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Hislop J, Tirosh O, Isaksson M, McCormick J, Hensman C. Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study. J Robot Surg 2024; 18:15. [PMID: 38217625 PMCID: PMC10787683 DOI: 10.1007/s11701-023-01785-7] [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: 09/04/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83-88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Oren Tirosh
- School of Health and Biomedical Sciences, RMIT, Melbourne, Australia
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
- Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, Australia.
| | - Chrys Hensman
- Swinburne University of Technology, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
- University of Adelaide, Adelaide, Australia
- LapSurgery Australia, Melbourne, Australia
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Hislop J, Orth D, Tirosh O, Isaksson M, Hensman C, McCormick J. Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis. Surg Endosc 2023; 37:6640-6659. [PMID: 37433911 PMCID: PMC10462557 DOI: 10.1007/s00464-023-10228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry. METHODS PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses. RESULTS A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools. CONCLUSIONS The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.
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Affiliation(s)
- Jaime Hislop
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Dominic Orth
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Oren Tirosh
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
- Institute for Health and Sport, Victoria University, Footscray, VIC, Australia.
| | - Mats Isaksson
- Department of Mechanical Engineering and Product Design Engineering, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Chris Hensman
- Department of Surgery, Monash University,, Melbourne, VIC, Australia
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- LapSurgery Australia, Melbourne, VIC, Australia
| | - John McCormick
- Centre for Transformative Media Technologies, Swinburne University of Technology, Melbourne, VIC, Australia
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Armbrust L, Lenz M, Elrod J, Kiwit A, Reinshagen K, Boettcher J, Boettcher M. Factors Influencing Performance in Laparoscopic Suturing and Knot Tying: A Cohort Study. Eur J Pediatr Surg 2023; 33:144-151. [PMID: 36516961 DOI: 10.1055/s-0042-1742302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic suturing and knot tying are regarded as some of the most difficult laparoscopic skills to learn. Training is essential to reach proficiency, but available training opportunities are limited. Various techniques to improve training have been evaluated. It appears that individual-related factors affect initial performance and response to training. Thus, the current study aimed to assess factors influencing laparoscopic-suturing and knot-tying performances. METHODS All patients were trained one-on-one (teacher-student) for 3 hours. Patients were tested before training (bowel anastomosis model) and directly after training (congenital diaphragmatic hernia or esophageal atresia model) to evaluate transferability. Primary endpoints were time, knot quality, precision, knot strength, and overall laparoscopic knotting performance. Moreover, factors such as (1) age, (2) gender, (3) handedness, (4) previous training or operative experience, (5) playing an instrument, (6) sportive activities, and (7) computer gaming which may influence the primary endpoints were assessed. RESULTS In total, 172 medical students or novice surgical residents were included. Training significantly improved all outcome parameters assessed in the current study. More than 50% of the patients reached proficiency after 3 hours of training. Personal factors like operative experience, playing music instruments, sportive activities, and computer gaming affected some outcome parameters. Handedness and gender affected initial performance but differences partially subsided after training. Younger participants showed a much better response to training. CONCLUSION In conclusion, several factors influence initial performance and response to the training of laparoscopic suturing and knot tying. Surgeons who want to improve their laparoscopic performance, should concentrate on playing a musical instrument and performing sports rather than playing videos gaming. It appears that training is a key and more practice opportunities should be incorporated into medical school and surgical curricula. Moreover, handedness may affect the outcome but only if the training concepts are not tailored to the dominant hand of the surgeon. Future training and surgical curricula should adapt to this and tailor their concepts accordingly.
