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Rochlen LR, Putnam E, Levine R, Tait AR. Mixed reality simulation for peripheral intravenous catheter placement training. BMC MEDICAL EDUCATION 2022; 22:876. [PMID: 36528576 PMCID: PMC9758658 DOI: 10.1186/s12909-022-03946-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Despite the advantages of simulation-based training, trainees are typically unable to view internal anatomical structures. This limitation can be overcome by using mixed reality (MR) wherein 3-D virtual anatomical images can be projected. This study was designed to evaluate the efficacy of an MR trainer for peripheral intravenous catheter (PIVC) placement. METHODS Sixty-two participants used projected images of arm veins to place a PIVC in a mannequin arm. Participants were evaluated using a checklist on their ability to successfully place the PIVC. Participants completed a survey to elicit demographic information and perceptions of the trainer. A follow-up survey at two-weeks assessed clinical experiences with PIVC placement since using the MR trainer. RESULTS First attempt catheter placement was successful in 48 (77.4%) cases. Only 11 (17.7%) and 3 (4.8%) of participants caused 'extravasation' and 'hematoma' formation on their first attempt, respectively. Fifty-nine participants (95.2%) agreed that ability to see internal structures was useful, and 58 (93.5%, respectively) agreed that the interactivity promoted learning and that MR should be included in training. CONCLUSIONS Results of this study showed that use of a novel MR trainer for PIVC placement appears to provide an environment conducive to successful learning. Most participants were successful at PIVC placement on their first attempt and an overwhelming number found it helpful in identifying landmarks and confirming correct needle angles for insertion. Given the increasing emphasis on simulation training, highly immersive MR tools appear to offer promise to close the gap between classroom instruction and clinical experience.
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Affiliation(s)
- Lauryn R Rochlen
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Elizabeth Putnam
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Robert Levine
- Emergency Care Center, Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
- ArchieMD, Inc., 6420 Congress Ave, Suite 2050, Boca Raton, FL, 33487, USA
| | - Alan R Tait
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Michigan Institute for Clinical & Health Research, 1600 Huron Parkway, Ann Arbor, MI, 48105, USA
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Valles J, Zhang T, McIntosh P, Pacilli M, Nataraja RM. Assessment of Core Surgical Skills Using a Mixed Reality Headset - The MoTOR Study. J Med Syst 2022; 46:102. [PMID: 36418760 DOI: 10.1007/s10916-022-01891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical skill assessment utilises direct observation and feedback by an expert which is potentially subjective, therefore obtaining objective data for hand and eye tracking is essential. Our aim was to evaluate a wearable mixed reality (MR) headset in these domains. METHODS Participants with differing levels of surgical expertise [novice (N), intermediate (I) & expert (E)] performed 4 simulated surgical tasks; 2 general dexterity (tasks 1&2) and 2 surgical skills (tasks 3&4) wearing the MR headset capturing their hand and eye movements (median & range). Metrics included hand path length and the speed of each index or thumb tip. Gaze data were also captured. Participant demographics, prior expertise and current experience were captured with an electronic survey. Data were analysed with a Shapiro-Wilk test or ANOVA as appropriate. A p-value of < 0.05 was significant. RESULTS Thirty-six participants were analysed (N = 18, I = 8, E = 8). Tasks 1&2 revealed 2 speed outcomes (left index and left-hand speed) which were significant. For tasks 3&4, various outcomes were significant: path length for left hand (N:45 cm vs. I:31 cm vs. E:27 cm, p = 0.03) and right hand (N:48 cm vs. I:29 cm vs. E:28 cm, p = 0.01) and total time (N:456s vs. I:292 vs. E: 245, p = 0.0002). With left-hand-tying, average path length (N:61 cm vs. I:39 vs. E:36, p = 0.04), average speed (N:11 cm/s vs. I:23 vs. E:24, p = 0.03), and total time (N:156s vs. I:43 vs. E:37, p = 0.003) were significant. The gaze-tracking was not statistically significant. CONCLUSION The MR headset can be utilised as a valid tool for surgical performance assessment. Outcomes including path length and speed can be valuable metrics captured by the MR Headset during the task completion for detecting surgical proficiency.
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Affiliation(s)
- John Valles
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia.,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Taiqing Zhang
- Virtual and Augmented Reality Services Unit, Monash eSolutions, Monash University, Melbourne, VIC, Australia
| | - Paul McIntosh
- Virtual and Augmented Reality Services Unit, Monash eSolutions, Monash University, Melbourne, VIC, Australia.,Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia.,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia. .,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Application of Design Structure Matrix to Simulate Surgical Procedures and Predict Surgery Duration. Minim Invasive Surg 2021; 2021:6340754. [PMID: 34912579 PMCID: PMC8668307 DOI: 10.1155/2021/6340754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background The complexities of surgery require an efficient and explicit method to evaluate and standardize surgical procedures. A reliable surgical evaluation tool will be able to serve various purposes such as development of surgery training programs and improvement of surgical skills. Objectives (a) To develop a modeling framework based on integration of dexterity analysis and design structure matrix (DSM), to be generally applicable to predict total duration of a surgical procedure, and (b) to validate the model by comparing its results with laparoscopic cholecystectomy surgery protocol. Method A modeling framework is developed through DSM, a tool used in engineering design, systems engineering and management, to hierarchically decompose and describe relationships among individual surgical activities. Individual decomposed activities are assumed to have uncertain parameters so that a rework probability is introduced. The simulation produces a distribution of the duration of the modeled procedure. A statistical approach is then taken to evaluate surgery duration through integrated numerical parameters. The modeling framework is applied for the first time to analyze a surgery; laparoscopic cholecystectomy, a common surgical procedure, is selected for the analysis. Results The present simulation model is validated by comparing its results of predicted surgery duration with the standard laparoscopic cholecystectomy protocols from the Atlas of Minimally Invasive Surgery with 2.5% error and that from the Atlas of Pediatric Laparoscopy and Thoracoscopy with 4% error. Conclusion The present model, developed based on dexterity analysis and DSM, demonstrates a validated capability of predicting laparoscopic cholecystectomy surgery duration. Future studies will explore its potential applications to other surgery procedures and in improving surgeons' performance and training novices.
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Nillahoot N, Patel S, Suthakorn J. A Technique for Mimicking Soft Tissue Manipulation from Experimental Data to a Wave Equation Model for a New Laparoscopic Virtual Reality Training System. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background:
The difficulty of laparoscopic procedures and the specific psychomotor skills required support the need for a training system for intensive and repetitive practice to acquire the specific skills. The present VR training systems have some limitations with respect to the soft tissue models in the training system. This is associated with the need for a real-time simulation, which requires a balance between computational cost and accuracy.
Objective:
The primary objective of the study is to develop a two dimensional wave equation model that closely mimics the soft tissue manipulation in a laparoscopic procedure for a VR training system.
Methods:
A novel mathematical model based on the wave equation is prepared to represent the interaction between the laparoscopic tool and the soft tissue. The parameters within the model are determined through experimental analysis of a soft tissue phantom. The experimental setup involves a linear actuator applying force to the soft tissue phantom to generate deformation. Data acquisition is conducted through a camera and a robotic force acquisition system which measures force, displacement of the linear actuator and records a video. Through image processing, the displacements of the markers on the phantom’s x-y plane during its deformation are determined and these parameters are used to develop the model, which finally is validated through a comparative analysis.
Results:
The results from the developed model are observed and compared statistically as well as graphically with the finite element model based on deformation data. The results show that the deformation data between the developed model and the available model is significantly similar.
Conclusion:
This study demonstrates the adaptability of the wave equation to meet the needs of the specific surgical procedure through modification of the model based on the experimental data. Moreover, the comparative analysis further corroborates the relevance and validity of the model for the surgical training system.
