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Koskinen J, He W, Elomaa AP, Kaipainen A, Hussein A, Zheng B, Huotarinen A, Bednarik R. Utilizing Grasp Monitoring to Predict Microsurgical Expertise. J Surg Res 2023; 282:101-108. [PMID: 36265429 DOI: 10.1016/j.jss.2022.09.018] [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: 01/21/2022] [Revised: 07/22/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Most microsurgical procedures require the surgeon to use tools to grasp and hold fragile objects in the surgical site. Prior research on grasping in surgery has mostly either been in other surgical techniques or used grasping as an auxiliary metric. We focus on microsurgery and investigate what grasping can tell about microsurgical skill and suturing performance. This study lays groundwork for using automatic detection of grasps to evaluate surgical skill. METHODS Five expert surgeons and six novices completed sutures on a microsurgical training board. Video recordings of the performance were annotated for the number of grasps, while an eye tracker recorded the participants' pupil dilations for cognitive workload assessment. Performance was measured with suturing duration and the University of Western Ontario Microsurgical Skills Assessment instrument (UWOMSA). Differences in skill, suturing performance and cognitive workload were compared with grasping behavior. RESULTS Novices needed significantly more grasps to complete sutures and failed to grasp more often than the experts. The number of grasps affected the suturing duration more in novices. Decreasing suturing efficiency as measured by UWOMSA instrument was associated with increase in grasps, even when we controlled for overall skill differences. Novices displayed larger pupil dilations when averaged over a sufficiently large sample, and the difference increased after the grasp. CONCLUSIONS Grasping action during microsurgical procedures can be used as a conceptually simple yet objective proxy in microsurgical performance assessment. If the grasps could be detected automatically, they could be used to aid in computational evaluation of surgical trainees' performance.
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Affiliation(s)
- Jani Koskinen
- School of Computing, University of Eastern Finland, Joensuu, Finland.
| | - Wenjing He
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Aku Kaipainen
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Ahmed Hussein
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Antti Huotarinen
- Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; Microsurgery Center, Kuopio University Hospital, Kuopio, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
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Peers versus Pros: Feedback using standards in simulation training. Am J Surg 2018; 216:1223-1229. [PMID: 30082027 DOI: 10.1016/j.amjsurg.2018.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Creating and updating expert performance-based standards for simulators is labor intensive and requires the regular availability of expert surgeons. We investigated how peer performance based standards compare to expert performance based standards. METHODS One hundred medical students took part in a four-session laparoscopic basic skills simulator training course. Performance for the FLS videotrainer tasks were compared between students who received feedback based on either peer standards, expert standards or no feedback at all (control group). RESULTS No difference in performance between our feedback groups was found. Compared to the control group, they were 18-36% faster but made 52% more errors for tasks on the FLS video trainer (U range [93.5-957], average p < .01). CONCLUSIONS We demonstrated that feedback based on peer standards is equally effective as feedback based on expert standards. The found trade-off between speed and error is not desirable and warrants further investigation.
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Drăghici L, Lițescu M, Munteanu R, Pătru C, Gorgan CL, Mirică R, Drăghici I. Errors and complications in laparoscopic surgery. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2017. [DOI: 10.25083/2559.5555.21.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases). In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.
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