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Affiliation(s)
- Lina Armbrust
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Moritz Lenz
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Surgery, University Medical Center Mannheim, Germany
| | - Antonia Kiwit
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Johannes Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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A Call to Action for Ergonomic Surgical Devices Designed for Diverse Surgeon End Users. Obstet Gynecol 2023; 141:463-466. [PMID: 36735398 DOI: 10.1097/aog.0000000000005068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
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Linear manipulator: Motion control of an n-link robotic arm mounted on a mobile slider. Heliyon 2023; 9:e12867. [PMID: 36691553 PMCID: PMC9860278 DOI: 10.1016/j.heliyon.2023.e12867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/17/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Linear manipulators are versatile linear robotics systems that can be reprogrammed to accommodate product changes quickly and are flexible to meet unique requirements. Such robotic systems tend to have higher accuracy, making them the perfect automation solution for those mundane, repetitious tasks. With the demand for linear systems in real-life applications expanding consistently, this paper addresses motion planning and control (MPC) of a new modified unanchored linear manipulator consisting of an n-link robotic arm mounted on a mobile slider along a rail. Using the method of the Lyapunov-based Control Scheme (LbCS), new centralized acceleration-based controllers are designed for the navigation of the system to an unreachable target. Via the scheme, the unanchored manipulator can perform assigned tasks with enhanced reachability. The limitations and singularities of the linear manipulator are treated as artificial obstacles in this motion control scheme. The robotic arm manipulator utilized in this research can reposition its base link to a desired location in the workplace due to changes in work requirements. The effectiveness of the motion planner and the resulting acceleration-based control laws are validated numerically using the Runge-Kutta Method and illustrated via computer simulations. The controllers devised in this research can solve specific and targeted motion control problems of smart cities' modern mechanical systems. The unanchored linear manipulator could be used in various disciplines where pick-and-place, assembly, material handling, and surgical procedures are required.
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Hege I, Hiedl M, Huth KC, Kiesewetter J. Differences in clinical reasoning between female and male medical students. Diagnosis (Berl) 2022; 10:100-104. [PMID: 36398356 DOI: 10.1515/dx-2022-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Background
In undergraduate medical education virtual patients (VPs) are a suitable method to teach clinical reasoning and support the visualization of this thinking process in a safe environment. The aim of our study was to investigate differences in the clinical reasoning process and diagnostic accuracy of female and male medical students.
Methods
During the summer term 2020, we provided access to 15 VPs for undergraduate students enrolled in a medical school in Bavaria, Germany. All interactions of the 179 learners within the VP system CASUS were recorded, exported, and analyzed.
Results
We found significant differences in the clinical reasoning of female and male learners. Female students documented more findings, differential diagnoses, tests, and treatment options and more often created a summary statement about the VP. Their overall performance was higher than those of their male peers, but we did not see any significant differences in diagnostic accuracy.
Conclusions
The significant differences between male and female medical students should be considered when planning teaching and research activities. A future study should investigate whether these differences can also be found in physicians.
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Affiliation(s)
- Inga Hege
- Medical Education Sciences , University of Augsburg , Augsburg , Germany
- Institute for Medical Education, LMU Munich , Germany
| | - Meike Hiedl
- Institute for Medical Education, LMU Munich , Germany
| | - Karin Christine Huth
- Department of Conservative Dentistry and Periodontology , University Hospital, LMU Munich , Germany
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Roh YS, Jang KI, Issenberg SB. Gender Differences in Psychological Safety, Academic Safety, Cognitive Load, and Debriefing Satisfaction in Simulation-Based Learning. Nurse Educ 2022; 47:E109-E113. [PMID: 35324496 DOI: 10.1097/nne.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As there is an increasing trend in the number of male-identifying learners in undergraduate nursing education, a need exists to identify the gender differences in learners' perceptions regarding simulation-based learning. PURPOSE This study aimed to identify the gender differences in psychological safety, academic safety, cognitive load, and debriefing satisfaction in simulation-based nursing education. METHODS A cross-sectional descriptive survey was implemented with 97 female and 95 male nursing students. Data were analyzed using Mann-Whitney U tests or independent-samples t tests. RESULTS Female nursing students reported a lower academic safety and higher intrinsic load than male nursing students. Male nursing students perceived a higher germane load than female nursing students. CONCLUSIONS The significance of the present study was the identification of gender differences in participant perception of the simulation learning experience for effective simulation design.
