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Giraldo-Londoño O, Bettale C, Martinez K, Thaqi M, Wheeler A. Low-Cost, High-Fidelity Skin and Intestine Surrogates for Surgical Training. J Surg Res 2025; 311:8-22. [PMID: 40378658 DOI: 10.1016/j.jss.2025.03.068] [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: 06/27/2024] [Revised: 03/14/2025] [Accepted: 03/25/2025] [Indexed: 05/19/2025]
Abstract
INTRODUCTION Organ surrogates play a pivotal role in training surgical residents, offering a safe and cost-effective alternative to live human patients or animals. However, existing surrogates often fall short, either due to their high cost or inability to accurately replicate the mechanical behavior and anatomical complexity of human tissue. This study aims to address these limitations by developing affordable, realistic, and biomechanically accurate organ surrogates tailored for surgical training. MATERIALS AND METHODS Our methods involve 3D printing customized molds for pour casting, injection molding, and rotational molding, employing off-the-shelf platinum-cure silicone rubbers and specially formulated silicone-based blends as base materials. This approach ensures cost-effectiveness and allows utilizing commercially available materials and accessible laboratory equipment, enabling low-cost in-house fabrication of multi-layered skin and intestine surrogates for surgical training. RESULTS Feedback received from surgical residents and surgeons at the University of Missouri School of Medicine indicates that our surrogates consistently outperform industry-standard models in terms of biomechanical accuracy. Moreover, our cost analysis revealed that our fabrication methods yield surrogates that are over 90% less expensive than commercial alternatives. CONCLUSIONS The skin and intestine surrogates developed in this study demonstrate the feasibility of creating affordable, high-fidelity surgical training models using accessible materials and established fabrication techniques. By addressing the limitations of existing surrogates, this work lays the foundation for developing a broader range of anatomical models. These advances have the potential to improve the effectiveness and accessibility of surgical training.
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Affiliation(s)
- Oliver Giraldo-Londoño
- Department of Civil and Environmental Engineering, University of Missouri, Columbia, Missouri.
| | - Chadwick Bettale
- Department of Industrial and Systems Engineering, University of Missouri, Columbia, Missouri
| | - Kyle Martinez
- Department of Chemical and Biomedical Engineering, University of Missouri, Columbia, Missouri
| | - Milot Thaqi
- Department of General Surgery, University of Missouri, Columbia, Missouri
| | - Andrew Wheeler
- Department of General Surgery, University of Missouri, Columbia, Missouri
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Buechel J, Kalisz A, Herbert SL, Scherer-Quenzer A, Blau-Schneider B, Starrach T, Kraft K, Wöckel A, Pecks U, Kiesel M. Development and validation of a cost-effective DIY simulation model for McDonald cerclage training. Arch Gynecol Obstet 2025; 311:989-996. [PMID: 39540910 PMCID: PMC11985586 DOI: 10.1007/s00404-024-07812-8] [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: 09/10/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE The prevention of preterm birth is a challenging task for obstetricians. Cervical cerclage, used as both a primary and secondary prevention method for spontaneous preterm birth, is a crucial surgical intervention. It is essential that obstetricians can learn this procedure in a simulated environment before performing the stitches on high-risk patients. This study aimed to develop a simulator based on 3D printing and evaluate its validity for clinical training. METHODS The objectives of this study were (1) to design and construct a cost-effective simulator for McDonald cerclage with two different cervix models-a closed cervix and a cervix with bulging membranes-using common material from a DIY store and 3D printing technology and (2) to validate its effectiveness through feedback from learners and experts in cervical cerclage. The self-made simulator was evaluated by obstetricians using a questionnaire with Likert scale. RESULTS Obstetricians and gynecologists assessed the simulator and found it useful for learning and practicing cervical cerclage. The simulator was deemed valuable for skill training. CONCLUSION Cervical cerclage is a complex procedure that should be mastered through simulation rather than initial practice on real patients. Our simulator is a cost-effective model suitable for various clinical settings. It has been validated by obstetricians for both preventive and therapeutic cerclage, demonstrating its efficacy for training in cerclage techniques. Future research should focus on less skilled obstetricians and gynecologists and investigate how repeated use of the simulator can enhance their performance in cerclage stitching.
