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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety. Surg Endosc 2024; 38:983-991. [PMID: 37973638 DOI: 10.1007/s00464-023-10528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice. METHODS A multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes. RESULTS Of the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability. CONCLUSIONS A safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.
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Affiliation(s)
- Gina Adrales
- Division of Minimally Invasive Surgery, Minimally Invasive Surgical Training and Innovation Center (MISTIC), Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Monash University Department of Surgery & Lap Surgery, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center Bonn, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- Tamale Teaching Hospital, University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Daneshgar Rahbar M, Mousavi Mojab SZ. Enhanced U-Net with GridMask (EUGNet): A Novel Approach for Robotic Surgical Tool Segmentation. J Imaging 2023; 9:282. [PMID: 38132700 PMCID: PMC10744415 DOI: 10.3390/jimaging9120282] [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: 10/22/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
This study proposed enhanced U-Net with GridMask (EUGNet) image augmentation techniques focused on pixel manipulation, emphasizing GridMask augmentation. This study introduces EUGNet, which incorporates GridMask augmentation to address U-Net's limitations. EUGNet features a deep contextual encoder, residual connections, class-balancing loss, adaptive feature fusion, GridMask augmentation module, efficient implementation, and multi-modal fusion. These innovations enhance segmentation accuracy and robustness, making it well-suited for medical image analysis. The GridMask algorithm is detailed, demonstrating its distinct approach to pixel elimination, enhancing model adaptability to occlusions and local features. A comprehensive dataset of robotic surgical scenarios and instruments is used for evaluation, showcasing the framework's robustness. Specifically, there are improvements of 1.6 percentage points in balanced accuracy for the foreground, 1.7 points in intersection over union (IoU), and 1.7 points in mean Dice similarity coefficient (DSC). These improvements are highly significant and have a substantial impact on inference speed. The inference speed, which is a critical factor in real-time applications, has seen a noteworthy reduction. It decreased from 0.163 milliseconds for the U-Net without GridMask to 0.097 milliseconds for the U-Net with GridMask.
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Affiliation(s)
- Mostafa Daneshgar Rahbar
- Department of Electrical and Computer Engineering, Lawrence Technological University, Southfield, MI 48075, USA
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Feenstra TM, Mak-van der Vossen MC, Schijven MP, Nieveen van Dijkum EJM. Digital Training Resources in the Dutch Surgical Residency Curricula and the Perspectives of Residents: A Thematic Analysis of Resident Interviews. JOURNAL OF SURGICAL EDUCATION 2023; 80:457-467. [PMID: 36402731 DOI: 10.1016/j.jsurg.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Digital training resources show great promise in augmenting traditional surgical education - especially in times of social distancing and limited surgical caseload. Embedding digital resources in surgical curricula is however not current, nor common practice in Dutch hospitals. While the digital world has become part of a resident's everyday life, surprisingly little is known about surgical residents' experiences and expectations towards use of digital resources for their own surgical education. This study aims to identify digital resources currently used in Dutch surgical curricula and to describe surgical residents' perspectives towards digital education. METHODS A series of semi-structured interviews with Dutch surgical residents were conducted until data sufficiency occurred. The interviews consisted of two parts: 1) current surgical training and implemented digital resources, and 2) future surgical training and the role of digital resources therein. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed. RESULTS Sixteen surgical residents were interviewed - two out of each of the eight educational regions for surgery in the Netherlands. Five digital resource categories were identified and four general educational themes (requirements, advantages, disadvantages, and general education themes), overarching 13 sub-themes. In general, residents were enthusiastic with regard to using digital resources, especially when the perceived advantages supported their autonomy. CONCLUSIONS Dutch surgical residents indicate that digital resources may support their educational experiences, but state that ideally they must be combined with much appreciated on-the-job training, and be offered to them tailored to their individual needs. No resources are considered to be a "magic bullet" in itself. The specific needs of residents and educators need to be addressed clearly in order to successfully adopt and implement digital resources on a larger scale.
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Affiliation(s)
- Tim M Feenstra
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, North Holland, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, the Netherlands
| | - Marianne C Mak-van der Vossen
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, North Holland, the Netherlands; Amsterdam Public Health research institute University of Amsterdam, Amsterdam, North Holland, the Netherlands
| | - Marlies P Schijven
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, North Holland, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, the Netherlands
| | - Els J M Nieveen van Dijkum
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, North Holland, the Netherlands; Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, the Netherlands; Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, North Holland, the Netherlands.
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Stella E, Agosti I, Di Blas N, Finazzi M, Lanzi PL, Loiacono D. A virtual reality classroom to teach and explore crystal solid state structures. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 82:6993-7016. [PMID: 35971458 PMCID: PMC9365684 DOI: 10.1007/s11042-022-13410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/01/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED We present an educational application of virtual reality that we created to help students gain an in-depth understanding of the internal structure of crystals and related key concepts. Teachers can use it to give lectures to small groups (10-15) of students in a shared virtual environment, both remotely (with teacher and students in different locations) and locally (while sharing the same physical space). Lectures can be recorded, stored in an online repository, and shared with students who can either review a recorded lecture in the same virtual environment or can use the application for self-studying by exploring a large collection of available crystal structures. We validated our application with human subjects receiving positive feedback. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11042-022-13410-0https://doi.org/10.1007/s11042-022-13410-0.
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Effects of surgical flow disruptions on surgeons' resources: a pilot study. Surg Endosc 2020; 34:4525-4535. [PMID: 31720810 DOI: 10.1007/s00464-019-07239-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon's pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons' physiological resources. METHODS Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. RESULTS The results indicate that expert surgeons' mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p = .059) and at the end of procedures (p = .001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p = .041) and at the end (p = .026), than at the start and end of a short procedure. CONCLUSION Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons' mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons' pool of resources.
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Alvarez-Lopez F, Maina MF, Saigí-Rubió F. Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study. J Med Internet Res 2020; 22:e17491. [PMID: 32673217 PMCID: PMC7388055 DOI: 10.2196/17491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. Objective This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. Methods For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. Results A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). Conclusions The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.
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Affiliation(s)
| | - Marcelo Fabián Maina
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Virtual Operating Room Simulation Setup (VORSS) for Procedural Training in Minimally Invasive Surgery – a Pilot Study. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AbstractVirtual reality (VR) training is widely used in several minimal invasive surgery (MIS) training curricula for procedural training. However, VR training in its current state lack immersive training environments, such as using head-mounted displays that is implemented in military or aviation training and even entertainment. The virtual operating room simulation setup (VORSS) is explored in this study to determine the effectiveness of immersive training in MIS. Twenty-eight surgeons and surgical trainees performed a laparoscopic cholecystectomy on the VORSS comprising of a head-mounted 360-degree realistic OR surrounding on a VR laparoscopic simulator. The VORSS replicated a full setup of instruments and surgical team-members as well as some of the distractions occurring during surgical procedures. Questionnaires were followed by semi-structured interviews to collect the data. Experts and novices found the VORSS to be intuitive and easy to use (p = 0.001). The outcome of the usability test, applying QUESI and NASA-TLX, reflected the usability of the VORSS (p < 0.05), at the cognitive level, which indicates a good sense of immersion and satisfaction, when performing the procedure within VORSS. The need for personalized experience within the setup was strongly noted from most of the participants. The VORSS for procedural training has the potential to become a useful tool to provide immersive training in MIS surgery. Further optimizing of the VORSS realism and introduction of distractors in the OR should result in an improvement of the system.