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Hardon SF, van Gastel LA, Horeman T, Daams F. Assessment of technical skills based on learning curve analyses in laparoscopic surgery training. Surgery 2021; 170:831-840. [PMID: 34090675 DOI: 10.1016/j.surg.2021.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Objective force- and motion-based assessment is currently lacking in laparoscopic skills curricula. This study aimed to evaluate the added value of parameter-based assessment and feedback during training. METHODS Laparoscopy-naïve surgical residents that took part in a 3-week skills training curriculum were included. A box trainer equipped with the ForceSense system was used for assessment of tissue manipulation- (MaxForce) and instrument-handling skills (Path length and Time). Learning curves were established using linear regression tests. Pre- and post-course comparisons indicated the overall progression and were compared to predefined proficiency levels. A post-course survey was carried out to assess face validity. RESULTS In total, 4,268 trials, executed by 24 residents, were successfully assessed. Median (interquartile range) MaxForce outcomes improved from 2.7 Newton (interquartile range 1.9-3.8) to 1.8 Newton (interquartile range 1.2-2.4) between pre- and post-course assessment (P ≤ .009). Instrument Path length improved from 7,102.2 mm (interquartile range 5,255.2-9,025.9) to 3,545.3 mm (interquartile range 2,842.9-4,563.2) (P ≤.001). Time to execute the task improved from 159.8 seconds (interquartile range 119.8-219.0) to 60.7 seconds (interquartile range 46.0-79.5) (P ≤ .001). The learning curves revealed during what training phase the proficiency benchmarks were reached for each trainee. In the survey outcomes, trainees indicated that this curriculum should be part of a surgical residency program (mean visual analog scale score of 9.2 ± 0.9 standard deviation). CONCLUSION Force-, motion-, and time-parameters can be objectively measured during basic laparoscopic skills curricula and do indicate progression of skills over time. The ForceSense parameters enable curricula to be designed for specific proficiency-based training goals and offer the possibility for objective classification of the levels of expertise.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Leonie A van Gastel
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands. https://twitter.com/freekdaams
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Kovoor JG, Gupta AK, Gladman MA. Validity and effectiveness of augmented reality in surgical education: A systematic review. Surgery 2021; 170:88-98. [PMID: 33744003 DOI: 10.1016/j.surg.2021.01.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current challenges in surgical training have led to the investigation of augmented reality as a potential method of supplementary education. However, its value for this purpose remains uncertain. The aim of this study was to perform a systematic review of the published literature to evaluate the validity and effectiveness of augmented reality in surgical education, and to compare it with other simulation modalities. METHODS Electronic literature searches were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two authors independently extracted pertinent data and assessed study quality. The primary outcome measures of interest were the validity and effectiveness of augmented reality as an educational tool. RESULTS Of 6,500 articles, 24 studies met eligibility criteria for inclusion, of which 2 were randomized. Ten studies investigated validity, with 7 establishing both face and content validity and an additional 1 just content validity. Construct validity was demonstrated in 9 of 11 studies. Of the 11 studies that examined the effectiveness of augmented reality in skills acquisition, 9 demonstrated enhanced learning. Of the 5 studies in which the effectiveness of augmented reality as an educational tool was compared with other modes of simulation, augmented reality was found to be superior in 2 and equivalent in the others. CONCLUSION Overall, the majority, including 2 high-quality randomized controlled trials, demonstrated the validity and effectiveness of augmented reality in surgical education. However, the quality of published studies was poor with marked heterogeneity. Although these results are encouraging, additional high-quality studies, preferably in the real-life environment, are required before the widespread implementation of augmented reality within surgical curricula can be recommended.
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Affiliation(s)
- Joshua G Kovoor
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia
| | - Aashray K Gupta
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia
| | - Marc A Gladman
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia.
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Visual Intelligence: Prediction of Unintentional Surgical-Tool-Induced Bleeding during Robotic and Laparoscopic Surgery. ROBOTICS 2021. [DOI: 10.3390/robotics10010037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Unintentional vascular damage can result from a surgical instrument’s abrupt movements during minimally invasive surgery (laparoscopic or robotic). A novel real-time image processing algorithm based on local entropy is proposed that can detect abrupt movements of surgical instruments and predict bleeding occurrence. The uniform nature of the texture of surgical tools is utilized to segment the tools from the background. By comparing changes in entropy over time, the algorithm determines when the surgical instruments are moved abruptly. We tested the algorithm using 17 videos of minimally invasive surgery, 11 of which had tool-induced bleeding. Our preliminary testing shows that the algorithm is 88% accurate and 90% precise in predicting bleeding. The average advance warning time for the 11 videos is 0.662 s, with the standard deviation being 0.427 s. The proposed approach has the potential to eventually lead to a surgical early warning system or even proactively attenuate tool movement (for robotic surgery) to avoid dangerous surgical outcomes.
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8
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Farcas MA, Azzie G. Performance assessment - The knowledge, skills and attitudes of surgical performance. Semin Pediatr Surg 2020; 29:150903. [PMID: 32423592 DOI: 10.1016/j.sempedsurg.2020.150903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pediatric surgical education has traditionally focused on the hard cognitive and psychomotor (technical) skills. While more and more attention is being paid to softer skills such as communication, collaboration, leadership, health advocacy, professionalism and scholarship, the bulk of curricula remain focused on the hard skills. An intricate part of education is the assessment of performance. This article reviews the current literature on the assessment of cognitive and psychomotor skills, focusing particularly on the assessment of technical skills in the realm of simulation.
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Affiliation(s)
- Monica A Farcas
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, St. Michael's Hospital, Toronto, Canada; Ki Ka Shing Knowledge Institute, Toronto, Canada; Institute for Biomedical Engineering, Science and Technology, Toronto, Canada.
| | - Georges Azzie
- Department of Surgery, University of Toronto, Toronto, Canada; Department of Pediatric Surgery, Hopitaux Pédiatriques de Nice CHU-Lenval, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
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Langlois J, Bellemare C, Toulouse J, Wells GA. Spatial abilities training in the field of technical skills in health care: A systematic review. Heliyon 2020; 6:e03280. [PMID: 32190751 PMCID: PMC7068633 DOI: 10.1016/j.heliyon.2020.e03280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/24/2019] [Accepted: 01/06/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To conduct a systematic review of the effect of interventions on spatial abilities in the field of technical skills in health care. Methods A literature search was conducted up to November 14, 2017 in Scopus and in several databases on EBSCOhost platform. Citations were obtained, articles related to retained citations were reviewed and a final list of included studies was identified. Methods in the field of technical skills relating an intervention to spatial abilities test scores between intervention groups or obtained before and after the intervention were identified as eligible. The quality of included studies was assessed and data were extracted in a systematic way. Results A series of 5513 citations was obtained. Ninety-nine articles were retained and fully reviewed, yielding four included studies. No difference in the Hidden Figure Test score after one year was observed after residency training in General Surgery of at least nine months. A first-year dental curriculum was not found to elevate the Novel Object Cross-Sections Test score (P = 0.07). A two-semester learning period of abdominal sonography was found to increase the Revised Minnesota Paper Form Board Test score (P < 0.05). A hands-on radiology course using interactive three-dimensional image post-processing software consisting of seven two-hour long seminars on a weekly basis was found to amplify the Cube Perspective Test score (P < 0.001). Conclusion Spatial abilities tests scores were enhanced by courses in abdominal sonography and hands-on radiology, but were not improved by residency training in General Surgery and first-year dental curriculum.
