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Malik MU, Connelly TM, Awan NA, Bhatti FR, Hayat RS, Awan HRH. The development and evaluation of a homemade laparoscopic endotrainer using the IDEAL framework and MISTELS scoring system: a pilot study. ANZ J Surg 2024; 94:84-88. [PMID: 38225746 DOI: 10.1111/ans.18865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/06/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. METHODS The validated modified (MISTELS) score was used to test the reliability of a low-cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1-6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. RESULTS 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test-retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895-0.981) and 0.64 (95% CI, 0.35-0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. CONCLUSION It is possible to assemble a low-cost, reliable trainer at home to enhance laparoscopic skills during residency.
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Affiliation(s)
- Muhammad Usman Malik
- District Surgical Department, District Headquarter Teaching Hospital, Sargodha, Pakistan
| | - Tara M Connelly
- Department of Colon and Rectal Surgery, University Hospital, Limerick, Ireland
| | - Naila Akhtar Awan
- Department of Dermatology, Rana Medical Complex, Jauharabad, Pakistan
| | - Fatima Rizwan Bhatti
- Department of Psychiatry, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Rana Saddaqat Hayat
- District Surgical Department, District Headquarter Teaching Hospital, Sargodha, Pakistan
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2
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Crihfield EG, Uppalapati P, Abittan B, Laibangyang A, Brahmbhatt S, Burlingame M, Goldberg GL, Rabin JM. Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes. Surg Open Sci 2023; 16:82-93. [PMID: 37789947 PMCID: PMC10542196 DOI: 10.1016/j.sopen.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/09/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
Background To determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners. Methods 74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. Results Mean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores. Conclusions Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.
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Affiliation(s)
- Eric G. Crihfield
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Pooja Uppalapati
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Baruch Abittan
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Anya Laibangyang
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Sonam Brahmbhatt
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Madeleine Burlingame
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Jill M. Rabin
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
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Murthy SS, Are C. Education of the cancer surgical workforce: Gaps, priorities, and strategies. J Surg Oncol 2023; 128:938-942. [PMID: 37818912 DOI: 10.1002/jso.27443] [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: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023]
Abstract
Cancer is a leading cause of noncommunicable disease-related mortality. The predicted number of new cancer cases will increase from 19.3 million in 2020 to 30.2 million by 2040. To mitigate the cancer burden, it is critical to build capacity of the cancer workforce, especially in systems with limited resources. We provide a global overview of gaps and implementation strategies that can increase the quality and quantity of the global surgical cancer workforce.
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Affiliation(s)
- Shilpa S Murthy
- Division of Colon and Rectal Surgery, Yale University Department of Surgery, New Haven, Connecticut, USA
| | - Chandrakanth Are
- Division of Surgical Oncology, University of Nebraska, Department of Surgery, Omaha, Nebraska, USA
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Oussi N, Forsberg E, Dahlberg M, Enochsson L. Tele-mentoring - a way to expand laparoscopic simulator training for medical students over large distances: a prospective randomized pilot study. BMC MEDICAL EDUCATION 2023; 23:749. [PMID: 37817201 PMCID: PMC10566045 DOI: 10.1186/s12909-023-04719-x] [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: 01/09/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Studies have shown the clinical benefits of laparoscopic simulator training. Decreasing numbers of operations by surgical residents have further increased the need for surgical simulator training. However, many surgical simulators in Sweden are often insufficiently used or not used at all. Furthermore, large geographical distances make access to curriculum-based surgical simulator training at established simulator centres difficult. The aim of this study was to evaluate whether tele-mentoring (TM) could be well tolerated and improve basic laparoscopic surgical skills of medical students 900 km away from the teacher. METHODS Twenty students completed an informed consent and a pre-experimental questionnaire. The students were randomized into two groups: (1) TM (N = 10), receiving instructor feedback via video-link and (2) control group (CG, N = 10) with lone practice. Initial warm-up occurred in the Simball Box simulator with one Rope Race task followed by five consecutive Rope Race and three Peg Picker tasks. Afterwards, all students completed a second questionnaire. RESULTS The whole group enjoyed the simulator training (prescore 73.3% versus postscore 89.2%, P < 0.0001). With TM, the simulator Rope Race overall score increased (prescore 30.8% versus postscore 43.4%; P = 0.004), and the distance that the laparoscopic instruments moved decreased by 40% (P = 0.015), indicating better precision, whereas in the CG it did not. In Peg Picker, the overall scores increased, whereas total time and distance of the instruments decreased in both groups, indicating better performance and precision. CONCLUSIONS Simulation training was highly appreciated overall. The TM group showed better overall performance with increased precision in what we believe to be the visuospatially more demanding Rope Race tasks compared to the CG. We suggest that surgical simulator tele-mentoring over long distances could be a viable way to both motivate and increase laparoscopic basic skills training in the future.
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Affiliation(s)
- Ninos Oussi
- Centre for Clinical Research, Region Sörmland, Uppsala University, Eskilstuna, Sweden
- Division of Urology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Emil Forsberg
- Department of Surgical and Perioperative Sciences, Division of Surgery, Umeå University, Umeå, Sweden
| | - Michael Dahlberg
- Department of Surgical and Perioperative Sciences, Division of Surgery, Umeå University, Umeå, Sweden
- Department of Surgery, Sunderby Hospital, Luleå, 971 80, Sweden
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Division of Surgery, Umeå University, Umeå, Sweden.
- Department of Surgery, Sunderby Hospital, Luleå, 971 80, Sweden.
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
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Pollok F, Lund SB, Traynor MD, Alva-Ruiz R, MacArthur TA, Watkins RD, Mahony CR, Woerster M, Yeh VJH, Matovu A, Clarke DL, Laack TA, Rivera M. Systematic Review of Procedural Skill Simulation in Health Care in Low- and Middle-Income Countries. Simul Healthc 2023:01266021-990000000-00076. [PMID: 37440427 DOI: 10.1097/sih.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
ABSTRACT Low- and middle-income countries (LMICs) have adopted procedural skill simulation, with researchers increasingly investigating simulation efforts in resource-strained settings. We aim to summarize the current state of procedural skill simulation research in LMICs focusing on methodology, clinical area, types of outcomes and cost, cost-effectiveness, and overall sustainability. We performed a comprehensive literature review of original articles that assessed procedural skill simulation from database inception until April 2022.From 5371 screened articles, 262 were included in this review. All included studies were in English. Most studies were observational cohort studies (72.9%) and focused on obstetrics and neonatal medicine (32.4%). Most measured outcome was the process of task performance (56.5%). Several studies mentioned cost (38.9%) or sustainability (29.8%). However, few articles included actual monetary cost information (11.1%); only 1 article assessed cost-effectiveness. Based on our review, future research of procedural skill simulation in LMICS should focus on more rigorous research, cost assessments, and on less studied areas.
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Affiliation(s)
- Franziska Pollok
- From the Multidisciplinary Simulation Center (F.P., S.B.L., M.W., T.A.L.), Mayo Clinic, Rochester, MN; Department for Anesthesiology (F.P., M.W.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Surgery (S.B.L., M.D.T., R.A.-R., T.A.M., R.D.W., C.R.M., V.J.-H.Y., M.R.), Mayo Clinic, Rochester, MN; Department of Surgery (A.M.), Mubende Regional Referral Hospital, Mubende, Uganda; Department of Molecular Medicine and Surgery (A.M.), Karolinska Institutet, Sweden; University of KwaZulu Natal, Pietermaritzburg (D.L.C.), KwaZulu Natal, South Africa; University of Witwatersrand, Johannesburg (D.L.C.), Gauteng, South Africa; and Department of Emergency Medicine (T.A.L.), Mayo Clinic, Rochester, MN
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Ramadan K, Chaiton K, Burke J, Labrakos D, Maeda A, Okrainec A. Virtual fundamentals of laparoscopic surgery (FLS) boot-camp using telesimulation: an educational solution during the covid-19 pandemic. Surg Endosc 2023; 37:3926-3933. [PMID: 37067595 PMCID: PMC10108785 DOI: 10.1007/s00464-023-09995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/23/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has organized an FLS boot-camp to teach PGY1 residents the FLS manual skills. During the COVID-19 pandemic, in-person sessions were not possible. The purpose of this study was to utilize telesimulation as an education solution for teaching FLS technical skills to PGY1 residents during the COVID-19 pandemic. METHODS A virtual FLS program was established. A complete, easily portable FLS kit was distributed to participants and instructors to set up an FLS box and connect remotely using telesimulation. The program was delivered by three senior residents using the Zoom™ platform. Participants were split into groups of 3-4 individuals, each receiving three 1-h sessions. Sessions were structured with initial demonstration of tasks followed by individual coaching of participants in 'break-out' rooms. The official FLS exam was administered in-person on the 4th week. Pre- and post-course surveys were administered to participants gauging self-reported proficiency with FLS tasks and overall course feedback. Anonymized FLS exam results were collected. RESULTS A total of 14 residents participated, and 11 responded to the survey. Participants reported that their overall FLS skills proficiency significantly improved on a 5-point likert scale from 1.5 ± 0.5 pre-course to 4.0 ± 0.5 post-course (mean ± SD). Participants unanimously stated that having the FLS box at home was valuable and enabled them to practice more. On the FLS exam, 13 of 14 participants passed the manual skills component. CONCLUSIONS We developed a telesimulation hands-on FLS course as an alternative to in-person training. The course was practical and effective and was preferred to traditional methods by participants. With ever-expanding technological solutions, virtual telesimulation education is an attractive and underutilized tool, not only in the setting of COVID-19, but also more broadly across current educational programs.
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Affiliation(s)
- Khaled Ramadan
- Department of Surgery, Faculty of Medicine, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada
| | - Karen Chaiton
- Temerty Advanced Surgical Education and Simulation Centre, The Michener Institute of Education, University Health Network, 222 St., Patrick St., Toronto, ON, M5T 1V4, Canada
| | - Jaime Burke
- Division of General Surgery, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Dimitra Labrakos
- Temerty Advanced Surgical Education and Simulation Centre, The Michener Institute of Education, University Health Network, 222 St., Patrick St., Toronto, ON, M5T 1V4, Canada
| | - Azusa Maeda
- Division of General Surgery, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Allan Okrainec
- Department of Surgery, Faculty of Medicine, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.
- Temerty Advanced Surgical Education and Simulation Centre, The Michener Institute of Education, University Health Network, 222 St., Patrick St., Toronto, ON, M5T 1V4, Canada.
- Division of General Surgery, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
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Seltzer H, Swayze E, Thottathil L, Dewey J, Jabara J, Mehta A, Frederick J, Yousif P, Parikh S, Tsuei A, Miller L, Linares LS. The Impact of Homemade Laparoscopic Box Trainers on Medical Student Surgical Skills: A Randomized Control Pilot Study. Surg Innov 2023; 30:84-93. [PMID: 35499271 DOI: 10.1177/15533506221094956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. Design: This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a 2 week curriculum of instructional videos alone (n = 8, 47.1%) vs videos plus a home laparoscopic box trainer (n = 9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. Participants: Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. Results: For the box trainer group vs the videos alone group: mean change in mistakes was -10.0 (standard deviation [SD]:17.1) vs +.5 (SD:21.59) (P = .28); mean change in time was -433.24 (SD:304.67) seconds vs -366.16 (SD:240.10) seconds (P = .62); mean change in instrument path length was -4.27 (SD:4.38) meters vs -3.19 (SD:4.86) meters (P = .64). The box trainer group ranked "I feel as though surgery comes naturally" 1.58 points higher (95% confidence interval [CI]: .85, 2.32; P < .01) and "I am worried about being skilled at surgery" 1.26 points lower (95% CI: 2.29, -.24; P = .02) upon completing the study. The videos alone group reported no significant changes in survey responses. Conclusion: Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.
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Affiliation(s)
- Harrison Seltzer
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Emma Swayze
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Letty Thottathil
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - John Dewey
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jordan Jabara
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Aditya Mehta
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - John Frederick
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Paul Yousif
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Sonia Parikh
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Angie Tsuei
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - L Silvia Linares
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Xia J, Mao J, Chen H, Xu X, Zhang J, Yang J, Wang Z. Development and evaluation of a portable and soft 3D-printed cast for laparoscopic choledochojejunostomy model in surgical training. BMC MEDICAL EDUCATION 2023; 23:77. [PMID: 36721193 PMCID: PMC9889129 DOI: 10.1186/s12909-023-04055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Laparoscopic choledochojejunostomy (LCJ) is an essential basic skill for biliary surgeons. Therefore, we established a convenient and effective LCJ 3D printing model to evaluate whether the model could simulate the actual operation situation and determine its effectiveness and validity in surgical training. METHODS A 3D printing dry laboratory model was established to simulate LCJ. The face and content validity of the model were evaluated by six experienced biliary surgeons based on 5-point Likert scale questionnaires. A total of 15 surgeons with different levels of experience performed LCJ on the model and evaluated the structural validity of the model using the objective structured assessment of technical skills (OSATS). Simultaneously, the operation time of each surgery was also recorded. A study was also performed to further evaluate the learning curve of residents. RESULTS The operating space score of the model was 4.83 ± 0.41 points. The impression score of bile duct and intestinal canal was 4.33 ± 0.52 and 4.17 ± 0.41 points, respectively. The tactile sensation score of bile duct suture and intestinal canal suture was 4.00 ± 0.63 and 3.83 ± 0.41points, respectively. The OSATS score for model operation in the attending group was 29.20 ± 0.45 points, which was significantly higher than that in the fellow group (26.80 ± 1.10, P = 0.007) and the resident group (19.80 ± 1.30, P < 0.001). In addition, there was a statistical difference in operation time among surgeons of different experience levels (P < 0.05). Residents could significantly improve the surgical score and shorten the time of LCJ through repeated training. CONCLUSIONS The 3D printing LCJ model can simulate the real operation scenes and distinguish surgeons with different levels of experience. The model is expected to be one of the training methods for biliary tract surgery in the future.
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Affiliation(s)
- Jianfu Xia
- Department of General Surgery, The Second Affiliated Hospital of Shanghai University (Wenzhou Central Hospital), Wenzhou, 325000, China
- Soochow University, Suzhou, 215000, China
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou, 310000, China
| | - Jinlei Mao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Hao Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Xiaodong Xu
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Jing Zhang
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Jin Yang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Zhifei Wang
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou, 310000, China.
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Berdida DJE, Elero FSL, Donato MFT, Dungo MKS, Dunque NIO, Dy KJE, Elarmo RAGF, Espineli JMB, Espineli VJG. Filipino nursing students' use of low-cost simulators during the COVID-19 pandemic: A summative content analysis of YouTube videos. TEACHING AND LEARNING IN NURSING : OFFICIAL JOURNAL OF THE NATIONAL ORGANIZATION FOR ASSCIATE DEGREE NURSING 2023; 18:134-143. [PMID: 35999891 PMCID: PMC9388447 DOI: 10.1016/j.teln.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
This study examined Filipino nursing students' use of household materials as low-cost simulators and how they aid in online return demonstrations. Summative content analysis guided this study. We collected uploaded YouTube videos (n = 14) depicting Filipino nursing students using low-cost simulators in their skills demonstration. We used Bengtsson's approach to content analysis to analyze the data. Four themes of low-cost simulators were identified: home and hardware, health and beauty, creative articles, and entertainment. The categories under home and hardware were tools, containers, furniture, and packaging. Health and beauty low-cost simulators were toiletries and medical supplies. Creative articles included fabrics, clothing accessories, and stationeries. Entertainment low-cost-simulators had toys and computer accessories. During the COVID-19 pandemic, our research uncovered home equipment employed as low-cost simulators to help nursing students' online simulation of skills demonstration. We recommend further investigation of whether students learned using low-cost simulators.
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Narang K, Imsirovic A, Dhanda J, Smith CF. Virtual Reality for Anatomy and Surgical Teaching. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1397:135-149. [DOI: 10.1007/978-3-031-17135-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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Varela E, Castelli I, Szwarcfiter V, Turner L, Gaete MI, Belmar F, Cortés M, Jiménez G, Corvetto M, Varas J. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1708. [PMID: 36542006 PMCID: PMC9767423 DOI: 10.1590/0102-672020220002e1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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Affiliation(s)
- Eduardo Varela
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Ignacio Castelli
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Vania Szwarcfiter
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Lawrence Turner
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - María Inés Gaete
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Francisca Belmar
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Matías Cortés
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Gerónimo Jiménez
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Marcia Corvetto
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Julián Varas
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
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Development and Validity of a Novel Ex Vivo Porcine Organs Laparoscopic Roux-en-Y Gastric Bypass Training Model. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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14
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Transfer of open and laparoscopic skills to robotic surgery: a systematic review. J Robot Surg 2022:10.1007/s11701-022-01492-9. [PMID: 36418717 PMCID: PMC10374669 DOI: 10.1007/s11701-022-01492-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
AbstractDue to its advantages over open surgery and conventional laparoscopy, uptake of robot-assisted surgery has rapidly increased. It is important to know whether the existing open or laparoscopic skills of robotic novices shorten the robotic surgery learning curve, potentially reducing the amount of training required. This systematic review aims to assess psychomotor skill transfer to the robot in clinical and simulated settings. PubMed, EMBASE, Cochrane Library and Scopus databases were systematically searched in accordance with PRISMA guidelines from inception to August 2021 alongside website searching and citation chaining. Article screening, data extraction and quality assessment were undertaken by two independent reviewers. Outcomes included simulator performance metrics or in the case of clinical studies, peri- and post-operative metrics. Twenty-nine studies met the eligibility criteria. All studies were judged to be at high or moderate overall risk of bias. Results were narratively synthesised due to heterogeneity in study designs and outcome measures. Two of the three studies assessing open surgical skill transfer found evidence of successful skill transfer while nine of twenty-seven studies evaluating laparoscopic skill transfer found no evidence. Skill transfer from both modalities is most apparent when advanced robotic tasks are performed in the initial phase of the learning curve but quality and methodological limitations of the existing literature prevent definitive conclusions. The impact of incorporating laparoscopic simulation into robotic training curricula and on the cost effectiveness of training should be investigated.
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Martín-Calvo N, Gómez B, Díez N, Llorente M, Fernández S, Ferreiro Abal A, Javier Pueyo F. Development and validation of a low-cost laparoscopic simulation box. Cir Esp 2022:S2173-5077(22)00381-7. [PMID: 36265771 DOI: 10.1016/j.cireng.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. METHODS A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. RESULTS The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points). CONCLUSION The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.
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Affiliation(s)
- Nerea Martín-Calvo
- University of Navarra, Faculty of Medicine, Department of Preventive Medicine and Public Health, 31008 Pamplona, Spain; CIBER-obn, Institute Salud Carlos III, 28029 Madrid, Spain; IdiSNA, Institute of Health Research of Navarra, Spain.
| | - Beatriz Gómez
- University of Navarra, Faculty of Medicine, 31008 Pamplona, Spain
| | - Nieves Díez
- University of Navarra, Faculty of Medicine, Department of Pathology, Anatomy and Physiology, 31008 Pamplona, Spain
| | - Marcos Llorente
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernández
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Ane Ferreiro Abal
- University of Navarra, School of Engineering, 20018 San Sebastián, Spain
| | - Francisco Javier Pueyo
- Department of Anesthesiology, Perioperative Medicine and Critical Care, University of Navarra Clinic, 31008 Pamplona, Spain
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Chu KM, Bust L, Forgan T. Colorectal Surgery Practice, Training, and Research in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:410-416. [PMID: 36111082 PMCID: PMC9470283 DOI: 10.1055/s-0042-1746190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Colorectal surgery (CRS) practice, training, and research differ between low- and middle-income countries (LMICs) and high-income countries due to disparity in resources. LMIC CRS is primarily done by general surgeons due to the paucity of fully trained colorectal surgeons. The majority of colon and rectal resections are done using open techniques, and laparoscopy and robotic platforms are only available in select private or academic centers. Multi-disciplinary teams are not available in most hospitals, so surgeons must have a broad knowledge base, and learn to adapt their practice. Formal CRS training opportunities through accredited post-residency fellowships and professional colorectal surgical associations are limited in LMICs. CRS is less established as an academic field, and less data are generated in LMICs. There are fewer staff and less dedicated funding for CRS research. However, LMIC colorectal surgeons and researchers can contribute valuable clinical findings especially on conditions of higher prevalence in their settings such as anal squamous cell carcinoma and obstetric fistulas. Effective surgical care for colorectal conditions requires significant investment in infrastructure, training, and governance in LMICs. This is critical to improve access to safe surgical care for all.
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Affiliation(s)
- Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Lynn Bust
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
| | - Tim Forgan
- Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
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Martín-Calvo N, Gómez B, Díez N, Llorente M, Fernández S, Ferreiro Abal A, Pueyo FJ. Development and validation of a low-cost laparoscopic simulation box. Cir Esp 2022:S2173-5077(22)00293-9. [PMID: 35985573 DOI: 10.1016/j.cireng.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. METHODS A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. RESULTS The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points). CONCLUSION The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.
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Affiliation(s)
- Nerea Martín-Calvo
- University of Navarra, Faculty of Medicine, Department of Preventive Medicine and Public Health, 31008 Pamplona, Spain; CIBER-obn, Institute Salud Carlos III, 28029 Madrid, Spain; IdiSNA, Institute of Health Research of Navarra, 31008 Pamplona, Spain.
| | - Beatriz Gómez
- University of Navarra, Faculty of Medicine, 31008 Pamplona, Spain
| | - Nieves Díez
- University of Navarra, Faculty of Medicine, Department of Pathology, Anatomy and Physiology, 31008 Pamplona, Spain
| | - Marcos Llorente
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernández
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Ane Ferreiro Abal
- University of Navarra, School of Engineering, 20018, San Sebastián, Spain
| | - Francisco Javier Pueyo
- Department of Anesthesiology, Perioperative Medicine and Critical Care, University of Navarra Clinic, 31008 Pamplona, Spain
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18
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Distance Education for Basic Surgical Skills Using Homemade Tools—DIY Methods for Emergency Situations. SUSTAINABILITY 2022. [DOI: 10.3390/su14148639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of our research was to establish a reproducible curriculum that offers the possibility to gain basic surgical skills (knot tying, suturing, laparoscopy basics) through distance education in emergency situations by using tools available in the household. Forty-six volunteering third- and fourth-year medical students were involved in the study. The distance education system was set up using homemade or easily obtainable tools (an empty can, shoe box, sponge, etc.) to teach surgical knotting, suturing, and basic laparoscopic skills. The reachable learning objectives were contrasted with the original course plan. Feedback from the students has been collected. The students’ results were compared to the regular course of the previous years. Seventy-nine percent of the original learning objectives could be reached completely, and 15% partially. The necessary tools were available for 82% of the students. The students evaluated the course for 4.26 in general and 4.86 considering the circumstances (on a 5-level-scale). The homemade trainers were assessed over four as an acceptable substitution. Students’ exam results decreased only by 7% compared to the previous two years. Basic surgical skills can be educated with acceptable efficiency and student satisfaction using distance teaching and homemade tools. This is the first study where not only the simulators but the surgical instruments were replaced with household tools and evaluated by a reproducible curriculum.
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Takegawa PH, Kalil J, Bustorff-Silva JM, Miranda ML. Effectiveness of an inexpensive short-term theoretical-practical course on videosurgery for surgeons in training. BMC MEDICAL EDUCATION 2022; 22:527. [PMID: 35799171 PMCID: PMC9264716 DOI: 10.1186/s12909-022-03594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The rapid development of video surgery and minimally invasive surgical techniques prompted many studies on the methods of teaching these techniques to young surgeons in training. However, the characteristics of a short-term course that is both easily accessible and efficient for this group of surgeons remain controversial. To investigate this issue, a short-term training method was proposed for first year surgery residents, using inexpensive handmade wooden simulation boxes with the students smartphones as cameras. Its effectiveness was evaluated, as well as possible factors that could influence student performance, such as gender and previous experience with video games. METHODS Thirty-six first-year General Surgery residents, entering in 2019 and 2020, participated in the study: 21 were males and 15 were females with ages between 22 and 29 years old, (mean 25.47 years). All participants performed a pre-established exercise (placing two simple stitches using a laparoscopic simulator), which was timed and scored. They then participated in a short theoretical-practical course, consisting of an initial lecture followed by 4 exercises on handcrafted wooden laparoscopic video surgery simulators. Afterwards, they were asked to repeat the same exercise from the first step. Finally, they answered a questionnaire that included questions on previous videogame experience. The data were tabulated and submitted to statistical analysis. RESULTS In the pre-training exercise, 15 (41.66%) participants were able to perform the two simple stitches in the simulator box within the maximum time limit of 5 minutes. After the short course, 22 (61.11%) of participants were able to perform the complete exercise. Improvement in the time to complete the practical exercise was statistically significant (p = 0.0296) after participating in the theoretical-practical course. A better pre- and post-training performance was demonstrated by the 17 participants with experience with video games (p = 0.0116), and a better post-training performance was demonstrated by female participants (p = 0.0405). CONCLUSION This short-term inexpensive theoretical-practical course in laparoscopic training for surgeons in training was effective in reducing the execution time of a laparoscopic stitch in a simulation box. Previous experience with video games and/or female gender appear to be associated with improved performance.
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Affiliation(s)
- Paula Haveroth Takegawa
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Jefferson Kalil
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Joaquim Murray Bustorff-Silva
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Márcio Lopes Miranda
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
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Tan Q, Yang Y, Yao Y, Yang N, Jin L, Hu X, Xu X, Wang Z, Yang J, Zheng J. Development and Validation of a Homemade and Low-Cost Three-Dimensional Laparoscopic Simulator for Novices. J Laparoendosc Adv Surg Tech A 2022; 32:1071-1077. [PMID: 35467968 DOI: 10.1089/lap.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of this study was to design a low-cost three-dimensional (3D) laparoscopic simulator and validate its training effectiveness. Materials and Methods: We designed a low-cost 3D laparoscopic simulator using magnifying glass and cardboard box. Thirty-two laparoscopic novices were randomly divided into 3D group and two-dimensional (2D) group. The 3D group was trained on 3D simulator four times with 24 hours interval, and the 2D group was trained on 2D simulator. Five standardized laparoscopic tasks were performed by novices in each training. In the second part, subjects were transferred to the opposite simulator for one test after 24 hours of the fourth training. The completing time and errors for each task were recorded to assess the construct validity of simulator. Finally, the face validity and the content validity were evaluated through a closed-ended questionnaire. Results: There was no significant difference between the two groups in demographic or psychometric variables (P > .05). Compared with the 2D group, novices using 3D simulator had a better performance in five laparoscopic tasks, including a faster completing time (P < .001) and lower errors during training (P < .05). Additionally, the increased laparoscopic skill involved with our 3D simulator could be transferred to subsequent performance in 2D simulator (P < .05). Meanwhile, the score of face validity and content validity in our 3D simulator was significantly higher than that in 2D simulator (P < .05). Conclusion: Our 3D laparoscopic simulator effectively improved laparoscopic skills of novice surgeons, suggesting that the low-cost 3D simulator had satisfactory performance to satisfy requirement for novice training.
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Affiliation(s)
- Qi Tan
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yang Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yanxi Yao
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Nengrui Yang
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lulu Jin
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiangyu Hu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiaolei Xu
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Zhongzheng Wang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Jixin Yang
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Ji Zheng
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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Castillo-Segura P, Fernández-Panadero C, Alario-Hoyos C, Muñoz-Merino PJ, Delgado Kloos C. A cost-effective IoT learning environment for the training and assessment of surgical technical skills with visual learning analytics. J Biomed Inform 2021; 124:103952. [PMID: 34798158 DOI: 10.1016/j.jbi.2021.103952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Surgeons need to train and certify their technical skills. This is usually done with the intervention of experts who monitor and assess trainees. Nevertheless, this is a time-consuming task that is subject to variations among evaluators. In recent decades, subjectivity has been significantly reduced through 1) the introduction of standard curricula, such as the Fundamentals of Laparoscopic Surgery (FLS) program, which measures students' performance in specific exercises, and 2) rubrics, which are widely accepted in the literature and serve to provide feedback about the overall technical skills of the trainees. Although these two elements reduce subjectivity, they do not, however, eliminate the figure of the expert evaluator, and so the process remains time consuming. OBJECTIVES The objective of this work is to automate those parts of the work of the expert evaluator that the technology can measure objectively, using sensors to collect evidence, and visualizations to provide feedback. We designed and developed 1) a cost-effective IoT (Internet of Things) learning environment for the training and assessment of surgical technical skills and 2) visualizations supported by the literature on visual learning analytics (VLA) to provide feedback about the exercises (in real time) and overall performance (at the end of the training) of the trainee. METHODS A hybrid approach was followed based on previous research for the design of the sensor based IoT learning environment. Previous studies were used as the basis for getting best practices on the tracking of surgical instruments and on the detection of the force applied to the tissue, with a focus on reducing the costs of data collection. The monitoring of the specific exercises required the design of sensors and collection mechanisms from scratch as there is little existing research on this subject. Moreover, it was necessary to design the overall architecture to collect, process, synchronize and communicate the data coming from the different sensors to provide high-level information relevant to the end user. The information to be presented was already validated by the literature and the focus was on how to visualize this information and the optimal time for its presentation to end users. The visualizations were validated with 18 VLA experts assessing the technical aspects of the visualizations and 4 medical experts assessing their functional aspects. RESULTS This IoT learning environment amplifies the evaluation mechanisms already validated by the literature, allowing automatic data collection. First, it uses IoT sensors to automatically correct two of the exercises defined in the FLS (peg transfer and precision cutting), providing real-time visualizations. Second it monitors the movement of the surgical instruments and the force applied to the tissues during the exercise, computing 6 of the high-level indicators used by expert evaluators in their rubrics (efficiency, economy of movement, hand tremor, depth perception, bimanual dexterity, and respect for tissue), providing feedback about the technical skills of the trainee using a radar chart with these six indicators at the end of the training (summative visualizations). CONCLUSIONS The proposed IoT learning environment is a promising and cost-effective alternative to help in the training and assessment of surgical technical skills. The system shows the trainees' progress and presents new indicators about the correctness of each specific exercise through real-time visualizations, as well as their general technical skills through summative visualizations, aligned with the 6 more frequent indicators in standardized scales. Early results suggest that although both types of visualizations are useful, it is necessary to reduce the cognitive load of the graphs presented in real time during training. Nevertheless, an additional evaluation is needed to confirm these results.
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Affiliation(s)
- Pablo Castillo-Segura
- Universidad Carlos III de Madrid, Avenida Universidad 30, 28911 Leganés, Madrid, Spain.
| | | | - Carlos Alario-Hoyos
- Universidad Carlos III de Madrid, Avenida Universidad 30, 28911 Leganés, Madrid, Spain.
| | - Pedro J Muñoz-Merino
- Universidad Carlos III de Madrid, Avenida Universidad 30, 28911 Leganés, Madrid, Spain.
| | - Carlos Delgado Kloos
- Universidad Carlos III de Madrid, Avenida Universidad 30, 28911 Leganés, Madrid, Spain.
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Lovasik BP, Fay KT, Patel A, Stetler J, Papandria D, Santore MT, Davis SS, Lin E, Srinivasan JK. Development of a laparoscopic surgical skills simulation curriculum: Enhancing resident training through directed coaching and closed-loop feedback. Surgery 2021; 171:897-903. [PMID: 34521515 DOI: 10.1016/j.surg.2021.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Performance feedback through peer coaching and rigorous self-assessment is a critical part of technical skills improvement. However, formal collaborative programs using operative video-based skills assessments to generate peer coaching feedback have only been validated among attending surgeons. In this study, we developed a unique longitudinal, simulation video-based laparoscopic skills resident curriculum using video-based peer coaching and evaluated its association with skills acquisition among surgical trainees. METHODS The laparoscopic simulation curriculum consists of a pre-practice laparoscopic skill video recording, followed by receipt of directed coaching and feedback on performance from a faculty coach, a peer coach, and self-coaching. Residents then completed 6 weeks of feedback-directed practice and submitted a second post-practice laparoscopic skill video recording of the same skill, which was evaluated by a minimally invasive surgery expert grader. All general surgery residents in a single institution were enrolled, with 107 residents completing the curriculum in its initial 2 years. RESULTS Overall, more than two-thirds of residents achieved skills proficiency on their expert assessments, with similar rates of residents achieving skills proficiency at all postgraduate year levels. Significant improvements between the pre-practice assessments and post-practice assessments were most frequently seen in the instrument handling, precision, and motion & flow categories (P < .05 each). Faculty provided the highest number and proportion of closed-loop comments; residents' self-coaching feedback had the lowest number of closed-loop comments, with 83% of self-assessments containing none. CONCLUSION In this study, we describe the successful implementation of a longitudinal laparoscopic skills video-based coaching curriculum designed to improve residents' laparoscopic technical abilities through iterative directed practice supplemented by formative closed-loop feedback. This feasible, reproducible, and low-cost simulation curriculum can be adapted to other training programs and skills acquisition endeavors. This program also prepares trainees for ongoing performance feedback after completion of residency through rigorous self-assessment and peer-to-peer coaching.
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Affiliation(s)
- Brendan P Lovasik
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/blovasik
| | - Katherine T Fay
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ankit Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/ankitpatelmd
| | - Jamil Stetler
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Dominic Papandria
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Matthew T Santore
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - S Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Edward Lin
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/edlinemory
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Parente G, De Marziani L, Cordola C, Gargano T, Libri M, Lima M. Training minimally invasive surgery's basic skills: is expensive always better? Pediatr Surg Int 2021; 37:1287-1293. [PMID: 34110478 DOI: 10.1007/s00383-021-04937-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed. MATERIAL AND METHODS The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). RESULTS HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available. CONCLUSION Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy. .,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | - Luca De Marziani
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
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Development of a Low-Fidelity Laparoscopic Sacrocolpopexy Simulation Model and Evaluation of Curriculum. Female Pelvic Med Reconstr Surg 2021; 27:474-480. [PMID: 34027910 DOI: 10.1097/spv.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Minimally invasive sacrocolpopexy (SCP) is a compelling surgical procedure that requires advanced laparoscopic suturing and dissection skills and knowledge of pelvic retroperitoneal anatomy. The aim of this study was to develop a low-cost laparoscopic SCP model and educational curriculum to improve dissection and suturing skills along with anatomic knowledge to avoid complications. METHODS The pelvic SCP model was developed with easily available material that was placed on the commercial pelvic bone model to construct a vagina, major vessels, ureter, peritoneum, and areolar tissue. A comprehensive curriculum encompassing didactic and technical skills components on the pelvic model was used to teach laparoscopic SCP. Participants completed precurriculum and postcurriculum multiple-choice questionnaires to evaluate the didactic component. A modified Objective Structured Assessment of Technical Skills (OSATS) tool was used to measure technical skills before and after technical skills curriculum. RESULTS Among the 10 senior residents, 6 (60%) were studying at their fourth postgraduate year, and 3 (30%) were studying at their third postgraduate year. Postcurriculum test scores (14.5 vs 10.6) for assessment of cognitive knowledge were significantly improved (P < 0.001). The median postcurriculum OSATS scores (26.5; range, 18-30) were significantly improved (P = 0.005). Laparoscopic SCP OSATS scores increased from median 21 to median 26.5 after cognitive and technical curriculum, showing a 21.4% improvement. The majority (70%) of residents believed that the SCP model would be useful to enhance skills acquisition before performing the skill in the operating room. CONCLUSIONS A low-fidelity laparoscopic SCP curriculum showed improvement in cognitive knowledge and technical skills.
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Keni S, Ilin R, Partridge R, Hughes MA, Brennan PM. Using Automated Continuous Instrument Tracking to Benchmark Simulated Laparoscopic Performance and Personalize Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:998-1006. [PMID: 33077417 DOI: 10.1016/j.jsurg.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/29/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Laparoscopic simulation is widely used in surgical training. However, the impact of training on performance is difficult to assess. Observation is time-intensive and subjective. SurgTrac laparoscopic box-trainer instrument tracking software provides continuous, automated, real-time, objective performance feedback. We used this data to assess the relationship between task attempts and performance. We assessed whether improvement in performance with repetition could be modeled in learning curves that might be used for benchmarking. DESIGN Anonymized SurgTrac data for performances undertaken between 10/2016 and 05/2019 were retrospectively extracted. The thread transfer task, a basic instrument handling task, was assessed. Task duration and instrument-based metrics were analyzed; total distance travelled by instrument tips, average speed, average acceleration, and the ratio of movements between the left and right hands. Curve estimation regression was used to assess the relationship between attempt number and metrics for pooled data across the entire cohort of users and amongst individual users with ≥50 attempts. Threshold for significance p = 0.05. SETTING SurgTrac has generated the largest available database of performances in box trainer simulated tasks with 64,000 activities performed by over 1450 users in 77 countries to date. PARTICIPANTS Data was derived from the unselected world-wide cohort of SurgTrac users. No participants were excluded. RESULTS Five hundred seventy-eight users performed 13,027 attempts in the thread transfer task. Across the entire cohort, SurgTrac performance metrics were significantly associated with attempt number. Task duration and total distance decreased with attempt number. This benefit persisted across 100 attempts. Ambidexterity increased with attempt number. Individual candidate performance improved in line with predicted learning curves for better performing candidates. CONCLUSIONS We analyzed the largest database of simulated laparoscopic task performances. Performance improves with practice. Using learning curves derived from peer-group performances as benchmarks, users may be regularly and objectively assessed to support personalization of training.
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Affiliation(s)
| | | | | | | | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
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27
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Duboureau H, Renaud-Petel M, Klein C, Haraux E. Development and evaluation of a low-cost part-task trainer for laparoscopic repair of inguinal hernia in boys and the acquisition of basic laparoscopy skills. J Pediatr Surg 2021; 56:674-677. [PMID: 32631609 DOI: 10.1016/j.jpedsurg.2020.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/24/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine the fidelity of our model of laparoscopic inguinal hernia repair (LIHR) in boys and evaluate its value in resident training programs and the learning of basic laparoscopy skills. METHODS We created a simulation model with inexpensive, easy-to-obtain equipment. Study participants from 34 university hospital departments received a user manual and an evaluation questionnaire (11 items rated on a 5-point Likert scale). We considered that the evaluation was positive when the median overall score was 4 or over. We compared the results for residents (n=26) vs. expert surgeons (n=29) (t tests). RESULTS The duration of the procedure was significantly longer among the residents (30.0±16.8 min) than among the expert surgeons (20.5±11.7 min; p=0.01). In both groups, the participants rated the model favorably with regard to the overall impression (median score: 4.0±1.0), realism (4.0±0.9), ease of access to the required equipment (5.0±0.6), the quality of the user manual (5.0±0.6), ease of assembly (5.0±0.8), ease of the procedure (5.0±0.8), value in resident training programs (4.0±0.9), and value in learning basic laparoscopy skills (5.0±0.8)). The evaluation was positive (4.0±0.9). CONCLUSION Our low-cost model was an effective teaching and training tool for LIHR and basic laparoscopy skills. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hortense Duboureau
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France
| | | | - Céline Klein
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France
| | - Elodie Haraux
- Department of Pediatric Surgery, Amiens University Hospital, F-80054 Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France.
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De Witte B, Barnouin C, Moreau R, Lelevé A, Martin X, Collet C, Hoyek N. A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results. BMC Surg 2021; 21:139. [PMID: 33736639 PMCID: PMC7977247 DOI: 10.1186/s12893-021-01128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/01/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.
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Affiliation(s)
- Benjamin De Witte
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Charles Barnouin
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Richard Moreau
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Arnaud Lelevé
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France.
| | - Xavier Martin
- Faculty of Medicine, Surgery School, Univ Lyon, University Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Service d'Urologie et de chirurgie de la Transplantation, Hôpital Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Christian Collet
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Nady Hoyek
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
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A systematic review of low-cost simulators in ENT surgery. The Journal of Laryngology & Otology 2021; 135:486-491. [PMID: 33734059 DOI: 10.1017/s0022215121000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Simulation training has become a key part of the surgical curriculum over recent years. Current trainees face significantly reduced operating time as a result of the coronavirus disease 2019 pandemic, alongside increased costs to surgical training, thus creating a need for low-cost simulation models. METHODS A systematic review of the literature was performed using multiple databases. Each model included was assessed for the ease and expense of its construction, as well as its validity and educational value. RESULTS A total of 18 low-cost simulation models were identified, relating to otology, head and neck surgery, laryngeal surgery, rhinology, and tonsil surgery. In only four of these models (22.2 per cent) was an attempt made to demonstrate the educational impact of the model. Validation was rarely formally assessed. CONCLUSION More efforts are required to standardise validation methods and demonstrate the educational value of the available low-cost simulation models in otorhinolaryngology.
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30
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Listijono DR, Rosen DMB, Choi S, Bukhari M, Cario GM, Chou D. Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee. Case Rep Obstet Gynecol 2021; 2021:5560309. [PMID: 33747585 PMCID: PMC7960069 DOI: 10.1155/2021/5560309] [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: 01/07/2021] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Over the last few years, there is an apparent growing concern amongst O&G trainees of the inadequacy in exposure to minimally invasive gynaecology surgical training, which has been inadvertently compounded by the more stringent working hour regulations and disproportionately increasing number of trainees relative to surgical volume. Therefore, it is vitally important for trainees to maximise opportunities in the operating theatre and develop autonomy in carrying out more complex surgical procedures. This case report outlines the step-by-step approach of laparoscopic excision of a cornual ectopic pregnancy performed by a trainee under the supervision of a surgical mentor. This manuscript highlights key characteristic traits of a trainee that serve to foster surgical trust and simple but effective steps to foster surgical preparedness.
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Affiliation(s)
- Dave R. Listijono
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
- IVF Australia, Sydney, Australia
| | | | - Sarah Choi
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
| | | | | | - Danny Chou
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
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Consorti F, Panzera G. Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:422-427. [PMID: 35515747 PMCID: PMC8936611 DOI: 10.1136/bmjstel-2020-000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022]
Abstract
Background Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results. Objectives The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes. Study selection We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model. Findings We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (−0.19, 95% CI −0.44 to 0.06) and for time (−0.14, 95% CI −0.54 to 0.27). Conclusion Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.
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Affiliation(s)
- Fabrizio Consorti
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| | - Gianmarco Panzera
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
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Stoddart MT, Rolt LMF. Using video calling to simulate arthroscopic surgery in a resource-poor setting. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:41-43. [DOI: 10.1136/bmjstel-2019-000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/14/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Abstract
There is high demand for arthroscopic procedures in the developing world. Simulation allows trainees to develop basic arthroscopic skills away from theatre, where there may be reduced surgical exposure compared with centres with established arthroscopic practice. Smartphones are widely available and accessible throughout the world. We propose a method to create a low-cost, low-fidelity arthroscopic simulator that can be used at home by using the video call function of smartphones. We used readily available materials from a local market. An adequately sized cardboard box was used to house exercises, LED head torch as a light source, bamboo skewers as probes and a smartphone with video call function allowed visualisation without the need to purchase additional equipment. The whole simulator was constructed using less than 50 ZAR (US$3) of new materials. The arthroscopic simulator can be built simply and is easily portable. Established training exercises can be practised and allow development of basic arthroscopic skills. Our home-made simulator is inexpensive, simple to construct and does not require additional hardware (or software) purchases by the trainee. It is a perfect solution for individuals who want to practise their arthroscopic skills, either at home or at the workplace.
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Alvarez-Lopez F, Maina MF, Arango F, Saigí-Rubió F. Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity. JMIR Serious Games 2020; 8:e19723. [PMID: 33107833 PMCID: PMC7655469 DOI: 10.2196/19723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/06/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery. Objective The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). Methods In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability. Results Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. Conclusions The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.
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Affiliation(s)
- Fernando Alvarez-Lopez
- Faculty of Health Sciences, Universidad de Manizales, Manizales, Colombia.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marcelo Fabián Maina
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Fernando Arango
- Faculty of Health Sciences, Universidad de Manizales, Manizales, Colombia
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An early introduction to surgical skills: Validating a low-cost laparoscopic skill training program purpose built for undergraduate medical education. Am J Surg 2020; 221:95-100. [PMID: 32888629 DOI: 10.1016/j.amjsurg.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medical student exposure to laparoscopy is limited to observation despite the prevalence of minimally invasive techniques in practice. The high cost of laparoscopic simulation equipment, commonly called "box trainers", limits undergraduate exposure to skill training. METHODS Students at a Midwestern medical school were recruited to participate in an experimental laparoscopic skill training program. One cohort (n = 17) used a DIY box trainer design freely available on MedEdPORTAL. A second cohort (n = 17) used a commercially available equivalent. Pre- and post-training attempts for four tasks were scored and the difference was calculated. The average differences for each cohort were then contrasted statistically. RESULTS Significant performance improvements (pre- and post-training) were demonstrated regardless of group allocation. The difference in performance between the cohorts was not significant for any task (p > 0.05). CONCLUSIONS This low-cost training program using DIY box trainers is as effective as commercially available equivalent box trainers for introducing laparoscopic skills to medical students.
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Evaluation of a novel low-cost laparoscopic training model for core laparoscopic skills. J Pediatr Surg 2020; 55:1475-1480. [PMID: 31753612 DOI: 10.1016/j.jpedsurg.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/13/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022]
Abstract
UNLABELLED The study involves the testing of a novel laparoscopic training model by surgeons of various levels of experience. BACKGROUND There has been an increasing requirement for low-cost simulation. Our aim was to evaluate the construct validity of a low-cost model for teaching core laparoscopic skills. METHODS The Double-Glove model was made from 2 latex gloves, one placed in the other. The inner glove was filled with water and 3 ovals were drawn on the outer glove. Participants were required to dissect the middle oval out without perforating the inner glove or leaving the line border of the middle oval. The task was assessed using a previously validated scoring system (minimum -120; maximum 80). RESULTS Ninety-five participants completed the task: 40 novices, 45 intermediates, and 10 experts. The model revealed statistical significance between the three groups. Experts scored higher than novices (58/80 vs 11.7/80; p < 0.0001) and intermediates (58/80 vs 29.1/80; p = 0.0004), and intermediates scored higher than novices (29.1/80 vs 11.7/80; p = 0.014). Novices took more time to complete the task compared to intermediates (10 min vs 7.87 min; p < 0.0001) and experts (10 min vs 6.98 min; p < 0.0001). No correlation between time taken and score obtained was seen (r = -0.06, r = 0.01, r = -0.2 for novice, intermediate, and expert groups). CONCLUSION By differentiating between groups of variable experience, the model demonstrated construct validity. It offers an inexpensive model that can be utilized in low-cost laparoscopic simulation. TYPE OF STUDY Study of a diagnostic test. LEVEL OF EVIDENCE II.
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Pelly T, Shanmugathas N, Bowyer H, Wali A, Pankhania R. Low-cost simulation models in Urology: a systematic review of the literature. Cent European J Urol 2020; 73:373-380. [PMID: 33133668 PMCID: PMC7587474 DOI: 10.5173/ceju.2020.0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Simulation models have been found to be effective and valid for training in Urology. Due to increasing costs of surgical training, there is a need for low-cost simulation models to enable Urology trainees to improve their skills. MATERIAL AND METHODS A literature review was performed using the PubMed and Embase databases until March 2020. A total of 157 abstracts were identified using the search criteria, of which 20 articles were identified describing simulation models for Urology training. Articles reviewed described simulation models created from materials costing less than $150. Data was extracted from the relevant articles in order to critically assess each paper for validity, ease of construct and educational impact. RESULTS Models were found pertaining to suprapubic catheterization (6), cystoscopy (3), percutaneous nephrolithotomy (5), scrotal examination (1), circumcision (1), ureteroscopy (1), transurethral resection of the prostate and bladder (2), and open prostatectomy (1). 18/20 (90%) assessed for either face, content, or construct validity. None of the papers evaluated assessed for transferability of skills to performance in real patients. CONCLUSIONS A plethora of low-cost simulation models for urological procedures are described in the literature, many of which can be easily constructed from cheap and accessible materials. However there is a need for further efforts to validate or assess for transferability of skills to clinical practice.
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Affiliation(s)
- Theo Pelly
- Kingston Hospital, Department of Urology, London, United Kingdom
| | | | - Henry Bowyer
- Great Ormond Street Hospital, Department of Paediatric Surgery, London, United Kingdom
| | - Anuj Wali
- Guy’s Hospital, Department of Cardiothoracic Surgery, London, United Kingdom
| | - Rahul Pankhania
- Royal Sussex County Hospital, Department of Paediatric Surgery, Brighton, United Kingdom
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Lefor AK, Harada K, Kawahira H, Mitsuishi M. The effect of simulator fidelity on procedure skill training: a literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:97-106. [PMID: 32425176 PMCID: PMC7246118 DOI: 10.5116/ijme.5ea6.ae73] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the effect of simulator fidelity on procedure skill training through a review of existing studies. METHODS MEDLINE, OVID and EMBASE databases were searched between January 1990 and January 2019. Search terms included "simulator fidelity and comparison" and "low fidelity" and "high fidelity" and "comparison" and "simulator". Author classification of low- and high-fidelity was used for non-laparoscopic procedures. Laparoscopic simulators are classified using a proposed schema. All included studies used a randomized methodology with two or more groups and were written in English. Data was abstracted to a standard data sheet and critically appraised from 17 eligible full papers. RESULTS Of 17 studies, eight were for laparoscopic and nine for other skill training. Studies employed evaluation methodologies, including subjective and objective measures. The evaluation was conducted once in 13/17 studies and before-after in 4/17. Didactic training only or control groups were used in 5/17 studies, while 10/17 studies included two groups only. Skill acquisition and simulator fidelity were different for the level of training in 1/17 studies. Simulation training was followed by clinical evaluation or a live animal evaluation in 3/17 studies. Low-fidelity training was not inferior to training with a high-fidelity simulator in 15/17 studies. CONCLUSIONS Procedure skill after training with low fidelity simulators was not inferior to skill after training with high fidelity simulators in 15/17 studies. Some data suggest that the effectiveness of different fidelity simulators depends on the level of training of participants and requires further study.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Kanako Harada
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kawahira
- Jichi Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Mamoru Mitsuishi
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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Sánchez Ussa S, Ariza Gutiérrez A. Educación quirúrgica en Colombia en la era del COVID–19. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
La enfermedad por Coronavirus-2 en poco tiempo ha logrado encender las alarmas de los sistemas de salud a nivel mundial. Además de las implicaciones económicas, sanitarias, políticas, culturales y sociales, está claro que ha cambiado la vida de los seres humanos incluyendo como se desarrollan los programas de postgrado en medicina.
Múltiples comunidades científicas alrededor del mundo han manifestado la necesidad de diferir los procedimientos quirúrgicos electivos y priorizar la atención de los pacientes por encima de la academia, lo que podría disminuir la exposición de residentes de cirugía general a actos quirúrgicos esenciales para su aprendizaje.
Como respuesta a ello, los autores presentan este artículo en donde se discute el papel de la educación virtual y la simulación como posibles respuestas a la dificultad educativa que representa la pandemia del COVID-19.
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Oussi N, Enochsson L, Henningsohn L, Castegren M, Georgiou E, Kjellin A. Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor. J Surg Res 2020; 250:1-11. [PMID: 32014696 DOI: 10.1016/j.jss.2019.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Training using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents' laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students. MATERIALS AND METHODS Sixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer-virtual reality (MIST-VR) simulator, finalizing a questionnaire. RESULTS More Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students' performance in the MIST-simulator. No such correlations were found in the LapMentor group. CONCLUSIONS Results indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students' performance in the MIST-VR simulator, with some gender-specific differences.
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Affiliation(s)
- Ninos Oussi
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
| | - Lars Enochsson
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Lars Henningsohn
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Urology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Markus Castegren
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Sweden
| | - Evangelos Georgiou
- Medical Physics Laboratory and Simulation Center, Medical School, University of Athens, Athens, Greece
| | - Ann Kjellin
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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Soriero D, Atzori G, Barra F, Pertile D, Massobrio A, Conti L, Gusmini D, Epis L, Gallo M, Banchini F, Capelli P, Penza V, Scabini S. Development and Validation of a Homemade, Low-Cost Laparoscopic Simulator for Resident Surgeons (LABOT). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010323. [PMID: 31906532 PMCID: PMC6981870 DOI: 10.3390/ijerph17010323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022]
Abstract
Several studies have demonstrated that training with a laparoscopic simulator improves laparoscopic technical skills. We describe how to build a homemade, low-cost laparoscopic training simulator (LABOT) and its validation as a training instrument. First, sixty surgeons filled out a survey characterized by 12 closed-answer questions about realism, ergonomics, and usefulness for surgical training (global scores ranged from 1—very insufficient to 5—very good). The results of the questionnaires showed a mean (±SD) rating score of 4.18 ± 0.65 for all users. Then, 15 students (group S) and 15 residents (group R) completed 3 different tasks (T1, T2, T3), which were repeated twice to evaluate the execution time and the number of users’ procedural errors. For T1, the R group had a lower mean execution time and a lower rate of procedural errors than the S group; for T2, the R and S groups had a similar mean execution time, but the R group had a lower rate of errors; and for T3, the R and S groups had a similar mean execution time and rate of errors. On a second attempt, all the participants tended to improve their results in doing these surgical tasks; nevertheless, after subgroup analysis of the T1 results, the S group had a better improvement of both parameters. Our laparoscopic simulator is simple to build, low-cost, easy to use, and seems to be a suitable resource for improving laparoscopic skills. In the future, further studies should evaluate the potential of this laparoscopic box on long-term surgical training with more complex tasks and simulation attempts.
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Affiliation(s)
- Domenico Soriero
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Giulia Atzori
- Department of Surgical Sciences and Integrated Methodologies, University of Genoa, 16132 Genoa, Italy;
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-3349437959
| | - Davide Pertile
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Andrea Massobrio
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Luigi Conti
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Dario Gusmini
- Association of Architects of Bergamo, 24100 Bergamo, Italy
| | - Lorenzo Epis
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Maurizio Gallo
- Department of Internal Medicine (Di.M.I.), University of Genoa, 16132 Genoa, Italy;
| | - Filippo Banchini
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Patrizio Capelli
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Veronica Penza
- Biomedical Robotics Lab, Advanced Robotics Department, Istituto Italiano di Tecnologia, 16152 Genoa, Italy;
| | - Stefano Scabini
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
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Ashley CW, Donaldson K, Evans KM, Nielsen B, Everett EN. Surgical Cross-Training With Surgery Naive Learners: Implications for Resident Training. JOURNAL OF SURGICAL EDUCATION 2019; 76:1469-1475. [PMID: 31303542 DOI: 10.1016/j.jsurg.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/26/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE While current literature has explored the transferability of laparoscopic surgical skills to robotic surgery, this study looks to investigate the transferability of surgical skills between robotic surgical simulation and simulated traditional laparoscopy. DESIGN Participants completed a survey regarding prior surgery exposure and other confounding factors including previous video game experience and self-assessed hand-eye coordination. Following orientation to the laparoscopic simulator (LS) and robotic surgical simulator (RoSS), participants were timed performing the Balloon Grasp and Ball Drop tasks on the RoSS and the Peg Transfer and Ball Drop tasks on the LS. Participants were then randomized to either the laparoscopic or RoSS arm and timed performing the Ball Drop task 10 times and then reassessed performing the Ball Drop using the unpracticed modality. SETTING Clinical Simulation Laboratory at the University of Vermont PARTICIPANTS: A total of 31 medical students with limited experience in laparoscopic and robotic surgery. RESULTS There were no statistically significant differences in the demographics or prior surgical and videogame experience between the participants in the laparoscopic and robotic arms of the study (X2 = 0.72, p = 0.75). Timed initial assessment of the RoSS Balloon Grasp (p = 0.84) and Ball Drop (p = 0.79) tasks and the LS Peg Transfer (p = 0.14) and Ball Drop (p = 0.44) tasks were not statistically different between the 2 arms. The simulator modality which was practiced yielded the greatest improvement. The degree of improvement on the unpracticed modality was not statistically different between the groups (p = 0.57), and it was not significantly better than 2 rounds of sequential practice on the practiced modality (LS, p = 0.98 and RoSS, p = 0.55). CONCLUSIONS With practice, both groups increased surgical skill on the unpracticed modality. However, this degree of improvement was equal, suggesting there is no transferability of skills between laparoscopy and robotics.
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Affiliation(s)
- Charles W Ashley
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Katherine M Evans
- Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont
| | - Brian Nielsen
- Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. College of Medicine, Kalamazoo, Michigan
| | - Elise N Everett
- Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, Vermont.
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Arts EE, Leijte E, Witteman BP, Jakimowicz JJ, Verhoeven B, Botden SM. Face, Content, and Construct Validity of the Take-Home EoSim Augmented Reality Laparoscopy Simulator for Basic Laparoscopic Tasks. J Laparoendosc Adv Surg Tech A 2019; 29:1419-1426. [DOI: 10.1089/lap.2019.0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Elke E.A. Arts
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erik Leijte
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jack J. Jakimowicz
- Department of Industrial Design, Technical University Delft, Delft, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Bas Verhoeven
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sanne M.B.I. Botden
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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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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Hasnaoui A, Zaafouri H, Haddad D, Bouhafa A, Ben Maamer A. Reliability testing of a modified MISTELS score using a low-cost trainer box. BMC MEDICAL EDUCATION 2019; 19:132. [PMID: 31060548 PMCID: PMC6503379 DOI: 10.1186/s12909-019-1572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Training programs such as the fundamentals of laparoscopic surgery (FLS) that are based on simulation are being currently used in several western countries. FLS allows skill acquisition and evaluation of competency in laparoscopic surgery. On the practical side, evaluation is determined by the MISTELS metrics (MISTELS is the acronym for the McGill inanimate system for training and evaluation of laparoscopic skills). This training program may be modified so that it can be implemented in countries with limited resources using a low-cost trainer box. Would the use of a low-cost trainer box alter the reliability of the MISTELS score? OBJECTIVE OF STUDY The aim of the study was to evaluate the reliability of a modified MISTELS using a low-cost trainer box. METHODS It was a prospective study carried out at Habib Thameur hospital in Tunis (Tunisia), between April 2016 and August 2016. The study involved residents from different surgical specialties in the departments of general surgery and paediatric surgery of the hospital during 2015 and 2016. This study assessed the reliability of a modified MISTELS system (Only three tasks were performed out of the five tasks used in the original MISTELS system). Evaluation was based on Cronbach's alpha and intraclass correlation coefficients (ICC). A low-cost trainer box was designed and constructed. The residents included in the study performed three series of three tasks using this trainer box. The first series was scored by two trained raters to evaluate inter-rater reliability. The two-other series were successively performed to evaluate test-retest reliability. RESULTS The internal consistency, assessed by Cronbach's alpha, was at 0.929 which is an acceptable score. As for inter-rater and test-retest reliabilities that were assessed by ICCs, they yielded excellent scores that were at 1 and 0.95 (95% CI, 0.891-0.978) respectively. CONCLUSIONS The reliability of a modified MISTELS is not altered by the use of a low-cost trainer box. The score of the modified MISTELS is a reliable score for evaluating technical skills of surgical residents using a low-cost trainer box.
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Affiliation(s)
- Anis Hasnaoui
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia.
| | - Haithem Zaafouri
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Dhafer Haddad
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Ahmed Bouhafa
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
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Sellers T, Ghannam M, Asantey K, Klei J, Olive E, Roach V. Low-Cost Laparoscopic Skill Training for Medical Students Using Homemade Equipment. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10810. [PMID: 30931389 PMCID: PMC6415328 DOI: 10.15766/mep_2374-8265.10810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Despite the increasing prevalence of minimally invasive surgery (MIS), medical students receive little training in MIS techniques like laparoscopy. Cost is perhaps the biggest obstacle, as expensive laparoscopic skill simulators (box trainers) are needed to mimic the laparoscopic environment. Low-cost, homemade box trainers have been built and described in the literature but are generally relegated to self-directed practice for surgical residents. These do-it-yourself (DIY) box trainers are uniquely capable of addressing cost as a major barrier to laparoscopic skills training for medical students but have not previously been used specifically for this purpose. METHODS Students from the Oakland University William Beaumont School of Medicine (n = 17) participated in a laparoscopic skills training course using DIY box trainers. Four basic laparoscopic tasks were taught using live demonstrations followed by directed practice. Learners were instructed to record their first and last attempts in order to enable self-assessment of their progress. RESULTS All learners were able to successfully complete each of the four laparoscopic tasks by the end of their respective sessions. Feedback from the learners in the form of a postsession survey indicated that the course provided an enjoyable and high-quality experience. DISCUSSION This resource is effective at providing medical students with a low-cost opportunity to experience laparoscopy and develop basic laparoscopic skills.
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Affiliation(s)
- Taylor Sellers
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Moleca Ghannam
- Medical Student, Student, Oakland University William Beaumont School of Medicine
| | - Kojo Asantey
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Jennifer Klei
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Elizabeth Olive
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Victoria Roach
- Assistant Professor of Anatomy, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
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Bolton WS, Aruparayil N, Quyn A, Scott J, Wood A, Bundu I, Gnanaraj J, Brown JM, Jayne DG. Disseminating technology in global surgery. Br J Surg 2019; 106:e34-e43. [DOI: 10.1002/bjs.11036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care.
Methods
This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included.
Results
Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery.
Conclusion
Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.
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Affiliation(s)
- W S Bolton
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - N Aruparayil
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A Quyn
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - J Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Wood
- Department of Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - I Bundu
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - J Gnanaraj
- Karunya Institute of Technology and Science, Karunya Nagar, Coimbatore, India
| | - J M Brown
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - D G Jayne
- Section of Translational Anaesthesia and Surgery, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Jaksa L, Nigicser I, Szabó B, Nagy DÁ, Galambos P, Haidegger T. CogInfoCom-Driven Surgical Skill Training and Assessment. TOPICS IN INTELLIGENT ENGINEERING AND INFORMATICS 2019. [DOI: 10.1007/978-3-319-95996-2_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Parkhomenko E, Yoon R, Okhunov Z, Patel RM, Dolan B, Kaler K, Schwartz MJ, Shah PH, Bierwiler H, Gamboa AJ, Miano R, Germani S, Fabbro DD, Zordani A, Micali S, Kavoussi LR, Clayman RV, Landman J. Multi-institutional Evaluation of Producing and Testing a Novel 3D-Printed Laparoscopic Trainer. Urology 2018; 124:297-301. [PMID: 30419263 DOI: 10.1016/j.urology.2018.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To create, distribute, and evaluate the efficacy of a portable, cost-effective 3D-printed laparoscopic trainer for surgical skills development. METHODS The UCI Trainer (UCiT) laparoscopic simulator was developed via computer-aided designs (CAD), which were used to 3D-print the UCiT. Once assembled, a tablet computer with a rear-facing camera was attached for video and optics. Four institutions were sent the UCiT CAD files with a 3D-printer and instructions for UCiT assembly. For a comparison of the UCiT to a standard trainer, peg transfer and intracorporeal knot tying skills were accessed. These tasks were scored, and participants were asked to rate their experience with the trainers. Lastly, a questionnaire was given to individuals who 3D-printed and assembled the UCiT. RESULTS We recruited 25 urologists; none had any 3D-printing experience. The cost of printing each trainer was $26.50 USD. Each institution used the Apple iPad for optics. Six of eight participants assembled the UCiT in < 45 minutes, and rated assembly as somewhat easy. On objective scoring, participants performed tasks equally well on the UCiT vs the conventional trainer. On subjective scoring, the conventional trainer provided a significantly better experience vs the UCiT; however, all reported that the UCiT was useful for surgical education. CONCLUSION The UCiT is a low cost, portable training tool that is easy to assemble and use. UCiT provided a platform whereby participants performed laparoscopic tasks equal to performing the same tasks on the more expensive, nonportable standard trainer.
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Affiliation(s)
| | - Renai Yoon
- Department of Urology, University of California, Orange, CA
| | | | - Roshan M Patel
- Department of Urology, University of California, Orange, CA
| | - Benjamin Dolan
- Department of Engineering, University of California, Irvine, CA
| | - Kamaljot Kaler
- Department of Urology, University of California, Orange, CA
| | - Michael J Schwartz
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Paras H Shah
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Hannah Bierwiler
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Aldrin Joseph Gamboa
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Roberto Miano
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Germani
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Dario Del Fabbro
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Zordani
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Louis R Kavoussi
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | | | - Jaime Landman
- Department of Urology, University of California, Orange, CA.
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Gheza F, Oginni FO, Crivellaro S, Masrur MA, Adisa AO. Affordable Laparoscopic Camera System (ALCS) Designed for Low- and Middle-Income Countries: A Feasibility Study. World J Surg 2018; 42:3501-3507. [PMID: 29728732 DOI: 10.1007/s00268-018-4657-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs. METHODS A common zero degrees 10 mm scope is attached on the camera of a low-price smartphone. Two elastic bands are used to fix the scope right in front of the smartphone's main camera; alternatively, a low-cost camera coupler can be used. The device is covered with sterile transparent drapes and a light source connected with a fiber-optic cable for endoscopic use. The image can be seen in real time on a common TV screen through an HDMI connection to the smartphone, with a sterile drape. RESULTS We were able to perform the five tasks of the Fundamentals of Laparoscopic Surgery curriculum, using our vision system with proficiency. In a pig model, we performed a tubal ligation to simulate an appendectomy and we were able to suture. No major differences were measured between the two connection systems. CONCLUSIONS A low-cost laparoscopic camera system can benefit surgeons and trainees in LMICs. The system is already attractive for use during training, but further studies are needed to evaluate its potential clinical role in LMICs.
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Affiliation(s)
- Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 453E, Chicago, IL, 60613, USA.
| | - Fadekemi O Oginni
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Simone Crivellaro
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 453E, Chicago, IL, 60613, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 453E, Chicago, IL, 60613, USA
| | - Adewale O Adisa
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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