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Ganni S, Botden SMBI, Chmarra M, Li M, Goossens RHM, Jakimowicz JJ. Validation of Motion Tracking Software for Evaluation of Surgical Performance in Laparoscopic Cholecystectomy. J Med Syst 2020; 44:56. [PMID: 31980955 PMCID: PMC6981315 DOI: 10.1007/s10916-020-1525-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/16/2020] [Indexed: 01/22/2023]
Abstract
Motion tracking software for assessing laparoscopic surgical proficiency has been proven to be effective in differentiating between expert and novice performances. However, with several indices that can be generated from the software, there is no set threshold that can be used to benchmark performances. The aim of this study was to identify the best possible algorithm that can be used to benchmark expert, intermediate and novice performances for objective evaluation of psychomotor skills. 12 video recordings of various surgeons were collected in a blinded fashion. Data from our previous study of 6 experts and 23 novices was also included in the analysis to determine thresholds for performance. Video recording were analyzed both by the Kinovea 0.8.15 software and a blinded expert observer using the CAT form. Multiple algorithms were tested to accurately identify expert and novice performances. ½ L + [Formula: see text] A + [Formula: see text] J scoring of path length, average movement and jerk index respectively resulted in identifying 23/24 performances. Comparing the algorithm to CAT assessment yielded in a linear regression coefficient R2 of 0.844. The value of motion tracking software in providing objective clinical evaluation and retrospective analysis is evident. Given the prospective use of this tool the algorithm developed in this study proves to be effective in benchmarking performances for psychomotor skills evaluation.
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Affiliation(s)
- Sandeep Ganni
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands.
- GSL Medical College, Department of Surgery, Rajahmundry, India.
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Magdalena Chmarra
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Meng Li
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
| | - Richard H M Goossens
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Jack J Jakimowicz
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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Alvarez-Lopez F, Maina MF, Saigí-Rubió F. Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review. J Med Internet Res 2019; 21:e11925. [PMID: 31066679 PMCID: PMC6533048 DOI: 10.2196/11925] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 01/04/2019] [Accepted: 01/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture–based human-computer interaction is currently being explored as a solution in surgical environments. Objective The aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS). Methods For this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected. Results A total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms. Conclusions COTS devices applied to hand and instrument gesture–based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up.
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Affiliation(s)
- Fernando Alvarez-Lopez
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Faculty of Health Sciences, Universidad de Manizales, Caldas, Colombia
| | - Marcelo Fabián Maina
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Green JL, Suresh V, Bittar P, Ledbetter L, Mithani SK, Allori A. The Utilization of Video Technology in Surgical Education: A Systematic Review. J Surg Res 2018; 235:171-180. [PMID: 30691792 DOI: 10.1016/j.jss.2018.09.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/05/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of surgical video has great potential to enhance surgical education, but there exists limited information about how to effectively use surgical videos. We performed a systematic review of video technology in surgical training and provided evidence-based recommendations for its effective use. MATERIALS AND METHODS A systematic review of literature on surgical video in residency education was conducted. All articles meeting inclusion criteria were evaluated for technical characteristics pertaining to video usage. Included studies were critically appraised using a quality-scoring system. Recommendations were provided for the effective implementation of video in surgical education based on associations with improved training outcomes. RESULTS Twenty articles met inclusion criteria. In these studies, the source of video acquisition was primarily laparoscopy (40.0% of papers), and the main perspective of video was endoscopy (45.0%). Features of videos included supplementation with other educational tools (55.0%), schematic diagrams or images (50.0%), audio (40.0%), and narration (25.0%). Videos were primarily viewed preoperatively (60.0%) or postoperatively (50.0%). The intended viewer for videos was usually residents (70.0%) but also included attendings/faculty (30.0%). When compared with a nonvideo training group, video training was associated with improved resident knowledge (100%), improved operative performance (81.3%), and greater participant satisfaction (100%). CONCLUSIONS Based on this review, we recommend that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilize audio in video. For video review, we recommend that residents review video preoperatively and postoperatively for learning and that attendings review video postoperatively for assessment.
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Affiliation(s)
- Jason L Green
- Duke University School of Medicine, Durham, North Carolina.
| | - Visakha Suresh
- Duke University School of Medicine, Durham, North Carolina
| | - Peter Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina
| | - Suhail K Mithani
- Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Allori
- Pediatric Plastic & Craniofacial Surgery, Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Kowalewski KF, Minassian A, Hendrie JD, Benner L, Preukschas AA, Kenngott HG, Fischer L, Müller-Stich BP, Nickel F. One or two trainees per workplace for laparoscopic surgery training courses: results from a randomized controlled trial. Surg Endosc 2018; 33:1523-1531. [PMID: 30194644 DOI: 10.1007/s00464-018-6440-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no standards for optimal utilization of workplaces in laparoscopic training. This study aimed to define whether laparoscopy training should be done alone or in pairs (known as dyad training). METHODS This was a three-arm randomized controlled trial with laparoscopically naïve medical students (n = 100). Intervention groups participated alone (n = 40) or as dyad (n = 40) in a multimodality training curriculum with e-learning, basic, and procedural skills training using box and VR trainers. The control group (n = 20) had no training. Post-performance of a cadaveric porcine laparoscopic cholecystectomy (LC) was measured as the primary outcome by blinded raters using the objective structured assessment of technical skills (OSATS). Global operative assessment of laparoscopic skills (GOALS), time for LC, and VR performances were secondary outcomes. RESULTS There were no differences between groups for performance scores [OSATS: alone (40.2 ± 9.8) vs. dyad (39.8 ± 8.6), p = 0.995; alone vs. control (37.1 ± 7.4), p = 0.548; or dyad vs. control, p = 0.590; and GOALS score: alone (10.6 ± 3.0) vs. dyad (10.0 ± 2.7), p = 0.599; alone vs. control (10.1 ± 3.0), p = 0.748; or dyad vs. control, p = 0.998]. Dyad finished LC faster than control [median = 62.5 min (CI 58.0-73.0) vs. 76.5 min (CI 72.0-80+); p = 0.042], while there were no inter-group differences between alone vs. control [median = 69.0 min (CI 62.0-76.0) vs. control; p = 0.099] or alone vs. dyad (p = 0.840). Dyad and alone showed superior performance on the VR trainer vs. control for time, number of movements, and path length, but not for complications and application of cautery. CONCLUSIONS The curriculum provided trainees with the laparoscopic skills needed to perform LC safely, irrespective of the number of trainees per workplace. Dyad training reduced the operation time needed for LC. Therefore, dyad training seems to be a promising alternative, especially if training time is limited and resources must be used as efficiently as possible. Trial registration German Clinical Trials Register: DRKS00004675.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Andreas Minassian
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jonathan David Hendrie
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Laura Benner
- Institute for Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Anas Amin Preukschas
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes Götz Kenngott
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Kowalewski KF, Garrow CR, Proctor T, Preukschas AA, Friedrich M, Müller PC, Kenngott HG, Fischer L, Müller-Stich BP, Nickel F. LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy-results of a randomized controlled trial. Surg Endosc 2018; 32:3830-3838. [PMID: 29435758 DOI: 10.1007/s00464-018-6110-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple training modalities for laparoscopy have different advantages, but little research has been conducted on the benefit of a training program that includes multiple different training methods compared to one method only. This study aimed to evaluate benefits of a combined multi-modality training program for surgical residents. METHODS Laparoscopic cholecystectomy (LC) was performed on a porcine liver as the pre-test. Randomization was stratified for experience to the multi-modality Training group (12 h of training on Virtual Reality (VR) and box trainer) or Control group (no training). The post-test consisted of a VR LC and porcine LC. Performance was rated with the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded experts. RESULTS Training (n = 33) and Control (n = 31) were similar in the pre-test (GOALS: 13.7 ± 3.4 vs. 14.7 ± 2.6; p = 0.198; operation time 57.0 ± 18.1 vs. 63.4 ± 17.5 min; p = 0.191). In the post-test porcine LC, Training had improved GOALS scores (+ 2.84 ± 2.85 points, p < 0.001), while Control did not (+ 0.55 ± 2.34 points, p = 0.154). Operation time in the post-test was shorter for Training vs. Control (40.0 ± 17.0 vs. 55.0 ± 22.2 min; p = 0.012). Junior residents improved GOALS scores to the level of senior residents (pre-test: 13.7 ± 2.7 vs. 18.3 ± 2.9; p = 0.010; post-test: 15.5 ± 3.4 vs. 18.8 ± 3.8; p = 0.120) but senior residents remained faster (50.1 ± 20.6 vs. 25.0 ± 1.9 min; p < 0.001). No differences were found between groups on the post-test VR trainer. CONCLUSIONS Structured multi-modality training is beneficial for novices to improve basics and overcome the initial learning curve in laparoscopy as well as to decrease operation time for LCs in different stages of experience. Future studies should evaluate multi-modality training in comparison with single modalities. TRIAL REGISTRATION German Clinical Trials Register DRKS00011040.