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Affiliation(s)
- Jean Langlois
- Department of Emergency Medicine, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Bellemare
- Department of Multidisciplinary Services, Clinical Quality Division, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josée Toulouse
- Librairies and Archives Services, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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10
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Development of an instrumented thoracoscopic surgical trainer for objective evaluation of esophageal atresia/tracheoesophageal fistula repair. Med Biol Eng Comput 2020; 58:601-609. [PMID: 31927721 DOI: 10.1007/s11517-019-02107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
Operative repair of complex conditions such as esophageal atresia and tracheoesophageal fistula (EA/TEF) is technically demanding, but few training opportunities exist outside the operating theater for surgeons to attain these skills. Learning them during surgery on actual neonates where the stakes are high, margins for error narrow, and where outcomes are influenced by technical expertise, is problematic. There is an increasing demand for high-fidelity simulation that can objectively measure performance. We developed such a simulator to measure force and motion reliably, allowing quantitative feedback of technical skill. A 3D-printed simulator for thoracoscopic repair of EA/TEF was instrumented with motion and force tracking components. A 3D mouse, inertial measurement unit (IMU), and optical sensor that captured force and motion data in four degrees of freedom (DOF) were calibrated and verified for accuracy. The 3D mouse had low average relative errors of 2.81%, 3.15%, and 6.15% for 0 mm, 10 mm offset in Y, and 10 mm offset in X, respectively. This increased to - 23.5% at an offset of 42 mm. The optical sensors and IMU displayed high precision and accuracy with low SDs and average relative errors, respectively. These parameters can be a useful measurement of performance for thoracoscopic EA/TEF simulation prior to surgery. Graphical abstract Inclusion of sensors into a high-fidelity simulator design can produce quantitative feedback which can be used to objectively asses performance of a technically difficult procedure. As a result, more surgical training can be done prior to operating on actual patients in the operating theater.
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Sugand K, Wescott RA, Carrington R, Hart A, van Duren BH. Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial. J Bone Joint Surg Am 2019; 101:e88. [PMID: 31483408 DOI: 10.2106/jbjs.18.00928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, London, United Kingdom.,Royal National Orthopedic Hospital, Stanmore, United Kingdom
| | - Robert A Wescott
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | | | - Alister Hart
- Royal National Orthopedic Hospital, Stanmore, United Kingdom.,Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | - Bernard H van Duren
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, United Kingdom
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12
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Bilgic E, Alyafi M, Hada T, Landry T, Fried GM, Vassiliou MC. Simulation platforms to assess laparoscopic suturing skills: a scoping review. Surg Endosc 2019; 33:2742-2762. [PMID: 31089881 DOI: 10.1007/s00464-019-06821-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic suturing (LS) has become a common technique used in a variety of advanced laparoscopic procedures. However, LS is a challenging skill to master, and many trainees may not be competent in performing LS at the end of their training. The purpose of this review is to identify simulation platforms available for assessment of LS skills, and determine the characteristics of the platforms and the LS skills that are targeted. METHODS A scoping review was conducted between January 1997 and October 2018 for full-text articles. The search was done in various databases. Only articles written in English or French were included. Additional studies were identified through reference lists. The search terms included "laparoscopic suturing" and "clinical competence." RESULTS Sixty-two studies were selected. The majority of the simulation platforms were box trainers with inanimate tissue, and targeted basic suturing and intracorporeal knot-tying techniques. Most of the validation came from internal structure (rater reliability) and relationship to other variables (compare training levels/case experience, and various metrics). Consequences were not addressed in any of the studies. CONCLUSION We identified many types of simulation platforms that were used for assessing LS skills, with most being for assessment of basic skills. Platforms assessing the competence of trainees for advanced LS skills were limited. Therefore, future research should focus on development of LS tasks that better reflect the needs of the trainees.
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Affiliation(s)
- Elif Bilgic
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, QC, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada
| | - Motaz Alyafi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada
| | - Tomonori Hada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada
| | - Tara Landry
- Montreal General Hospital Medical Library, McGill University Health Centre, Montreal, QC, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 313, 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. 313, Montreal, QC, H3G 1A4, Canada.
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Hollensteiner M, Botzenmayer M, Fürst D, Winkler M, Augat P, Sandriesser S, Schrödl F, Esterer B, Gabauer S, Püschel K, Schrempf A. Characterization of polyurethane-based synthetic vertebrae for spinal cement augmentation training. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:153. [PMID: 30269238 PMCID: PMC6182710 DOI: 10.1007/s10856-018-6161-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
Vertebral augmentation techniques are used to stabilize impacted vertebrae. To minimize intraoperative risks, a solid education of surgeons is desirable. Thus, to improve education of surgeons as well as patient safety, the development of a high-fidelity simulator for the surgical training of cement augmentation techniques was initiated. The integrated synthetic vertebrae should be able to provide realistic haptics during all procedural steps. Synthetic vertebrae were developed, tested and validated with reference to human vertebrae. As a further reference, commercially available vertebrae surrogates for orthopedic testing were investigated. To validate the new synthetic vertebrae, characteristic mechanical parameters for tool insertion, balloon dilation pressure and volume were analyzed. Fluoroscopy images were taken to evaluate the bone cement distribution. Based on the measurement results, one type of synthetic vertebrae was able to reflect the characteristic parameters in comparison to human vertebrae. The different tool insertion forces (19.7 ± 4.1, 13.1 ± 0.9 N, 1.5 ± 0.2 N) of the human reference were reflected by one bone surrogate (11.9 ± 9.8, 24.3 ± 3.9 N, 2.4 ± 1.0 N, respectively). The balloon dilation pressure (13.0 ± 2.4 bar), volume (2.3 ± 1.5 ml) of the synthetic vertebrae were in good accordance with the human reference (10.7 ± 3.4 bar, 3.1 ± 1.1 ml). Cement application forces were also in good accordance whereas the cement distribution couldn't be reproduced accurately. Synthetic vertebrae were developed that delivered authentic haptics during transpedicular instrument insertion, balloon tamp dilation and bone cement application. The validated vertebra model will be used within a hybrid simulator for minimally invasive spine surgery to educate and train surgeons.
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Affiliation(s)
- Marianne Hollensteiner
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria.
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
| | - Melanie Botzenmayer
- Institute of Applied Sciences and Mechatronics, Munich University of Applied Sciences, Munich, Germany
| | - David Fürst
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
| | - Martin Winkler
- Institute for Biomechanics, Trauma Clinic, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Institute for Biomechanics, Trauma Clinic, Murnau, Germany
| | - Sabrina Sandriesser
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
- Institute for Biomechanics, Trauma Clinic, Murnau, Germany
| | - Falk Schrödl
- Institute of Anatomy, Paracelsus Medical University, Salzburg & Nuremberg, Austria
| | - Benjamin Esterer
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
| | - Stefan Gabauer
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
| | - Klaus Püschel
- Department of Forensic Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Andreas Schrempf
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
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Nataraja RM, Webb N, Lopez PJ. Simulation in paediatric urology and surgery, part 2: An overview of simulation modalities and their applications. J Pediatr Urol 2018; 14:125-131. [PMID: 29456118 DOI: 10.1016/j.jpurol.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/29/2017] [Indexed: 01/19/2023]
Abstract
Surgical training has changed radically in the last few decades. The traditional Halstedian model of time-bound apprenticeship has been replaced with competency-based training. In our previous article, we presented an overview of learning theory relevant to clinical teaching; a summary for the busy paediatric surgeon and urologist. We introduced the concepts underpinning current changes in surgical education and training. In this next article, we give an overview of the various modalities of surgical simulation, the educational principles that underlie them, and potential applications in clinical practice. These modalities include; open surgical models and trainers, laparoscopic bench trainers, virtual reality trainers, simulated patients and role-play, hybrid simulation, scenario-based simulation, distributed simulation, virtual reality, and online simulation. Specific examples of technology that may be used for these modalities are included but this is not a comprehensive review of all available products.
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Affiliation(s)
- R M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Australia.
| | - N Webb
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne Australia
| | - P J Lopez
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne Australia; Department of Urology, Hospital Exequiel Gonzalez Cortes, Santiago, Chile; Clinica Alemana, Santiago, Chile
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15
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Fujii K, Gras G, Salerno A, Yang GZ. Gaze gesture based human robot interaction for laparoscopic surgery. Med Image Anal 2017; 44:196-214. [PMID: 29277075 DOI: 10.1016/j.media.2017.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 02/07/2023]
Abstract
While minimally invasive surgery offers great benefits in terms of reduced patient trauma, bleeding, as well as faster recovery time, it still presents surgeons with major ergonomic challenges. Laparoscopic surgery requires the surgeon to bimanually control surgical instruments during the operation. A dedicated assistant is thus required to manoeuvre the camera, which is often difficult to synchronise with the surgeon's movements. This article introduces a robotic system in which a rigid endoscope held by a robotic arm is controlled via the surgeon's eye movement, thus forgoing the need for a camera assistant. Gaze gestures detected via a series of eye movements are used to convey the surgeon's intention to initiate gaze contingent camera control. Hidden Markov Models (HMMs) are used for real-time gaze gesture recognition, allowing the robotic camera to pan, tilt, and zoom, whilst immune to aberrant or unintentional eye movements. A novel online calibration method for the gaze tracker is proposed, which overcomes calibration drift and simplifies its clinical application. This robotic system has been validated by comprehensive user trials and a detailed analysis performed on usability metrics to assess the performance of the system. The results demonstrate that the surgeons can perform their tasks quicker and more efficiently when compared to the use of a camera assistant or foot switches.
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Affiliation(s)
- Kenko Fujii
- The Hamlyn Centre for Robotic Surgery, Imperial College London, UK
| | - Gauthier Gras
- The Hamlyn Centre for Robotic Surgery, Imperial College London, UK
| | - Antonino Salerno
- The Hamlyn Centre for Robotic Surgery, Imperial College London, UK
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, UK.
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16
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Harris DJ, Vine SJ, Wilson MR, McGrath JS, LeBel ME, Buckingham G. The effect of observing novice and expert performance on acquisition of surgical skills on a robotic platform. PLoS One 2017; 12:e0188233. [PMID: 29141046 PMCID: PMC5687728 DOI: 10.1371/journal.pone.0188233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Observational learning plays an important role in surgical skills training, following the traditional model of learning from expertise. Recent findings have, however, highlighted the benefit of observing not only expert performance but also error-strewn performance. The aim of this study was to determine which model (novice vs. expert) would lead to the greatest benefits when learning robotically assisted surgical skills. METHODS 120 medical students with no prior experience of robotically-assisted surgery completed a ring-carrying training task on three occasions; baseline, post-intervention and at one-week follow-up. The observation intervention consisted of a video model performing the ring-carrying task, with participants randomly assigned to view an expert model, a novice model, a mixed expert/novice model or no observation (control group). Participants were assessed for task performance and surgical instrument control. RESULTS There were significant group differences post-intervention, with expert and novice observation groups outperforming the control group, but there were no clear group differences at a retention test one week later. There was no difference in performance between the expert-observing and error-observing groups. CONCLUSIONS Similar benefits were found when observing the traditional expert model or the error-strewn model, suggesting that viewing poor performance may be as beneficial as viewing expertise in the early acquisition of robotic surgical skills. Further work is required to understand, then inform, the optimal curriculum design when utilising observational learning in surgical training.
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Affiliation(s)
- David J. Harris
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Samuel J. Vine
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Mark R. Wilson
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - John S. McGrath
- Exeter Surgical Health Services Research Unit, RD&E Hospital, Exeter, United Kingdom
- University of Exeter Medical School, Exeter, United Kingdom
| | - Marie-Eve LeBel
- Division of Orthopaedic Surgery, University of Western Ontario, London, Canada
| | - Gavin Buckingham
- Department of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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First-Person Point-of-View-Augmented Reality for Central Line Insertion Training: A Usability and Feasibility Study. Simul Healthc 2017; 12:57-62. [PMID: 27930431 DOI: 10.1097/sih.0000000000000185] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The value of simulation in medical education and procedural skills training is well recognized. Despite this, many mannequin-based trainers are limited by the inability of the trainee to view the internal anatomical structures. This study evaluates the usability and feasibility of a first-person point-of-view-augmented reality (AR) trainer on needle insertion as a component of central venous catheter placement. METHODS Forty subjects, including medical students and anesthesiology residents and faculty, participated. Augmented reality glasses were provided through which the relevant internal anatomical landmarks were projected. After a practice period, participants were asked to place the needle in the mannequin without the benefit of the AR-projected internal anatomy. The ability of the trainees to correctly place the needle was documented. Participants also completed a short survey describing their perceptions of the AR technology. RESULTS Participants reported that the AR technology was realistic (77.5%) and that the ability to view the internal anatomy was helpful (92.5%). Furthermore, 85% and 82.1%, respectively, believed that the AR technology promoted learning and should be incorporated into medical training. The ability to successfully place the needle was similar between experienced and nonexperienced participants; however, less experienced participants were more likely to inadvertently puncture the carotid artery. CONCLUSIONS Results of this pilot study demonstrated the usability and feasibility of AR technology as a potentially important adjunct to simulated medical skills training. Further development and evaluation of this innovative technology under a variety of simulated medical training settings would be an important next step.
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Owlia M, Khabbazan M, Mirbagheri MM, Mirbagheri A. Real-time tracking of laparoscopic instruments using kinect for training in virtual reality. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3945-3948. [PMID: 28269148 DOI: 10.1109/embc.2016.7591590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Training of laparoscopic surgery in Virtual Reality (VR) environment has been proved as an effective step before clinical practice. Tracking the position of instruments in realtime is an essential part of developing a VR trainer. In this study, we used Microsoft Kinect and color markers instead of using similar traditional means such as mechanical sensors. The orientation and position of instruments were determined and compared with the results obtained using the SinaSim commercial laparoscopic surgery trainer, which measures these values using encoders. The final results indicated that even though the newly developed systems possess an inferior accuracy compared to the mechanical sensors, low cost and portability makes it capable of replacing traditional methods of tracking.
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19
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Montealegre-Gallegos M, Mahmood F, Kim H, Bergman R, Mitchell JD, Bose R, Hawthorne KM, O'Halloran TD, Wong V, Hess PE, Matyal R. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics. Ann Card Anaesth 2017; 19:245-50. [PMID: 27052064 PMCID: PMC4900337 DOI: 10.4103/0971-9784.179595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. METHODS AND RESULTS During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. CONCLUSION Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.
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Affiliation(s)
- Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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20
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Analysis of motion in laparoscopy: the deconstruction of an intra-corporeal suturing task. Surg Endosc 2016; 31:3130-3139. [DOI: 10.1007/s00464-016-5337-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
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21
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Klein AM, Gross J. Development and validation of a high-fidelity phonomicrosurgical trainer. Laryngoscope 2016; 127:888-893. [DOI: 10.1002/lary.26230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Adam M. Klein
- Emory Voice Center; Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta Georgia U.S.A
| | - Jennifer Gross
- Washington University School of Medicine; St. Louis Missouri U.S.A
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22
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Van Sickle KR, Ritter EM, Smith CD. The Pretrained Novice: Using Simulation-Based Training to Improve Learning in the Operating Room. Surg Innov 2016; 13:198-204. [PMID: 17056786 DOI: 10.1177/1553350606293370] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Enabling trainees to acquire advanced technical skills before they begin the operating room experience benefits both trainee and patient. Whether medical students who had received exclusively simulation-based training could perform laparoscopic suturing and knot-tying as well as senior surgery residents was determined. Simulators were used to train 11 fourth-year medical students with no previous suturing experience to perform intracorporeal suturing and to successfully tie a free-hand intracorporeal knot. Students’ skills were assessed by the performance of the fundal suturing portion of a Nissen fundoplication in a porcine model. Their operative performance was evaluated for time, needle manipulations, and total errors. Results were compared to those of 11 senior-level surgery residents performing the same task. The study concluded that trainees could learn advanced technical skills such as laparoscopic suturing and knot tying by using simulation exclusively. The trainees and senior level surgery residents had a similar number of needle manipulations.
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Affiliation(s)
- Kent R Van Sickle
- Department of Surgery, Division of General and Laparoendoscopic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
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23
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Barsom EZ, Graafland M, Schijven MP. Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 2016; 30:4174-83. [PMID: 26905573 PMCID: PMC5009168 DOI: 10.1007/s00464-016-4800-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/03/2016] [Indexed: 12/16/2022]
Abstract
Background Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training. Methods PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated. Results Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use. Conclusion Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.
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Affiliation(s)
- E Z Barsom
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M Graafland
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Hagelsteen K, Sevonius D, Bergenfelz A, Ekelund M. Simball Box for Laparoscopic Training With Advanced 4D Motion Analysis of Skills. Surg Innov 2016; 23:309-16. [DOI: 10.1177/1553350616628678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background. Laparoscopic skills training and evaluation outside the operating room is important for all surgeons learning new skills. To study feasibility, a video box trainer tracking 4-dimensional (4D) metrics was evaluated as a laparoscopic training tool. Method. Simball Box is a video box trainer with authentic surgical instruments and camera with video recording, equipped with 4D motion analysis registered through trocars using machine vision technology. Residents attending a 3-day laparoscopy course were evaluated performing a laparoscopic surgical knot at start, middle, and end. Metrics were obtained. Feedback data were presented in reference to expert/tutorial performance. Results. Ten right-handed residents were included. Median time (range) to finish the task was 359 (253-418), 129 (95-166), and 95 (52-156) seconds; 655%, 236%, and 174% of tutorial performance, with significance pre-/midcourse ( P < .0001), pre-/postcourse ( P < .0001), and mid-/postcourse ( P = .0050). Combined median total instrument motion decreased pre-/midcourse from 1208 (845-1751) to 522 cm (411-810 cm); P = .042 to 405 cm (246-864 cm) postcourse; pre-/postcourse P < .0001; 673%, 291%, 225% of tutorial performance. Total angular distance in radians (range) was 150 (87-251), 65 (42-116), and 50 (33-136) with significance pre-/midcourse ( P = .022) and pre-/postcourse ( P = .0002). Right-handed average speed (cm/s) increased: 1.94 (1.11-2.27) pre-, 2.39 (1.56-2.83) mid-, 2.60 (1.67-3.19) postcourse with significance pre-/midcourse ( P = .022) and pre-/postcourse ( P = .002). Average acceleration (mm/s2) and motion smoothness (µm/s3) failed to show any difference. Conclusion. For laparoscopic training and as a promising evaluation device, Simball Box obtained metrics mirroring progression well.
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Affiliation(s)
| | - Dan Sevonius
- Skåne University Hospital, Sweden
- Lund University, Lund, Sweden
| | | | - Mikael Ekelund
- Skåne University Hospital, Sweden
- Lund University, Lund, Sweden
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25
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Lahanas V, Loukas C, Georgiou E. A simple sensor calibration technique for estimating the 3D pose of endoscopic instruments. Surg Endosc 2015; 30:1198-204. [PMID: 26123335 DOI: 10.1007/s00464-015-4330-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe a simple and easy-to-use calibration method that is able to estimate the pose (tip position and orientation) of a rigid endoscopic instrument with respect to an electromagnetic tracking device attached to the handle. METHODS A two-step calibration protocol was developed. First, the orientation of the instrument shaft is derived by performing a 360° rotation of the instrument around its shaft using a firmly positioned surgical trocar. Second, the 3D position of the instrument tip is obtained by allowing the tip to come in contact with a planar surface. RESULTS The results indicate submillimeter accuracy in the estimation of the tooltip position, and subdegree accuracy in the estimation of the shaft orientation, both with respect to a known reference frame. The assets of the proposed method are also highlighted by illustrating an indicative application in the field of augmented reality simulation. CONCLUSIONS The proposed method is simple, inexpensive, does not require employment of special calibration frames, and has potential applications not only in training systems but also in the operating room.
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Affiliation(s)
- Vasileios Lahanas
- Medical Physics Laboratory Simulation Centre, School of Medicine, University of Athens, Mikras Asias St. 75, 11527, Athens, Greece.
| | - Constantinos Loukas
- Medical Physics Laboratory Simulation Centre, School of Medicine, University of Athens, Mikras Asias St. 75, 11527, Athens, Greece
| | - Evangelos Georgiou
- Medical Physics Laboratory Simulation Centre, School of Medicine, University of Athens, Mikras Asias St. 75, 11527, Athens, Greece
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Buscaglia JM, Fakhoury J, Loyal J, Denoya PI, Kazi E, Stein SA, Scriven R, Bergamaschi R. Simulated colonoscopy training using a low-cost physical model improves responsiveness of surgery interns. Colorectal Dis 2015; 17:530-5. [PMID: 25537052 DOI: 10.1111/codi.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
AIM Surgery residents are required to become proficient in colonoscopy before completing training. The aim of this study was to evaluate the responsiveness of surgery interns to simulated colonoscopy training. METHOD Interns, defined as postgraduate year 1 residents without exposure to endoscopy, underwent training in a physical model including colonoscopy, synthetic anatomy trays with luminal tattoos and a hybrid simulator. After baseline testing and mentored training, final testing was performed using five predetermined proficiency criteria. Content-valid metrics defined by the extent of departure from clinical reality were evaluated by two blinded assessors. Responsiveness was defined as change in performance over time and assessed comparing baseline testing with nonmentored final testing. RESULTS Twelve interns (eight male, mean age 26, 80% right-handed) performed 48 colonoscopies each over 1 year. Improvement was seen in the overall procedure time (24 min 46 s vs 20 min 54 s; P = 0.03), passing the splenic flexure (20 min 33 s vs 10 min 45 s; P = 0.007), passing the hepatic flexure (23 min 31 s vs 12 min 45 s; P = 0.003), caecal intubation time (23 min 38 s vs 13 min 26 s; P = 0.008), the duration of loss of view of the lumen (75% vs 8.3%; P = 0.023), incomplete colonoscopy (100% vs 33.3%; P = 0.042), colonoscope withdrawal < 6 min (16.7% vs 8.3%; P = 0.052). Tattoo identification time (9 min 16 s vs 12 min 25 s; P = 0.50), colon looped time (2 min 12 s vs 1 min 45 s; P = 0.50) and rate of colon perforation (8.3% vs 8.3%; P = 1) remained unchanged. Interrater reliability was 1.0 for all measures. CONCLUSION Simulated colonoscopy training in a low-cost physical model improved the performance of surgery interns with decreased procedure time, increased rates of complete colonoscopy and appropriate scope withdrawal.
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Affiliation(s)
- J M Buscaglia
- Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA
| | - J Fakhoury
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - J Loyal
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - P I Denoya
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - E Kazi
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - S A Stein
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - R Scriven
- Department of Surgery, State University of New York, Stony Brook, New York, USA
| | - R Bergamaschi
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
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Heskin L, Mansour E, Lane B, Kavanagh D, Dicker P, Ryan D, Gildea-Byrne K, Pawlikowska T, Tierney S, Traynor O. The impact of a surgical boot camp on early acquisition of technical and nontechnical skills by novice surgical trainees. Am J Surg 2015; 210:570-7. [PMID: 26026339 DOI: 10.1016/j.amjsurg.2014.12.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/19/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acquisition of skills early in surgical training represents a significant challenge at present because of training time constraints. The aim of this study was to investigate if an intensive surgical boot camp was effective in transferring skills at the beginning of a surgical training program. METHODS New core surgical trainees (n = 58) took part in a 5-day boot camp. There were pretest and posttest assessments of knowledge, technical skills, and confidence levels. The boot camp used simulation and senior surgical faculty to teach a defined range of technical and nontechnical skills. RESULTS The scores for knowledge (53.8% vs 68.4%, P < .01), technical skills (35.9% to 60.6% vs 50.6% to 78.2%, P < .01), and confidence levels improved significantly during boot camp. Skills improvements were still present a year later. CONCLUSION The 5-day surgical boot camp proved to be an effective way to rapidly acquire surgical knowledge and skills while increasing the confidence levels of trainees.
