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Tjønnås MS, Muller S, Våpenstad C, Tjønnås J, Ose SO, Das A, Sandsund M. Stress responses in surgical trainees during simulation-based training courses in laparoscopy. BMC MEDICAL EDUCATION 2024; 24:407. [PMID: 38610013 PMCID: PMC11010405 DOI: 10.1186/s12909-024-05393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. METHODS We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. RESULTS Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). CONCLUSION Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway.
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway.
| | - Sébastien Muller
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Cecilie Våpenstad
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
- The National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy (MiDT), St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250, Prinsesse Kristinas Gate 5, Torgarden, Trondheim, NO-7006, Norway
| | - Johannes Tjønnås
- Department of Mathematics and Cybernetics, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO- 7465, Norway
| | - Solveig Osborg Ose
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Anita Das
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
| | - Mariann Sandsund
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
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García-Cabra DA, Montoya-Alvarez S, Ordorica-Flores RM, Ochoa-Toledo L, Lorias-Espinoza D, Pérez-Escamirosa F. Novices' learning curve in single-port surgery using three surgical training programs. MINIM INVASIV THER 2024; 33:90-101. [PMID: 38109095 DOI: 10.1080/13645706.2023.2293917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the novices' learning curves and proficiency level reached in laparoendoscopic single-site (LESS) surgery using three surgical training programs. MATERIAL AND METHODS Participants were randomly divided into three groups, who trained in a specific practice regimen for 12 days using a laparoscopic box simulator and three tasks. Group A trained in three stages using conventional laparoscopic surgery (CLS) with straight instruments, and LESS with straight and articulating instruments for four days each. Group B trained in two stages in LESS with straight and articulating instruments for six days each. Group C trained only in LESS with articulating instruments exclusively for all 12 days. Performance was registered daily during the 12 days to evaluate the participants' progress. RESULTS Pre- and post-training analysis of the three groups showed significant differences in performance, denoting the significant improvement in their LESS skills, with no difference between the groups. Group C reached a high level of technical competence with their specific training program in LESS, obtaining a lower asymptote and slow learning rate. CONCLUSION Specific training programs in LESS settings using articulated instruments showed a slower learning rate than the other programs but better proficiency in the technique with the best surgical performance.
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Affiliation(s)
- Damaris Areli García-Cabra
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
- Facultad de Medicina, Universidad Veracruzana, Managua, Veracruz, México
| | - Salvador Montoya-Alvarez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | | | - Luis Ochoa-Toledo
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Daniel Lorias-Espinoza
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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Gholami S, Manon A, Yao K, Billard A, Meling TR. An objective skill assessment framework for microsurgical anastomosis based on ALI scores. Acta Neurochir (Wien) 2024; 166:104. [PMID: 38400918 DOI: 10.1007/s00701-024-05934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The current assessment and standardization of microsurgical skills are subjective, posing challenges in reliable skill evaluation. We aim to address these limitations by developing a quantitative and objective framework for accurately assessing and enhancing microsurgical anastomosis skills among surgical trainees. We hypothesize that this framework can differentiate the proficiency levels of microsurgeons, aligning with subjective assessments based on the ALI score. METHODS We select relevant performance metrics from the literature on laparoscopic skill assessment and human motor control studies, focusing on time, instrument kinematics, and tactile information. This information is measured and estimated by a set of sensors, including cameras, a motion capture system, and tactile sensors. The recorded data is analyzed offline using our proposed evaluation framework. Our study involves 12 participants of different ages ([Formula: see text] years) and genders (nine males and three females), including six novice and six intermediate subjects, who perform surgical anastomosis procedures on a chicken leg model. RESULTS We show that the proposed set of objective and quantitative metrics to assess skill proficiency aligns with subjective evaluations, particularly the ALI score method, and can effectively differentiate novices from more proficient microsurgeons. Furthermore, we find statistically significant disparities, where microsurgeons with intermediate level of skill proficiency surpassed novices in both task speed, reduced idle time, and smoother, briefer hand displacements. CONCLUSION The framework enables accurate skill assessment and provides objective feedback for improving microsurgical anastomosis skills among surgical trainees. By overcoming the subjectivity and limitations of current assessment methods, our approach contributes to the advancement of surgical education and the development of aspiring microsurgeons. Furthermore, our framework emerges to precisely distinguish and classify proficiency levels (novice and intermediate) exhibited by microsurgeons.
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Affiliation(s)
- Soheil Gholami
- Learning Algorithms and Systems Laboratory (LASA), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Anaëlle Manon
- Learning Algorithms and Systems Laboratory (LASA), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Kunpeng Yao
- Learning Algorithms and Systems Laboratory (LASA), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Aude Billard
- Learning Algorithms and Systems Laboratory (LASA), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital of Denmark, Rigshospitalet, Copenhagen, Denmark
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Aghazadeh F, Zheng B, Tavakoli M, Rouhani H. Surgical tooltip motion metrics assessment using virtual marker: an objective approach to skill assessment for minimally invasive surgery. Int J Comput Assist Radiol Surg 2023; 18:2191-2202. [PMID: 37597089 DOI: 10.1007/s11548-023-03007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Surgical skill assessment has primarily been performed using checklists or rating scales, which are prone to bias and subjectivity. To tackle this shortcoming, assessment of surgical tool motion can be implemented to objectively classify skill levels. Due to the challenges involved in motion tracking of surgical tooltips in minimally invasive surgeries, formerly used assessment approaches may not be feasible for real-world skill assessment. We proposed an assessment approach based on the virtual marker on surgical tooltips to derive the tooltip's 3D position and introduced a novel metric for surgical skill assessment. METHODS We obtained the 3D tooltip position based on markers placed on the tool handle. Then, we derived tooltip motion metrics to identify the metrics differentiating the skill levels for objective surgical skill assessment. We proposed a new tooltip motion metric, i.e., motion inconsistency, that can assess the skill level, and also can evaluate the stage of skill learning. In this study, peg transfer, dual transfer, and rubber band translocation tasks were included, and nine novices, five surgical residents and five attending general surgeons participated. RESULTS Our analyses showed that tooltip path length (p [Formula: see text] 0.007) and path length along the instrument axis (p [Formula: see text] 0.014) differed across the three skill levels in all the tasks and decreased by skill level. Tooltip motion inconsistency showed significant differences among the three skill levels in the dual transfer (p [Formula: see text] 0.025) and the rubber band translocation tasks (p [Formula: see text] 0.021). Lastly, bimanual dexterity differed across the three skill levels in all the tasks (p [Formula: see text] 0.012) and increased by skill level. CONCLUSION Depth perception ability (indicated by shorter tooltip path lengths along the instrument axis), bimanual dexterity, tooltip motion consistency, and economical tooltip movements (shorter tooltip path lengths) are related to surgical skill. Our findings can contribute to objective surgical skill assessment, reducing subjectivity, bias, and associated costs.
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Affiliation(s)
- Farzad Aghazadeh
- Department of Mechanical Engineering, 10-390 Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, 10-390 Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada.
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Tonbul G, Topalli D, Cagiltay NE. A systematic review on classification and assessment of surgical skill levels for simulation-based training programs. Int J Med Inform 2023; 177:105121. [PMID: 37290214 DOI: 10.1016/j.ijmedinf.2023.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nowadays, advances in medical informatics have made minimally invasive surgery (MIS) procedures the preferred choice. However, there are several problems with the education programs in terms of surgical skill acquisition. For instance, defining and objectively measuring surgical skill levels is a challenging process. Accordingly, the aim of this study is to conduct a literature review for an investigation of the current approaches for classifying the surgical skill levels and for identifying the skill training tools and measurement methods. MATERIALS AND METHODS In this research, a search is conducted and a corpus is created. Exclusion and inclusion criteria are applied by limiting the number of articles based on surgical education, training approximations, hand movements, and endoscopic or laparoscopic operations. To satisfy these criteria, 57 articles are included in the corpus of this study. RESULTS Currently used surgical skill assessment approaches have been summarized. Results show that various classification approaches for the surgical skill level definitions are being used. Besides, many studies are conducted by omitting particularly important skill levels in between. Additionally, some inconsistencies are also identified across the skill level classification studies. CONCLUSION In order to improve the benefits of simulation-based training programs, a standardized interdisciplinary approach should be developed. For this reason, specific to each surgical procedure, the required skills should be identified. Additionally, appropriate measures for assessing these skills, which can be defined in simulation-based MIS training environments, should be refined. Finally, the skill levels gained during the developmental stages of these skills, with their threshold values referencing the identified measures, should be redefined in a standardized manner.
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Affiliation(s)
- Gokcen Tonbul
- Graduate School of Natural and Applied Sciences, Atilim University, Ankara, Turkey; Strategy and Technology Research Center, Baskent University, Ankara, Turkey.
| | - Damla Topalli
- Department of Computer Engineering, Atilim University, Ankara, Turkey
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Stan C, Vesa D, Tănase MI, Bulmaci M, Pop S, Rădeanu DG, Cosgarea M, Maniu A. Can Non-Virtual Reality Simulation Improve Surgical Training in Endoscopic Sinus Surgery? A Literature Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:637-646. [PMID: 37360838 PMCID: PMC10290466 DOI: 10.2147/amep.s406537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Simulation in endoscopic sinus surgery allows residents to learn anatomy, to achieve the correct handling of various rhinological instruments, and to practice different surgical procedures. Physically or non-virtual reality models are the main items in endoscopic sinus surgery simulation. The objective of this review is to identify and make a descriptive analysis of non-virtual endoscopic sinus surgery simulators which have been proposed for training. As a new state of the art, surgical simulators are developed continuously, so they can be used to learn basic endoscopic surgery skills by repetitive maneuvers, permitting detection of surgical error and incidents without risk for the patient. Of all training physical models, the ovine model stands out because of the similarities of the sinonasal pathways, the wide availability, and the low costs. Considering the similar nature of the tissues involved, the techniques and surgical instruments can be used almost interchangeably with minimal differences. Every surgical technique studied until now has a degree of risk and the only aspects that consistently reduced the number of complications are training, repetition, and hands-on experience.
