022; 15:280-291. [PMID: 35259115 DOI: 10.1109/toh.2022.3157832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pulse palpation is an important procedure that allows a physician to rapidly assess the status of a patient's cardiovascular system. This paper explores the possibility of using vibrotactile stimuli to render fine temporal profiles of pulse pressure waves. A lightweight wearable vibrotactile glove, called Hap-pulse, is designed to render fine pulse waves through vibrotactile stimuli on users' fingertips. To preserve the fine features of original pulse waves, models are fitted from real pulse wave data (photoplethysmogram (PPG) pulse waveform database), using fourth-order polynomial functions. A square wave envelope mapping algorithm is proposed to produce vibration amplitudes of Linear Resonance Actuators (LRAs), which aims to render the detailed waveform of systolic and diastolic blood pressure states. Evaluation results suggest that Hap-pulse can render pulse waves with an average correlation coefficient 97.84%. To validate the distinguishability and fidelity of Hap-pulse's palpation rendering, a user study consisting of traditional Chinese medicine doctors and unskilled students is conducted. The correct recognition rate of identifying four typical pulse waves is 87.08% (doctors), 57.50% (untrained students) and 79.59% (trained students). These results indicate a novel application of rendering subtle pulse wave signals with vibrotactile gloves, which illustrates the potential of simulating patient palpation training in virtual or remote medical diagnosis.
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15
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Moore M, Mabedi C, Phull M, Payne SR, Biyani CS. The utility of Urological Clinical and Simulation Training for Sub-Saharan Africa. BJU Int 2022; 129:563-571. [PMID: 35338556 DOI: 10.1111/bju.15731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Madeline Moore
- Urology Registrar Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Charles Mabedi
- Consultant Urologist, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Stephen R Payne
- Urolink Secretary, British Association of Urological Surgeons
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Co-Director Surgical Cadaveric Simulation Lab, University of Leeds, Leeds
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16
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Mathern N, Sandmann J, Sichtermann T, Ridwan H, Riabikin A, Stockero A, Nikoubashman O, Wiesmann M, German Stroke School Group. Can training on ex-vivo models increase neurointerventionalists’ subjective self-confidence in the operating room? PLoS One 2022; 17:e0264180. [PMID: 35192670 PMCID: PMC8863251 DOI: 10.1371/journal.pone.0264180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
In a changing learning environment where young neurointerventionalists spend less time in the operating room, computer simulators have been established as a new training model. Our aim was the comparison of silicone models and computer simulators, and the evaluation of their influence on subjective self-confidence of operators. Pre- and postquestionnaires of 27 participants and 9 tutors were evaluated after the participation in a three-days interventional stroke course using silicone models and computer simulators. Training on computer simulators was considered as more realistic and important before patient contact than training on silicone models. Participants rated their own abilities as significantly better after participation in the course and felt significantly better prepared for patient care. Training on computer simulators can increase the subjective self-confidence of trainees. We suggest a stepwise training program, comprising both ex-vivo and the porcine in-vivo model, finished by conventional operating room teaching, to prepare neuroradiologists for optimal patient care when performing interventions.
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Affiliation(s)
- Nathalie Mathern
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Johanna Sandmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thorsten Sichtermann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Riabikin
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - German Stroke School Group
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
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Novel high-quality and reality biomaterial as a kidney surgery simulation model. PLoS One 2022; 17:e0263179. [PMID: 35176048 PMCID: PMC8853465 DOI: 10.1371/journal.pone.0263179] [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: 06/08/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Surgical training using live animals such as pigs is one of the best ways of achieving skilled techniques and fostering confidence in preclinical medical students and surgeon trainees. However, due to animal welfare ethics, laboratory animals’ usage for training should be kept to a minimum. We have developed a novel kidney organ model utilizing a simple procedure in which the kidney is first refluxed with N-vinyl-2-pyrrolidone (NVP) solution for 1 hour in its bath, followed by permeation for 23 hours, with a subsequent freshwater refluxed for 48 hours in the washing step. Surgical simulation of the prepared kidney model (NVP-fixed kidney) was compared with three types of other basic known simulation models (fresh kidney, freeze-thaw kidney, and FA-fixed kidney) by various evaluations. We found the NVP-fixed kidney to mimicked fresh kidney function the most, pertaining to the hardness, and strength of the renal parenchyma. Moreover, the NVP-fixed kidney demonstrated successful blood-like fluids perfusion and electrocautery. Further, we confirmed that surgical training could be performed under conditions closer to actual clinical practice. Our findings suggest that our model does not only contribute to improving surgical skills but also inspires the utilization of otherwise, discarded inedible livestock organs as models for surgical training.
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18
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Current status of simulation-based training tools in general surgery: A systematic review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Baxter JA, Bhamber NS, Patel RS, Tennent D. The FAST Workstation Shows Construct Validity and Participant Endorsement. Arthrosc Sports Med Rehabil 2021; 3:e1133-e1140. [PMID: 34430894 PMCID: PMC8365199 DOI: 10.1016/j.asmr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine in what way the proposed simulation-based intervention (SBI) is an effective intervention for use in basic arthroscopic skills training. Methods Twenty candidates were recruited and grouped according to experience. Performance metrics included the time to activity completion, errors made, and Global Rating Scale score. Qualitative data were collected using a structured questionnaire. Results Performance on the SBI differed depending on previous arthroscopic training received. Performance on the simulator differed between groups to a statistically significant level regarding time to completion. A difference was also present between participants with no previous training and those with previous training when assessed using the Global Rating Scale. The SBI was deemed acceptable, user-friendly, and realistic. Participants practicing at the expert level believe that such an SBI would be beneficial in developing basic arthroscopic skills. Conclusions The results of this study provide evidence that the use of an SBI consisting of a benchtop workstation, laptop viewing platform, 30° arthroscope, and defined performance metrics can detect differences in the level of arthroscopic experience. This format of SBI has been deemed acceptable and useful to the intended user, increasing the feasibility of introducing it into surgical training. Clinical Relevance This study adds to the existing body of evidence supporting the potential benefits of benchtop SBIs in arthroscopic skills training. Improved performance on such an SBI may be beneficial for the purpose of basic arthroscopic skills training, and we would support the inclusion of this system in surgical training programs such as those developed by the Arthroscopy Association of North America and American Board of Orthopaedic Surgery.
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Affiliation(s)
- Jonathan A Baxter
- Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury, England
| | - Nivraj S Bhamber
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, England
| | - Rakesh S Patel
- School of Medicine, University of Nottingham, Nottingham, England
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20
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A Novel Suture Training System for Open Surgery Replicating Procedures Performed by Experts Using Augmented Reality. J Med Syst 2021; 45:60. [PMID: 33829327 PMCID: PMC8026441 DOI: 10.1007/s10916-021-01735-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
The surgical education environment has been changing significantly due to restricted work hours, limited resources, and increasing public concern for safety and quality, leading to the evolution of simulation-based training in surgery. Of the various simulators, low-fidelity simulators are widely used to practice surgical skills such as sutures because they are portable, inexpensive, and easy to use without requiring complicated settings. However, since low-fidelity simulators do not offer any teaching information, trainees do self-practice with them, referring to textbooks or videos, which are insufficient to learn open surgical procedures. This study aimed to develop a new suture training system for open surgery that provides trainees with the three-dimensional information of exemplary procedures performed by experts and allows them to observe and imitate the procedures during self-practice. The proposed system consists of a motion capture system of surgical instruments and a three-dimensional replication system of captured procedures on the surgical field. Motion capture of surgical instruments was achieved inexpensively by using cylindrical augmented reality (AR) markers, and replication of captured procedures was realized by visualizing them three-dimensionally at the same position and orientation as captured, using an AR device. For subcuticular interrupted suture, it was confirmed that the proposed system enabled users to observe experts' procedures from any angle and imitate them by manipulating the actual surgical instruments during self-practice. We expect that this training system will contribute to developing a novel surgical training method that enables trainees to learn surgical skills by themselves in the absence of experts.
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21
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Nebbia M, Kotze PG, Spinelli A. Training on Minimally Invasive Colorectal Surgery during Surgical Residency: Integrating Surgical Education and Advanced Techniques. Clin Colon Rectal Surg 2021; 34:194-200. [PMID: 33815002 DOI: 10.1055/s-0041-1722843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgery is an ever-evolving discipline and continually incorporates new technologies that have improved the ability of the operating room surgeon to perform. The next generation of minimally invasive surgery includes laparoscopic and robotic-assisted procedures. Graduating residents may be expected to have the skills to perform common colorectal procedures using these technologies, and residency programs are developing curriculums to teach these skills. Minimally invasive techniques are challenging and learning only by observation and practice alone is difficult. This requires dedicated training and mentoring. New simulation methods have been conceived specifically for minimally invasive procedures, and these embrace a combination of virtual reality simulators and box trainers, with animal and human tissue, as well as synthetic materials. The aim of this review is to provide an overview of training in minimally invasive colorectal surgery with a focus on different types of simulators that build the basis to develop and include a multistep training approach in a structured training curriculum for minimally invasive colorectal procedures.
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Affiliation(s)
- Martina Nebbia
- Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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22
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Udwadia TE. Training for laparoscopic colorectal surgery creating an appropriate porcine model and curriculum for training. J Minim Access Surg 2021; 17:180-187. [PMID: 33723182 PMCID: PMC8083748 DOI: 10.4103/jmas.jmas_86_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Laparoscopic colorectal surgery (LCRS) was first described in 1991, and its safety, efficacy and patient benefit were adequately documented in literature. However, its penetration and acceptability is poor in most countries, due to its long learning curve and lack of surgeons training and confidence. A Minimal Access Surgery (MAS) Training Center in Mumbai has over the last 7 years trained more than 8000 surgeons in various MAS specialities. The centre has initiated courses for LCRS training. Materials and Methods The anatomy of the pig colon is very different from human anatomy. The pig colon anatomy is altered to mimic human colon anatomy in the porcine abdomen, permitting hands-on practice on most laparoscopic colorectal surgical procedures, as part of the LCRS training course, under mentorship of expert faculty, who simultaneously assess participants performance. Results Each participant performs and assists for at least three procedures and is evaluated at each step of the procedure by a structured format. The overall evaluation by Faculty which though subjective, is detailed and favourable. Feedback of each participant is good and acceptable as a very helpful course. Conclusion This porcine model is ideal for hands-on training for LCRS. Participants achieve a good degree of skill level and confidence in performing LCRS procedures on fresh bleeding porcine cadaver models. The centre is factual and pragmatic and stresses that it needs more than a course to make a safe surgeon; operation room mentorship is the finishing school.
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Affiliation(s)
- Tehemton Erach Udwadia
- Center of Excellence for Minimal Access Surgery Training; Department of Surgery, Grant Medical College, Grant Medical College and J.J. Hospital; Department of Surgery, B. D. Petit Parsee General Hospital, Breach Candy Hospital, Mumbai, Maharashtra, India
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Geary AD, Pernar LIM, Hall JF. Novel Low-Cost, Low-Fidelity Hemorrhoidectomy Task Trainers. JOURNAL OF SURGICAL EDUCATION 2020; 77:1285-1288. [PMID: 32241669 PMCID: PMC7487032 DOI: 10.1016/j.jsurg.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Develop and describe a set of low-cost hemorrhoidectomy task trainer prototypes in the setting of inadequate junior resident surgical skill preparation for anorectal cases. DESIGN This is a study comparing expert and novice performance and opinions. Three task trainers were developed to simulate dissecting, knot-tying, and suturing in a confined space, like the anus. Participants were asked to dissect the peel off of an orange, tie seven 2-handed knots on a weight, and close a defect in a piece of felt with a running stitch. An 8-oz mason jar was used to simulate the confined space. Participants were asked to fill out a 5-point Likert-based evaluation regarding the skills. The primary outcome was time to complete each task in seconds. Secondary outcome measures were number of errors associated with each task, subjective achievability of tasks, and utility of tasks for improving surgical skills. SETTING General surgery residency program at a safety-net academic center. PARTICIPANTS Forty subjects participated in this study. There were 20 experts (7 attending surgeons, 13 PGY-1-PGY-5 surgical residents) and 20 novices (11 third- and 9 fourth-year medical students). RESULTS Experts knot-tied (59s vs 140s, p < 0.001) and sutured (219s vs 295s, p < 0.001) faster than novices. Experts were able to tie 7 knots in fewer attempts than novices (p < 0.001). There was no significant difference in speed of orange dissection between groups. There were no significant differences in the number or frequency of other errors. All participants felt the tasks were achievable (4.90/5) and would be useful in improving skills (4.93/5). CONCLUSIONS This study demonstrated that a set of low-cost, low-fidelity prototypical hemorrhoidectomy task trainers can discriminate between experts and novices. Simulation models such as these can offer useful practice opportunities for junior general surgery trainees.
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Affiliation(s)
- Alaina D Geary
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Luise I M Pernar
- Department of Surgery, Boston Medical Center, Boston, Massachusetts.
| | - Jason F Hall
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
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Roth M, Daas L, MacKenzie CR, Balasiu A, Stachon T, Neumann I, Steindor F, Seitz B, Geerling G. Development and Assessment of a Simulator for in Vivo Confocal Microscopy in Fungal and Acanthamoeba Keratitis. Curr Eye Res 2020; 45:1484-1489. [PMID: 32434387 DOI: 10.1080/02713683.2020.1772830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE In vivo confocal microscopy (IVCM) is a non-invasive imaging technique that allows morphological analysis as a diagnostic approach of the cornea in real time, thus providing a suspected diagnosis of fungal or amoebic keratitis immediately, whereas culture or PCR require several days or even weeks. Since these infections are rare, it is difficult for ophthalmologists to gain the experience necessary to differentiate infection from normal findings or artefacts. The purpose of this project was to establish a simulator, on which physicians could practice as well as acquiring a database of IVCM images of fungal or amoebic keratitis and respective analyses. PATIENTS AND METHODS An IVCM simulator was set up with cadaver human corneas, infected with either acanthamoeba, candida or aspergillus. Twenty-one ophthalmologists were trained in IVC microscopy first in a Dry Lab, then practically on the simulator. For evaluation, the participants were asked to fill out a standardized questionnaire, with a pre- and post-course self-assessment. RESULTS The self-assessed theoretical and practical skills in differentiating infectious from non-infectious keratitis in IVCM significantly increased (p = 0.0001, p = 0.0002, respectively). The barrier to use this technique decreased (p = 0.0474). CONCLUSION A very simple protocol based on a model of ex vivo corneal mycotic and amoebic infections can be used to train novices in the structured approach and diagnostic use of IVCM for corneal infections.
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Affiliation(s)
- M Roth
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - L Daas
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - C R MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine University , Düsseldorf, Germany
| | - A Balasiu
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine University , Düsseldorf, Germany
| | - T Stachon
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - I Neumann
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - F Steindor
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
| | - B Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - G Geerling
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf , Düsseldorf, Germany
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Keskinkılıç Yağız B, Yalaza M, Sapmaz A. Is Youtube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair? Surg Endosc 2020; 35:2014-2020. [PMID: 32367448 DOI: 10.1007/s00464-020-07596-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the quality of the most commonly viewed total extraperitoneal laparoscopic inguinal hernia repair (TEP) videos on Youtube, which is the largest social and medical media broadcasting service, concerning educational purposes. METHOD A search with the keyword "total extraperitoneal laparoscopic inguinal hernia repair" was performed on Youtube. The first 120 videos among the search results were downloaded and 55 of them were included in the study. A scoring system developed by the authors according to the recent literature was utilized for evaluation of the videos. Video demographics were evaluated for the quality and upload source. RESULTS Among the enrolled videos, video quality was rated as good in 13 (23.6%), as moderate in 22 (40%), and as poor in 20 (36.4%). Video length, presence of narration, number of likes, and comments were significantly higher in the good group. Upload source was an academic center in 14 (25.5%), a community hospital in 22 (40.0%), and a physician in 19 (34.5%). The mean video score of the academic center group (8 ± 4.095) and community hospital group (8.64 ± 3.259) was significantly higher than the physician group (5.47 ± 2.632) (p = 0.010). Video quality was not correlated with total views or views per day. CONCLUSION Total extraperitoneal laparoscopic inguinal hernia repair procedure videos uploaded to Youtube demonstrate considerable heterogeneity in terms of educational quality and the number of good quality videos is significantly low. This heterogeneity is attributed to the lack of peer review process for the evaluation of educational quality of the videos. Therefore, a physician intending to learn and practice a surgical procedure properly (TEP repair in this situation) should not consider a broadcasting service without a peer review process as a reliable training source.
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Affiliation(s)
- Betül Keskinkılıç Yağız
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey.
| | - Metin Yalaza
- Department of General Surgery, Subdivision of Surgical Oncology, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
| | - Ali Sapmaz
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
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Mu Y, Hocking D, Wang ZT, Garvin GJ, Eagleson R, Peters TM. Augmented reality simulator for ultrasound-guided percutaneous renal access. Int J Comput Assist Radiol Surg 2020; 15:749-757. [DOI: 10.1007/s11548-020-02142-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/26/2020] [Indexed: 12/27/2022]
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Takacs FZ, Gerlinger C, Hamza A, Findeklee S, Juhasz-Böss I, Breitbach GP, Solomayer EF, Radosa JC. A standardized simulation training program to type 1 loop electrosurgical excision of the transformation zone: a prospective observational study. Arch Gynecol Obstet 2020; 301:611-618. [PMID: 31853713 DOI: 10.1007/s00404-019-05416-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate a simulation-based standardized training program for type 1 loop electrosurgical excision procedure (LEEP) under direct colposcopic vision in postgraduate teaching. METHODS Seventeen participants (five experienced and 12 novice surgeons) performed 170 simulated cervical excisional procedures. Each participant performed 10 type 1 (cone length between 8 and 10 mm) excisional procedures under direct colposcopic vision on a low-fidelity simulator. Length of specimen was measured after each excision allowing the surgeons a subsequent resection to ensure a cone length of more than 8 mm. Main outcome measures were cone length, specimen fragmentation, and a self-developed score (LEEP score), which allowed the simultaneous evaluation of both measured parameters. RESULTS The precision of the excision showed statistically significant improvement in the novice group during the training procedures after five procedures [LEEP score 1.61 (SD 1.34) vs. 0.46 (SD 0.58); p = 0.023], while experts showed consistently high performance. Inexperienced surgeons performed more frequently cuts that were too deep than experienced surgeons (33/120, 27.5% vs. 4/50, 8%; p = 0.003). CONCLUSIONS Low-fidelity simulation training seems to be an effective method for learning the accurate cone length for a type 1 excision for novice surgeons. As excessive excisions are related with high risk for premature delivery in subsequent pregnancies, in our opinion, LEEP should be practiced in simulation training, especially before performing in woman of reproductive age.
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Affiliation(s)
- Ferenc Zoltan Takacs
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany.
| | - Christoph Gerlinger
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Amr Hamza
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Ingolf Juhasz-Böss
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Georg-Peter Breitbach
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
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Lesch H, Johnson E, Peters J, Cendán JC. VR Simulation Leads to Enhanced Procedural Confidence for Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2020; 77:213-218. [PMID: 31466895 PMCID: PMC8041454 DOI: 10.1016/j.jsurg.2019.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 08/04/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Active learning techniques result in greater knowledge acquisition compared to passive methods. For medical students with limited hands-on operative experiences, virtual reality platforms represent active learning and may enhance procedural training. We hypothesize that virtual reality simulators like Toolkit for Illustration of Procedures in Surgery (TIPS) are a more effective modality in teaching laparoscopic surgical techniques to medical students when compared to passive learning tools like videos. DESIGN In this crossover study, participants were randomly assigned to perform either a TIPS laparoscopic appendectomy followed by video of a laparoscopic cholecystectomy, or video of a laparoscopic appendectomy followed by TIPS laparoscopic cholecystectomy. A knowledge assessment followed each intervention. A postsurvey was used to gather feedback and subjective impressions of the learning experience. SETTING University of Central Florida College of Medicine. PARTICIPANTS Second, third, and fourth-year medical students (n = 37). RESULTS Validation of the content assessments revealed strong internal consistency (Cronbach's α = 0.73). A 2-tailed Fisher's exact test revealed that the video had greater ease of use (p = 0.032), but TIPS had greater utility as a learning tool (p < 0.001) and instilled greater confidence in the ability to reproduce procedural steps (p < 0.001). A 2-tailed t test of the average content quiz scores revealed no significant difference in percentage correct between groups on the laparoscopic appendectomy quiz (p = 0.772), but a difference favoring video learning on the laparoscopic cholecystectomy quiz (p = 0.042) CONCLUSIONS: Video and TIPS both enhanced different aspects of student learning; however, the active TIPS platform produced greater confidence in the ability to reproduce the steps of the procedure and had greater utility as a learning strategy. Videos are simple to use and can serve a complementary role in curriculum design.
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Affiliation(s)
- Heather Lesch
- University of Central Florida College of Medicine, Orlando, Florida
| | - Evan Johnson
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jörg Peters
- University of Florida College of Engineering, Gainesville, Florida
| | - Juan C Cendán
- University of Central Florida College of Medicine, Orlando, Florida.
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Use of laparoscopic videos amongst surgical trainees in the United Kingdom. Surgeon 2019; 17:334-339. [DOI: 10.1016/j.surge.2018.10.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/09/2018] [Accepted: 10/14/2018] [Indexed: 12/15/2022]
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Mann J, Rolinger J, Axt S, Kirschniak A, Wilhelm P. Novel box trainer for taTME - prospective evaluation among medical students. Innov Surg Sci 2019; 4:116-120. [PMID: 31709303 PMCID: PMC6817727 DOI: 10.1515/iss-2019-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Transanal total mesorectal excision (taTME) has been subject to extensive research and increasing clinical application. It allows further reduction of trauma by accessing via a natural orifice. Manifold platforms and instruments have been introduced and heterogeneity in surgical techniques exists. Because of the technique’s complexity there is a persistent need for dedicated training devices and concepts. Materials and methods The key steps of taTME were analyzed and a box trainer with three modules resembling these steps was designed and manufactured. Twenty-one surgically inexperienced medical students performed five repetitions of the three tasks with the new box trainer. Time and error count were analyzed for assessment of a learning curve. Results A significant reduction of processing time could be demonstrated for tasks 1–3 (p < 0.001; p < 0.001; p = 0.001). The effect size was high for comparison of repetition 1 and 5 and decreased over the course (task 1: r = 0.88 vs. r = 0.21; task 2: r = 0.86 vs. r = 0.23; task 3: r = 0.74 vs. r = 0.44). Also, a significant reduction of errors was demonstrated for tasks 1 and 2. The decrease of effect size was analogously demonstrated. Conclusions The trainer might help to reduce the use of animal models for testing of platforms and instruments as well as gaining first-hand experience in transanal rectal resection.
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Affiliation(s)
- Jakob Mann
- Department of Orthopaedic and Trauma Surgery, DIAKOVERE Henriettenstift Hospital, Hannover, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, University of Tuebingen, Tuebingen, Germany
| | - Steffen Axt
- Department of Surgery and Transplantation, University of Tuebingen, Tuebingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, University of Tuebingen, Tuebingen, Germany
| | - Peter Wilhelm
- Department of Surgery and Transplantation, University of Tuebingen, Tuebingen, Germany
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Green CA, Mahuron KM, Harris HW, O'Sullivan PS. Integrating Robotic Technology Into Resident Training: Challenges and Recommendations From the Front Lines. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1532-1538. [PMID: 30998574 PMCID: PMC6768698 DOI: 10.1097/acm.0000000000002751] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To develop recommendations for improving the integration of robotic technology into today's apprentice-based resident training. METHOD During a national meeting in 2017, 24 robotic surgeons were interviewed about their experiences integrating robotic technology into resident training. Qualitative thematic analysis of interview notes and recordings revealed themes related to challenges and recommendations. RESULTS Four themes emerged, each corresponding to a general recommendation for integrating robotic technology into training. The first, surgical techniques versus tools, contrasts faculty's sequential mastery-surgical techniques first, then the robotic tool-with residents' simultaneous learning. The recommendation is to create separate learning opportunities for focused skill acquisition. The second theme, timing of exposure to the robotic tool, describes trainees' initial focus on tool use for basic surgical steps. The recommendation is to increase access to basic robotic cases. The third theme covers the relationship of laparoscopic and robotic surgery. The recommendation is to emphasize similar and dissimilar features during all minimally invasive surgical cases. The fourth theme, use of the dual console (which enables two consoles to operate the robot, the primary determines the secondary's functionality), highlights the unique teaching opportunities this console creates. The recommendation is for surgeons to give verbal guidance so residents completely understand surgical techniques. CONCLUSIONS Surgical educators should consider technique versus tool, timing of exposure to the tool, overlapping and varying features of robotic and laparoscopic surgery, and use of the dual console as they develop curricula to ensure thorough acquisition and synthesis of all elements of robotic surgery.
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Affiliation(s)
- Courtney A Green
- C.A. Green is a general surgery resident, University of California, San Francisco, San Francisco, California. K.M. Mahuron is a general surgery resident, University of California, San Francisco, San Francisco, California. H.W. Harris is professor and chief, Division of General Surgery, J. Engelbert Dunphy Endowed Chair in Surgery, and program director, National Institutes of Health T32 Training Program in Gastrointestinal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor, Departments of Medicine and Surgery, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco School of Medicine. She is also endowed chair of surgical education, Department of Surgery, University of California, San Francisco, San Francisco, California
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Lindquist NR, Leach M, Simpson MC, Antisdel JL. Evaluating Simulator-Based Teaching Methods for Endoscopic Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2019; 98:490-495. [PMID: 31018690 DOI: 10.1177/0145561319844742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A multitude of simulator systems for endoscopic sinus surgery (ESS) are available as training tools for residents preparing to enter the operating room. These include human cadavers, virtual reality, realistic anatomic models, and low-fidelity gelatin molds. While these models have been validated and evaluated as independent tools for surgical trainees, no study has performed direct comparison of their outcomes. To address this deficiency, we aimed to evaluate the utility of high-fidelity and low-fidelity trainers as compared to a traditional control (no simulator exposure) for novice trainees acquiring basic ESS skills. Thirty-four first-year medical students were randomized to 3 groups and taught basic sinus anatomy and instrumentation. Two groups received training with either the high-fidelity or low-fidelity trainer, while 1 group served as control. These groups were then tested with cadaveric specimens. These sessions were recorded and graded by an expert. There was no statistical difference in performance between the 3 study groups with regard to identification of anatomy, endoscopic competency, or completion of basic tasks. When the high-fidelity and low-fidelity arms were grouped into a single "trained" cohort, they demonstrated significantly improved time to completion for basic anatomy (P = .043) and total time (P = .041). This is the first study to perform a direct comparison of performance between high-fidelity and low-fidelity ESS simulators and controls. Although we found no difference in performance of novice trainees with regard to basic anatomical identification or procedural tasks associated with ESS, the use of ESS simulators may improve time to completion.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew Leach
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jastin L Antisdel
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Chen LX, Fuller T, Mclntire DD, Kho KA. Introduction to Open Surgical Skills Curriculum: Randomized Trial of Self-Paced vs Group Video Tutorial Viewing. JOURNAL OF SURGICAL EDUCATION 2019; 76:453-458. [PMID: 30213739 DOI: 10.1016/j.jsurg.2018.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/04/2018] [Accepted: 08/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE At our residency program, incoming interns are traditionally taught fundamental open surgical skills like suturing and knot tying in a group setting by viewing 12 instructional videos consecutively followed by individual baseline skill testing. We sought to evaluate if introduction to open surgical skills via self-paced viewing of video tutorials, as opposed to traditional group viewing, results in improved surgical skill acquisition in Obstetrics and Gynecology (OBGYN) interns as measured by higher proficiency score with decreased workload stress and anxiety. DESIGN, SETTING, PARTICIPANTS A randomized control trial was conducted in which OBGYN PGY-1 residents in 2015 and 2016 (N = 35) were introduced to basic open surgical skills, such as knot tying and suturing, by viewing 12 video tutorials produced at UTSW (https://youtu.be/4w3hyL9muVU) for a surgical skills curriculum. Residents were randomized to 2 groups: group viewing vs self-paced viewing. Performance scores were calculated based on time and accuracy while workload and anxiety were measured by preand post-testing surveys using the National Aeronautics and Space Administration-Task Load Index and Spielberger State-Trait Anxiety Inventory 6 item questionnaires. RESULTS There was no significant difference in proficiency score between the group vs self-paced viewing in 8 out of 12 tasks using the Wilcoxon signed rank test (p > 0.10). There was no statistically significant differences in workload stress based on the National Aeronautics and Space Administration-Task Load Index questionnaire (p = 0.399) or self-reported anxiety based on the Spielberger State-Trait Anxiety Inventory 6 item questionnaire (p = 0.607). CONCLUSIONS Contrary to recent educational data suggesting self-paced learning may improve outcomes, viewing instructional videos in a group setting continues to be a time efficient method to introduce basic open surgical skills to incoming OBGYN interns.
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Affiliation(s)
- Lucy X Chen
- University of Texas Southwestern Medical Center, Department of Obstetrics & Gynecology, Dallas, Texas
| | - Tobi Fuller
- University of Texas Southwestern Medical Center, Department of Obstetrics & Gynecology, Dallas, Texas
| | - Donald D Mclntire
- University of Texas Southwestern Medical Center, Department of Obstetrics & Gynecology, Dallas, Texas
| | - Kimberly A Kho
- University of Texas Southwestern Medical Center, Department of Obstetrics & Gynecology, Dallas, Texas.
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A robotic teaching session: separating tool from technique to emphasize a cognitive focused teaching environment. J Robot Surg 2019; 13:735-739. [PMID: 30627940 DOI: 10.1007/s11701-019-00921-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
Most robotic curriculum requires simulation on a console prior to operative exposure. This practice does not permit experiencing the physical collisions with the robotic tools, which occurs during surgery. We designed and evaluated an innovative curriculum to address cognitive components and trouble-shoot robotic collisions when the surgeon lacks haptic feedback. We adapted our previous curriculum, designed to teach and document proficiency of robotic docking and instrument exchange, to include robotic collisions. Participants received a 10-min, didactic presentation describing finger grips, internal and external collisions, and instruction on how to trouble-shoot each type. Residents worked in pairs, one at the console and the other at bedside, to complete two simulation exercises. Participants manipulated the robot to determine how best to resolve the situations. Residents completed retrospective post-course surveys and instructors completed a final survey. For comparison, non-participants, PGY-matched surgical trainees, also completed a survey. All participants demonstrated proficiency in docking and instrument exchange. Compared to pre-session, post-session knowledge and confidence improved in five domains reflecting session objectives (p < 0.05). Participants could list and troubleshoot collisions more than the non-participant matched peers (p < 0.05). Instructors supported the additional collision components, but noted learners needed more time. Two of three non-participants expressed interest in a teaching session to address these components. Collisions occur using robotic technology and rarely get addressed in surgical training. We describe an opportunity for surgeons to trouble-shoot robotic collisions in a safe, simulated environment. This easily transferable curriculum represents one of the first industry-independent robotic teaching sessions for surgical trainees.
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Bolton WS, Aruparayil N, Quyn A, Scott J, Wood A, Bundu I, Gnanaraj J, Brown JM, Jayne DG. Disseminating technology in global surgery. Br J Surg 2019; 106:e34-e43. [DOI: 10.1002/bjs.11036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care.
Methods
This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included.
Results
Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery.
Conclusion
Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.
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Affiliation(s)
- W S Bolton
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - N Aruparayil
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A Quyn
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - J Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Wood
- Department of Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - I Bundu
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - J Gnanaraj
- Karunya Institute of Technology and Science, Karunya Nagar, Coimbatore, India
| | - J M Brown
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - D G Jayne
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Binkley J, Bukoski AD, Doty J, Crane M, Barnes SL, Quick JA. Surgical Simulation: Markers of Proficiency. JOURNAL OF SURGICAL EDUCATION 2019; 76:234-241. [PMID: 29983346 DOI: 10.1016/j.jsurg.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Surgical simulation has become an integral component of surgical training. Simulation proficiency determination has been traditionally based upon time to completion of various simulated tasks. We aimed to determine objective markers of proficiency in surgical simulation by comparing novel assessments with conventional evaluations of technical skill. DESIGN Categorical general surgery residents completed 10 laparoscopic cholecystectomy modules using a high-fidelity simulator. We recorded and analyzed simulation task times, as well as number of hand movements, instrument path length, instrument acceleration, and participant affective engagement during each simulation. Comparisons were made to Objective Structured Assessment of Technical Skill (OSATS) and Accreditation Council for Graduate Medical Education Milestones, as well as previous laparoscopic experience, duration of laparoscopic cholecystectomies performed by participants, and postgraduate year. Comparisons were also made to Fundamentals of Laparoscopic Surgery task times. Spearman's rho was utilized for comparisons, significance set at >0.50. SETTING University of Missouri, Columbia, Missouri, an academic tertiary care facility. PARTICIPANTS Fourteen categorical general surgery residents (postgraduate year 1-5) were prospectively enrolled. RESULTS One hundred forty simulations were included. The number of hand movements and instrument path lengths strongly correlated with simulation task times (ρ 0.62-0.87, p < 0.0001), FLS task completion times (ρ 0.50-0.53, p < 0.0001), and prior real-world laparoscopic cholecystectomy experience (ρ -0.51 to -0.53, p < 0.0001). No significant correlations were identified between any of the studied markers with Accreditation Council for Graduate Medical Education Milestones, Objective Structured Assessment of Technical Skill evaluations, total previous laparoscopic experience, or postgraduate year level. Neither instrument acceleration nor participant engagement showed significant correlation with any of the conventional markers of real-world or simulation skill proficiency. CONCLUSIONS Simulation proficiency, measured by instrument and hand motion, is more representative of simulation skill than simulation task time, instrument acceleration, or participant engagement.
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Affiliation(s)
- Jana Binkley
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Alex D Bukoski
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Jennifer Doty
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Megan Crane
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Stephen L Barnes
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, Missouri.
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Green CA, Kim EH, O'Sullivan PS, Chern H. Using Technological Advances to Improve Surgery Curriculum: Experience With a Mobile Application. JOURNAL OF SURGICAL EDUCATION 2018; 75:1087-1095. [PMID: 29397357 DOI: 10.1016/j.jsurg.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/23/2017] [Accepted: 12/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Our previous home-video basic surgical skills curriculum required substantial faculty time and resources, and was limited by delayed feedback and technical difficulties. Consequently, we integrated that curriculum with a mobile application platform. Our purpose is to describe this application and learner satisfaction. MATERIALS AND METHODS The mobile platform incorporates a patented pedagogical design based on Ericsson's deliberate practice and Bandura's social learning theory. Instructors built step-wise skills modules. During the challenge phase, learners watched a video of surgical tasks completed by experts and uploaded a video of themselves performing the same task. In the Peer Review phase, they used a grading rubric to provide feedback. In the Recap stage, learners received individual feedback and could review their own videos. Two groups of learners, graduating medical students and matriculating surgical residents, participated in this independent learning platform, along with 2 to 4 laboratory sessions, and completed a survey about their experience. Survey responses were summarized descriptively and comments analyzed using content analysis. RESULTS Fifty learners submitted videos of assigned tasks and completed peer reviews. Learners reported positive experiences specifically for the Peer Review Stage, structured home practice, ease of mobile access to submit and review videos, and ongoing immediate feedback. Over half of the learners reported spending at least 10 to 30 minute practicing skills before recording their videos and over 80% rerecorded at least 2 times before submission. Content analysis revealed learners engaged with the educational concepts designed into the platform. CONCLUSION Learners easily used and were satisfied with a mobile-technology teaching platform that maintained the fundamental content, educational theories, and organizational structure of our previously effective surgical skills curriculum. Prior challenges were directly addressed through the mobile application's ease of use, support of deliberate practice, and improved timeliness of feedback.