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Affiliation(s)
- Leonie Heskin
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ehab Mansour
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Lane
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara Kavanagh
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pat Dicker
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Donncha Ryan
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kate Gildea-Byrne
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Teresa Pawlikowska
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Tierney
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oscar Traynor
- National Surgical Training Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons. Surg Endosc 2014; 29:3392-403. [DOI: 10.1007/s00464-014-4032-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
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Lahanas V, Loukas C, Smailis N, Georgiou E. A novel augmented reality simulator for skills assessment in minimal invasive surgery. Surg Endosc 2014; 29:2224-34. [PMID: 25303925 DOI: 10.1007/s00464-014-3930-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/27/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Over the past decade, simulation-based training has come to the foreground as an efficient method for training and assessment of surgical skills in minimal invasive surgery. Box-trainers and virtual reality (VR) simulators have been introduced in the teaching curricula and have substituted to some extent the traditional model of training based on animals or cadavers. Augmented reality (AR) is a new technology that allows blending of VR elements and real objects within a real-world scene. In this paper, we present a novel AR simulator for assessment of basic laparoscopic skills. METHODS The components of the proposed system include: a box-trainer, a camera and a set of laparoscopic tools equipped with custom-made sensors that allow interaction with VR training elements. Three AR tasks were developed, focusing on basic skills such as perception of depth of field, hand-eye coordination and bimanual operation. The construct validity of the system was evaluated via a comparison between two experience groups: novices with no experience in laparoscopic surgery and experienced surgeons. The observed metrics included task execution time, tool pathlength and two task-specific errors. The study also included a feedback questionnaire requiring participants to evaluate the face-validity of the system. RESULTS Between-group comparison demonstrated highly significant differences (<0.01) in all performance metrics and tasks denoting the simulator's construct validity. Qualitative analysis on the instruments' trajectories highlighted differences between novices and experts regarding smoothness and economy of motion. Subjects' ratings on the feedback questionnaire highlighted the face-validity of the training system. CONCLUSIONS The results highlight the potential of the proposed simulator to discriminate groups with different expertise providing a proof of concept for the potential use of AR as a core technology for laparoscopic simulation training.
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Affiliation(s)
- Vasileios Lahanas
- Medical Physics Laboratory Simulation Centre, School of Medicine, University of Athens, Mikras Asias St. 75, 11527, Athens, Greece,
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Sánchez-Margallo JA, Sánchez-Margallo FM, Pagador Carrasco JB, Oropesa García I, Gómez Aguilera EJ, Moreno del Pozo J. Usefulness of an Optical Tracking System in Laparoscopic Surgery for Motor Skills Assessment. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.cireng.2013.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sánchez-Margallo JA, Sánchez-Margallo FM, Pagador Carrasco JB, Oropesa García I, Gómez Aguilera EJ, Moreno del Pozo J. Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras. Cir Esp 2014; 92:421-8. [DOI: 10.1016/j.ciresp.2013.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/04/2013] [Accepted: 01/07/2013] [Indexed: 01/22/2023]
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Nasr A, Carrillo B, Gerstle JT, Azzie G. Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills. J Pediatr Surg 2014; 49:791-4. [PMID: 24851772 DOI: 10.1016/j.jpedsurg.2014.02.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Construct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS). METHODS Participants were asked to perform a standardized intracorporeal suturing task. They were classified as novices, intermediates, and experts. Motion in the four degrees of freedom available during traditional MAS (PITCH, YAW, ROLL and SURGE) was assessed using range, velocity, and acceleration. RESULTS Analysis of motion allowed discrimination between the 75 participants according to level of expertise. The most discriminating motion parameter was the acceleration in performing the ROLL (pronation/supination) with values of 30±27 for novices, 15±5 for intermediates, and 3.7±3 for experts (p<0.001). CONCLUSIONS Tracking and analyzing the motion of instruments within the PLS simulator allow discrimination between novices, intermediates, and experts, thus establishing construct validity. Further development may establish motion analysis as a useful "real time" modality to teach and assess MAS skills.
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Affiliation(s)
- Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Brian Carrillo
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Ted Gerstle
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Georges Azzie
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Kalisch BJ, Aebersold M, McLaughlin M, Tschannen D, Lane S. An Intervention to Improve Nursing Teamwork Using Virtual Simulation. West J Nurs Res 2014; 37:164-79. [DOI: 10.1177/0193945914531458] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to test the use of virtual simulation to improve teamwork among nursing staff. Using a quasi-experimental design, nursing staff ( n = 43) from one patient care unit participated in a 1-hr session, which focused on common nursing teamwork problems. The overall mean teamwork scores improved from pre- ( M = 3.25, SD = 0.58) to post-intervention ( M = 3.49, SD = 0.67, p < .012). The intervention also had large (0.60 ≤ d ≤ 0.97) and significant effects on the measures of three teamwork subscales (i.e., trust, team orientation, and backup).
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Dehabadi M, Fernando B, Berlingieri P. The use of simulation in the acquisition of laparoscopic suturing skills. Int J Surg 2014; 12:258-68. [DOI: 10.1016/j.ijsu.2014.01.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/25/2014] [Indexed: 01/19/2023]
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Hennessey IA, Hewett P. Construct, Concurrent, and Content Validity of the eoSim Laparoscopic Simulator. J Laparoendosc Adv Surg Tech A 2013; 23:855-60. [DOI: 10.1089/lap.2013.0229] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Peter Hewett
- University of Adelaide, Adelaide, South Australia, Australia
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Giannotti D, Patrizi G, Casella G, Di Rocco G, Marchetti M, Frezzotti F, Bernieri MG, Vestri AR, Redler A. Can virtual reality simulators be a certification tool for bariatric surgeons? Surg Endosc 2013; 28:242-8. [PMID: 23996341 PMCID: PMC3889499 DOI: 10.1007/s00464-013-3179-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/08/2013] [Indexed: 12/12/2022]
Abstract
Background Construct validity of virtual laparoscopic simulators for basic laparoscopic skills has been proposed; however, it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. This study tested the ability of the Lap Mentor simulator to recognize the experience in advanced laparoscopic procedures and to assess its role in the certification of bariatric surgeons. Methods Twenty surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery. The general group included 10 general surgeons performing between 75 and 100 nonbariatric laparoscopic procedures. The bariatric group included 10 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the simulator in one basic task (task 1: eye–hand coordination) and in two tasks of the gastric bypass module (task 2: creation of the gastric pouch; task 3: gastrojejunal anastomosis). Results Comparing the groups, no significant differences were found in task 1. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (21 vs. 48 cm3), in the percentage of fundus included in the pouch (8.4 vs. 29.4 %), in the complete dissection at the angle of His (10 vs. 3), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies. Conclusions The Lap Mentor may be proposed as a certification tool for bariatric surgeons because it also recognizes their specific skills in the technical details of the procedure that affect long-term results. Furthermore, the possibility of analyzing the performance in detail can help define areas where the surgeon is lacking. These findings indicate a potential role of the Lap Mentor in tailoring the training to maximize improvement.