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Affiliation(s)
- Constantin Stan
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Doiniţa Vesa
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Mihai Ionuț Tănase
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Mara Bulmaci
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Sever Pop
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Doinel Gheorghe Rădeanu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Marcel Cosgarea
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Alma Maniu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
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Heiliger C, Andrade D, Geister C, Winkler A, Ahmed K, Deodati A, Treuenstätt VHEV, Werner J, Eursch A, Karcz K, Frank A. Tracking and evaluating motion skills in laparoscopy with inertial sensors. Surg Endosc 2023:10.1007/s00464-023-09983-y. [PMID: 36976421 DOI: 10.1007/s00464-023-09983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Analysis of surgical instrument motion is applicable in surgical skill assessment and monitoring of the learning progress in laparoscopy. Current commercial instrument tracking technology (optical or electromagnetic) has specific limitations and is expensive. Therefore, in this study, we apply inexpensive, off-the-shelf inertial sensors to track laparoscopic instruments in a training scenario. METHODS We calibrated two laparoscopic instruments to the inertial sensor and investigated its accuracy on a 3D-printed phantom. In a user study during a one-week laparoscopy training course with medical students and physicians, we then documented and compared the training effect in laparoscopic tasks on a commercially available laparoscopy trainer (Laparo Analytic, Laparo Medical Simulators, Wilcza, Poland) and the newly developed tracking setup. RESULTS Eighteen participants (twelve medical students and six physicians) participated in the study. The student subgroup showed significantly poorer results for the count of swings (CS) and count of rotations (CR) at the beginning of the training compared to the physician subgroup (p = 0.012 and p = 0.042). After training, the student subgroup showed significant improvements in the rotatory angle sum, CS, and CR (p = 0.025, p = 0.004 and p = 0.024). After training, there were no significant differences between medical students and physicians. There was a strong correlation between the measured learning success (LS) from the data of our inertial measurement unit system (LSIMU) and the Laparo Analytic (LSLap) (Pearson's r = 0.79). CONCLUSION In the current study, we observed a good and valid performance of inertial measurement units as a possible tool for instrument tracking and surgical skill assessment. Moreover, we conclude that the sensor can meaningfully examine the learning progress of medical students in an ex-vivo setting.
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Affiliation(s)
- Christian Heiliger
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Christian Geister
- Department of Mechanical, Automotive and Aeronautical Engineering, University of Applied Sciences, Munich, Germany
| | - Alexander Winkler
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
- Chair for Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Khaled Ahmed
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Alessandra Deodati
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Viktor H Ehrlich V Treuenstätt
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Andreas Eursch
- Department of Mechanical, Automotive and Aeronautical Engineering, University of Applied Sciences, Munich, Germany
| | - Konrad Karcz
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany
| | - Alexander Frank
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University (LMU) Hospital, 81377, Munich, Germany.
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Franco-González IT, Minor-Martínez A, Ordorica-Flores RM, Sossa-Azuela JH, Pérez-Escamirosa F. Objective psychomotor laparoscopic skills evaluation using a low-cost wearable device based on accelerometry: construct and concurrent validity study. Surg Endosc 2023; 37:3280-3290. [PMID: 36890413 DOI: 10.1007/s00464-023-09953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Motion analysis of surgical maneuvers provides useful quantitative information for the objective evaluation of the surgeons. However, surgical simulation laboratories for laparoscopic training do not usually integrate devices that help quantify the level of skills of the surgeons due to their limited resources and the high costs of new technologies. The purpose of this study is to present the construct and concurrent validity of a low-cost motion tracking system, based on a wireless triaxial accelerometer, employed to objectively evaluate psychomotor skills of surgeons during laparoscopic training. METHODS An accelerometry system, a wireless three-axis accelerometer with appearance of wristwatch, was placed on the dominant hand of the surgeons to register the motion during the laparoscopy practice with the EndoViS simulator, which simultaneously recorded the motion of the laparoscopic needle driver. This study included the participation of 30 surgeons (6 experts, 14 intermediates and 10 novices) who performed the task of intracorporeal knot-tying suture. Using 11 motion analysis parameters (MAPs), the performance of each participant was assessed. Subsequently, the scores of the three groups of surgeons were statistically analyzed. In addition, a validity study was conducted comparing the metrics between the accelerometry-tracking system and the EndoViS hybrid simulator. RESULTS Construct validity was achieved for 8 of the 11 metrics examined with the accelerometry system. Concurrent validity demonstrated that there is a strong correlation between the results of the accelerometry system and the EndoViS simulator in 9 of 11 parameters, showing reliability of the accelerometry system as an objective evaluation method. CONCLUSION The accelerometry system was successfully validated. This method is potentially useful to complement the objective evaluation of surgeons during laparoscopic practice in training environments such as box-trainers and simulators.
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Affiliation(s)
- Iván Tlacaélel Franco-González
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación Y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México
| | - Arturo Minor-Martínez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación Y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México.
| | - Ricardo Manuel Ordorica-Flores
- Departamento de Cirugía Endoscópica, Hospital Infantil de México Federico Gómez, Calle Dr. Márquez No. 162, Cuauhtémoc, Doctores, 06720, Ciudad de México, México
| | - Juan Humberto Sossa-Azuela
- Centro de Investigación en Computación, Instituto Politécnico Nacional, Av. Juan de Dios Bátiz S/N, Esq. Miguel Othón de Mendizábal, Col. Nueva Industrial Vallejo, 07738, Ciudad de México, México
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas Y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, México
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A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept. Healthcare (Basel) 2023; 11:healthcare11040507. [PMID: 36833041 PMCID: PMC9957301 DOI: 10.3390/healthcare11040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.
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Boekestijn I, Azargoshasb S, van Oosterom MN, Slof LJ, Dibbets-Schneider P, Dankelman J, van Erkel AR, Rietbergen DDD, van Leeuwen FWB. Value-assessment of computer-assisted navigation strategies during percutaneous needle placement. Int J Comput Assist Radiol Surg 2022; 17:1775-1785. [PMID: 35934773 PMCID: PMC9468110 DOI: 10.1007/s11548-022-02719-8] [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: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
Navigational strategies create a scenario whereby percutaneous needle-based interventions of the liver can be guided using both pre-interventional 3D imaging datasets and dynamic interventional ultrasound (US). To score how such technologies impact the needle placement process, we performed kinematic analysis on different user groups.
Methods
Using a custom biopsy phantom, three consecutive exercises were performed by both novices and experts (n = 26). The exercise came in three options: (1) US-guidance, (2) US-guidance with pre-interventional image-registration (US + Reg) and (3) US-guidance with pre-interventional image-registration and needle-navigation (US + Reg + Nav). The traveled paths of the needle were digitized in 3D. Using custom software algorithms, kinematic metrics were extracted and related to dexterity, decision making indices to obtain overall performance scores (PS).
Results
Kinematic analysis helped quantifying the visual assessment of the needle trajectories. Compared to US-guidance, novices yielded most improvements using Reg (PSavg(US) = 0.43 vs. PSavg(US+Reg) = 0.57 vs. PSavg(US+Reg+Nav) = 0.51). Interestingly, the expert group yielded a reversed trend (PSavg(US) = 0.71 vs PSavg(US+Reg) = 0.58 vs PSavg(US+Reg+Nav) = 0.59).
Conclusion
Digitizing the movement trajectory allowed us to objectively assess the impact of needle-navigation strategies on percutaneous procedures. In particular, our findings suggest that these advanced technologies have a positive impact on the kinematics derived performance of novices.
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Maillet J, Rossi J, Hug F, Proquez JJ, Nordez A. Influence of experience on kinematics of upper limbs during sewing gesture. APPLIED ERGONOMICS 2022; 102:103737. [PMID: 35397280 DOI: 10.1016/j.apergo.2022.103737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/20/2022] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
To teach a skilled motor task, it is crucial to understand the characteristics of expertise. The aim of the present study was to compare the kinematics of the hand sewing task between novices (n = 10), intermediates (n = 10) and experts (n = 10). Compared to novices and intermediates, the proximal joint of expert participants was less involved in the task than their distal joints. The shoulder of experts stayed closer to the trunk, while the ranges of motion of the wrist and fingers were higher. This ability enabled them to avoid lifting the arm, which was resting on the table. We observed a low cycle-to-cycle variability of the movement pattern for experts, while it was more variable in novices. Moreover, experts shared similar joints synergies attesting of an "experts" common gesture. This knowledge gained about the hand sewing kinematics can be used to refine the training process of dressmakers.
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Affiliation(s)
- Jean Maillet
- Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000, Nantes, France; Institut Français du Textile et de l'Habillement IFTH, France
| | - Jeremy Rossi
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - François Hug
- Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000, Nantes, France; Institut Universitaire de France IUF, Paris, France; Université Côte d'Azur, LAMHESS, Nice, France
| | | | - Antoine Nordez
- Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000, Nantes, France; Institut Universitaire de France IUF, Paris, France.