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Affiliation(s)
- Young Sook Roh
- Professor (Roh), Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea; Professor (Jang), College of Nursing, The Kyungbok University, Namyangju-si, Gyeonggi-do, Republic of Korea; and Professor (Issenberg), University of Miami Miller School of Medicine, Miami, Florida
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Investigation of the Association Between Surgeon Sex and Laparoscopic Device Ergonomic Strain in Gynecologic Surgery. J Minim Invasive Gynecol 2022; 29:984-991. [PMID: 35513300 DOI: 10.1016/j.jmig.2022.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To assess if female compared to male sex is associated with greater ergonomic strain with use of 4 advanced energy laparoscopic devices (LigaSure, HALO PKS, ENSEAL, and Harmonic scalpel). DESIGN Online survey distributed by e-mail using the REDCap platform. All responses were anonymous. SETTING Nationwide survey in the United States. PARTICIPANTS Gynecologic surgeons were surveyed through the Society of Gynecologic Surgeons listserv and 4 Obstetrics and Gynecology departmental listservs. INTERVENTIONS The survey was distributed between 5/01/2020-11/01/2020. The primary outcome was the presence of physical complaints due to laparoscopic devices. Descriptive statistics compared surgeon characteristics and ergonomic symptoms. Logistic regression was performed, adjusted for surgeon characteristics. MEASUREMENTS AND MAIN RESULTS The response rate was 39%, comprising 149 women (78%) and 41 men (22%). Women compared to men had a significantly younger age (mean 34 vs 44 years old, p<.01), smaller glove size (mean 6.5 vs 7.5, p<.01), shorter height (median 66 vs 71 in, p<.01), and were less frequently in practice for >10 years (19% vs 49%, p<.01). Women significantly more often reported physical complaints related to use of laparoscopic devices (79% vs 41%, p<.01). Women reported all devices had too large a fit for appropriate use (p<.01). Women were found to have 5.37 times the odds of physical complaints attributed to the use of laparoscopic instruments (cOR 5.37, 95% CI 2.56-11.25); with adjustment for glove size, age, and laparoscopic case volume and duration, this was no longer significant (aOR 2.02, 95% 0.59-6.93). CONCLUSION Women significantly more often report physical complaints and inappropriate fit of the LigaSure, HALO PKS, ENSEAL, and Harmonic scalpel. Female sex is associated with fivefold greater odds of physical complaints with laparoscopic device use. Further investigation of the surgeon factors underlying device-related strain is a critical next step to understanding and reducing surgeon ergonomic injury.
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Wu Q, Wang Y, Lu L, Chen Y, Long H, Wang J. Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice. Front Med (Lausanne) 2022; 9:855403. [PMID: 35433717 PMCID: PMC9006810 DOI: 10.3389/fmed.2022.855403] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/10/2022] [Indexed: 01/05/2023] Open
Abstract
Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.
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Affiliation(s)
- Qingming Wu
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yubin Wang
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Lili Lu
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Yong Chen
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Hui Long
- Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jun Wang
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Jun Wang,
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Kirubarajan A, Young D, Khan S, Crasto N, Sobel M, Sussman D. Artificial Intelligence and Surgical Education: A Systematic Scoping Review of Interventions. JOURNAL OF SURGICAL EDUCATION 2022; 79:500-515. [PMID: 34756807 DOI: 10.1016/j.jsurg.2021.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To synthesize peer-reviewed evidence related to the use of artificial intelligence (AI) in surgical education DESIGN: We conducted and reported a scoping review according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis with extension for Scoping Reviews guideline and the fourth edition of the Joanna Briggs Institute Reviewer's Manual. We systematically searched eight interdisciplinary databases including MEDLINE-Ovid, ERIC, EMBASE, CINAHL, Web of Science: Core Collection, Compendex, Scopus, and IEEE Xplore. Databases were searched from inception until the date of search on April 13, 2021. SETTING/PARTICIPANTS We only examined original, peer-reviewed interventional studies that self-described as AI interventions, focused on medical education, and were relevant to surgical trainees (defined as medical or dental students, postgraduate residents, or surgical fellows) within the title and abstract (see Table 2). Animal, cadaveric, and in vivo studies were not eligible for inclusion. RESULTS After systematically searching eight databases and 4255 citations, our scoping review identified 49 studies relevant to artificial intelligence in surgical education. We found diverse interventions related to the evaluation of surgical competency, personalization of surgical education, and improvement of surgical education materials across surgical specialties. Many studies used existing surgical education materials, such as the Objective Structured Assessment of Technical Skills framework or the JHU-ISI Gesture and Skill Assessment Working Set database. Though most studies did not provide outcomes related to the implementation in medical schools (such as cost-effective analyses or trainee feedback), there are numerous promising interventions. In particular, many studies noted high accuracy in the objective characterization of surgical skill sets. These interventions could be further used to identify at-risk surgical trainees or evaluate teaching methods. CONCLUSIONS There are promising applications for AI in surgical education, particularly for the assessment of surgical competencies, though further evidence is needed regarding implementation and applicability.
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Affiliation(s)
| | - Dylan Young
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Noelle Crasto
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Mara Sobel
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, Ontario, Canada; Institute for Biomedical Engineering, Science and Technology (iBEST) at Ryerson University and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Dafna Sussman
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, Ontario, Canada; Institute for Biomedical Engineering, Science and Technology (iBEST) at Ryerson University and St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
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Boettcher J, Mietzsch S, Wenkus J, Mokhaberi N, Klinke M, Reinshagen K, Boettcher M. The Spaced Learning Concept Significantly Improves Acquisition of Laparoscopic Suturing Skills in Students and Residents: A Randomized Control Trial. Eur J Pediatr Surg 2021; 31:518-524. [PMID: 33186998 DOI: 10.1055/s-0040-1721041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Spaced learning consists of blocks with highly condensed content that interrupted by breaks during which distractor activities, such as physical activity, are performed. The concept has been shown to be superior in complex motor skill acquisition like laparoscopic suturing and knot tying. Preliminary studies have solely been conducted with medical students. Therefore, it remained unanswered if the spaced learning concept would also work for pediatric surgery residents. MATERIALS AND METHODS The study aimed to evaluate the effectiveness of spaced learning, students, and residents were asked to perform four surgeons' square knots on a bowel model within 30 minutes prior and post 3 hours of hands-on training. To examine the long-term skills, the same subjects were asked to perform a comparable, but more complex task 12 months later without receiving training in the meantime. Total time, knot stability, suture accuracy, knot quality, and laparoscopic performance were assessed. Additionally, motivation was accessed by using the questionnaire on current motivation. Differences were calculated using mixed analysis of variance, Mann-Whitney U test, and multivariate analysis of covariance. RESULTS A total of 20 medical students and 14 residents participated in the study. After randomization, 18 were trained using the spaced learning concept and 16 via conventional methods. Both groups had comparable baseline characteristics and improved significantly after training in all assessed measures. The spaced learning concept improved procedure performance as well as knot quality and stability in both students and residents. However, residents that trained via spaced learning showed significantly better long-term results regarding knot quality and speed in comparison to students. Although anxiety was significantly reduced in both training groups over time, residents were significantly more interested regarding knot tying than students. CONCLUSION This study dispels any remaining doubt that the spaced learning concept might only work for medical students. It appears that the spaced learning concept is very suitable for residents in acquiring complex motor skills. It is superior to conventional training, resulting in improved procedural performance as well as knot quality and speed. Hence, tailored training programs should not only be integrated early on in students' curricula but also in surgical training programs.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Mietzsch
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wenkus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nariman Mokhaberi
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michaela Klinke
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Peng C, Ng KM, Roszczynialski KN, Warrington SJ, Schertzer K. Rapid Cycle Deliberate Practice in Virtual Reality: Teaching Transvenous Pacemaker Insertion to Emergency Medicine Residents. Cureus 2021; 13:e18503. [PMID: 34754663 PMCID: PMC8569655 DOI: 10.7759/cureus.18503] [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: 10/05/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Transvenous pacemaker insertion is a critical life-saving procedure that is infrequently performed. Traditional mannequin-based training paradigms are resource intensive and sometimes inadequate due to time constraints. Rapid Cycle Deliberate Practice (RCDP) is an effective teaching modality for highly scripted procedures. We propose using a simulation-based technique of RCDP in virtual reality (VR) to teach this procedure. Methods Sixteen emergency medicine residents were recruited. A pre-survey was administered at the start of the session, followed by a baseline task trainer checklist-based assessment. This checklist was created based on expert consensus. Participants then underwent the RCDP VR intervention with a subsequent repeat checklist-based assessment as well as a post-survey. Results Post-test scores were found to be significantly higher than pre-test scores after residents completed VR deliberate practice simulation (19.5±3.5 vs 24.1±2.0; p<0.001). Subanalysis did not reveal any significant difference based on post-graduate year, previous performance of procedure on a live patient, or previous VR experience. The experience increased participant feelings of preparedness and comfort in performing the procedure (2-disagree vs 4-agree) based on a 5-point Likert scale. Conclusions Virtual reality using RCDP to teach transvenous pacemaker insertion demonstrated an improvement in task trainer performance. Further investigation into whether this translates into better patient outcomes or can be generalized to other procedures needs to be considered.