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Affiliation(s)
- K F Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - C R Garrow
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - T Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - A A Preukschas
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Friedrich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P C Müller
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - H G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - L Fischer
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Ganni S, Botden SMBI, Chmarra M, Goossens RHM, Jakimowicz JJ. A software-based tool for video motion tracking in the surgical skills assessment landscape. Surg Endosc 2018; 32:2994-2999. [PMID: 29340824 PMCID: PMC5956097 DOI: 10.1007/s00464-018-6023-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data. METHODS 6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The recorded videos were analysed using Kinovea 0.8.15 and the following parameters calculated the path length, average instrument movement and number of sudden or extreme movements. RESULTS The analysed data showed that experts had significantly shorter path length (median 127 cm vs. 187 cm, p = 0.01), smaller average movements (median 0.40 cm vs. 0.32 cm, p = 0.002) and fewer sudden movements (median 14.00 vs. 21.61, p = 0.001) than their novice counterparts. CONCLUSION The use of software-based video motion tracking of laparoscopic cholecystectomy is a simple and viable method enabling objective assessment of surgical performance. It provides clear discrimination between expert and novice performance.
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Affiliation(s)
- Sandeep Ganni
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands. .,Department of Surgery, GSL Medical College, Rajahmundry, India. .,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Magdalena Chmarra
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Richard H M Goossens
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jack J Jakimowicz
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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Schmitt F, Mariani A, Eyssartier E, Granry JC, Podevin G. Learning Laparoscopic Skills: Observation or Practice? J Laparoendosc Adv Surg Tech A 2018; 28:89-94. [DOI: 10.1089/lap.2017.0254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Françoise Schmitt
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
| | - Aurora Mariani
- Department of Paediatric Surgery, Robert Debré Hospital, Paris, France
| | - Emilie Eyssartier
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
| | | | - Guillaume Podevin
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
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15
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Lindlohr C, Lefering R, Saad S, Heiss MM, Pape-Köhler C. Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial. Langenbecks Arch Surg 2017; 402:645-653. [PMID: 28238058 DOI: 10.1007/s00423-017-1567-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. METHODS This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. RESULTS In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. CONCLUSION The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
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Affiliation(s)
- Cornelia Lindlohr
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - S Saad
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany
| | - M M Heiss
- Department for Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - C Pape-Köhler
- Department for General and Abdominal Surgery, Protestant Hospital, Cologne-Weyertal, Germany
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16
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Systematic review of the implementation of simulation training in surgical residency curriculum. Surg Today 2016; 47:777-782. [DOI: 10.1007/s00595-016-1455-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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17
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Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 2016; 31:2520-2528. [PMID: 27655381 DOI: 10.1007/s00464-016-5254-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe. METHODS Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim®) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded. RESULTS Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives). CONCLUSION This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.
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Affiliation(s)
- Katrine Jensen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
| | - Flemming Bjerrum
- JMC Simulation Unit, The Juliane Marie Centre, Section 4704, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Holst Pedersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
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18
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What is the Safe Training to Educate the Laparoscopic Cholecystectomy for Surgical Residents in Early Learning Curve? ACTA ACUST UNITED AC 2016. [DOI: 10.7602/jmis.2015.19.2.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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King N, Kunac A, Johnsen E, Gallina G, Merchant AM. Design and validation of a cost-effective physical endoscopic simulator for fundamentals of endoscopic surgery training. Surg Endosc 2016; 30:4871-4879. [PMID: 26905575 DOI: 10.1007/s00464-016-4824-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/06/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The American Board of Surgery will require graduating surgical residents to achieve proficiency in endoscopy. Surgical simulation can help residents to prepare for this proficiency test, accelerate skill acquisition, shorten the learning, and improve patient safety. Currently, endoscopic simulators are extremely cost-prohibitive. We therefore designed an inexpensive physical endoscopic simulator to (1) facilitate Fundamentals of Endoscopic Surgery skills training and (2) teach basic colonoscopy skills, for <$200.00. METHODS We constructed the Rutgers Open Source Colonoscopy Simulator (ROSCO) from easily acquired commercial materials. For construct validation, we compared novices to experts in a two-arm non-randomized study. Each participant performed the five tasks and a full cecal intubation on the simulator. Face and content validity surveys were taken by the experts, after the construct validity study to determine the simulator's ability to achieve the intended task with "realism." Data were collected on (1) cost and construction, (2) time to completion of individual tasks, (3) percentage of task completion, and (4) survey statistics. RESULTS Our simulator requires no advanced expertise, costs $62.77 US, and weighs 8.5 pounds. The ROSCO simulator was clearly able to distinguish expert from novice. Expert task times for completing all five tasks, performing the loop reduction, and reaching the splenic and hepatic flexures on the simulator were significantly better than novice times (p < 0.05). All participants were able to complete all five tasks on the simulator 100 % of the time. Three out of five experts "Agreed" or "Strongly Agreed" with five out of the six statements regarding the simulator's teaching ability. Four out of five experts rated each of the five specific aspects of the simulator as "Realistic" or "Very Realistic." CONCLUSIONS We have designed a low-cost colonoscopy simulator with easily available materials and which requires very little advanced construction expertise and have demonstrated construct, face, and content validity. We believe this will have broad impact for endoscopic simulation, surgical education, and health education cost.
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Affiliation(s)
- Neil King
- Division of General Surgery, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA
| | - Anastasia Kunac
- Division of Trauma and Critical Care, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA
| | - Erik Johnsen
- Department of Surgery, Rutgers-New Jersey Medical School, 185 So. Orange Ave., MSB G-506, Newark, NJ, 07103, USA
| | - Gregory Gallina
- Division of Surgery, Hackensack University Medical Center, Hackensack, NJ, 07601, USA
| | - Aziz M Merchant
- Division of General Surgery, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA. .,Department of Surgery, Rutgers-New Jersey Medical School, 185 So. Orange Ave., MSB G-506, Newark, NJ, 07103, USA.