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Ohtake S, Makiyama K, Yamashita D, Tatenuma T, Yao M. Objective assessment of laparoscopic targeting skills using a Short-Time Power of Difference (STPOD) method. Int J Comput Assist Radiol Surg 2022; 17:1029-1037. [PMID: 35426565 PMCID: PMC9124661 DOI: 10.1007/s11548-022-02622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To ensure that the use of surgical training tools results in improvement of surgical skills, it is necessary to be able to measure and assess surgeons' skills. We established the Short-Time Power of Difference (STPOD) method as an evaluation tool for evaluating targeting technique. The STPOD method evaluates the distance from the actual movement of the forceps to the shortest linear path between two points in a short time period. We examined the effectiveness of the STPOD method as a new forceps kinematic analysis. METHODS Six residents were categorized as novices and six urologists as experts. All participants performed box trainer training and LapPASS® Simulator training. During the procedure, objective scores (time, distance, and STPOD) were recorded. STPOD (Power) evaluated motion smoothness and STPOD (Stop) evaluated the stop time of the forceps. RESULTS STPOD (Stop) on the right side of the experts was significantly lower than that of the novices in the box trainer. Furthermore, there were significant differences in the distances of left side and STPOD (Power) between the experts and the novices in the simulator. In the correlation of parameters between the box trainer and the simulator, time showed the strongest correlation, STPOD (Power) and distance showed a mild correlation. CONCLUSION We showed the construct validity of STPOD (Power) and STPOD (Stop) using both the box trainer and the simulator. This method is a good evaluation tool for assessing a physician's skill; however, there are much more complex motions that are performed in actual surgery. Future studies are needed to focus on evaluation in an environment closer to actual surgery and comparing with other existing methods.
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Affiliation(s)
- Shinji Ohtake
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Daisuke Yamashita
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
- Department of Urology, Yokohama Sakae Kyosai Hospital, Yokohama, 247-8581 Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
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13
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Novel high-quality and reality biomaterial as a kidney surgery simulation model. PLoS One 2022; 17:e0263179. [PMID: 35176048 PMCID: PMC8853465 DOI: 10.1371/journal.pone.0263179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Surgical training using live animals such as pigs is one of the best ways of achieving skilled techniques and fostering confidence in preclinical medical students and surgeon trainees. However, due to animal welfare ethics, laboratory animals’ usage for training should be kept to a minimum. We have developed a novel kidney organ model utilizing a simple procedure in which the kidney is first refluxed with N-vinyl-2-pyrrolidone (NVP) solution for 1 hour in its bath, followed by permeation for 23 hours, with a subsequent freshwater refluxed for 48 hours in the washing step. Surgical simulation of the prepared kidney model (NVP-fixed kidney) was compared with three types of other basic known simulation models (fresh kidney, freeze-thaw kidney, and FA-fixed kidney) by various evaluations. We found the NVP-fixed kidney to mimicked fresh kidney function the most, pertaining to the hardness, and strength of the renal parenchyma. Moreover, the NVP-fixed kidney demonstrated successful blood-like fluids perfusion and electrocautery. Further, we confirmed that surgical training could be performed under conditions closer to actual clinical practice. Our findings suggest that our model does not only contribute to improving surgical skills but also inspires the utilization of otherwise, discarded inedible livestock organs as models for surgical training.
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Koskinen J, Torkamani-Azar M, Hussein A, Huotarinen A, Bednarik R. Automated tool detection with deep learning for monitoring kinematics and eye-hand coordination in microsurgery. Comput Biol Med 2021; 141:105121. [PMID: 34968859 DOI: 10.1016/j.compbiomed.2021.105121] [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: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
In microsurgical procedures, surgeons use micro-instruments under high magnifications to handle delicate tissues. These procedures require highly skilled attentional and motor control for planning and implementing eye-hand coordination strategies. Eye-hand coordination in surgery has mostly been studied in open, laparoscopic, and robot-assisted surgeries, as there are no available tools to perform automatic tool detection in microsurgery. We introduce and investigate a method for simultaneous detection and processing of micro-instruments and gaze during microsurgery. We train and evaluate a convolutional neural network for detecting 17 microsurgical tools with a dataset of 7500 frames from 20 videos of simulated and real surgical procedures. Model evaluations result in mean average precision at the 0.5 threshold of 89.5-91.4% for validation and 69.7-73.2% for testing over partially unseen surgical settings, and the average inference time of 39.90 ± 1.2 frames/second. While prior research has mostly evaluated surgical tool detection on homogeneous datasets with limited number of tools, we demonstrate the feasibility of transfer learning, and conclude that detectors that generalize reliably to new settings require data from several different surgical procedures. In a case study, we apply the detector with a microscope eye tracker to investigate tool use and eye-hand coordination during an intracranial vessel dissection task. The results show that tool kinematics differentiate microsurgical actions. The gaze-to-microscissors distances are also smaller during dissection than other actions when the surgeon has more space to maneuver. The presented detection pipeline provides the clinical and research communities with a valuable resource for automatic content extraction and objective skill assessment in various microsurgical environments.
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Affiliation(s)
- Jani Koskinen
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland.
| | - Mastaneh Torkamani-Azar
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland
| | - Ahmed Hussein
- Microsurgery Center, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland; Department of Neurosurgery, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt
| | - Antti Huotarinen
- Microsurgery Center, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland; Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland
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Tronchot A, Berthelemy J, Thomazeau H, Huaulmé A, Walbron P, Sirveaux F, Jannin P. Validation of virtual reality arthroscopy simulator relevance in characterising experienced surgeons. Orthop Traumatol Surg Res 2021; 107:103079. [PMID: 34597826 DOI: 10.1016/j.otsr.2021.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Virtual reality (VR) simulation is particularly suitable for learning arthroscopy skills. Despite significant research, one drawback often outlined is the difficulty in distinguishing performance levels (Construct Validity) in experienced surgeons. Therefore, it seems adequate to search new methods of performance measurements using probe trajectories instead of commonly used metrics. HYPOTHESIS It was hypothesized that a larger experience in surgical shoulder arthroscopy would be correlated with better performance on a VR shoulder arthroscopy simulator and that experienced operators would share similar probe trajectories. MATERIALS & METHODS After answering to standardized questionnaires, 104 trajectories from 52 surgeons divided into 2 cohorts (26 intermediates and 26 experts) were recorded on a shoulder arthroscopy simulator. The procedure analysed was the "loose body removal" in a right shoulder joint. 10 metrics were computed on the trajectories including procedure duration, overall path length, economy of motion and smoothness. Additionally, Dynamic Time Warping (DTW) was computed on the trajectories for unsupervised hierarchical clustering of the surgeons. RESULTS Experts were significantly faster (Median 70.9s Interquartile range [56.4-86.3] vs. 116.1s [82.8-154.2], p<0.01), more fluid (4.6.105mm.s-3 [3.1.105-7.2.105] vs. 1.5.106mm.s-3 [2.6.106-3.5.106], p=0.05), and economical in their motion (19.3mm2 [9.1-25.9] vs. 33.8mm2 [14.8-50.5], p<0.01), but there was no significant difference in performance for path length (671.4mm [503.8-846.1] vs 694.6mm [467.0-1090.1], p=0.62). The DTW clustering differentiates two expertise related groups of trajectories with performance similarities, respectively including 48 expert trajectories for the first group and 52 intermediates and 4 expert trajectories for the second group (Sensitivity of 92%, Specificity of 100%). Hierarchical clustering with DTW significantly identified expert operators from intermediate operators and found trajectory similarities among 24/26 experts. CONCLUSION This study demonstrated the Construct Validity of the VR shoulder arthroscopy simulator within groups of experienced surgeons. With new types of metrics simply based on the simulator's raw trajectories, it was possible to significantly distinguish levels of expertise. We demonstrated that clustering analysis with Dynamic Time Warping was able to reliably discriminate between expert operators and intermediate operators. CLINICAL RELEVANCE The results have implications for the future of arthroscopic surgical training or post-graduate accreditation programs using virtual reality simulation. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Alexandre Tronchot
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | | | - Hervé Thomazeau
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Arnaud Huaulmé
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Paul Walbron
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - François Sirveaux
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - Pierre Jannin
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
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Franco-González IT, Pérez-Escamirosa F, Minor-Martínez A, Rosas-Barrientos JV, Hernández-Paredes TJ. Development of a 3D Motion Tracking System for the Analysis of Skills in Microsurgery. J Med Syst 2021; 45:106. [PMID: 34731325 DOI: 10.1007/s10916-021-01787-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Microsurgical skills of trainee surgeons have been subjectively evaluated due to the lack of technological tools. The objective of this investigation is to present the construct validity of the mitracks3D, which is a system designed to help in the objective evaluation of microsurgery trainees. To achieve this, a stereoscopic vision system records the 3D motion of two tweezers manipulated by surgeons during microsurgery training. Using motion analysis parameters (MAPs), quantitative information about their microsurgical skills and performance is obtained. For validation, 14 participants were enrolled and divided into two groups: expert microsurgeons (3 female, 2 male) and trainee surgeons (4 female, 5 male). The 3D motion tracking was acquired while the surgeons practiced with two training models: transferring objects and suture. Twelve MAPs were used to objective assessment the skill levels of each participant. Subsequent, statistical analysis was computed to compare the scores of both groups. Validation results showed statistically significant differences in 8 of the 12 MAPs and in 10 of the 12 MAPs using the transferring and the suturing models, respectively. The capability of mitracks3D to differentiate the performance of microsurgeons by analyzing their movements was shown. The mitracks3D system was successfully validated. With this system was possible to differentiate the psychomotor microsurgical skills between the two groups of surgeons. The mitracks3D system is a suitable device for the evaluation of microsurgical skills in a variety of surgical specialties that require it during the training of their residents.
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Affiliation(s)
- Iván Tlacaélel Franco-González
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México.
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, México
| | - Arturo Minor-Martínez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, México
| | - José Vicente Rosas-Barrientos
- Hospital Regional 1º de Octubre del ISSSTE, Av. Instituto Politécnico Nacional 1669, Col. Magdalena de las Salinas, 07760, Ciudad de México, México
| | - Tania Josefina Hernández-Paredes
- Hospital Regional 1º de Octubre del ISSSTE, Av. Instituto Politécnico Nacional 1669, Col. Magdalena de las Salinas, 07760, Ciudad de México, México
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Estrin A, Rodriguez-Diaz JM, Hayes GM. Real-time analysis of intraoperative delays and variations in intraoperative workflow with level of experience of the primary surgeon in small animal surgery. Vet Surg 2021; 50:1600-1608. [PMID: 34591346 DOI: 10.1111/vsu.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the causes of intraoperative delays and the changes in delays and surgical workflow with the level of training of the primary surgeon. STUDY DESIGN Prospective observational study. SAMPLE POPULATION Seventy-three small animal surgical procedures performed at an academic teaching institution between January 17, 2018 and April 10, 2018. METHODS Procedures (trainee = 37, faculty = 36) totaling 103.2 h were observed and video recorded. Operative time was allocated to the surgical approach, exploration, exposure, intervention, and closure phases. Suballocations were made to specific tasks within these categories (such as cutting or hemostasis). Intraoperative delays and reasons were recorded. Differences in use of time between trainee and faculty surgeons were analyzed. RESULTS Delays constituted 9.2% (±4.4) of the operative time, of which 6.5%(±3.6) were surgeon controlled and 2.6% (±2.7) were non-surgeon controlled. Surgeons preparing instrumentation outside of the operative field and retrieval of equipment from supply areas were the greatest contributors to delays. Intraoperative delays did not increase when the trainee was placed in the primary surgeon role (P = .78). During the approach faculty surgeons spent proportionally less time on hemostasis (P = .02), and during closure they spent less time suturing (P = .03) than trainees. CONCLUSION Trainee surgeons did not have greater intraoperative delays. Delays were created when surgeons prepared their own instrumentation. Workflow differed between experts and trainees. CLINICAL SIGNIFICANCE Advancing a trainee surgeon into the primary role is unlikely to increase intraoperative delays, which can be reduced by the inclusion of trained scrub technicians. A focus on efficient hemostasis and fluidity when suturing may improve operative efficiency for surgical trainees.
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Affiliation(s)
- Alexander Estrin
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | | | - Galina M Hayes
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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Kitaguchi D, Takeshita N, Matsuzaki H, Igaki T, Hasegawa H, Ito M. Development and Validation of a 3-Dimensional Convolutional Neural Network for Automatic Surgical Skill Assessment Based on Spatiotemporal Video Analysis. JAMA Netw Open 2021; 4:e2120786. [PMID: 34387676 PMCID: PMC8363914 DOI: 10.1001/jamanetworkopen.2021.20786] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE A high level of surgical skill is essential to prevent intraoperative problems. One important aspect of surgical education is surgical skill assessment, with pertinent feedback facilitating efficient skill acquisition by novices. OBJECTIVES To develop a 3-dimensional (3-D) convolutional neural network (CNN) model for automatic surgical skill assessment and to evaluate the performance of the model in classification tasks by using laparoscopic colorectal surgical videos. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used surgical videos acquired prior to 2017. In total, 650 laparoscopic colorectal surgical videos were provided for study purposes by the Japan Society for Endoscopic Surgery, and 74 were randomly extracted. Every video had highly reliable scores based on the Endoscopic Surgical Skill Qualification System (ESSQS, range 1-100, with higher scores indicating greater surgical skill) established by the society. Data were analyzed June to December 2020. MAIN OUTCOMES AND MEASURES From the groups with scores less than the difference between the mean and 2 SDs, within the range spanning the mean and 1 SD, and greater than the sum of the mean and 2 SDs, 17, 26, and 31 videos, respectively, were randomly extracted. In total, 1480 video clips with a length of 40 seconds each were extracted for each surgical step (medial mobilization, lateral mobilization, inferior mesenteric artery transection, and mesorectal transection) and separated into 1184 training sets and 296 test sets. Automatic surgical skill classification was performed based on spatiotemporal video analysis using the fully automated 3-D CNN model, and classification accuracies and screening accuracies for the groups with scores less than the mean minus 2 SDs and greater than the mean plus 2 SDs were calculated. RESULTS The mean (SD) ESSQS score of all 650 intraoperative videos was 66.2 (8.6) points and for the 74 videos used in the study, 67.6 (16.1) points. The proposed 3-D CNN model automatically classified video clips into groups with scores less than the mean minus 2 SDs, within 1 SD of the mean, and greater than the mean plus 2 SDs with a mean (SD) accuracy of 75.0% (6.3%). The highest accuracy was 83.8% for the inferior mesenteric artery transection. The model also screened for the group with scores less than the mean minus 2 SDs with 94.1% sensitivity and 96.5% specificity and for group with greater than the mean plus 2 SDs with 87.1% sensitivity and 86.0% specificity. CONCLUSIONS AND RELEVANCE The results of this prognostic study showed that the proposed 3-D CNN model classified laparoscopic colorectal surgical videos with sufficient accuracy to be used for screening groups with scores greater than the mean plus 2 SDs and less than the mean minus 2 SDs. The proposed approach was fully automatic and easy to use for various types of surgery, and no special annotations or kinetics data extraction were required, indicating that this approach warrants further development for application to automatic surgical skill assessment.
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Affiliation(s)
- Daichi Kitaguchi
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Nobuyoshi Takeshita
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Hiroki Matsuzaki
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Takahiro Igaki
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Hiro Hasegawa
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Masaaki Ito
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
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19
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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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Hurley OA. Sport Cyberpsychology in Action During the COVID-19 Pandemic (Opportunities, Challenges, and Future Possibilities): A Narrative Review. Front Psychol 2021; 12:621283. [PMID: 33746838 PMCID: PMC7977283 DOI: 10.3389/fpsyg.2021.621283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Interest in sport cyberpsychology has become more popular over the last decade, primarily due to the increased use of technology and the online world, including social media, within sport settings (Hurley, 2018). In 2020, this became even more apparent for many athletes, their support teams and their sport organisations, when their professional and social worlds became cyber-dominated due to the COVID-19 pandemic. Many challenges were encountered by: (i) the athletes, in their efforts to remain active and well during this time when all competitions were cancelled and (ii) the healthcare professionals, working with these athletes, in their efforts to continue to support the athletes, when severe travel restrictions and social distancing were in place for considerable periods of time. The purpose of this paper, using a narrative review process, is to present and scrutinise an array of Internet interventions, remote psychological supports and applications (apps) that the athletes and their support personnel used to help them meet their physical, social, and emotional needs during the pandemic. The beneficial and restrictive features of these online options will be presented. Two main themes will be considered in order to focus this discussion, namely, (i) the potential physical and mental opportunities and challenges using the online world extensively during this time presented for the individuals working in sport and (ii) suggestions for how such online interventions used by the athletes, their coaches and sport science personnel during the pandemic may be maintained in some positive ways into the future, to help the athletes prepare for their upcoming competitions, their training and their future careers when they retire from elite sport.
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Affiliation(s)
- Olivia A. Hurley
- Department of Technology and Psychology, Institute of Art, Design, and Technology, Dublin, Ireland
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Billmann F, Strobel O, Billeter A, Thomusch O, Keck T, Langan EA, Pfeiffer A, Nickel F, Müller-Stich BP. Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis. Surg Endosc 2021; 35:891-899. [PMID: 32095951 PMCID: PMC7819942 DOI: 10.1007/s00464-020-07463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufflation pressures of or in excess of 25 mm Hg CO2 are routinely used during posterior retroperitoneoscopic adrenalectomy (PRA) in most centres. A critical analysis of the surgical literature provides limited evidence to support this strategy. OBJECTIVE To determine whether high pressure (≥ 25 mm Hg) compared with lower pressure (< 25 mm Hg) retroperitoneoscopy reduces operating time and complications. METHODS A multi-centre retrospective cohort study was performed using data collected over a period of almost one decade (1st November 2008 until 1st February 2018) from surgical centres in Germany. A total of 1032 patients with benign adrenal tumours were identified. We compared patients undergoing PRA with insufflation pressures of < 25 mm Hg (G20 group) versus ≥ 25 mm Hg (G25 group). A propensity score matching analysis was performed using BMI, tumour size and surgeon's experience as independent variables. The main outcomes were (1) the incidence of perioperative complications and (2) the length of operating time. RESULTS The baseline patient characteristics were similar in both groups, with the exception of tumour size, BMI and surgeon's experience in PRA. After propensity score matching, perioperative outcomes, especially perioperative complications (3.7% vs. 5.5% in G20 and G25, respectively; p = 0.335) and operation duration (47 min vs. 45 min in G20 and G25, respectively; p = 0.673), did not significantly differ between the groups. CONCLUSION Neither patient safety nor operative success was compromised when PRA was performed with insufflation pressures below 25 mm Hg. Prospective studies are required to determine whether an optimal insufflation pressure exists that maximizes patient safety and minimizes the risks of post-surgical complications. Nevertheless, our results call for a careful re-evaluation of the routine use of high insufflation pressures during PRA. In the absence of prospective data, commencing PRA with lower insufflation pressures, with the option of increasing insufflation pressures to counter intraoperative bleeding or exposition difficulties, may represent a reasonable strategy.