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Affiliation(s)
- Cynthia Peng
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Kristen M Ng
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | | | - Steven J Warrington
- Emergency Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Kimberly Schertzer
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
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Impact of Women's Domination in Plastic Surgery Residency Program in Indonesia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3757. [PMID: 34422531 PMCID: PMC8373561 DOI: 10.1097/gox.0000000000003757] [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: 02/27/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
A shift in gender dominance from man to woman in the medical field has occurred from time to time globally, including in Indonesia’s plastic surgery community. This shift may alter the education and clinical settings of plastic surgery. This study aimed to explore the effect of the phenomenon of women’s dominance in plastic surgery residency programs in Indonesia.
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Esperto F, Prata F, Antonelli A, Alloni R, Campanozzi L, Cataldo R, Civitella A, Fiori C, Ghilardi G, Guglielmelli E, Minervini A, Muto G, Rocco B, Sighinolfi C, Pang KH, Simone G, Tambone V, Tuzzolo P, Scarpa RM, Papalia R. Bioethical implications of robotic surgery in urology: a narrative review. Minerva Urol Nephrol 2021; 73:700-710. [PMID: 34308607 DOI: 10.23736/s2724-6051.21.04240-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robotic technologies are being increasingly implemented in healthcare, including urology, holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals, patients, researchers and institutions that need to be addressed. The aim of this review is to investigate the existing literature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges and make preliminary suggestions to ensure an ethical implementation of these technologies. METHODS We performed a narrative review of the pertaining literature through a systematic search of two databases (PubMed and Web of Science) in August 2020. RESULTS Our search yielded 76 articles for full-text evaluation and 48 articles were included in the narrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) robotic surgery accessibility; 2) safety; 3) gender gap; 4) costs and 5) learning curve. 1) Robotic surgery is expensive, and in some health systems may lead to inequality in healthcare access. In more affluent countries the national distribution of several robotic platforms may influence the centralization of robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers. 2) There is a considerable gap between surgical skills and patients' perception of competence, leading to ethical consequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series is between 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches. 3) No data about gap differences in accessibility to robotic platforms were retrieved from our search. 4) Robotic platforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand. It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higher than 10 cases per week. 5) A validated, structured curriculum and accreditation has been created for robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patient safety and short learning curve. CONCLUSIONS Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in more affluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sex. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regarding efficacy, efficiency and safety.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy -
| | - Francesco Prata
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Rossana Alloni
- Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Campanozzi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rita Cataldo
- Anesthesia and Intensive Care Section, Department of Anesthesia, Intensive Care and Pain Therapy, Campus Bio-Medico University of Rome, Rome, Italy
| | - Angelo Civitella
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University of Rome, Rome, Italy
| | - Eugenio Guglielmelli
- Laboratory of Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Karl H Pang
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
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15
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Alkatout I, Günther V, Brügge S, Ackermann J, Krüger M, Bauerschlag D, Maass N, Lippross S, Cascorbi I, Egberts JH, Becker T, Osmonov D, Jünemann KP, Wedel T. Involvement of medical students in a surgery congress: impact on learning motivation, decision-making for a career in surgery, and educational curriculum. Wien Med Wochenschr 2021; 171:182-193. [PMID: 33443613 PMCID: PMC8057979 DOI: 10.1007/s10354-020-00802-w] [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: 09/28/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
During the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany.
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Sandra Brügge
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Magret Krüger
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Dirk Bauerschlag
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, House C, 24105, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma Surgery and Orthopaedics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General‑, Visceral‑, Thoracic‑, Transplant- and Paediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thomas Becker
- Department of General‑, Visceral‑, Thoracic‑, Transplant- and Paediatric Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology and Pediatric Urology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thilo Wedel
- Center for Clinical Anatomy, Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany
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16
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Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery-A Virtual Surgical Training Model. SENSORS 2020; 20:s20205891. [PMID: 33080919 PMCID: PMC7594064 DOI: 10.3390/s20205891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/28/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon's work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants' professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient's safety.
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