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Affiliation(s)
- Domenico Giannotti
- Department of Surgical Sciences, Policlinico "Umberto I", "Sapienza" - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
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Does the incorporation of motion metrics into the existing FLS metrics lead to improved skill acquisition on simulators? A single blinded, randomized controlled trial. Ann Surg 2013; 258:46-52. [PMID: 23470570 DOI: 10.1097/sla.0b013e318285f531] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We hypothesized that training to expert-derived levels of speed and motion will lead to improved learning and will translate to better operating room (OR) performance of novices than training to goals of speed or motion alone. BACKGROUND Motion tracking has been suggested to be a more sensitive performance metric than time and errors for the assessment of surgical performance. METHODS An institutional review board-approved, single blinded, randomized controlled trial was conducted at our level-I American College of Surgeons accredited Education Institute. Forty-two novices trained to proficiency in laparoscopic suturing after being randomized into 3 groups: The speed group (n = 14) had to achieve expert levels of speed, the motion group (n = 15) expert levels of motion (path length and smoothness), and the speed and motion group (n = 13) both levels. To achieve proficiency, all groups also had to demonstrate error-free performance. The FLS suture module (task 5) was used for training inside the ProMIS simulator that tracks instrument motion. All groups participated in transfer and retention tests in the OR. OR performance was assessed by a blinded expert rater using Global Operative Assessment of Laparoscopic Skills, speed, accuracy, and inadvertent injuries. RESULTS Thirty (71%) participants achieved proficiency and participated in the transfer and retention tests. The speed group achieved simulator proficiency significantly faster than the other groups (P < 0.001). With the exception of a higher injury rate during the transfer test for the speed group (that reversed during the retention test), there were no significant performance differences among the groups on all assessed parameters. CONCLUSIONS The incorporation of motion metrics into the time/accuracy goals of the FLS laparoscopic suturing curriculum had limited impact on participant skill transfer to the OR. Given the increased training requirements for such a curriculum, further study is needed before the addition of motion metrics to the current FLS metrics can be recommended.
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Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii. Surg Endosc 2013; 27:4224-31. [PMID: 23760943 DOI: 10.1007/s00464-013-3027-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. METHODS This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. RESULTS Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. CONCLUSIONS This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.
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Wu F, Chen X, Lin Y, Wang C, Wang X, Shen G, Qin J, Heng PA. A virtual training system for maxillofacial surgery using advanced haptic feedback and immersive workbench. Int J Med Robot 2013; 10:78-87. [DOI: 10.1002/rcs.1514] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Fule Wu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Yanping Lin
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Chengtao Wang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University
| | - Xudong Wang
- Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Guofang Shen
- Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Jing Qin
- Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences
- Department of Computer Science and Engineering; The Chinese University of Hong Kong
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering; The Chinese University of Hong Kong
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Sharma M, Macafee D, Horgan AF. Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial. Am J Surg 2013; 206:23-31. [PMID: 23623462 DOI: 10.1016/j.amjsurg.2012.10.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether training on fresh cadavers improves the laparoscopic skills performance of novices. METHODS Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, were randomized into control (group A) and practice groups (group B). Group B performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers (FFCs) improvised from fundamentals of laparoscopic skills technical curriculum. Performance on cadavers was scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. The baseline technical ability of the 2 groups and any transfer of skills from FFCs was measured using a full procedural laparoscopic cholecystectomy task on a virtual reality simulator before and after practice on FFCs, respectively. Nonparametric tests were used for analysis of the results. RESULTS Twenty candidates were randomized; 1 withdrew before the study commenced, and 19 were analyzed (group A, n = 9; group B; n = 10). Four of 5 tasks (nondominant to dominant hand transfer, simulated appendectomy, intracorporeal, and extracorporeal knot tying) on FFCs showed significant improvement on learning curve analysis. After training, significant improvement was shown for safety of cautery (P = .040) and the left arm path length (P = .047) on the virtual reality simulator by the practice group. CONCLUSIONS Training on FFCs significantly improves basic laparoscopic skills and can improve full procedural performance.
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Affiliation(s)
- Mitesh Sharma
- Newcastle Surgical Training Centre, Department of General Surgery, Freeman Hospital NHS Trust, Newcastle Upon Tyne NE7 7DN, UK.
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Learning curve on the TrEndo laparoscopic simulator compared to an expert level. Surg Endosc 2013; 27:2934-9. [DOI: 10.1007/s00464-013-2859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/28/2013] [Indexed: 12/17/2022]
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Mason JD, Ansell J, Warren N, Torkington J. Is motion analysis a valid tool for assessing laparoscopic skill? Surg Endosc 2012; 27:1468-77. [PMID: 23233011 DOI: 10.1007/s00464-012-2631-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The use of simulation for laparoscopic training has led to the development of objective tools for skills assessment. Motion analysis represents one area of focus. This study was designed to assess the evidence for the use of motion analysis as a valid tool for laparoscopic skills assessment. METHODS Embase, MEDLINE and PubMed were searched using the following domains: (1) motion analysis, (2) validation and (3) laparoscopy. Studies investigating motion analysis as a tool for assessment of laparoscopic skill in general surgery were included. Common endpoints in motion analysis metrics were compared between studies according to a modified form of the Oxford Centre for Evidence-Based Medicine levels of evidence and recommendation. RESULTS Thirteen studies were included from 2,039 initial papers. Twelve (92.3 %) reported the construct validity of motion analysis across a range of laparoscopic tasks. Of these 12, 5 (41.7 %) evaluated the ProMIS Augmented Reality Simulator, 3 (25 %) the Imperial College Surgical Assessment Device (ICSAD), 2 (16.7 %) the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), 1 (8.33 %) the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) and 1 (8.33 %) the Robotic and Video Motion Analysis Software (ROVIMAS). Face validity was reported by 1 (7.7 %) study each for ADEPT and ICSAD. Concurrent validity was reported by 1 (7.7 %) study each for ADEPT, ICSAD and ProMIS. There was no evidence for predictive validity. CONCLUSIONS Evidence exists to validate motion analysis for use in laparoscopic skills assessment. Valid parameters are time taken, path length and number of hand movements. Future work should concentrate on the conversion of motion data into competency-based scores for trainee feedback.
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Affiliation(s)
- John D Mason
- Cardiff University School of Medicine, Welsh Institute of Minimal Access Therapy, Cardiff Medicentre, Heath Park, Cardiff, UK.
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Hamstra SJ. Keynote address: the focus on competencies and individual learner assessment as emerging themes in medical education research. Acad Emerg Med 2012; 19:1336-43. [PMID: 23279242 DOI: 10.1111/acem.12021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 12/01/2022]
Abstract
This article describes opportunities for scholarship in medical education, based on a brief overview of recent changes in medical education. The implications arising from these changes are discussed, with recommendations for focus, and suggestions and examples for making progress in this field. The author discusses 1) the historical context of the current shift toward competency-based medical education, 2) the potential contribution of social and behavioral sciences to medical education scholarship, 3) methods and approaches for supporting scholarship in medical education, and very briefly 4) trends in simulation. The author concludes with a call for quality in medical education scholarship and argues that the most promising and fruitful area of medical education scholarship for the future lies in the field of assessment of individual competence.
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Affiliation(s)
- Stanley J. Hamstra
- Academy for Innovation in Medical Education (AIME); University of Ottawa Skills and Simulation Centre; Departments of Medicine, Surgery, and Anesthesia; Faculty of Medicine University of Ottawa; Ottawa; Ontario; Canada
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Kovac E, Azhar RA, Quirouet A, Delisle J, Anidjar M. Construct validity of the LapSim virtual reality laparoscopic simulator within a urology residency program. Can Urol Assoc J 2012; 6:253-9. [PMID: 23093534 DOI: 10.5489/cuaj.12047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE : We assessed the construct validity of the LapSim laparoscopic surgical simulator in a urology residency training program. METHODS : In total, 15 residents participated in the study between July 2007 and July 2008. The subjects were tested six times at one-month intervals on three skill tasks (lifting and grasping, cutting and clip application) using the LapSim laparoscopic simulator. The testing sessions were divided into the first three sessions (seminar 1), and the subsequent three sessions (seminar 2). We evaluated the following parameters: total time, path length, angular path length, tissue damage, maximum damage and stretch damage. The subjects were divided into junior (PGY 1,2) and senior resident groups (PGY 3,4,5). The Wilcoxon Signed-Rank test for paired samples was used to compare the performances of the juniors and seniors during seminar 1 to their performance in seminar 2 to determine whether there was improvement over time. The Wilcoxon Rank-Sum test for independent samples was used to compare the performance of the juniors to that of the seniors for seminar 1, seminar 2 and the combination of both seminars to determine whether the more experienced senior residents performed better than the less experienced juniors. RESULTS : No significant performance improvement between testing sessions could be demonstrated. Similarly, there was no significant difference in performance between junior and senior residents. CONCLUSIONS : Construct validity could not be demonstrated for the total time, path length, angular path length and tissue handling parameters of the LapSim laparoscopic surgical simulator when examined within the context of a urology residency program.