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Affiliation(s)
- Franck Billmann
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Oliver Strobel
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian Billeter
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Oliver Thomusch
- Department of Surgery, University Hospital of Freiburg Im Breisgau, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ewan Andrew Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Dermatological Science, University of Manchester, Manchester, UK
| | - Aylin Pfeiffer
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Wu C, Cha J, Sulek J, Sundaram CP, Wachs J, Proctor RW, Yu D. Sensor-based indicators of performance changes between sessions during robotic surgery training. APPLIED ERGONOMICS 2021; 90:103251. [PMID: 32961465 PMCID: PMC7606790 DOI: 10.1016/j.apergo.2020.103251] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 05/27/2023]
Abstract
Training of surgeons is essential for safe and effective use of robotic surgery, yet current assessment tools for learning progression are limited. The objective of this study was to measure changes in trainees' cognitive and behavioral states as they progressed in a robotic surgeon training curriculum at a medical institution. Seven surgical trainees in urology who had no formal robotic training experience participated in the simulation curriculum. They performed 12 robotic skills exercises with varying levels of difficulty repetitively in separate sessions. EEG (electroencephalogram) activity and eye movements were measured throughout to calculate three metrics: engagement index (indicator of task engagement), pupil diameter (indicator of mental workload) and gaze entropy (indicator of randomness in gaze pattern). Performance scores (completion of task goals) and mental workload ratings (NASA-Task Load Index) were collected after each exercise. Changes in performance scores between training sessions were calculated. Analysis of variance, repeated measures correlation, and machine learning classification were used to diagnose how cognitive and behavioral states associate with performance increases or decreases between sessions. The changes in performance were correlated with changes in engagement index (rrm=-.25,p<.001) and gaze entropy (rrm=-.37,p<.001). Changes in cognitive and behavioral states were able to predict training outcomes with 72.5% accuracy. Findings suggest that cognitive and behavioral metrics correlate with changes in performance between sessions. These measures can complement current feedback tools used by medical educators and learners for skills assessment in robotic surgery training.
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Affiliation(s)
- Chuhao Wu
- Purdue University, West Lafayette, IN, United States
| | - Jackie Cha
- Purdue University, West Lafayette, IN, United States
| | - Jay Sulek
- Indiana University, Indianapolis, IN, United States
| | | | - Juan Wachs
- Purdue University, West Lafayette, IN, United States
| | | | - Denny Yu
- Purdue University, West Lafayette, IN, United States.
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23
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Balkhoyor AM, Awais M, Biyani S, Schaefer A, Craddock M, Jones O, Manogue M, Mon-Williams MA, Mushtaq F. Frontal theta brain activity varies as a function of surgical experience and task error. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2020; 2:e000040. [PMID: 35047792 PMCID: PMC8749254 DOI: 10.1136/bmjsit-2020-000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/19/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta-a putative biomarker for cognitive control processes. DESIGN SETTING AND PARTICIPANTS Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4-7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate. RESULTS Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain-behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=-0.594, p=0.0058), but no such relationship emerged for novices. CONCLUSION We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.
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Affiliation(s)
- Ahmed Mohammed Balkhoyor
- School of Dentistry, University of Leeds, Leeds, UK
- Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | - Alexandre Schaefer
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Matt Craddock
- School of Psychology, Lincoln University, Lincoln, UK
| | - Olivia Jones
- School of Psychology, University of Leeds, Leeds, UK
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24
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Billmann F, Billeter A, Thomusch O, Keck T, El Shishtawi S, Langan EA, Strobel O, Müller-Stich BP. Minimally invasive partial versus total adrenalectomy for unilateral primary hyperaldosteronism-a retrospective, multicenter matched-pair analysis using the new international consensus on outcome measures. Surgery 2020; 169:1361-1370. [PMID: 33077201 DOI: 10.1016/j.surg.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/22/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary hyperaldosteronism is a recognized risk factor for myocardial infarction, stroke, and atrial fibrillation. Minimally invasive adrenalectomy is the first-line treatment for localized primary hyperaldosteronism. Whether minimally invasive adrenalectomy should be performed using a cortex-sparing technique (partial minimally invasive adrenalectomy) or not (total minimally invasive adrenalectomy) remains a subject of debate. The aim of our study was to evaluate the clinical and biochemical efficacy of both procedures and to examine the morbidity associated with partial minimally invasive adrenalectomy versus total minimally invasive adrenalectomy in a multicenter study. METHODS Using a retrospective study design, we determined the efficacy, morbidity, and mortality of partial minimally invasive adrenalectomy and total minimally invasive adrenalectomy. The Primary Aldosteronism Surgical Outcome Study classification was used to explore clinical and biochemical success. Matched-pair analysis was used in order to address possible bias. RESULTS We evaluated 234 matched patients with unilateral primary hyperaldosteronism: 78 (33.3%) underwent partial minimally invasive adrenalectomy, and 156 (66.7%) were treated with total minimally invasive adrenalectomy. Complete clinical success was achieved in 40.6%, and partial clinical success in an additional 52.6% of patients in the entire cohort. Complete biochemical success was seen in 94.0% of patients. Success rates and the incidence of perioperative complications were comparable between groups. Both postoperative hypocortisolism (11.5% vs 25.0% after partial minimally invasive adrenalectomy and total minimally invasive adrenalectomy, respectively; P < .001) and postoperative hypoglycemia (2.6% vs 7.1% after partial minimally invasive adrenalectomy and total minimally invasive adrenalectomy; P = .039) occurred more frequently after total minimally invasive adrenalectomy. CONCLUSION Our study provides evidence that patients with unilateral primary hyperaldosteronism are good surgical candidates for partial minimally invasive adrenalectomy. Not only is the surgical outcome comparable to that of total minimally invasive adrenalectomy, but also postsurgical morbidity, particularly in terms of hypocortisolism and hypoglycemia, may be reduced.
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Affiliation(s)
- Franck Billmann
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Adrian Billeter
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Oliver Thomusch
- Department of Surgery, University Hospital of Freiburg im Breisgau, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig Holstein, Campus Lübeck, Germany
| | | | - Ewan A Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Germany; Department of Dermatological Science, University of Manchester, United Kingdom
| | - Oliver Strobel
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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25
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Hermsen JL, Mohamadipanah H, Yang S, Wise B, Fiedler A, DiMusto P, Pugh C. Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment. Ann Thorac Surg 2020; 112:652-660. [PMID: 32971063 DOI: 10.1016/j.athoracsur.2020.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A high-fidelity simulator that uses a perfused porcine heart, cannulae, and tubing has been demonstrated to be a useful training adjunct. We hypothesized that multimodal assessment of cardiopulmonary bypass (CPB) skills within this high-fidelity simulated environment could discern expert from trainee performance. METHODS Three traditional fellows (postgraduate year 6-8) and 3 attending surgeons each performed 3 aortic cannulations. The third sequence included venous cannulation, commencement of CPB, and placement of a cardioplegia catheter and aortic cross-clamp. Performance across 20 cognitive and 21 technical domains was evaluated. Surgeon and assistant hand movements and economy of motion were assessed by electromagnetic motion sensors worn under sterile gloves. RESULTS Analysis showed a significant difference in cognitive (6.7 ± 2.3 vs 4.6 ± 2.7, P = .03) but not technical (6.2 ± 2.5 vs 5.8 ± 2.2, P = .7) scores favoring the experts. In addition, experts showed higher efficiency by spending 64 ± 14 seconds to construct a nonpledgeted aortic purse-string suture and secure it with a Rummel, while trainees spent 82 ± 30 seconds to complete this task (P = .03). Motion analysis revealed similar path lengths between experts and trainees for cannulation and CPB but significantly shorter path lengths for experts in cross-clamp (47.5 ± 15.5 m vs 91.9 ± 20.3 m, P = .04). CONCLUSIONS Multimodal assessment using cognitive, technical, and motion analysis of basic CPB tasks using a high-fidelity simulation environment is a valid system to measure performance and discriminate experts from trainees. This construct may allow for development of "competence thresholds" with important implications for training and certification in cardiothoracic surgery.
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Affiliation(s)
- Joshua L Hermsen
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
| | | | - Su Yang
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brett Wise
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Amy Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul DiMusto
- Division of Vascular Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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26
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van Ginkel MPH, Schijven MP, van Grevenstein WMU, Schreuder HWR. Bimanual Fundamentals: Validation of a New Curriculum for Virtual Reality Training of Laparoscopic Skills. Surg Innov 2020; 27:523-533. [PMID: 32865136 PMCID: PMC8580384 DOI: 10.1177/1553350620953030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background. To determine face and construct validity for the new
Bimanual Fundamentals curriculum for the Simendo® Virtual Reality
Laparoscopy Simulator and prove its efficiency as a training and objective
assessment tool for surgical resident’s advanced psychomotor skills.
Methods. 49 participants were recruited: 17 medical
students (novices), 15 residents (intermediates), and 17 medical specialists
(experts) in the field of gynecology, general surgery, and urology in 3 tertiary
medical centers in the Netherlands. All participants performed the 5 exercises
of the curriculum for 3 consecutive times on the simulator. Intermediates and
experts filled in a questionnaire afterward, regarding the reality of the
simulator and training goals of each exercise. Statistical analysis of
performance was performed between novices, intermediates, and experts.
Parameters such as task time, collisions/displacements, and path length right
and left were compared between groups. Additionally, a total performance score
was calculated for each participant. Results. Face validity
scores regarding realism and training goals were overall positive (median scores
of 4 on a 5-point Likert scale). Participants felt that the curriculum was a
useful addition to the previous curricula and the used simulator would fit in
their residency programs. Construct validity results showed significant
differences on the great majority of measured parameters between groups. The
simulator is able to differentiate between performers with different levels of
laparoscopic experience. Conclusions. Face and construct
validity for the new Bimanual Fundamental curriculum for the Simendo virtual
reality simulator could be established. The curriculum is suitable to use in
resident’s training programs to improve and maintain advanced psychomotor
skills.
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Affiliation(s)
- Martijn P H van Ginkel
- Department of Obstetrics and Gynecology, 8124University Medical Center Utrecht, the Netherlands
| | | | | | - Henk W R Schreuder
- Department of Gynecologic Oncology, Cancer Center, 8124University Medical Center Utrecht, the Netherlands
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27
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Mohamadipanah H, Perrone KH, Peterson K, Nathwani J, Huang F, Garren A, Garren M, Witt A, Pugh C. Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes. ACS Biomater Sci Eng 2020; 6:2630-2640. [DOI: 10.1021/acsbiomaterials.9b01019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hossein Mohamadipanah
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Kenneth H. Perrone
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Katherine Peterson
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Jay Nathwani
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Felix Huang
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, #1022, Chicago, Illinois 60611, United States
| | - Anna Garren
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Margaret Garren
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Anna Witt
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
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28
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Bahar L, Sharon Y, Nisky I. Surgeon-Centered Analysis of Robot-Assisted Needle Driving Under Different Force Feedback Conditions. Front Neurorobot 2020; 13:108. [PMID: 32038218 PMCID: PMC6993204 DOI: 10.3389/fnbot.2019.00108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/06/2019] [Indexed: 11/24/2022] Open
Abstract
Robotic assisted minimally invasive surgery (RAMIS) systems present many advantages to the surgeon and patient over open and standard laparoscopic surgery. However, haptic feedback, which is crucial for the success of many surgical procedures, is still an open challenge in RAMIS. Understanding the way that haptic feedback affects performance and learning can be useful in the development of haptic feedback algorithms and teleoperation control systems. In this study, we examined the performance and learning of inexperienced participants under different haptic feedback conditions in a task of surgical needle driving via a soft homogeneous deformable object-an artificial tissue. We designed an experimental setup to characterize their movement trajectories and the forces that they applied on the artificial tissue. Participants first performed the task in an open condition, with a standard surgical needle holder, followed by teleoperation in one of three feedback conditions: (1) no haptic feedback, (2) haptic feedback based on position exchange, and (3) haptic feedback based on direct recording from a force sensor, and then again with the open needle holder. To quantify the effect of different force feedback conditions on the quality of needle driving, we developed novel metrics that assess the kinematics of needle driving and the tissue interaction forces, and we combined our novel metrics with classical metrics. We analyzed the final teleoperated performance in each condition, the improvement during teleoperation, and the aftereffect of teleoperation on the performance when using the open needle driver. We found that there is no significant difference in the final performance and in the aftereffect between the 3 conditions. Only the two conditions with force feedback presented statistically significant improvement during teleoperation in several of the metrics, but when we compared directly between the improvements in the three different feedback conditions none of the effects reached statistical significance. We discuss possible explanations for the relative similarity in performance. We conclude that we developed several new metrics for the quality of surgical needle driving, but even with these detailed metrics, the advantage of state of the art force feedback methods to tasks that require interaction with homogeneous soft tissue is questionable.
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Affiliation(s)
| | | | - Ilana Nisky
- Department of Biomedical Engineering, Zlotowski Center of Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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29
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Ganni S, Botden SMBI, Chmarra M, Li M, Goossens RHM, Jakimowicz JJ. Validation of Motion Tracking Software for Evaluation of Surgical Performance in Laparoscopic Cholecystectomy. J Med Syst 2020; 44:56. [PMID: 31980955 PMCID: PMC6981315 DOI: 10.1007/s10916-020-1525-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/16/2020] [Indexed: 01/22/2023]
Abstract
Motion tracking software for assessing laparoscopic surgical proficiency has been proven to be effective in differentiating between expert and novice performances. However, with several indices that can be generated from the software, there is no set threshold that can be used to benchmark performances. The aim of this study was to identify the best possible algorithm that can be used to benchmark expert, intermediate and novice performances for objective evaluation of psychomotor skills. 12 video recordings of various surgeons were collected in a blinded fashion. Data from our previous study of 6 experts and 23 novices was also included in the analysis to determine thresholds for performance. Video recording were analyzed both by the Kinovea 0.8.15 software and a blinded expert observer using the CAT form. Multiple algorithms were tested to accurately identify expert and novice performances. ½ L + [Formula: see text] A + [Formula: see text] J scoring of path length, average movement and jerk index respectively resulted in identifying 23/24 performances. Comparing the algorithm to CAT assessment yielded in a linear regression coefficient R2 of 0.844. The value of motion tracking software in providing objective clinical evaluation and retrospective analysis is evident. Given the prospective use of this tool the algorithm developed in this study proves to be effective in benchmarking performances for psychomotor skills evaluation.
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Affiliation(s)
- Sandeep Ganni
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands.
- GSL Medical College, Department of Surgery, Rajahmundry, India.
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Magdalena Chmarra
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Meng Li
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
| | - Richard H M Goossens
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Jack J Jakimowicz
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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30
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Levin M, McKechnie T, Khalid S, Grantcharov TP, Goldenberg M. Automated Methods of Technical Skill Assessment in Surgery: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2019; 76:1629-1639. [PMID: 31272846 DOI: 10.1016/j.jsurg.2019.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The goal of the current study is to systematically review the literature addressing the use of automated methods to evaluate technical skills in surgery. BACKGROUND The classic apprenticeship model of surgical training includes subjective assessments of technical skill. However, automated methods to evaluate surgical technical skill have been recently studied. These automated methods are a more objective, versatile, and analytical way to evaluate a surgical trainee's technical skill. STUDY DESIGN A literature search of the Ovid Medline, Web of Science, and EMBASE Classic databases was performed. Articles evaluating automated methods for surgical technical skill assessment were abstracted. The quality of all included studies was assessed using the Medical Education Research Study Quality Instrument. RESULTS A total of 1715 articles were identified, 76 of which were selected for final analysis. An automated methods pathway was defined that included kinetics and computer vision data extraction methods. Automated methods included tool motion tracking, hand motion tracking, eye motion tracking, and muscle contraction analysis. Finally, machine learning, deep learning, and performance classification were used to analyse these methods. These methods of surgical skill assessment were used in the operating room and simulated environments. The average Medical Education Research Study Quality Instrument score across all studies was 10.86 (maximum score of 18). CONCLUSIONS Automated methods for technical skill assessment is a growing field in surgical education. We found quality studies evaluating these techniques across many environments and surgeries. More research must be done to ensure these techniques are further verified and implemented in surgical curricula.
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Affiliation(s)
- Marc Levin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Tyler McKechnie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shuja Khalid
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada
| | - Teodor P Grantcharov
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Goldenberg
- Surgical Safety Technologies, Li Ka Shing International Knowledge Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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31
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Pérez-Escamirosa F, Alarcón-Paredes A, Alonso-Silverio GA, Oropesa I, Camacho-Nieto O, Lorias-Espinoza D, Minor-Martínez A. Objective classification of psychomotor laparoscopic skills of surgeons based on three different approaches. Int J Comput Assist Radiol Surg 2019; 15:27-40. [PMID: 31605351 DOI: 10.1007/s11548-019-02073-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The determination of surgeons' psychomotor skills in minimally invasive surgery techniques is one of the major concerns of the programs of surgical training in several hospitals. Therefore, it is important to assess and classify objectively the level of experience of surgeons and residents during their training process. The aim of this study was to investigate three classification methods for establishing automatically the level of surgical competence of the surgeons based on their psychomotor laparoscopic skills. METHODS A total of 43 participants, divided into an experienced surgeons group with ten experts (> 100 laparoscopic procedures performed) and non-experienced surgeons group with 24 residents and nine medical students (< 10 laparoscopic procedures performed), performed three tasks in the EndoViS training system. Motion data of the instruments were captured with a video-tracking system built into the EndoViS simulator and analyzed using 13 motion analysis parameters (MAPs). Radial basis function networks (RBFNets), K-star (K*), and random forest (RF) were used for classifying surgeons based on the MAPs' scores of all participants. The performance of the three classifiers was examined using hold-out and leave-one-out validation techniques. RESULTS For all three tasks, the K-star method was superior in terms of accuracy and AUC in both validation techniques. The mean accuracy of the classifiers was 93.33% for K-star, 87.58% for RBFNets, and 84.85% for RF in hold-out validation, and 91.47% for K-star, 89.92% for RBFNets, and 83.72% for RF in leave-one-out cross-validation. CONCLUSIONS The three proposed methods demonstrated high performance in the classification of laparoscopic surgeons, according to their level of psychomotor skills. Together with motion analysis and three laparoscopic tasks of the Fundamental Laparoscopic Surgery Program, these classifiers provide a means for objectively classifying surgical competence of the surgeons for existing laparoscopic box trainers.
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Affiliation(s)
- Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, Mexico
- Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Circuito Interior, Av. Universidad 3000, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, Mexico
| | - Antonio Alarcón-Paredes
- Laboratory of Computing Technologies and Electronics, Faculty of Engineering, Universidad Autónoma de Guerrero, Av. Lázaro Cárdenas S/N, Ciudad Universitaria, 39070, Chilpancingo, Guerrero, Mexico.
| | - Gustavo Adolfo Alonso-Silverio
- Laboratory of Computing Technologies and Electronics, Faculty of Engineering, Universidad Autónoma de Guerrero, Av. Lázaro Cárdenas S/N, Ciudad Universitaria, 39070, Chilpancingo, Guerrero, Mexico
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Avda Complutense, 30, 28040, Madrid, Spain
| | - Oscar Camacho-Nieto
- Intelligent Computing Laboratory, Centro de Innovación y Desarrollo Tecnológico en Computación (CIDETEC-IPN), Av. Juan de Dios Bátiz, Col. Nueva Industrial Vallejo, 07700, Ciudad de México, Mexico
| | - Daniel Lorias-Espinoza
- Department of Electrical Engineering, Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. IPN 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, Mexico
| | - Arturo Minor-Martínez
- Department of Electrical Engineering, Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. IPN 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, Mexico
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Mansoor SM, Våpenstad C, Mårvik R, Glomsaker T, Bliksøen M. Construct validity of eoSim - a low-cost and portable laparoscopic simulator. MINIM INVASIV THER 2019; 29:261-268. [PMID: 31280633 DOI: 10.1080/13645706.2019.1638411] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To examine the construct validity of the low-cost, portable laparoscopic simulator eoSim using motion analysis.Material and methods: Novice and experienced surgeons (≤ 100 and >100 laparoscopic procedures performed, respectively) completed four tasks on the eoSim using the SurgTrac software: intracorporeal suture and tie, tube ligation, peg capping and precision cutting. The following metrics were recorded: Time to complete task, distance traveled, handedness (left- versus right hand use), time off-screen, distance between instrument tips, speed, acceleration and motion smoothness.Results: Compared to novices (n = 22), experienced surgeons (n = 14) completed tasks in less time (p ≤ .025), except when performing peg capping (p = .052). On all tasks, they also scored lower on the distance metric (p ≤ .001). Differences in handedness (left hand compared between groups, right hand compared between groups) were found to be significant for three tasks (p ≤ .025). In general, the experienced group made greater use of their left hand than the novice group.Conclusion: The eoSim can differentiate between experienced and novice surgeons on the tasks intracorporeal suture and tie, tube ligation and precision cutting, thus providing a convenient method for surgical departments to implement testing of their surgeons' basic laparoscopic skills.