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Affiliation(s)
- Courtney A Green
- Department of Surgery, University of California, San Francisco, California.
| | - Edward H Kim
- Department of Surgery, University of California, San Francisco, California
| | | | - Hueylan Chern
- Department of Surgery, University of California, San Francisco, California
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Affiliation(s)
- Wei Jia
- Ear, Nose and Throat (ENT) Education Department, London North West Healthcare NHS Trust, Harrow, UK
| | - Basil Al-Omari
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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Carneiro F, Abreu P, Restivo MT. Hysteresis Compensation in a Tactile Device for Arterial Pulse Reproduction. SENSORS (BASEL, SWITZERLAND) 2018; 18:E1631. [PMID: 29783750 PMCID: PMC5982225 DOI: 10.3390/s18051631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/17/2022]
Abstract
This paper describes a system for training healthcare practitioners in the identification of different arterial pulses. The driving system uses a linear solenoid in an open loop force control. Due to the large hysteresis it exhibited, a form of compensation was implemented, based on the classic Preisach model of hysteresis. Implementation of said model resulted in a significant reduction of force tracking error, demonstrating the feasibility of the chosen approach for the intended application.
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Affiliation(s)
- Fernando Carneiro
- LAETA-INEGI, Associated Laboratory for Energy, Transports and Aeronautics-Institute of Science and Innovation in Mechanical and Industrial Engineering, University of Porto, 4200-465 Porto, Portugal.
| | - Paulo Abreu
- LAETA-INEGI, Associated Laboratory for Energy, Transports and Aeronautics-Institute of Science and Innovation in Mechanical and Industrial Engineering, University of Porto, 4200-465 Porto, Portugal.
| | - Maria Teresa Restivo
- LAETA-INEGI, Associated Laboratory for Energy, Transports and Aeronautics-Institute of Science and Innovation in Mechanical and Industrial Engineering, University of Porto, 4200-465 Porto, Portugal.
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Sinceri S, Berchiolli R, Marconi M, Cioni R, Ferrari V, Ferrari M, Moglia A, Carbone M. Face, content, and construct validity of a simulator for training in endovascular procedures. MINIM INVASIV THER 2018; 27:315-320. [DOI: 10.1080/13645706.2018.1458038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sara Sinceri
- EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Marconi
- Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Division of Diagnostic and Interventional Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vincenzo Ferrari
- EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marina Carbone
- EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Gaitanidis A, Simopoulos C, Pitiakoudis M. What to consider when designing a laparoscopic colorectal training curriculum: a review of the literature. Tech Coloproctol 2018; 22:151-160. [PMID: 29512045 DOI: 10.1007/s10151-018-1760-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/03/2017] [Indexed: 12/27/2022]
Abstract
Multiple studies have demonstrated the benefits of laparoscopic colorectal surgery (LCS), but in several countries it has still not been widely adopted. LCS training is associated with several challenges, such as patient safety concerns and a steep learning curve. Current evidence may facilitate designing of efficient training curricula to overcome these challenges. Basic training with virtual reality simulators has witnessed meteoric advances and may be essential during the early parts of the learning curve. Cadaveric and animal model training still constitutes an indispensable training tool, due to a higher degree of difficulty and greater resemblance to real operative conditions. In addition, recent evidence favors the use of novel training paradigms, such as proficiency-based training, case selection and modular training. This review summarizes the recent advances in LCS training and provides the evidence for designing an efficient training curriculum to overcome the challenges of LCS training.
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Affiliation(s)
- A Gaitanidis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece.
| | - C Simopoulos
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece
| | - M Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 68100, Alexandroupoli, Greece
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Wynn G, Lykoudis P, Berlingieri P. Development and implementation of a virtual reality laparoscopic colorectal training curriculum. Am J Surg 2017; 216:610-617. [PMID: 29268942 DOI: 10.1016/j.amjsurg.2017.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Contemporary surgical training can be compromised by fewer practical opportunities. Simulation can fill this gap to optimize skills' development and progress monitoring. A structured virtual reality (VR) laparoscopic sigmoid colectomy curriculum is constructed and its validity and outcomes assessed. METHODS Parameters and thresholds were defined by analysing the performance of six expert surgeons completing the relevant module on the LAP Mentor simulator. Fourteen surgical trainees followed the curriculum, performance being recorded and analysed. Evidence of validity was assessed. RESULTS Time to complete procedure, number of movements of right and left instrument, and total path length of right and left instrument movements demonstrated evidence of validity and clear learning curves, with a median of 14 attempts needed to complete the curriculum. CONCLUSIONS A structured curriculum is proposed for training in laparoscopic sigmoid colectomy in a VR environment based on objective metrics in addition to expert consensus. Validity has been demonstrated for some key metrics.