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21
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Watanabe Y, Bilgic E, Lebedeva E, McKendy KM, Feldman LS, Fried GM, Vassiliou MC. A systematic review of performance assessment tools for laparoscopic cholecystectomy. Surg Endosc 2015; 30:832-44. [PMID: 26092014 DOI: 10.1007/s00464-015-4285-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple tools are available to assess clinical performance of laparoscopic cholecystectomy (LC), but there are no guidelines on how best to implement and interpret them in educational settings. The purpose of this systematic review was to identify and critically appraise LC assessment tools and their measurement properties, in order to make recommendations for their implementation in surgical training. METHODS A systematic search (1989-2013) was conducted in MEDLINE, Embase, Scopus, Cochrane, and grey literature sources. Evidence for validity (content, response process, internal structure, relations to other variables, and consequences) and the conditions in which the evidence was obtained were evaluated. RESULTS A total of 54 articles were included for qualitative synthesis. Fifteen technical skills and two non-technical skills assessment tools were identified. The 17 tools were used for either: recorded procedures (nine tools, 60%), direct observation (five tools, 30%), or both (three tools, 18%). Fourteen (82%) tools reported inter-rater reliability and one reported a Generalizability Theory coefficient. Nine (53%) had evidence for validity based on clinical experience and 11 (65%) compared scores to other assessments. Consequences of scores, educational impact, applications to residency training, and how raters were trained were not clearly reported. No studies mentioned cost. CONCLUSIONS The most commonly reported validity evidence was inter-rater reliability and relationships to other known variables. Consequences of assessments and rater training were not clearly reported. These data and the evidence for validity should be taken into consideration when deciding how to select and implement a tool to assess performance of LC, and especially how to interpret the results.
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Affiliation(s)
- Yusuke Watanabe
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Elif Bilgic
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Ekaterina Lebedeva
- The Henry K.M. De Kuyper Education Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Katherine M McKendy
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Melina C Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
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22
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Obdeijn MC, Bavinck N, Mathoulin C, van der Horst CMAM, Schijven MP, Tuijthof GJM. Education in wrist arthroscopy: past, present and future. Knee Surg Sports Traumatol Arthrosc 2015; 23:1337-1345. [PMID: 23835770 DOI: 10.1007/s00167-013-2592-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 06/26/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Arthroscopy has assumed an important place in wrist surgery. It requires specific operative skills that are now mainly acquired in the operating room. In other fields of endoscopic surgery, e-learning and virtual reality (VR) have introduced new perspectives in teaching skills. This leads to the following research question: Could the current way of teaching wrist arthroscopy skills be supported using new educational media, such as e-learning and simulator training? METHOD The literature was searched for available methods of teaching endoscopic skills. Articles were assessed on the evidence of validity. In addition, a survey was sent to all members of the European Wrist Arthroscopy Society (EWAS) to find out whether hand surgeons express a need to embrace modern educational tools such as e-learning or simulators for training of wrist arthroscopy skills. RESULTS This study shows that the current way of teaching wrist arthroscopy skills can be supported using new educational media, such as e-learning and simulator training. Literature indicates that e-learning can be a valuable tool for teaching basic knowledge of arthroscopy and supports the hypothesis that the use of virtual reality and simulators in training enhances operative skills in surgical trainees. This survey indicates that 55 out of 65 respondents feel that an e-learning program would be a valuable asset and 62 out of the 65 respondents are positive on the additional value of wrist arthroscopy simulator in training. CONCLUSION Study results support the need and relevance to strengthen current training of wrist arthroscopy using e-learning and simulator training. LEVEL OF EVIDENCE V.
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Affiliation(s)
- M C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - N Bavinck
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - C Mathoulin
- Institut de la Main, Clinique Jouvenet, Paris, France
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G J M Tuijthof
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Müller-Stich BP. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 2015; 94:e764. [PMID: 25997044 PMCID: PMC4602875 DOI: 10.1097/md.0000000000000764] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.
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Affiliation(s)
- Felix Nickel
- From the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (FN, JAB, HMR, JC, HGK, GRL, MK, LF, BPM-S); and Department of Psychology, University of Copenhagen, Copenhagen, Denmark (MG)
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Kenngott HG, Wagner M, Nickel F, Wekerle AL, Preukschas A, Apitz M, Schulte T, Rempel R, Mietkowski P, Wagner F, Termer A, Müller-Stich BP. Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 2015; 400:273-81. [PMID: 25701196 DOI: 10.1007/s00423-015-1289-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Computer-assisted surgery is a wide field of technologies with the potential to enable the surgeon to improve efficiency and efficacy of diagnosis, treatment, and clinical management. PURPOSE This review provides an overview of the most important new technologies and their applications. METHODS A MEDLINE database search was performed revealing a total of 1702 references. All references were considered for information on six main topics, namely image guidance and navigation, robot-assisted surgery, human-machine interface, surgical processes and clinical pathways, computer-assisted surgical training, and clinical decision support. Further references were obtained through cross-referencing the bibliography cited in each work. Based on their respective field of expertise, the authors chose 64 publications relevant for the purpose of this review. CONCLUSION Computer-assisted systems are increasingly used not only in experimental studies but also in clinical studies. Although computer-assisted abdominal surgery is still in its infancy, the number of studies is constantly increasing, and clinical studies start showing the benefits of computers used not only as tools of documentation and accounting but also for directly assisting surgeons during diagnosis and treatment of patients. Further developments in the field of clinical decision support even have the potential of causing a paradigm shift in how patients are diagnosed and treated.
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Affiliation(s)
- H G Kenngott
- Department of General, Abdominal and Transplant Surgery, Ruprecht-Karls-University, Heidelberg, Germany
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Abstract
In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional apprenticeship model and toward a competency-based one. Simulation can be a standardized and safe method for training and assessing surgeons. Use of simulation for training has become significant alongside the development of laparoscopic techniques, and evidence suggests that skills obtained in simulation are applicable in real clinical scenarios. Simulation allows trainees to make mistakes, to ask the "what if?" questions, and to learn and reflect on such situations without risking patient safety. Virtual reality simulators have been used to allow experts to plan complicated operations and assess perioperative risks. Most recently, fully immersive simulations, such as those with whole theater teams involved, and patient-centered simulations allow development of other key skills aside from purely technical ones. Use of simulation in isolation from traditional teaching methods will furnish the surgeon in training with skills, but the best time and place to use such skills comes only with experience. In this article we examine the role of simulation in surgical training and its impact in the context of reduced training time.
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Affiliation(s)
- Riaz A Agha
- 1 Department of Plastic Surgery, Pinderfields Hospital, Wakefield, United Kingdom
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Abstract
BACKGROUND The patient safety imperative has raised expectations regarding the responsibility of medical educators and decision makers to ensure that physicians are competent. Ensuring that trainees are ready for independent practice upon graduation is challenged by reduced work hours such that trainees spend less time in the OR and perform fewer cases than desirable. METHODS The literature on the assessment of technical and non--technical operative skills and professionalism was reviewed in order to make recommendations to identify barriers to evaluation. DISCUSSION Barriers to documenting performance deficiencies include uncertainty as to what should be documented, and concerns about the negative impact of critical evaluations on faculty popularity. Additional challenges include a lack of clear standards for performance and effective remediation options. CONCLUSIONS Trainee performance should be evaluated in a rigorous, reliable and meaningful way to ensure that graduates have the skills necessary for safe, independent practice.
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Nickel F, Jede F, Minassian A, Gondan M, Hendrie JD, Gehrig T, Linke GR, Kadmon M, Fischer L, Müller-Stich BP. One or two trainees per workplace in a structured multimodality training curriculum for laparoscopic surgery? Study protocol for a randomized controlled trial - DRKS00004675. Trials 2014; 15:137. [PMID: 24754961 PMCID: PMC3999459 DOI: 10.1186/1745-6215-15-137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopy training courses have been established in many centers worldwide to ensure adequate skill learning before performing operations on patients. Different training modalities and their combinations have been compared regarding training effects. Multimodality training combines different approaches for optimal training outcome. However, no standards currently exist for the number of trainees assigned per workplace. METHODS This is a monocentric, open, three-arm randomized controlled trial. The participants are laparoscopically-naive medical students from Heidelberg University. After a standardized introduction to laparoscopic cholecystectomy (LC) with online learning modules, the participants perform a baseline test for basic skills and LC performance on a virtual reality (VR) trainer. A total of 100 students will be randomized into three study arms, in a 2:2:1 ratio. The intervention groups participate individually (Group 1) or in pairs (Group 2) in a standardized and structured multimodality training curriculum. Basic skills are trained on the box and VR trainers. Procedural skills and LC modules are trained on the VR trainer. The control group (Group C) does not receive training between tests. A post-test is performed to reassess basic skills and LC performance on the VR trainer. The performance of a cadaveric porcine LC is then measured as the primary outcome using standardized and validated ratings by blinded experts with the Objective Structured Assessment of Technical Skills. The Global Operative Assessment of Laparoscopic Surgical skills score and the time taken for completion are used as secondary outcome measures as well as the improvement of skills and VR LC performance between baseline and post-test. Cognitive tests and questionnaires are used to identify individual factors that might exert influence on training outcome. DISCUSSION This study aims to assess whether workplaces in laparoscopy training courses for beginners should be used by one trainee or two trainees simultaneously, by measuring the impact on operative performance and learning curves. Possible factors of influence, such as the role of observing the training partner, exchange of thoughts, active reflection, model learning, motivation, pauses, and sympathy will be explored in the data analysis. This study will help optimize the efficiency of laparoscopy training courses. TRIAL REGISTRATION NUMBER DRKS00004675.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg 2014; 259:236-48. [PMID: 24100339 DOI: 10.1097/sla.0000000000000245] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A systematic review to determine whether skills acquired through simulation-based training transfer to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy. BACKGROUND Simulation-based training assumes that skills are directly transferable to the operation room, but only a few studies have investigated the effect of simulation-based training on surgical performance. METHODS A systematic search strategy that was used in 2006 was updated to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. RESULTS Seventeen randomized controlled trials and 3 nonrandomized comparative studies were included in this review. In most cases, simulation-based training was in addition to patient-based training programs. Only 2 studies directly compared simulation-based training in isolation with patient-based training. For laparoscopic cholecystectomy (n = 10 studies) and endoscopy (n = 10 studies), participants who reached simulation-based skills proficiency before undergoing patient-based assessment performed with higher global assessment scores and fewer errors in the operating room than their counterparts who did not receive simulation training. Not all parameters measured were improved. Two of the endoscopic studies compared simulation-based training in isolation with patient-based training with different results: for sigmoidoscopy, patient-based training was more effective, whereas for colonoscopy, simulation-based training was equally effective. CONCLUSIONS Skills acquired by simulation-based training seem to be transferable to the operative setting for laparoscopic cholecystectomy and endoscopy. Future research will strengthen these conclusions by evaluating predetermined competency levels on the same simulators and using objective validated global rating scales to measure operative performance.
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Immersive training: breaking the bubble and measuring the heat. Surg Endosc 2014; 28:1545-54. [PMID: 24399519 DOI: 10.1007/s00464-013-3350-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training 'in situation', representing more realistically the demands imposed on the surgeons during minimal access surgery. METHODS Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus. RESULTS The results of the Mann-Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27). CONCLUSIONS Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks.
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Cole SJ, Mackenzie H, Ha J, Hanna GB, Miskovic D. Randomized controlled trial on the effect of coaching in simulated laparoscopic training. Surg Endosc 2013; 28:979-86. [PMID: 24196554 DOI: 10.1007/s00464-013-3265-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/04/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND The effect of coaching on surgical quality and understanding in simulated training remains unknown. The aim of this study was compare the effects of structured coaching and autodidactic training in simulated laparoscopic surgery. METHODS Seventeen surgically naive medical students were randomized into two groups: eight were placed into an intervention group and received structured coaching, and nine were placed into a control group and received no training. They each performed 10 laparoscopic cholecystectomies on a virtual reality simulator. The surgical quality of the first, fifth, and 10th operations was evaluated by 2 independent blinded assessors using the Competency Assessment Tool (CAT) for cholecystectomy. Understanding of operative strategy was tested before the first, fifth, and 10th operation. Performance metrics, path length, total number of movements, operating time, and error frequency were evaluated. The groups were compared by the Mann-Whitney U test. Proficiency gain curves were plotted using curve fit and CUSUM models; change point analysis was performed by multiple Wilcoxon signed rank analyses. RESULTS The intervention group scored significantly higher on the CAT assessment of procedures 1, 5, and 10, with increasing disparity. They also performed better in the knowledge test at procedures 5 and 10, again with an increasing difference. The learning curve for error frequency of the intervention group reached competency after operation 7, whereas the control group did not plateau by procedure 10. The learning curves of both groups for path length and number movements were almost identical; the mean operation time was shorter for the control group. CONCLUSIONS Clinically relevant markers of proficiency including error reduction, understanding of surgical strategy, and surgical quality are significantly improved with structured coaching. Path length and number of movements representing merely manual skills are developed with task repetition rather than influenced by coaching. Structured coaching may represent a key component in the acquisition of procedural skills.