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Affiliation(s)
- Johanna Buechel
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
- Maternal Health and Midwifery, Julius-Maximilians-University, Würzburg, Germany.
| | - Adam Kalisz
- Department of Electrical, Electronic and Communication Engineering, Information Technology (LIKE), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Saskia-Laureen Herbert
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Anne Scherer-Quenzer
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Bettina Blau-Schneider
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Teresa Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Katrina Kraft
- University Clinic of Gynecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Pecks
- Maternal Health and Midwifery, Julius-Maximilians-University, Würzburg, Germany
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Kiesel
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
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Haber JJ, Helou E. A Comparative Study of Laparoscopic Skills Between Novices and Experts: How to Steepen the Learning Curve. Cureus 2024; 16:e75069. [PMID: 39759683 PMCID: PMC11695803 DOI: 10.7759/cureus.75069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2024] [Indexed: 01/07/2025] Open
Abstract
Introduction and aim Laparoscopic surgery has revolutionized the field of surgery over the past few decades. The learning curve in laparoscopy is known to be slow, flat, and complex. This study aims to conduct a comparative analysis of laparoscopic skills, specifically focusing on suturing, knot tying, and needle handling, between novices and experts. The purpose is to objectively quantify the disparities in skill proficiency, identify specific areas needing improvement in training curricula, and contribute to the development of more effective training methodologies for emerging laparoscopic surgeons. Methods Residents from different specialties and institutions had their laparoscopic training and evaluation sessions recorded during their curriculum and compared with the performance of experienced surgeons from the Hôtel-Dieu de France University Hospital (Beirut, LBN) during live surgeries. This comparative study was based on the universally recognized Global Operative Assessment of Laparoscopic Skills (GOALS) score and an assessment of a detailed set of laparoscopic skills and techniques used during needle handling and knot tying. Results Twenty-one tasks performed by novices and 11 tasks performed by experts were considered. A significant difference was found in the GOALS score between the two groups (experts: 23.4/25; novices: 15.9/25). Moreover, a statistically significant difference was found to be present in favor of the experts in the following skills/techniques: using thread handling and forceps rotation for needle manipulation, laying the needle on a fixed driver arm before grasping it, using needle curvature for knot tying, using upward-facing forceps convexity when tying, using an open thread loop before tying, thread handling capacity, knot tying capacity, and number of needle skills performed per task. Conclusion This study demonstrates that many micro-steps in laparoscopic suturing are more prevalent among expert surgeons than among trainees. Incorporating these micro-steps into training could significantly accelerate learning curves, enabling trainees to refine their skills more efficiently and keep pace with the latest surgical advancements in their specialties.
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Affiliation(s)
- Julien J Haber
- Urology, Université Saint-Joseph, Hôtel-Dieu de France University Hospital, Beirut, LBN
| | - Elie Helou
- Urology, Université Saint-Joseph, Hôtel-Dieu de France University Hospital, Beirut, LBN
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Lin GT, Chen JY, Shang-Guan ZX, Fan DH, Zhong Q, Wu D, Liu ZY, Jiang YM, Wang JB, Lin JX, Lu J, Chen QY, Huang ZH, Lin JL, Xie JW, Li P, Huang CM, Zheng CH. Robot-assisted versus laparoscopic-assisted gastrectomy among malnourished patients with gastric cancer based on textbook outcome. Surg Endosc 2024; 38:2666-2676. [PMID: 38512349 DOI: 10.1007/s00464-024-10769-z] [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: 10/02/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Textbook outcome (TO) has been widely employed as a comprehensive indicator to assess the short-term prognosis of patients with cancer. Preoperative malnutrition is a potential risk factor for adverse surgical outcomes in patients with gastric cancer (GC). This study aimed to compare the TO between robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG) in malnourished patients with GC. METHODS According to the diagnostic consensus of malnutrition proposed by Global Leadership Initiative on Malnutrition (GLIM) and Nutrition Risk Index (NRI), 895 malnourished patients with GC who underwent RAG (n = 115) or LAG (n = 780) at a tertiary referral hospital between January 2016 and May 2021 were included in the propensity score matching (PSM, 1:2) analysis. RESULTS After PSM, no significant differences in clinicopathological characteristics were observed between the RAG (n = 97) and LAG (n = 194) groups. The RAG group had significantly higher operative time and lymph nodes harvested, as well as significantly lower blood loss and hospital stay time compared to the LAG group. More patients in the RAG achieved TO. Logistic regression analysis revealed that RAG was an independent protective factor for achieving TO. There were more adjuvant chemotherapy (AC) cycles in the RAG group than in the LAG group. After one year of surgery, a higher percentage of patients (36.7% vs. 22.8%; P < 0.05) in the RAG group recovered from malnutrition compared to the LAG group. CONCLUSIONS For malnourished patients with GC, RAG performed by experienced surgeons can achieved a higher rate of TO than those of LAG, which directly contributed to better AC compliance and a faster restoration of nutritional status.
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Affiliation(s)
- Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun-Yu Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Deng-Hui Fan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Yi-Ming Jiang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Hong Huang
- Public Technology Service Center, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Brügge S, Günther V, Cascorbi I, Maass N, Ruchay Z, Fischer MR, Huber J, Alkatout I. Encouraging medical students to become surgeons? Impact of psychological and surgical factors on career choice at medical school. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc21. [PMID: 38779696 PMCID: PMC11106567 DOI: 10.3205/zma001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 01/10/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024]
Abstract
Aim Training decisions are viewed as a problem by the majority of medical students.In the present study we compared sociodemographic and psychological characteristics of students who are interested in surgical training to those who preferred a non-surgical specialty. Furthermore, we examined whether students who wish to be trained as surgeons performed better than their non-surgical counterparts in a course designed to acquire skills in minimally invasive surgery. Method From October 2020 to January 2021 we performed a cross-sectional survey among 116 medical students prior to their year of practical training at Christian-Albrechts University in Kiel. Based on their intended field of specialization, the students were divided into a non-surgical and a surgical group. Sociodemographic and psychological characteristics such as self-efficacy expectations, resilience and stress perception were evaluated and compared between groups. Simultaneously, we compared their surgical performance in two laparoscopic exercises and their self-assessment as surgeons. Statistical differences between the training groups were determined by the Mann-Whitney U test or Pearson's Chi square test. Results Ninety-two students participated in the study, of whom 64.1% intended to train in a non-surgical specialty and 35.9% in a surgical specialty. Students who wished to be trained as surgeons had higher general self-efficacy expectations (p<0.001) and greater resilience (p=0.009). However, on comparison they had a lower stress level (p=0.047). The inter-group comparison of training results and self-assessment as surgeons revealed no unequivocal differences in surgical performance. Conclusion Interest in surgical specialties is correlated, among other factors, with the strength of psychological skills such as general self-efficacy expectations, resilience and stress perception. Early attention to these psychological resources in academic training might assist medical students in future career choices.
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Affiliation(s)
- Sandra Brügge
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Ingolf Cascorbi
- University Hospitals Schleswig-Holstein, Campus Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Nicolai Maass
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Zino Ruchay
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Martin R. Fischer
- Ludwig-Maximilians University Munich, Institute for Didactics and Training Research in Medicine, Munich, Germany
| | - Johanna Huber
- Ludwig-Maximilians University Munich, Institute for Didactics and Training Research in Medicine, Munich, Germany
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
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Tercan C, Sivas MC, Aktoz F. The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study. