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Szabó DI, Vereczkei A, Papp A. From gaming to surgery: the influence of digital natives on robotic skills development. J Robot Surg 2024; 19:12. [PMID: 39613927 DOI: 10.1007/s11701-024-02178-0] [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: 10/04/2024] [Accepted: 11/23/2024] [Indexed: 12/01/2024]
Abstract
Our study investigates the potential correlation between generational differences, like age and previous experience with digital innovations, such as video games and smartphones, and the performance on the Da Vinci Skills Simulator, the cornerstone of robotic surgery training. Thirty participants were involved from three age groups: Generation Alpha, Generation Z, and Generation X. None had prior robotic surgical experience. Participants performed the Wrist Articulation 1 task on the Da Vinci Skills Simulator after two practice rounds. Analysis of performance metrics and statistical tests were conducted to assess the differences between groups. Additionally, participants had completed a survey on their habits related to video gaming, smartphone, and computer usage. A trend was observed where performance declined with age, meaning that Generation Alpha performed the most successfully compared to the other generations, although the difference was not statistically significant (p = 0.51). However, significant differences were found in Glass Movement (GM) by Generation Z showing superior precision, making less errors (p = 0.019). The study found no correlation between simulator performance and early or frequent exposure to smartphones or video games. Interestingly, frequent two-thumb typing on smartphones correlated with better performance in the GM metric (p = 0.006). Generation Z demonstrated greater precision in handling the simulator, reflecting that robotic surgery training might be best to be started at the beginning of residency programs. Young doctors using two-thumb typing develop robotic surgery skills faster. Further studies are needed to determine whether this quicker learning would also lead to better skills later on.
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Affiliation(s)
- Dominik Imre Szabó
- Department of Surgery, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary.
| | - András Vereczkei
- Department of Surgery, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - András Papp
- Department of Surgery, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
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Neis F, Brucker SY, Bauer A, Shields M, Purvis L, Liu X, Ershad M, Walter CB, Dijkstra T, Reisenauer C, Kraemer B. Novel workflow analysis of robot-assisted hysterectomy through objective performance indicators: a pilot study. Front Med (Lausanne) 2024; 11:1382609. [PMID: 39219795 PMCID: PMC11363259 DOI: 10.3389/fmed.2024.1382609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The curriculum for a da Vinci surgeon in gynecology requires special training before a surgeon performs their first independent case, but standardized, objective assessments of a trainee's workflow or skills learned during clinical cases are lacking. This pilot study presents a methodology to evaluate intraoperative surgeon behavior in hysterectomy cases through standardized surgical step segmentation paired with objective performance indicators (OPIs) calculated directly from robotic data streams. This method can provide individual case analysis in a truly objective capacity. Materials and methods Surgical data from six robot-assisted total laparoscopic hysterectomies (rTLH) performed by two experienced surgeons was collected prospectively using an Intuitive Data Recorder. Each rTLH video was annotated and segmented into specific, functional surgical steps based on the recorded video. Once annotated, OPIs were compared through workflow analysis and across surgeons during two critical surgical steps: colpotomy and vaginal cuff closure. Results Through visualization of the individual steps over time, we observe workflow consistencies and variabilities across individual surgeons of a similar experience level at the same hospital, creating unique surgeon behavior signatures across each surgical case. OPI differences across surgeons were observed for both the colpotomy and vaginal cuff closure steps, specifically reflecting camera movement, energy usage and clutching behaviors. Comparing colpotomy and vaginal cuff closure time needed for the step and the events of energy use were significantly different (p < 0.001). For the comparison between the two surgeons only the event count for camera movement during colpotomy showed significant differences (p = 0.03). Conclusion This pilot study presents a novel methodology to analyze and compare individual rTLH procedures with truly objective measurements. Through collection of robotic data streams and standardized segmentation, OPI measurements for specific rTLH surgery steps can be reliably calculated and compared to those of other surgeons. This provides opportunity for critical standardization to the gynecology field, which can be integrated into individualized training plans in the future. However, more studies are needed to establish context surrounding these metrics in gynecology.
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Affiliation(s)
- Felix Neis
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Sara Yvonne Brucker
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Armin Bauer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | | | - Lilia Purvis
- Intuitive Surgical Inc., Sunnyvale, CA, United States
| | - Xi Liu
- Intuitive Surgical Inc., Sunnyvale, CA, United States
| | | | | | - Tjeerd Dijkstra
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Kraemer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
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Ackermann J, Pape J, Vogler F, Pahls J, Baumann J, Holthaus B, Noé GK, Anapolski M, Ruchay Z, Westermann A, Günther V, Andresen K, Allahqoli L, Moawad G, Neymeyer J, Brügge S, Maass N, Mettler L, Alkatout I. The Feasibility of Practical Training in Minimally Invasive Surgery at Medical School-A Prospective Study on the Pelvitrainer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:159. [PMID: 38256419 PMCID: PMC10819215 DOI: 10.3390/medicina60010159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises (p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.
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Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Felix Vogler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, 49401 Damme, Germany;
| | - Günter Karl Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Kristin Andresen
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran;
| | - Gaby Moawad
- Department of Obstetrics and Gynaecology, The George Washington University Hospital, Washington, DC 20037, USA;
| | - Jörg Neymeyer
- Clinic of Urology, Charité—Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany;
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
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Chen G, Li L, Hubert J, Luo B, Yang K, Wang X. Effectiveness of a vision-based handle trajectory monitoring system in studying robotic suture operation. J Robot Surg 2023; 17:2791-2798. [PMID: 37728690 DOI: 10.1007/s11701-023-01713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
Data on surgical robots are not openly accessible, limiting further study of the operation trajectory of surgeons' hands. Therefore, a trajectory monitoring system should be developed to examine objective indicators reflecting the characteristic parameters of operations. 20 robotic experts and 20 first-year residents without robotic experience were included in this study. A dry-lab suture task was used to acquire relevant hand performance data. Novices completed training on the simulator and then performed the task, while the expert team completed the task after warm-up. Stitching errors were measured using a visual recognition method. Videos of operations were obtained using the camera array mounted on the robot, and the hand trajectory of the surgeons was reconstructed. The stitching accuracy, robotic control parameters, balance and dexterity parameters, and operation efficiency parameters were compared. Experts had smaller center distance (p < 0.001) and larger proximal distance between the hands (p < 0.001) compared with novices. The path and volume ratios between the left and right hands of novices were larger than those of experts (both p < 0.001) and the total volume of the operation range of experts was smaller (p < 0.001). The surgeon trajectory optical monitoring system is an effective and non-subjective method to distinguish skill differences. This demonstrates the potential of pan-platform use to evaluate task completion and help surgeons improve their robotic learning curve.
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Affiliation(s)
- Gaojie Chen
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Lu Li
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Jacques Hubert
- Department of Urology, CHRU Nancy Brabois University Hospital, Vandoeuvre-Lès-Nancy, France
- IADI-UL-INSERM (U1254), University Hospital, Vandoeuvre-Lès-Nancy, France
| | - Bin Luo
- Medicine-Remote Mapping Associated Laboratory, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
- State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, Hubei, China
| | - Kun Yang
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
| | - Xinghuan Wang
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
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Ackermann J, Baumann J, Pape J, Pahls J, Ruchay Z, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Peters G, Willer D, Westermann A, Brügge S, Günther V, Maass N, Mettler L, Alkatout I. Factors influencing surgical performance and learning progress in minimally invasive surgery - results of an interdisciplinary multicenter study. Int J Surg 2023; 109:2975-2986. [PMID: 37462985 PMCID: PMC10583955 DOI: 10.1097/js9.0000000000000590] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. The authors need selection procedures and decision support systems for the recruitment of medical students and young surgeons. The authors aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students. MATERIALS AND METHODS The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting. RESULTS In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multistage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries ( r =0.28-0.45, P <0.001/ r =0.1-0.28, P <0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance ( r =0.18-0.27, P <0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, that is the higher the age, the lower the surgical performance ( r =0.13/ r =0.22, P <0.05/ P <0.001). CONCLUSION Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.
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Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | | | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, Damme
| | - Günter Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, University Hospital of Giessen, Giessen, Germany
| | - Göntje Peters
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Damaris Willer
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
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Kılınçarslan Ö, Türk Y, Vargör A, Özdemir M, Hassoy H, Makay Ö. Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills. J Robot Surg 2023; 17:1435-1442. [PMID: 36754922 DOI: 10.1007/s11701-023-01540-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci® Skills Simulator™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.
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Affiliation(s)
- Özgür Kılınçarslan
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Bornova, 35100, İzmir, Turkey
| | - Yiğit Türk
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Bornova, 35100, İzmir, Turkey
| | - Aslı Vargör
- Ege University School of Medicine, İzmir, Turkey
| | - Murat Özdemir
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Bornova, 35100, İzmir, Turkey
| | - Hür Hassoy
- Department of Public Health, Ege University School of Medicine, İzmir, Turkey
| | - Özer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Bornova, 35100, İzmir, Turkey.
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Harke NN, Kuczyk MA, Huusmann S, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Ubrig B, Gloger S, Osmonov D, Eraky A, Witt JH, Liakos N, Wagner C, Hadaschik BA, Radtke JP, Al Nader M, Imkamp F, Siemer S, Stöckle M, Zeuschner P. Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients. EUR UROL SUPPL 2022; 46:45-52. [PMID: 36506259 PMCID: PMC9732453 DOI: 10.1016/j.euros.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. Objective To assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design setting and participants In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Intervention Transperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysis The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitations BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. Conclusions Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summary In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
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Affiliation(s)
- Nina N. Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Markus A. Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Stephan Huusmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Frank Schiefelbein
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Andreas Schneller
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Georg Schoen
- Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Clemens Wiesinger
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Simon Gloger
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jörn H. Witt
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | | | | | - Mulham Al Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Florian Imkamp
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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8
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Cheng SC, Chao YK. Editorial Perspective: Robot-Assisted Evaluation of Robotic Surgical Skills. Ann Surg Oncol 2022; 29:6524-6525. [PMID: 35790587 DOI: 10.1245/s10434-022-12062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/18/2022]
Affiliation(s)
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
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9
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Toguchi M, Kondo T, Yoshida K, Tanabe K, Takagi T. Perioperative outcomes following robot-assisted partial nephrectomy for renal cell carcinoma according to surgeon generation. BMC Surg 2022; 22:205. [PMID: 35619129 PMCID: PMC9137184 DOI: 10.1186/s12893-022-01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The experience of performing robot-assisted partial nephrectomy (RAPN) is associated with better surgical outcomes. However, surgeon’s generation may impact surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon’s experience. Methods This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. According to the surgeon’s generation, the patients were divided into two groups: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1–50, 51–100, 101–150) were evaluated between these groups. Results Between 1 to 50 cases and 101–150 cases, no significant differences in patient characteristics were observed between the two generations. Between 51–100 cases, age at surgery was significantly younger in the first-generation than in the second-generation group (58 years vs. 64 years, p = 0.04). The second-generation group had a shorter operation time in cases 1–50 (169 min vs. 188 min, p = 0.0001), 51–100 (145 min vs. 169 min, p = 0.008), and 101–150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group than in the first-generation group between 1–50 cases, the difference was not noted between 51–100 cases and 101–150 cases. Conclusion Patients operated by second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistance experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon’s introduction.
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Affiliation(s)
- Makoto Toguchi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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10
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Abstract
OBJECTIVE This systematic review aims to examine the use of standard-setting methods in the context of simulation-based training of surgical procedures. SUMMARY OF BACKGROUND Simulation-based training is increasingly used in surgical education. However, it is important to determine which level of competency trainees must reach during simulation-based training before operating on patients. Therefore, pass/fail standards must be established using systematic, transparent, and valid methods. METHODS Systematic literature search was done in four databases (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library). Original studies investigating simulation-based assessment of surgical procedures with application of a standard setting were included. Quality of evidence was appraised using GRADE. RESULTS Of 24,299 studies identified by searches, 232 studies met the inclusion criteria. Publications using already established standard settings were excluded (N = 70), resulting in 162 original studies included in the final analyses. Most studies described how the standard setting was determined (N = 147, 91%) and most used the mean or median performance score of experienced surgeons (n = 65, 40%) for standard setting. We found considerable differences across most of the studies regarding study design, set-up, and expert level classification. The studies were appraised as having low and moderate evidence. CONCLUSION Surgical education is shifting towards competency-based education, and simulation-based training is increasingly used for acquiring skills and assessment. Most studies consider and describe how standard settings are established using more or less structured methods but for current and future educational programs, a critical approach is needed so that the learners receive a fair, valid and reliable assessment.
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11
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Türkay S, Letheren K, Crawford R, Roberts J, Jaiprakash AT. The effects of gender, age, and videogame experience on performance and experiences with a surgical robotic arm: an exploratory study with general public. J Robot Surg 2021; 16:621-629. [PMID: 34312804 DOI: 10.1007/s11701-021-01287-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
Robotic surgery is increasing in prevalence, thanks to its potential benefits for patients (e.g., reduced blood loss) and surgeons (e.g., ergonomics). It is important to know what inherent characteristics of potential surgeons may facilitate robotic surgery training and performance. Findings from previous studies indicate videogames can be inexpensive tools that help improve hand-eye coordination, coordination of 3-D movements with 2-D images, and spatial orientation. In the context of robotic-assisted knee arthroscopy using a MAKO robotic arm, this study explored performance and subjective experiences of novices (N = 104) with a fake bone shaving task at a public event. Participants' performance was measured based on how much of the bone they successfully shaved. Findings showed that duration of videogame play per week was negatively related to performance with the robotic arm. Male and female participants performed similarly on the bone shaving task, and reported similar difficulty with and enjoyment of the task. However, female participants who played videogames performed better than those who did not play videogames. Participants who were younger than 11 had the worst performance and the most difficulty with the robotic arm. Overall, the findings indicate that the effect of videogame experience on the performance with the robotic arm may differ based on gender and age. This has implications on the length of training for surgeons of different gender using videogames and other emerging technologies.
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Affiliation(s)
- Selen Türkay
- School of Computer Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kate Letheren
- Centre for Behavioural Economics, Society and Technology, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ross Crawford
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD, Australia
| | - Jonathan Roberts
- School of Electrical Engineering and Robotics, Queensland University of Technology, Brisbane, QLD, Australia
| | - Anjali Tumkur Jaiprakash
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD, Australia.
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
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12
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Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
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Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
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13
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Schönburg S, Anheuser P, Kranz J, Fornara P, Oubaid V. Cognitive training for robotic surgery: a chance to optimize surgical training? A pilot study. J Robot Surg 2020; 15:761-767. [PMID: 33185847 PMCID: PMC8423692 DOI: 10.1007/s11701-020-01167-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
The rapid rise of robotic-assisted surgery (RAS) has necessitated an efficient and standardized training curriculum. Cognitive training (CT) can significantly improve skills, such as attention, working memory and problem solving, and can enhance surgical capacity and support RAS training. This pilot study was carried out between 02/2019 and 04/2019. The participants included 33 student volunteers, randomized into 3 groups: group 1 received training using the da Vinci training simulator, group 2 received computer-based cognitive training, and group 3 was the control group without training. Before (T1) and after-training (T2), performance was measured. Additionally, expert ratings and self-evaluations were collected. Subjective evaluations of performance were supplemented by evaluations based on three scales from the revised NEO Personality Inventory (NEO PI-R). In total, 25 probands remained with complete data for further analyses: n = 8 (group 1), n = 7 (group 2) and n = 10 (group 3). There were no significant differences in T1 and T2 among all three groups. The average training gain of group 1 and 2 was 15.87% and 24.6%, respectively, (a restricting condition is the loss of the last training session in group 2). Analyses of semi-structured psychological interviews (SPIs) revealed no significant differences for T1, but in T2, significance occurred at ‘self-reflection’ for group 2 (F(2.22) = 8.56; p < .005). The efficacy of CT in training highly complex and difficult procedures, such as RAS, is a proven and accepted fact. Further investigation involving higher numbers of training trials (while also being cost effective) should be performed.
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Affiliation(s)
- Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
| | - Petra Anheuser
- Department of Urology, Asclepius Clinic Wandsbek, Alphonsstrasse 14, 22043, Hamburg, Germany.
| | - Jennifer Kranz
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.,Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
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14
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Gil K, Jones M, Mouw T, Al-Kasspooles M, Brahmbhatt T, DiPasco PJ. Satisfaction or Distraction: Exposure to Nonpreferred Music May Alter the Learning Curve for Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2020; 77:1370-1376. [PMID: 32532698 DOI: 10.1016/j.jsurg.2020.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There is growing evidence supporting the benefits of preferred music on task performance, however there is a paucity of data regarding the potential impact on surgical and procedural learners. This study aims to assess the effects of nonpreferred music on surgical and procedural learners. DESIGN This was a single-blinded, randomized crossover trial in which each participant completed a survey regarding their demographic information and music preferences. Each participant then completed 3 training tasks, and 2 repetitions of the evaluative task while listen to music. Tasks were completed using a Da Vinci Skills Simulator Si. SETTING All tasks were completed in a live operating room at the University of Kansas Hospital, a tertiary care center. PARTICIPANTS Medical students at the University of Kansas Medical Center were recruited by email to participate. In total, 31 medical students completed the experience. RESULTS Thirty-one participants participated in this study. Group 2 (preferred music first, nonpreferred music second) showed no significant change in their test scores (72.73 vs 74.33, p = 0.34). However, Group 1 (nonpreferred music first, then preferred music) showed significant improvement between trial runs (70.31 vs 81.88, p < 0.001). There was no significant difference between the initial runs for each group. When analyzed irrespective of group assignment, there was a significant increase in scores for preferred music vs nonpreferred music (77.45 vs 72.26 p = 0.025). CONCLUSIONS Participants showed expected improvement with task repetition. This improvement may have been offset by exposure to nonpreferred music during repeat runs. Our findings suggest that the impact of music was nearly as large as the impact of prior exposure to the task. This may have implications for environmental conditions during resident procedural training, especially early in residency training when new tasks are being introduced and the skill level of the learner is still low.
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Affiliation(s)
- Kellen Gil
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas.
| | - Maddie Jones
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Tyler Mouw
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Mazin Al-Kasspooles
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Tejal Brahmbhatt
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter J DiPasco
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
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15
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Beulens AJW, Hashish YAF, Brinkman WM, Umari P, Puliatti S, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, Van der Poel HG, Bangma CH, Wagner C. Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance. J Robot Surg 2020; 15:397-428. [PMID: 32651769 DOI: 10.1007/s11701-020-01118-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
To understand the influence of proctored guidance versus simulator generated guidance (SGG) on the acquisition dexterity skills in novice surgeons learning RAS (robot assisted surgery). Prospective non-blinded 3-arm randomised controlled trial (RTC). Exclusion criteria: previous experience in RAS or robotic surgery simulation. The participants were assigned to three different intervention groups and received a different form of guidance: (1) proctored guidance, (2) simulator generated guidance, (3) no guidance, during training on virtual reality (VR) simulator. All participants were asked to complete multiple questionnaires. The training was the same in all groups with the exception of the intervention part. Catharina Hospital Eindhoven, The Netherlands. A total of 70 Dutch medical students, PhD-students, and surgical residents were included in the study. The participants were randomly assigned to one of the three groups. Overall, all the participants showed a significant improvement in their dexterity skills after the training. There was no significant difference in the improvement of surgical skills between the three different intervention groups. The proctored guidance group reported a higher participant satisfaction compared to the simulator-generated guidance group, which could indicate a higher motivation to continue the training. This study showed that novice surgeons. Significantly increase their dexterity skills in RAS after a short time of practicing on simulator. The lack of difference in results between the intervention groups could indicate there is a limited impact of "human proctoring" on dexterity skills during surgical simulation training. Since there is no difference between the intervention groups the exposure alone of novice surgeons to the robotic surgery simulator could possibly be sufficient to achieve a significant improvement of dexterity skills during the initial steps of RAS learning.
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Affiliation(s)
- A J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. .,Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Y A F Hashish
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - W M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P Umari
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - S Puliatti
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,Orsi Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - E L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - A J M Hendrikx
- Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - J P van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J J G van Merriënboer
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - H G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C H Bangma
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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16
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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: 1.2] [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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17
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Moncayo S, Compagnon R, Caire F, Grosos C, Bahans C, Ilhero P, Fourcade L, Ballouhey Q. Transition effects from laparocscopic to robotic surgery skills in small cavities. J Robot Surg 2019; 14:525-530. [PMID: 31515680 DOI: 10.1007/s11701-019-01024-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
Conventional laparoscopic surgery (LS) is being challenged by the ever-increasing use of robotic surgery (RS) to perform reconstructive procedures. The purpose of this study was to assess the acquisition of skills in both techniques and the potential transfer of skills from one technique to the other when restricted spaces are involved. A preclinical randomized crossover study design was implemented. Twelve subjects performed two different reproducible drill procedures: "Thread the Ring" (TR) and "Transfer the Plot" (TP). To assess surgical proficiency in confined workspaces, these exercises were performed with LS and RS technology in a pediatric laparoscopic surgery (PLS) simulator. Each performance was recorded and evaluated by two reviewers using objective structured assessment of technical skills (OSATS). The times to complete the TP and the TR procedure were significantly shorter with RS compared to LS (64 s vs. 319 s; p < 0.0001 for both TP and TR). A significant transfer effect of skills between LS and RS was noted for the TP exercise (p = 0.006). The percentage improvement was greater overall with LS, meaning a higher number of trials were required to adequately master the procedure. This study demonstrated that RS performed significantly better compared to LS on pediatric simulation devices. A transfer effect was identified from LS to RS exclusively. The learning curves showed that progression was definitely longer with LS. These results, indicate that novice surgeons should be encouraged to persist with learning LS, and they support the use of a pediatric robotic simulation device.
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Affiliation(s)
- S Moncayo
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - R Compagnon
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - F Caire
- Service de Neurochirurgie, Hôpital Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - C Grosos
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - C Bahans
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - P Ilhero
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - L Fourcade
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - Q Ballouhey
- Service de Chirurgie Viscérale Pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France.
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Cost, training and simulation models for robotic-assisted surgery in pediatric urology. World J Urol 2019; 38:1875-1882. [PMID: 31209563 DOI: 10.1007/s00345-019-02822-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/21/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Laparoscopic procedures in pediatric urology have been shown to be safe and effective over the last number of years. Coupled with this is the technological trend to provide minimally invasive options for even the most complex pediatric patients. Whilst robotic platforms continue to try to demonstrate superior patient outcomes in adults with mixed results, the utilization of robotic platforms for pediatric urology is increasing. METHODS A review of the current literature was undertaken to assess the evidence for training models and cost-effectiveness of robotic-assisted pediatric urology. CONCLUSIONS A growing body of evidence in this field has demonstrated that robotic platforms are safe and effective in children and can provide additional reconstructive benefits due to motion scaling, magnification, stereoscopic views, instrument dexterity and tremor reduction. The main drawbacks remain the financial implications associated with this platform through purchase, maintenance, and disposable costs. This review addresses some of the addresses issues pertaining to cost, training and simulation for robotic-assisted surgery in pediatric urology.
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Abstract
Introduction Traditional instruction for robotic surgery is typically devoid of training that addresses the delineation of interprofessional roles for operating room personnel. An emergency undocking scenario was developed for robotic surgeons with the objectives of improving time to access the patient, provider knowledge of and confidence in emergency undocking, completion of predetermined critical actions, and delineation of operating room personnel roles. Methods Over one month, participants joined in three sessions: Session 1 - formative, Session 2 - review, and Session 3 - summative. Embedded standardized participants (ESPs) represented members of the interprofessional team. Prior to entering the operating room for Sessions 1 and 3, trainees were asked to complete a confidence survey and multiple choice questionnaire (MCQ) for knowledge assessment. Participants were randomized to one of two cases and participated in the reciprocal case for the final session four weeks later. Following Session 1, participants underwent an educational intervention, including the proper technique for emergency undocking, emphasis on operating room personnel roles, and hands-on practice. Obstetrics and Gynecology (OBGYN) residents in post-graduate Years 2-4 and attending physicians with robotics privileges at Summa Health Akron Campus or Cleveland Clinic Akron General Medical Center were invited to participate. A total of 21 participants enrolled and finished the study. Results Among the 21 participants, there was a significant increase in the baseline level of knowledge (p-value=0.001) and in the confidence of surgeons when faced with an emergency undocking after the completion of our curriculum (p-value=0.003). Additionally, an improvement in the undocking times (p-value<0.001) and an increase in the critical actions performed (p-value=0.002) were observed. Conclusion The results of this study demonstrate that incorporating this curriculum into the training programs of robotic surgeons is an effective way to improve the surgical skill of emergency undocking.
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Affiliation(s)
- Derek A Ballas
- Obstetrics and Gynecology, Summa Health System, Akron, USA
| | - Megan Cesta
- Minimally Invasive Gynecologic Surgery, University of Louisville, Louisville, USA
| | | | - Rami Ahmed
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
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Kulcsar MAV, Canovas NS, de Araujo-Neto VJF, Kim JDU, Cernea CR. New method of sentinel lymph node biopsy in transoral robotic surgery for oropharyngeal squamous cell carcinoma. Clinics (Sao Paulo) 2018; 73:e550s. [PMID: 30540122 PMCID: PMC6256995 DOI: 10.6061/clinics/2018/e550s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 10/31/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Marco Aurélio V Kulcsar
- Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Natasha Sobreira Canovas
- Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vergilius Jose Furtado de Araujo-Neto
- Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jorge Du Ub Kim
- Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudio Roberto Cernea
- Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Ballas D, Cesta M, Roulette GD, Rusnak M, Ahmed R. Emergency Undocking in Robotic Surgery: A Simulation Curriculum. J Vis Exp 2018. [PMID: 29863667 DOI: 10.3791/57286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.
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Affiliation(s)
- Derek Ballas
- Department of Obstetrics & Gynecology, Summa Health; Department of Medical Education, Summa Health;
| | - Megan Cesta
- Department of Obstetrics & Gynecology, Summa Health
| | | | | | - Rami Ahmed
- Department of Medical Education, Summa Health
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Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 2018; 122:501-519. [PMID: 29603869 DOI: 10.1111/bju.14219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. MATERIALS AND METHODS A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. RESULTS Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. CONCLUSION There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present.
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Affiliation(s)
| | - Jason Y Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anthony Costello
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Kowalewski KF, Schmidt MW, Proctor T, Pohl M, Wennberg E, Karadza E, Romero P, Kenngott HG, Müller-Stich BP, Nickel F. Skills in minimally invasive and open surgery show limited transferability to robotic surgery: results from a prospective study. Surg Endosc 2018; 32:1656-1667. [PMID: 29435749 DOI: 10.1007/s00464-018-6109-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited evidence on the transferability of conventional laparoscopic and open surgical skills to robotic-assisted surgery. The primary aim of this study was to evaluate the transferability of expertise in conventional laparoscopy and open surgery to robotic-assisted surgery using the da Vinci Skills Simulator (dVSS). Secondary aims included evaluating the influence of individual participants' characteristics. METHODS Participants performed four tasks on the dVSS: Peg Board 1 (PB), Pick and Place (PP), Thread the Rings (TR), and Suture Sponge 1 (SS). Participants were classified into three groups (Novice, Intermediate, Experts) according to experience in laparoscopic and open surgery. All tasks were performed twice except for SS. Performance was assessed using the built-in scoring system. RESULTS 37 medical students and 25 surgeons participated. Experts did not perform significantly better than less experienced participants on the dVSS. Specifically, with regard to laparoscopic experience, total simulator scores were: Novices 68.2 ± 28.8; Intermediates 65.1 ± 31.2; Experts 65.1 ± 30.0; p = 0.611. Regarding open surgical experience, scores were: Novices 68.6 ± 28.7; Intermediates 68.2 ± 30.8; Experts 63.2 ± 30.3; p = 0.305. Although there were some significant differences among groups for single parameters in specific tasks, there was no constant superiority of one group. Laparoscopic and open surgical Novices improved significantly in overall score and time for all three tasks (p < 0.05). Laparoscopic intermediates improved only in PP time (4.64 ± 3.42; p = 0.006), open Intermediates in PB score (11.98 ± 13.01; p = 0.025), and open Experts in PP score (6.69 ± 11.48; p = 0.048). Laparoscopic experts showed no improvement. Participants with gaming experience had better overall scores than non-gamers when comparing all second attempts (Gamer 83.62 ± 7.57; Non-Gamer 76.31 ± 12.78; p = 0.008) as well as first and second attempts together (Gamer 72.08 ± 8.86; Non-Gamer 65.45 ± 11.68; p = 0.039). Musical and sports experience showed no correlation with robotic performance. CONCLUSIONS Robotic-assisted surgery requires skills distinct from conventional laparoscopy or open surgery. Basic robotic skills training prior to patient contact should be required.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mona W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Erica Wennberg
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Emir Karadza
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philipp Romero
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Madhavan K, Kolcun JPG, Chieng LO, Wang MY. Augmented-reality integrated robotics in neurosurgery: are we there yet? Neurosurg Focus 2017; 42:E3. [DOI: 10.3171/2017.2.focus177] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical robots have captured the interest—if not the widespread acceptance—of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. “Faster, better, cheaper” products should in theory conquer the market, but often fail. The psychology of change is complex, and the “follow the leader” mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons’ dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots (“cobots”), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a “follow the leader” phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon’s hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.
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Güldner C, Orth A, Dworschak P, Diogo I, Mandapathil M, Teymoortash A, Walliczek-Dworschak U. Evaluation of different time schedules in training with the Da Vinci simulator. Surg Endosc 2017; 31:4118-4125. [PMID: 28281118 DOI: 10.1007/s00464-017-5460-x] [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: 09/12/2016] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND This prospective study analyzed the effect of different time schedules in training on the main performance outcomes: overall score, time to complete, and economy of motion. METHODS The study was performed on the da Vinci Skills Simulator from December 2014 to April 2016. Forty robotic novices were randomized into two groups of 20 participants, which trained in the same three exercises but with different intervals between their training sessions. Each group performed training in Peg Board 1 in their first week, Match Board 2 in their second week, and Ring and Rail 2 in their third week. On their last day, Needle Targeting and Energy Dissection 2, for which no previous training had been received, were performed. Regarding the different training intervals, group 1 trained each exercise six times in a row once a week. Group 2 performed their training once a day for 5 days. Technical performance parameters were recorded by the Mimics simulator software for further analysis. In addition, the participants were asked to fill out a questionnaire concerning the robotics training. RESULTS Group 2 performed significantly better compared to group 1 in the main metrics in the more advanced exercises. For the easier exercises, the training frequency did not lead to significant differences in performance outcome. A significant skills gain was seen between the first and last training sessions for all exercises in both groups. CONCLUSIONS Performance in the final exercise NT was significantly better in group 2 than group 1. Regarding ED 2, no difference was found between the two groups. As the training of group 2 led to significantly better outcomes, we suggest that, especially for advanced exercises, it seems to be more favorable to perform training every day for a short period than to train once a week six times in a row.
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Affiliation(s)
- C Güldner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - A Orth
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - P Dworschak
- Center of Orthopedics and Traumatology, University Hospital of Marburg, University of Gießen and Marburg, Marburg, Germany
| | - I Diogo
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - M Mandapathil
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - A Teymoortash
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - U Walliczek-Dworschak
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Marburg, University of Gießen and Marburg, Baldingerstraße, 35043, Marburg, Germany.
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