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Affiliation(s)
- Simon J Cole
- Department of Surgery and Cancer, Imperial College London, London, UK
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Design and validation of an assessment tool for open surgical procedures. Surg Endosc 2013; 28:918-24. [DOI: 10.1007/s00464-013-3247-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
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Nickel F, Bintintan VV, Gehrig T, Kenngott HG, Fischer L, Gutt CN, Müller-Stich BP. Virtual reality does not meet expectations in a pilot study on multimodal laparoscopic surgery training. World J Surg 2013; 37:965-73. [PMID: 23430004 DOI: 10.1007/s00268-013-1963-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of the present study was to determine the value of virtual reality (VR) training for a multimodality training program of basic laparoscopic surgery. MATERIALS AND METHODS Participants in a two-day multimodality training for laparoscopic surgery used box trainers, live animal training, and cadaveric training on the pulsating organ perfusion (POP) trainer in a structured and standardized training program. The participants were divided into two groups. The VR group (n = 13) also practiced with VR training during the program, whereas the control group (n = 14) did not use VR training. The training modalities were assessed using questionnaires with a five-point Likert scale after the program. Concerning VR training, members of the control group assessed their expectations, whereas the VR group assessed the actual experience of using it. Skills performance was evaluated with five standardized test tasks in a live porcine model before (pre-test) and after (post-test) the training program. Laparoscopic skills were measured by task completion time and a general performance score for each task. Baseline tests were compared with laparoscopic experience of all participants for construct validity of the skills test. RESULTS The expected benefit from VR training of the control group was higher than the experienced benefit of the VR group. Box and POP training received better ratings from the VR group than from the control group for some purposes. Both groups improved their skill parameters significantly from pre-training to post-training tests [score +17 % (P < 0.01), time -29 % (P < 0.01)]. No significant difference was found between the two groups for laparoscopic skills improvement except for the score in the instrument coordination task. Construct validity of the skills test was significant for both time and score. CONCLUSIONS At its current level of performance, VR training does not meet expectations. No additional benefit was observed from VR training in our multimodality training program.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Single incision laparoscopic surgery - is it time for laboratory skills training? Wideochir Inne Tech Maloinwazyjne 2013; 8:216-20. [PMID: 24130635 PMCID: PMC3796722 DOI: 10.5114/wiitm.2011.33811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/25/2013] [Accepted: 02/19/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction With the introduction of new surgical equipment, there is always the need for new, more advanced training. The authors try to answer whether the use of the newest generation tools has an impact on achieving better results in single incision laparoscopic surgery (SILS) technique during the exercises in the surgical skills laboratory. Material and methods There were 51 participants in the study: 44 ‘novices’ and 7 ‘experts’. All subjects performed the ‘advanced grasping’ exercise according to the FLS programme manual using four types of laparoscopic approach including two SILS ports and SILS-dedicated instruments. The outcome measures involved task completion time and the number of errors. Results Tasks using straight laparoscopic instruments set together with classic three-port access as well as SILS access ports were finished significantly faster when compared with SILS-dedicated instruments (p < 0.05). There were no significant differences in performance times between the two setups with straight instruments (p < 0.05) and both setups with SILS-dedicated instruments, irrespective of the use of curved or dynamic articulated tools. Students with no previous laparoscopic experience had significantly worse task completion times in all tasks in comparison to students with laparoscopic laboratory training and the ‘experts’ group. Conclusions The use of the straight instruments in the SILS technique remain similar to its performance in full triangulation. SILS-dedicated instruments paradoxically increase the task completion time irrespective of possessed skills. The study showed the necessity of a SILS-dedicated tools training programme.
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Graafland M, Bok K, Schreuder HWR, Schijven MP. A Multicenter Prospective Cohort Study on Camera Navigation Training for Key User Groups in Minimally Invasive Surgery. Surg Innov 2013; 21:312-9. [DOI: 10.1177/1553350613505714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical students. The operating room nurses and medical students are currently not included as key user groups in structured laparoscopic training programs. A new virtual reality laparoscopic camera navigation (LCN) module was specifically developed for these key user groups. Methods. This multicenter prospective cohort study assesses face validity and construct validity of the LCN module on the Simendo virtual reality simulator. Face validity was assessed through a questionnaire on resemblance to reality and perceived usability of the instrument among experts and trainees. Construct validity was assessed by comparing scores of groups with different levels of experience on outcome parameters of speed and movement proficiency. Results. The results obtained show uniform and positive evaluation of the LCN module among expert users and trainees, signifying face validity. Experts and intermediate experience groups performed significantly better in task time and camera stability during three repetitions, compared to the less experienced user groups ( P < .007). Comparison of learning curves showed significant improvement of proficiency in time and camera stability for all groups during three repetitions ( P < .007). Conclusion. The results of this study show face validity and construct validity of the LCN module. The module is suitable for use in training curricula for operating room nurses and novice surgical trainees, aimed at improving team performance in minimally invasive surgery.
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Affiliation(s)
- Maurits Graafland
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Kiki Bok
- Division of Woman & Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henk W. R. Schreuder
- Division of Woman & Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Beyer-Berjot L, Aggarwal R. Toward technology-supported surgical training: the potential of virtual simulators in laparoscopic surgery. Scand J Surg 2013; 102:221-6. [PMID: 24056136 DOI: 10.1177/1457496913496494] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS The mastery of manual skills that are indispensable for the performance of surgical tasks is a competence specific to surgery. One way of facilitating this acquisition is to move the training out of the operating room and all of its restrictions. Surgical training out of the operating room, also called simulation, has spread widely in the past decade, especially in laparoscopic and endoscopic surgery. MATERIAL AND METHODS This review assesses the role of virtual reality (VR) simulators in laparoscopic surgery and their actual impact on technical skills. RESULTS AND CONCLUSIONS There is a wealth of simulators, ranging from low- to high-fidelity simulators incorporating haptic feedback. They comprise basic tasks, procedural modules, and full procedures. Virtual reality simulators have shown acceptable fidelity and validity evidence. Moreover, training out of the operating room on virtual reality simulators has demonstrated its positive impact on basic skills during real laparoscopic procedures in patients. The benefit of virtual reality over simple video trainers remains unclear for teaching basic skills. However, virtual reality simulators provide automatic feedback that permitted to design structured competency-based curricula and allow deliberate practice. Finally, advanced procedures and patient-specific models have been designed on virtual reality simulators, and further investigations are still awaited to appraise their educational value.
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Affiliation(s)
- L Beyer-Berjot
- Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
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Xiao D, Albayrak A, Jakimowicz JJ, Goossens RHM. A newly designed portable ergonomic laparoscopic skills Ergo-Lap simulator. MINIM INVASIV THER 2013; 22:337-45. [PMID: 23992382 DOI: 10.3109/13645706.2013.821997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The cost of laparoscopic simulators restricts the wide use of simulation for training of basic psychomotor skills. This paper describes the scientifically-based development of an inexpensive and portable Ergonomic Laparoscopic Skills (Ergo-Lap) simulator with multiple tasks. MATERIAL AND METHODS The design of this Ergo-Lap simulator and related training task panel was based on scientific research regarding the representative skills and the ergonomic guidelines for laparoscopic surgery. A user-centred design approach was followed. Fifty-three surgical participants with variable laparoscopic experience (14 medical students, 27 surgeons in training, and 12 experienced laparoscopic surgeons) performed several tasks on the prototype and gave their feedback by filling out a 5-point scale Likert scale questionnaire. RESULTS The results of the usability evaluation showed that the participants regarded the Ergo-Lap simulator as a useful device to practice the basic and advanced skills effectively. Forty-three of the 53 participants indicated they would like to purchase this simulator since it is easy to use and challenges their laparoscopic skills. CONCLUSIONS For laparoscopic skills training, this inexpensive Ergo-Lap simulator with diverse task choices offers a simple training opportunity for trainees who want to practice laparoscopic skills at home or at the office.
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Affiliation(s)
- Dongjuan Xiao
- Faculty of Industrial Design Engineering, Delft University of Technology , Delft , The Netherlands
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New comprehensive surgical curriculum of pre-graduate surgical education. Wideochir Inne Tech Maloinwazyjne 2013; 8:200-10. [PMID: 24130633 PMCID: PMC3796719 DOI: 10.5114/wiitm.2011.33756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 12/29/2012] [Accepted: 12/29/2012] [Indexed: 01/22/2023] Open
Abstract
Introduction Surgical education has become one of the most important directions in modern surgery evolution. To meet growing need for appropriate training in laparoscopic and, even more importantly, classic surgical skills, a curriculum involving contemporary tuition methods is needed. Advanced, structuralised training, which includes advanced technologies like virtual reality training, video coaching and motivative aspects of competition, seems to be important for an adequate education programme. Material and methods In academic years 2009/2010 and 2010/2011 the Department of General, Endocrine and Transplant Surgery of the Medical University of Gdansk together with the Pomeranian Foundation for Progress in Surgery organized 4480 h of training in that area of classic (2744) and laparoscopic (1736) skills. Both groups were involved in the programme of training in which the two most important aspects were reliable evaluation of the results and effective motivation to work. Skill evaluation at different stages of the programme were based on completion time and quality measurements. Apart from that, at the end of the course, the participants completed a questionnaire on their subjective perspective on this innovative curriculum, the quality and stability of the skills they obtained. Results In both arms of the programme (laparoscopic and classic) a statistically significant improvement was obtained as early as after the second and third sessions in half of the exercises. The acquired skills were stable over time, as proved by the plateau of completion time achieved in 11 out of 12 exercises. The results of the post-training questionnaire revealed that the participants were very satisfied with the structuralised form of training and appreciated the motivational role of competition. Conclusions Contemporary surgical training should be organized as a systematic, well-evaluated and goal-oriented programme similar to the one proposed by our team. The use of contemporary training aids should be utilized in training of every surgical skill, not only laparoscopy. This form of training, associated with the component of competition, enables good and stable results to be achieved, as well as high satisfaction of trainees.
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Miller S, Causey MW, Damle A, Maykel J, Steele S. Single-incision laparoscopic colectomy: training the next generation. Surg Endosc 2013; 27:1784-90. [PMID: 23389059 DOI: 10.1007/s00464-012-2684-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 10/23/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons. METHODS Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP). RESULTS A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC. CONCLUSIONS Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.
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Affiliation(s)
- Seth Miller
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
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Ikonen TS, Antikainen T, Silvennoinen M, Isojärvi J, Mäkinen E, Scheinin TM. Virtual reality simulator training of laparoscopic cholecystectomies - a systematic review. Scand J Surg 2012; 101:5-12. [PMID: 22414461 DOI: 10.1177/145749691210100102] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies. MATERIALS AND METHODS From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included. RESULTS The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000. CONCLUSIONS Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.
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Affiliation(s)
- T S Ikonen
- Finnish Office for Health Technology Assessment, National Institute of Health and Welfare, Helsinki, Finland.
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van Empel PJ, Verdam MGE, Strypet M, van Rijssen LB, Huirne JA, Scheele F, Bonjer HJ, Meijerink WJ. Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection. JOURNAL OF SURGICAL EDUCATION 2012; 69:564-570. [PMID: 22677599 DOI: 10.1016/j.jsurg.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/15/2011] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-week autonomous training period at home on a traditional laparoscopic box trainer. Previous research did not demonstrate a significant progress in laparoscopic skills after this training period. This study aims to identify factors determining autonomous training on a laparoscopic box trainer at home. METHODS Residents (n = 97) attending 1 of 7 ASC courses between January 2009 and June 2011 were consecutively included. After 6 weeks of autonomous, training a questionnaire was completed. A random subgroup of 30 residents was requested to keep a time log. All residents received an online survey after attending the ASC. We performed outcome comparison to examine the accuracy of individual responses. RESULTS Out of 97 residents, the main motives for noncompliant autonomous training included a lack of (training) time after working hours (n = 80, 83.3%), preferred practice time during working hours (n = 76, 31.6%), or another surgical interest than MIS (n = 79, 15.2%). Previously set training goals would encourage autonomous training according to 27.8% (n = 18) of residents. Thirty participants submitted a time log and reported an average 76.5-minute weekly training time. All residents confirmed that autonomous home practice on a laparoscopic box trainer is valuable. CONCLUSIONS Autonomous practice should be structured and inclusive of adequate and sufficient feedback points. A minimally required practice time should be set. An obligatory assessment, including corresponding consequence should be conducted. Compliance herewith may result in increased voluntary (autonomous) simulator based (laparoscopic) training by residents.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Single versus multimodality training basic laparoscopic skills. Surg Endosc 2012; 26:2172-8. [PMID: 22350237 PMCID: PMC3392502 DOI: 10.1007/s00464-012-2184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 01/19/2012] [Indexed: 01/22/2023]
Abstract
Introduction Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality training of basic laparoscopic skills. Methods Thirty-six medical students without laparoscopic experience performed six training sessions of 45 min each, one per day, in which four different basic tasks were trained. Participants in the single-modality group (S) (n = 18) practiced solely on a virtual reality (VR) simulator. Participants in the multimodality group (M) (n = 18) practiced on the same VR simulator (2x), a box trainer (2x), and an augmented reality simulator (2x). All participants performed a pre-test and post-test on the VR simulator (the four basic tasks + one additional basic task). Halfway through the training protocol, both groups performed a salpingectomy on the VR simulator as interim test. Results Both groups improved their performance significantly (Wilcoxon signed-rank, P < 0.05). The performances of group S and group M in the additional basic task and the salpingectomy did not differ significantly (Mann–Whitney U test, P > 0.05). Group S performed the four basic tasks in the post-test on the VR faster than group M (P ≤ 0.05), which can be explained by the fact that they were much more familiar with these tasks. Conclusions Training of basic laparoscopic tasks on single or multiple modalities does not result in different training outcome. Both training methods seem appropriate for the attainment of basic laparoscopic skills in future curricula.
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van Hove PD, Verdaasdonk EGG, van der Harst E, Jansen FW, Dankelman J, Stassen LPS. Effect of basic laparoscopic skills courses on essential knowledge of equipment. Surg Innov 2012; 19:460-6. [PMID: 22298751 DOI: 10.1177/1553350611432723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aims to evaluate the effect of laparoscopic skills courses on the knowledge of laparoscopic equipment. METHODS A knowledge test on laparoscopic equipment was developed, and participants of 3 separate basic laparoscopic skills courses in the Netherlands completed the test at the beginning and end of these courses. All lectures and demonstrations during the courses were recorded on video to assess the matching of its contents with the items in the test. As a reference, the test was also completed by a group of laparoscopic experts by e-mail. RESULTS In total, 36 participants (64.3%) completed both the pretest and posttest. Overall, the mean test score improved from 60.4% of the maximum possible score for the pretest to 68.4% for the posttest. There were no significant differences in test scores between the 3 separate courses. However, the actual content varied among the courses. The correspondence of the test items with the course content varied from 47% to 69%. Although 30% of the participants had already received training for laparoscopic equipment in their own hospital, 92.5% wanted to receive more training. 28 experts completed the test with a mean score of 75.7%, which was significantly better than the posttest score of the course participants. CONCLUSIONS The laparoscopic skills courses evaluated in this study had a modest positive effect on the acquisition of knowledge about laparoscopic equipment. Variance exists among their contents.
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Affiliation(s)
- P Diederick van Hove
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.
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Milburn J, Khera G, Hornby S, Malone P, Fitzgerald J. Introduction, availability and role of simulation in surgical education and training: Review of current evidence and recommendations from the Association of Surgeons in Training. Int J Surg 2012; 10:393-8. [DOI: 10.1016/j.ijsu.2012.05.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/11/2012] [Indexed: 11/16/2022]
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van Empel PJ, van der Veer WM, van Rijssen LB, Cuesta MA, Scheele F, Bonjer HJ, Meijerink WJ. Mapping the maze of minimally invasive surgery simulators. J Laparoendosc Adv Surg Tech A 2011; 22:51-60. [PMID: 22145607 DOI: 10.1089/lap.2010.0467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Brinkman WM, Buzink SN, Alevizos L, de Hingh IHJT, Jakimowicz JJ. Criterion-based laparoscopic training reduces total training time. Surg Endosc 2011; 26:1095-101. [PMID: 22042592 PMCID: PMC3310991 DOI: 10.1007/s00464-011-2005-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/10/2011] [Indexed: 01/22/2023]
Abstract
Introduction The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency. Methods During four training sessions within 1 week (one session per day) 34 medical interns (no laparoscopic experience) practiced on two basic tasks on the Simbionix LAP Mentor virtual-reality (VR) simulator: ‘clipping and grasping’ and ‘cutting’. Group C (criterion-based) (N = 17) trained to reach predefined criteria and stopped training in each session when these criteria were met, with a maximum training time of 1 h. Group T (time-based) (N = 17) trained for a fixed time of 1 h each session. Retention of skills was assessed 1 week after training. In addition, transferability of skills was established using the Haptica ProMIS augmented-reality simulator. Results Both groups improved their performance significantly over the course of the training sessions (Wilcoxon signed ranks, P < 0.05). Both groups showed skill transferability and skill retention. When comparing the performance parameters of group C and group T, their performances in the first, the last and the retention training sessions did not differ significantly (Mann–Whitney U test, P > 0.05). The average number of repetitions needed to meet the criteria also did not differ between the groups. Overall, group C spent less time training on the simulator than did group T (74:48 and 120:10 min, respectively; P < 0.001). Group C performed significantly fewer repetitions of each task, overall and in session 2, 3 and 4. Conclusions Criterion-based training of basic laparoscopic skills can reduce the overall training time with no impact on training outcome, transferability or retention of skills. Criterion-based should be the training of choice in laparoscopic skills curricula.