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Affiliation(s)
- Evan Kovac
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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EVA: laparoscopic instrument tracking based on Endoscopic Video Analysis for psychomotor skills assessment. Surg Endosc 2012; 27:1029-39. [PMID: 23052495 DOI: 10.1007/s00464-012-2513-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The EVA (Endoscopic Video Analysis) tracking system is a new system for extracting motions of laparoscopic instruments based on nonobtrusive video tracking. The feasibility of using EVA in laparoscopic settings has been tested in a box trainer setup. METHODS EVA makes use of an algorithm that employs information of the laparoscopic instrument's shaft edges in the image, the instrument's insertion point, and the camera's optical center to track the three-dimensional position of the instrument tip. A validation study of EVA comprised a comparison of the measurements achieved with EVA and the TrEndo tracking system. To this end, 42 participants (16 novices, 22 residents, and 4 experts) were asked to perform a peg transfer task in a box trainer. Ten motion-based metrics were used to assess their performance. RESULTS Construct validation of the EVA has been obtained for seven motion-based metrics. Concurrent validation revealed that there is a strong correlation between the results obtained by EVA and the TrEndo for metrics, such as path length (ρ = 0.97), average speed (ρ = 0.94), or economy of volume (ρ = 0.85), proving the viability of EVA. CONCLUSIONS EVA has been successfully validated in a box trainer setup, showing the potential of endoscopic video analysis to assess laparoscopic psychomotor skills. The results encourage further implementation of video tracking in training setups and image-guided surgery.
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Oropesa I, Chmarra MK, Sánchez-González P, Lamata P, Rodrigues SP, Enciso S, Sánchez-Margallo FM, Jansen FW, Dankelman J, Gómez EJ. Relevance of motion-related assessment metrics in laparoscopic surgery. Surg Innov 2012; 20:299-312. [PMID: 22983805 DOI: 10.1177/1553350612459808] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills and their correlation with the different abilities sought to measure. METHODS A framework for task definition and metric analysis is proposed. An explorative survey was first conducted with a board of experts to identify metrics to assess basic psychomotor skills. Based on the output of that survey, 3 novel tasks for surgical assessment were designed. Face and construct validation was performed, with focus on motion-related metrics. Tasks were performed by 42 participants (16 novices, 22 residents, and 4 experts). Movements of the laparoscopic instruments were registered with the TrEndo tracking system and analyzed. RESULTS Time, path length, and depth showed construct validity for all 3 tasks. Motion smoothness and idle time also showed validity for tasks involving bimanual coordination and tasks requiring a more tactical approach, respectively. Additionally, motion smoothness and average speed showed a high internal consistency, proving them to be the most task-independent of all the metrics analyzed. CONCLUSION Motion metrics are complementary and valid for assessing basic psychomotor skills, and their relevance depends on the skill being evaluated. A larger clinical implementation, combined with quality performance information, will give more insight on the relevance of the results shown in this study.
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Gray RJ, Kahol K, Islam G, Smith M, Chapital A, Ferrara J. High-fidelity, low-cost, automated method to assess laparoscopic skills objectively. JOURNAL OF SURGICAL EDUCATION 2012; 69:335-339. [PMID: 22483134 DOI: 10.1016/j.jsurg.2011.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/06/2011] [Accepted: 10/27/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND We sought to define the extent to which a motion analysis-based assessment system constructed with simple equipment could measure technical skill objectively and quantitatively. METHODS An "off-the-shelf" digital video system was used to capture the hand and instrument movement of surgical trainees (beginner level = PGY-1, intermediate level = PGY-3, and advanced level = PGY-5/fellows) while they performed a peg transfer exercise. The video data were passed through a custom computer vision algorithm that analyzed incoming pixels to measure movement smoothness objectively. RESULTS The beginner-level group had the poorest performance, whereas those in the advanced group generated the highest scores. Intermediate-level trainees scored significantly (p < 0.04) better than beginner trainees. Advanced-level trainees scored significantly better than intermediate-level trainees and beginner-level trainees (p < 0.04 and p < 0.03, respectively). CONCLUSIONS A computer vision-based analysis of surgical movements provides an objective basis for technical expertise-level analysis with construct validity. The technology to capture the data is simple, low cost, and readily available, and it obviates the need for expert human assessment in this setting.
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Affiliation(s)
- Richard J Gray
- Department of Surgery, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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Sharma M, Horgan A. Comparison of Fresh-Frozen Cadaver and High-Fidelity Virtual Reality Simulator as Methods of Laparoscopic Training. World J Surg 2012; 36:1732-7. [DOI: 10.1007/s00268-012-1564-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Aebersold M, Tschannen D, Bathish M. Innovative simulation strategies in education. Nurs Res Pract 2012; 2012:765212. [PMID: 22550573 PMCID: PMC3328148 DOI: 10.1155/2012/765212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/14/2012] [Accepted: 01/15/2012] [Indexed: 11/18/2022] Open
Abstract
The use of simulation in the undergraduate nursing curriculum is gaining popularity and is becoming a foundation of many nursing programs. The purpose of this paper is to highlight a new simulation teaching strategy, virtual reality (VR) simulation, which capitalizes on the technological skills of the new generation student. This small-scale pilot study focused on improving interpersonal skills in senior level nursing students using VR simulation. In this study, a repeated-measure design was used to evaluate the effectiveness of VR simulation on improving student's performance over a series of two VR scenarios. Using the Emergency Medicine Crisis Resource Management (EMCRM) tool, student performance was evaluated. Overall, the total EMCRM score improved but not significantly. The subscale areas of communication (P = .047, 95% CI: - 1.06, -.007) and professional behavior (P = .003, 95% CI: - 1.12, -.303) did show a significant improvement between the two scenario exposures. Findings from this study show the potential for virtual reality simulations to have an impact on nursing student performance.
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Affiliation(s)
- Michelle Aebersold
- Nursing Business and Health Systems, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA
| | - Dana Tschannen
- Nursing Business and Health Systems, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA
| | - Melissa Bathish
- Nursing Business and Health Systems, University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA
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van Empel PJ, van Rijssen LB, Commandeur JP, Verdam MGE, Huirne JA, Scheele F, Jaap Bonjer H, Jeroen Meijerink W. Validation of a new box trainer-related tracking device: the TrEndo. Surg Endosc 2012; 26:2346-52. [PMID: 22350239 PMCID: PMC3392508 DOI: 10.1007/s00464-012-2187-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 01/05/2012] [Indexed: 01/22/2023]
Abstract
Background There is an increasing demand for structured objective ex vivo training and assessment of laparoscopic psychomotor skills prior to implementation of these skills in practice. The aim of this study was to establish the internal validity of the TrEndo, a motion-tracking device, for implementation on a laparoscopic box trainer. Methods Face validity and content validity were addressed through a structured questionnaire. To assess construct validity, participants were divided into an expert group and a novice group and performed two basic laparoscopic tasks. The TrEndo recorded five motion analysis parameters (MAPs) and time. Results Participants demonstrated a high regard for face and content validity. All recorded MAPs differed significantly between experts and novices after performing a square knot. Overall, the TrEndo correctly assigned group membership in 84.7 and 95.7% of cases based on two laparoscopic tasks. Conclusion Face, content, and construct validities of the TrEndo were established. The TrEndo holds real potential as a (home) training device.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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