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Affiliation(s)
- Saira Mauland Mansoor
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.,Department of Surgery, Bærum Hospital, Vestre Viken, Bærum, Norway
| | - Cecilie Våpenstad
- The Norwegian National Advisory Unit of Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health research, SINTEF Technology and Society, Trondheim, Norway
| | - Ronald Mårvik
- The Norwegian National Advisory Unit of Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom Glomsaker
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Marte Bliksøen
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
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Våpenstad C, Fagertun Hofstad E, Eivind Bernstein T, Aadahl P, Johnsen G, Mårvik R. Optimal timing of assessment tasks depending on experience level of surgical trainees. MINIM INVASIV THER 2019; 29:161-169. [DOI: 10.1080/13645706.2019.1612441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Health Research, SINTEF Digital AS, Trondheim, Norway
| | | | - Tor Eivind Bernstein
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Aadahl
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gjermund Johnsen
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Callahan E, Bly R, Johnson K, Aghdasi N, Hannaford B, Moe K, Sardesai MG. Wrist Motion Variation between Novices and Experienced Surgeons Performing Simulated Airway Surgery. OTO Open 2018; 1:2473974X17738959. [PMID: 30480197 PMCID: PMC6239156 DOI: 10.1177/2473974x17738959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/08/2017] [Accepted: 10/05/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To determine whether wrist motion measured by a smartphone application can be used as a performance metric for a simulated airway procedure requiring both wrist and finger dexterity. We hypothesized that this accelerometer application could detect differences between novices and experienced surgeons performing simulated cricothyrotomy. Setting Academic medical center. Study Design Prospective pilot cohort study. Methods Voluntary surgeons and nonsurgeons were recruited. After viewing a training video, smartphones with accelerometer applications were attached to both wrists while subjects performed a cricothyrotomy on a validated task trainer. Procedure time and motion parameters, including average resultant acceleration (ARA), total resultant acceleration (TRA), and suprathreshold acceleration events (STAEs), were collected for dominant and nondominant hands. Subjects were stratified by prior experience. Blinded experts scored each performance using Objective Structured Assessment of Technical Skills (OSATS), and t tests were used to compare performance. Results Thirty subjects were enrolled. Median age was 26 years, and 20 subjects were male. In the dominant hand, significant differences were seen between novice and experienced surgeons in TRA (P = .005) and procedure time (P = .006), while no significant differences were seen in STAEs (P = .42) and ARA (P = .33). In the nondominant hand, all variables were significantly different between the 2 groups: STAEs (P = .012), ARA (P = .007), TRA (P = .004), and procedure time (P = .006). Conclusions Wrist motion measured by a low-cost smartphone application can distinguish between novice and experienced surgeons performing simulated airway surgery. This tool provides cost-effective and objective performance feedback.
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Affiliation(s)
- Edward Callahan
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Randall Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kaalan Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nava Aghdasi
- Department of Engineering, University of Washington, Seattle, Washington, USA
| | - Blake Hannaford
- Department of Engineering, University of Washington, Seattle, Washington, USA
| | - Kris Moe
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Maya G Sardesai
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Sugino T, Nakamura R, Kuboki A, Honda O, Yamamoto M, Ohtori N. Comparative analysis of surgical processes for image-guided endoscopic sinus surgery. Int J Comput Assist Radiol Surg 2018; 14:93-104. [PMID: 30196337 DOI: 10.1007/s11548-018-1855-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study proposes a method to analyze surgical performance by modeling, aligning, and comparing surgical processes. This method is intended to serve as a means to support the enhancement of surgical skills for endoscopic sinus surgeries (ESSs). We focus on surgical navigation systems used in image-guided ESSs and aim to construct a comparative analysis method for surgical processes based on the information about the surgical instruments motion obtained from the navigation system. METHODS The proposed method consists of the following three parts: quantification of surgical features, modeling of surgical processes, and alignment and comparison of surgical process models (SPMs). First, we defined time-series parameters using the navigation-based surgical data. Second, we created SPMs by applying the defined parameters and the relative positional information of the instruments to the patient's anatomy. Third, we constructed a method to align and compare SPMs based on dynamic time warping with barycenter averaging. RESULTS The proposed method was validated on a dataset containing surgical data obtained by an optical tracking system from 14 clinical ESS cases. We evaluated the validity of the comparative analysis by aligning and comparing SPMs between experts and residents. The validation results suggested that the proposed method could achieve proper alignment of the SPMs and clarify the differences in surgical processes between experts and residents. CONCLUSION We developed a method to enable a time-series comparative analysis of surgical processes based on the surgical data from the navigation system. This method can allow surgeons to identify differences between their procedures and reference procedures such as experts' procedures.
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Affiliation(s)
- Takaaki Sugino
- Graduate School of Engineering, Chiba University, Chiba, Japan
| | - Ryoichi Nakamura
- Graduate School of Engineering, Chiba University, Chiba, Japan. .,Center for Frontier Medical Engineering, Chiba University, Chiba, Japan. .,Faculty of Engineering, Chiba University, Chiba, Japan. .,PRESTO, Japan Science and Technology Agency, Saitama, Japan.
| | - Akihito Kuboki
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Honda
- Faculty of Engineering, Chiba University, Chiba, Japan
| | | | - Nobuyoshi Ohtori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
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Mohamadipanah H, Nathwani J, Peterson K, Forsyth K, Maulson L, DiMarco S, Pugh C. Shortcut assessment: Can residents’ operative performance be determined in the first five minutes of an operative task? Surgery 2018; 163:1207-1212. [DOI: 10.1016/j.surg.2018.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
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Oropesa I, Escamirosa FP, Sánchez-Margallo JA, Enciso S, Rodríguez-Vila B, Martínez AM, Sánchez-Margallo FM, Gómez EJ, Sánchez-González P. Interpretation of motion analysis of laparoscopic instruments based on principal component analysis in box trainer settings. Surg Endosc 2018; 32:3096-3107. [PMID: 29349544 DOI: 10.1007/s00464-018-6022-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Motion analysis parameters (MAPs) have been extensively validated for assessment of minimally invasive surgical skills. However, there are discrepancies on how specific MAPs, tasks, and skills match with each other, reflecting that motion analysis cannot be generalized independently of the learning outcomes of a task. Additionally, there is a lack of knowledge on the meaning of motion analysis in terms of surgical skills, making difficult the provision of meaningful, didactic feedback. In this study, new higher significance MAPs (HSMAPs) are proposed, validated, and discussed for the assessment of technical skills in box trainers, based on principal component analysis (PCA). METHODS Motion analysis data were collected from 25 volunteers performing three box trainer tasks (peg grasping/PG, pattern cutting/PC, knot suturing/KS) using the EVA tracking system. PCA was applied on 10 MAPs for each task and hand. Principal components were trimmed to those accounting for an explained variance > 80% to define the HSMAPs. Individual contributions of MAPs to HSMAPs were obtained by loading analysis and varimax rotation. Construct validity of the new HSMAPs was carried out at two levels of experience based on number of surgeries. RESULTS Three new HSMAPs per hand were defined for PG and PC tasks, and two per hand for KS task. PG presented validity for HSMAPs related to insecurity and economy of space. PC showed validity for HSMAPs related to cutting efficacy, peripheral unawareness, and confidence. Finally, KS presented validity for HSMAPs related with economy of space and knotting security. CONCLUSIONS PCA-defined HSMAPs can be used for technical skills' assessment. Construct validation and expert knowledge can be combined to infer how competences are acquired in box trainer tasks. These findings can be exploited to provide residents with meaningful feedback on performance. Future works will compare the new HSMAPs with valid scoring systems such as GOALS.
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Affiliation(s)
- Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Avda Complutense, 30, 28040, Madrid, Spain.
| | - Fernando Pérez Escamirosa
- Department of Surgery, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Circuito Interior, Av. Universidad 3000, Ciudad Universitaria, Coyoacán, 04510, Mexico City, Mexico
| | - Juan A Sánchez-Margallo
- Bioengineering and Health Technologies Unit, Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km 41.8, 10071, Cáceres, Spain
| | - Silvia Enciso
- Laparoscopy Unit, Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km 41.8, 10071, Cáceres, Spain
| | - Borja Rodríguez-Vila
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Avda Complutense, 30, 28040, Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Arturo Minor Martínez
- Department of Electrical Engineering, Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Av. IPN 2508, Col., San Pedro Zacatenco, 07360, Mexico City, Mexico
| | - Francisco M Sánchez-Margallo
- Bioengineering and Health Technologies Unit, Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km 41.8, 10071, Cáceres, Spain
| | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Avda Complutense, 30, 28040, Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Avda Complutense, 30, 28040, Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
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Ganni S, Botden SMBI, Chmarra M, Goossens RHM, Jakimowicz JJ. A software-based tool for video motion tracking in the surgical skills assessment landscape. Surg Endosc 2018; 32:2994-2999. [PMID: 29340824 PMCID: PMC5956097 DOI: 10.1007/s00464-018-6023-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data. METHODS 6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The recorded videos were analysed using Kinovea 0.8.15 and the following parameters calculated the path length, average instrument movement and number of sudden or extreme movements. RESULTS The analysed data showed that experts had significantly shorter path length (median 127 cm vs. 187 cm, p = 0.01), smaller average movements (median 0.40 cm vs. 0.32 cm, p = 0.002) and fewer sudden movements (median 14.00 vs. 21.61, p = 0.001) than their novice counterparts. CONCLUSION The use of software-based video motion tracking of laparoscopic cholecystectomy is a simple and viable method enabling objective assessment of surgical performance. It provides clear discrimination between expert and novice performance.
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Affiliation(s)
- Sandeep Ganni
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands. .,Department of Surgery, GSL Medical College, Rajahmundry, India. .,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Magdalena Chmarra
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Richard H M Goossens
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jack J Jakimowicz
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying. ACTA ACUST UNITED AC 2017; 14:29. [PMID: 29290752 PMCID: PMC5738461 DOI: 10.1186/s10397-017-1031-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/19/2017] [Indexed: 01/07/2023]
Abstract
Background Training of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1-G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T2) in the same manner than at T1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T3) in the same manner than at T1 and T2. At each repetition, scoring was based on the time taken for task completion system. Results The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001). Conclusions Our data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.
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Walker JL, Nathwani JN, Mohamadipanah H, Laufer S, Jocewicz FF, Gwillim E, Pugh CM. Residents' response to bleeding during a simulated robotic surgery task. J Surg Res 2017; 220:385-390. [PMID: 29180207 DOI: 10.1016/j.jss.2017.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/08/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to assess performance measurement validity of our newly developed robotic surgery task trainer. We hypothesized that residents would exhibit wide variations in their intercohort performance as well as a measurable difference compared to surgeons in fellowship training. MATERIALS AND METHODS Our laboratory synthesized a model of a pelvic tumor that simulates unexpected bleeding. Surgical residents and fellows of varying specialties completed a demographic survey and were allowed 20 minutes to resect the tumor using the da Vinci robot and achieve hemostasis. At a standardized event in the simulation, venous bleeding began, and participants attempted hemostasis using suture ligation. A motion tracking system, using electromagnetic sensors, recorded participants' hand movements. A postparticipation Likert scale survey evaluated participants' assessment of the model's realism and usefulness. RESULTS Three of the seven residents (postgraduate year 2-5), and the fellow successfully resected the tumor in the allotted time. Residents showed high variability in performance and blood loss (125-700 mL) both within their cohort and compared to the fellow (150 mL blood). All participants rated the model as having high realism and utility for trainees. CONCLUSIONS The results support that our bleeding pelvic tumor simulator has the ability to discriminate resident performance in robotic surgery. The combination of motion, decision-making, and blood loss metrics offers a multilevel performance assessment, analyzing both technical and decision-making abilities.
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Affiliation(s)
- Jessica L Walker
- Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | - Jay N Nathwani
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | - Shlomi Laufer
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Frank F Jocewicz
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Eran Gwillim
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Carla M Pugh
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Evaluation of contactless human–machine interface for robotic surgical training. Int J Comput Assist Radiol Surg 2017; 13:13-24. [DOI: 10.1007/s11548-017-1666-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/24/2017] [Indexed: 12/26/2022]
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Abstract
The convergence of technology and medicine has led to many advances in surgical training. Novel surgical simulators have led to significantly improved skills of graduating surgeons, leading to decreased time to proficiency, improved efficiency, decreased errors, and improvement in patient safety. Endoscopic sinus surgery poses a steep learning curve given the complex 3-dimensional anatomy of the nasal and paranasal cavities, and the necessary visual-spatial motor skills and bimanual dexterity. This article focuses on surgical simulation in rhinological training and how innovative high-fidelity and low-fidelity simulators can maximize resident training and improve procedural skills before operating in the live environment.
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Affiliation(s)
- Andrew Y Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA
| | - Marc Gibber
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA.
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Pernek I, Ferscha A. A survey of context recognition in surgery. Med Biol Eng Comput 2017; 55:1719-1734. [DOI: 10.1007/s11517-017-1670-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
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Molinas CR, Binda MM, Campo R. Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying. ACTA ACUST UNITED AC 2017; 14:12. [PMID: 28890675 PMCID: PMC5570794 DOI: 10.1186/s10397-017-1015-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023]
Abstract
Background Training of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK. Results The study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase 1, a baseline test was performed (T1, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T2, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T3, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups. Conclusions This study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.
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Affiliation(s)
- Carlos Roger Molinas
- Neolife - Medicina y Cirugia Reproductiva, Avenida Brasilia 760, 1434 Asuncion, Paraguay
| | - Maria Mercedes Binda
- Neolife - Medicina y Cirugia Reproductiva, Avenida Brasilia 760, 1434 Asuncion, Paraguay
| | - Rudi Campo
- European Academy of Gynaecological Surgery, Leuven, Belgium
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Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator. Otol Neurotol 2017; 38:e85-e91. [DOI: 10.1097/mao.0000000000001398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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What Are the Principles That Guide Behaviors in the Operating Room?: Creating a Framework to Define and Measure Performance. Ann Surg 2017; 265:255-267. [PMID: 27611618 DOI: 10.1097/sla.0000000000001962] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify the core principles that guide expert intraoperative behaviors and to use these principles to develop a universal framework that defines intraoperative performance. BACKGROUND Surgical outcomes are associated with intraoperative cognitive skills. Yet, our understanding of factors that control intraoperative judgment and decision-making are limited. As a result, current methods for training and measuring performance are somewhat subjective-more task rather than procedure-oriented-and usually not standardized. They thus provide minimal insight into complex cognitive processes that are fundamental to patient safety. METHODS Cognitive task analyses for 6 diverse surgical procedures were performed using semistructured interviews and field observations to describe the thoughts, behaviors, and actions that characterize and guide expert performance. Verbal data were transcribed, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 4 independent reviewers, and synthesized into a list of items. RESULTS A conceptual framework was developed based on 42 semistructured interviews lasting 45 to 120 minutes, 5 expert panels and 51 field observations involving 35 experts, and 135 sources from the literature. Five domains of intraoperative performance were identified: psychomotor skills, declarative knowledge, advanced cognitive skills, interpersonal skills, and personal resourcefulness. Within the advanced cognitive skills domain, 21 themes were perceived to guide the behaviors of surgeons: 18 for surgical planning and error prevention, and 3 for error/injury recognition, rescue, and recovery. The application of these thought patterns was highly case-specific and variable amongst subspecialties, environments, and individuals. CONCLUSIONS This study provides a comprehensive definition of intraoperative expertise, with greater insight into the complex cognitive processes that seem to underlie optimal performance. This framework provides trainees and other nonexperts with the necessary information to use in deliberate practice and the creation of effective thought habits that characterize expert performance. It may help to identify gaps in performance, and to isolate root causes of surgical errors with the ultimate goal of improving patient safety.
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Hofstad EF, Våpenstad C, Bø LE, Langø T, Kuhry E, Mårvik R. Psychomotor skills assessment by motion analysis in minimally invasive surgery on an animal organ. MINIM INVASIV THER 2017. [DOI: 10.1080/13645706.2017.1284131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erlend Fagertun Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Cecilie Våpenstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Eirik Bø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Esther Kuhry
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- National Center for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Tonutti M, Elson DS, Yang GZ, Darzi AW, Sodergren MH. The role of technology in minimally invasive surgery: state of the art, recent developments and future directions. Postgrad Med J 2016; 93:159-167. [DOI: 10.1136/postgradmedj-2016-134311] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 01/18/2023]
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Obdeijn MC, Horeman T, de Boer LL, van Baalen SJ, Liverneaux P, Tuijthof GJM. Navigation forces during wrist arthroscopy: assessment of expert levels. Knee Surg Sports Traumatol Arthrosc 2016; 24:3684-3692. [PMID: 25448136 DOI: 10.1007/s00167-014-3450-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To facilitate effective and efficient training in skills laboratory, objective metrics can be used. Forces exerted on the tissues can be a measure of safe tissue manipulation. To provide feedback during training, expert threshold levels need to be determined. The purpose of this study was to define the magnitude and the direction of navigation forces used during arthroscopic inspection of the wrist. METHODS We developed a set-up to mount a cadaver wrist to a 3D force platform that allowed measurement of the forces exerted on the wrist. Six experts in wrist arthroscopy performed two tasks: (1) Introduction of the camera and visualization of the hook. (2) Navigation through the wrist with visualization of five anatomic structures. The magnitude (Fabs) and direction of force were recorded, with the direction defined as α being the angle in the vertical plane and β being the angle in the horizontal plane. The 10th-90th percentile of the data were used to set threshold levels for training. RESULTS The results show distinct force patterns for each of the anatomic landmarks. Median Fabs of the navigation task is 3.8 N (1.8-7.3), α is 3.60 (-54-44) and β is 260 (0-72). CONCLUSION Unique expert data on navigation forces during wrist arthroscopy were determined. The defined maximum allowable navigation force of 7.3 N (90th percentile) can be used in providing feedback on performance during skills training. The clinical value is that this study contributes to objective assessment of skills levels.
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Affiliation(s)
- Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Lisanne L de Boer
- Department of Technical Medicine, MIRA Institute for Biomedical Technology and Technical Medicine Enschede, University of Twente, Enschede, Netherlands
| | - Sophie J van Baalen
- Department of Technical Medicine, MIRA Institute for Biomedical Technology and Technical Medicine Enschede, University of Twente, Enschede, Netherlands
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, Illkirch, France
| | - Gabrielle J M Tuijthof
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands.,Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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