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Affiliation(s)
- Willem M Brinkman
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
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Schreuder HW, van Hove PD, Janse JA, Verheijen RR, Stassen LP, Dankelman J. An “Intermediate Curriculum” for Advanced Laparoscopic Skills Training with Virtual Reality Simulation. J Minim Invasive Gynecol 2011; 18:597-606. [DOI: 10.1016/j.jmig.2011.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 01/22/2023]
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Diesen DL, Erhunmwunsee L, Bennett KM, Ben-David K, Yurcisin B, Ceppa EP, Omotosho PA, Perez A, Pryor A. Effectiveness of laparoscopic computer simulator versus usage of box trainer for endoscopic surgery training of novices. JOURNAL OF SURGICAL EDUCATION 2011; 68:282-289. [PMID: 21708364 DOI: 10.1016/j.jsurg.2011.02.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Teaching of laparoscopic skills is a challenge in surgical training programs. Because of the highly technical nature and the steep learning curve, students and residents must learn laparoscopic skills before performing them in the operating room. To improve efficiency of learning and patient safety, research in simulation is essential. Two types of simulators currently in use include virtual reality and box trainers. Our study examined which simulator technique was most effective in teaching novice trainees laparoscopic techniques. DESIGN This is a prospective, randomized, blinded, controlled trial that enrolled fourth-year medical students and surgical interns to participate in a supervised 6-month laparoscopic training program with either computer simulators or box trainers. Subjects were randomized and trained on appropriate laparoscopic camera skills, instrument handling, object positioning, dissection, ligation, suturing, and knot tying. Students within one group were not allowed to practice, learn or train on the opposing trainers. At time points 0, 2, and 6 months all subjects completed a series of laparoscopic exercises in a live porcine model, which were captured on DVD and scored by blinded expert investigators. RESULTS Scores improved overall from the pretest to subsequent tests after training with no difference between the virtual reality and box simulator groups. In the medical students specifically, there was overall improvement, and improvement in the needle-transfer and knot-tying skills specifically, with no difference between the box simulator and virtual reality groups. For the interns, both groups showed significant overall improvement with no difference between the virtual reality and box simulator groups or on individual skills. CONCLUSIONS We conclude that laparoscopic simulator training improves surgical skills in novice trainees. We found both the box trainers and the virtual reality simulators are equally effective means of teaching laparoscopic skills to novice learners.
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Affiliation(s)
- Diana L Diesen
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Zimmerman H, Latifi R, Dehdashti B, Ong E, Jie T, Galvani C, Waer A, Wynne J, Biffar D, Gruessner R. Intensive laparoscopic training course for surgical residents: program description, initial results, and requirements. Surg Endosc 2011; 25:3636-41. [PMID: 21643881 DOI: 10.1007/s00464-011-1770-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 05/09/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The Department of Surgery at the University of Arizona has created an intensive laparoscopic training course for surgical residents featuring a combined simulation laboratory and live swine model. We herein report the essential components to design and implement a rigorous training course for developing laparoscopic skills in surgical residents. MATERIALS AND METHODS At our institution, we developed a week-long pilot intensive laparoscopic training course. Six surgical residents (ranging from interns to chief residents) participate in the structured, multimodality course, without any clinical responsibilities. It consists of didactic instruction, laboratory training, practice in the simulation laboratory, and performance (under the direction of attending laparoscopic surgeons) of surgical procedures on pigs. The pigs are anesthetized and attended by veterinarians and technicians, and then euthanized at the end of each day. Three teams of two different training-level residents are paired. Daily briefing, debriefing, and analysis are performed at the close of each session. A written paper survey is completed at the end of the course. RESULTS This report describes the results of first 36 surgical residents trained in six courses. Preliminary data reveal that all 36 now feel more comfortable handling laparoscopic instruments and positioning trocars; they now perform laparoscopic surgery with greater confidence and favor having the course as part of their educational curriculum. CONCLUSION A multimodality intensive laparoscopic training course should become a standard requirement for surgical residents, enabling them to acquire basic and advanced laparoscopic skills on a routine basis.
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Affiliation(s)
- Hannah Zimmerman
- Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Room 5344, Tucson, AZ 85724, USA
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van Dongen KW, Verleisdonk EJMM, Schijven MP, Broeders IAMJ. Will the Playstation generation become better endoscopic surgeons? Surg Endosc 2011; 25:2275-80. [PMID: 21416186 PMCID: PMC3116125 DOI: 10.1007/s00464-010-1548-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 12/06/2010] [Indexed: 11/28/2022]
Abstract
Background A frequently heard comment is that the current “Playstation generation” will have superior baseline psychomotor skills. However, research has provided inconsistent results on this matter. The purpose of this study was to investigate whether the “Playstation generation” shows superior baseline psychomotor skills for endoscopic surgery on a virtual reality simulator. Methods The 46 study participants were interns (mean age 24 years) of the department of surgery and schoolchildren (mean age 12.5 years) of the first year of a secondary school. Participants were divided into four groups: 10 interns with videogame experience and 10 without, 13 schoolchildren with videogame experience and 13 without. They performed four tasks twice on a virtual reality simulator for basic endoscopic skills. The one-way analysis of variance (ANOVA) with post hoc test Tukey-Bonferroni and the independent Student’s t test were used to determine differences in mean scores. Results Interns with videogame experience scored significantly higher on total score (93 vs. 74.5; p = 0.014) compared with interns without this experience. There was a nonsignificant difference in mean total scores between the group of schoolchildren with and those without videogame experience (61.69 vs. 55.46; p = 0.411). The same accounts for interns with regard to mean scores on efficiency (50.7 vs. 38.9; p = 0.011) and speed (18.8 vs. 14.3; p = 0.023). In the group of schoolchildren, there was no statistical difference for efficiency (32.69 vs. 27.31; p = 0.218) or speed (13.92 vs. 13.15; p = 0.54). The scores concerning precision parameters did not differ for interns (23.5 vs. 21.3; p = 0.79) or for schoolchildren (mean 15.08 vs. 15; p = 0.979). Conclusions Our study results did not predict an advantage of videogame experience in children with regard to superior psychomotor skills for endoscopic surgery. However, at adult age, a difference in favor of gaming is present. The next generation of surgeons might benefit from videogame experience during their childhood.
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Affiliation(s)
- Koen W van Dongen
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
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