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Affiliation(s)
- Greg Wynn
- ICENI Centre for Minimally Invasive Surgery, Colchester, UK.
| | - Panagis Lykoudis
- Centre for Screen-Based Medical Simulation, Royal Free Hospital, London, UK; Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
| | - Pasquale Berlingieri
- Centre for Screen-Based Medical Simulation, Royal Free Hospital, London, UK; Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
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Kostusiak M, Hart M, Barone DG, Hofmann R, Kirollos R, Santarius T, Trivedi R. Methodological shortcomings in the literature evaluating the role and applications of 3D training for surgical trainees. MEDICAL TEACHER 2017; 39:1168-1173. [PMID: 28793829 DOI: 10.1080/0142159x.2017.1362102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM There has been an increased interest in the use of three-dimensional (3D) technology in surgical training. We wish to appraise the methodological rigor applied to evaluating the role and applications of 3D technology in surgical training, in particular, on the validity of these models and assessment methods in simulated surgical training. METHODS Literature search was performed using MEDLINE with the following terms: "3D"; "surgery"; and "training". Only studies evaluating the role of 3D technology in surgical training were eligible for inclusion and assessed for the level of evidence, validity of the simulation model, and assessment method used. RESULTS A total of 93 studies were analyzed, and majority of reviewed articles focused on 3D displays (36) and 3D printing (35). Most of these studies were case series, the most common assessment was subjective (69), with objective assessment used by 57 studies. Very few studies provided evidence for validity of the model or the assessment methods used. CONCLUSIONS 3D technology has a great potential in simulated surgical training. However, the validity of this technology and strong evidence for its beneficial effects in surgical training is lacking. Further work on validation of 3D technology and assessment tools is needed.
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Affiliation(s)
- Milosz Kostusiak
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
| | - Michael Hart
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
| | - Damiano Giuseppe Barone
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
| | - Riikka Hofmann
- b Faculty of Education , University of Cambridge , Cambridge , UK
| | - Ramez Kirollos
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
| | - Thomas Santarius
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
| | - Rikin Trivedi
- a Division of Neurosurgery, Addenbrooke's Hospital , University of Cambridge , Cambridge , UK
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Uptake of Transanal Total Mesorectal Excision in North America: Initial Assessment of a Structured Training Program and the Experience of Delegate Surgeons. Dis Colon Rectum 2017; 60:1023-1031. [PMID: 28891845 DOI: 10.1097/dcr.0000000000000823] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transanal total mesorectal excision is a new approach to curative-intent rectal cancer surgery. Training and surgeon experience with this approach has not been assessed previously in America. OBJECTIVE The purpose of this study was to characterize a structured training program and to determine the experience of delegate surgeons. DESIGN Data were assimilated from an anonymous, online survey delivered to attendees on course completion. Data on surgeon performance during hands-on cadaveric dissection were collected prospectively. SETTINGS This study was conducted at a single tertiary colorectal surgery referral center, and cadaveric hands-on training was conducted at a specialized surgeon education center. MAIN OUTCOME MEASURES The main outcome measurement was the use of the course and surgeon experience posttraining. RESULTS During a 12-month period, eight 2-day transanal total mesorectal excision courses were conducted. Eighty-one colorectal surgeons successfully completed the course. During cadaveric dissection, 71% achieved a complete (Quirke 3) specimen; 26% were near complete (Quirke 2), and 3% were incomplete (Quirke 1). A total of 9.1% demonstrated dissection in the incorrect plane, whereas 4.5% created major injury to the rectum or surrounding structures, excluding the prostate. Thirty eight (46.9%) of 81 surgeon delegates responded to an online survey. Of survey respondents, 94.6% believed training should be required before performing transanal total mesorectal excision. Posttraining, 94.3% of surgeon delegates planned to use transanal total mesorectal excision for distal-third rectal cancers, 74.3% for middle-third cancers, and 8.6% for proximal-third cancers. The most significant complication reported was urethral injury; 5 were reported by the subset of survey respondents who had performed this operation postcourse. LIMITATIONS The study was limited by inherent reporting bias, including observer and recall biases. CONCLUSIONS Although this structured training program for transanal total mesorectal excision was found to be useful by the majority of respondents, the risk of iatrogenic injury after training remains high, suggesting that this training pedagogy alone is insufficient. See Video Abstract at http://links.lww.com/DCR/A335.
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Morgan M, Aydin A, Salih A, Robati S, Ahmed K. Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:698-716. [PMID: 28188003 DOI: 10.1016/j.jsurg.2017.01.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/15/2016] [Accepted: 01/04/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation. DESIGN Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education. RESULTS A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE. CONCLUSIONS Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.
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Affiliation(s)
- Michael Morgan
- School of Medicine, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Alan Salih
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Shibby Robati
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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Sakakushev BE, Marinov BI, Stefanova PP, Kostianev SS, Georgiou EK. Striving for Better Medical Education: the Simulation Approach. Folia Med (Plovdiv) 2017; 59:123-131. [DOI: 10.1515/folmed-2017-0039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractMedical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties.Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used.Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators.The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.
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Nunes ALP, Maciel A, Cavazzola LT, Walter M. A laparoscopy-based method for BRDF estimation from in vivo human liver. Med Image Anal 2016; 35:620-632. [PMID: 27728873 DOI: 10.1016/j.media.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 01/07/2023]
Abstract
While improved visual realism is known to enhance training effectiveness in virtual surgery simulators, the advances on realistic rendering for these simulators is slower than similar simulations for man-made scenes. One of the main reasons for this is that in vivo data is hard to gather and process. In this paper, we propose the analysis of videolaparoscopy data to compute the Bidirectional Reflectance Distribution Function (BRDF) of living organs as an input to physically based rendering algorithms. From the interplay between light and organic matter recorded in video images, we propose the definition of a process capable of establishing the BRDF for inside-the-body organic surfaces. We present a case study around the liver with patient-specific rendering under global illumination. Results show that despite the limited range of motion allowed within the body, the computed BRDF presents a high-coverage of the sampled regions and produces plausible renderings.
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Affiliation(s)
- A L P Nunes
- Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Federal Institute of Paraná, Londrina, Brazil.
| | - A Maciel
- Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - L T Cavazzola
- Institute of Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - M Walter
- Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Sippey M, Spaniolas K, Manwaring ML, Pofahl WE, Kasten KR. Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy. Am J Surg 2016; 211:1026-34. [PMID: 26601647 DOI: 10.1016/j.amjsurg.2015.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/21/2022]
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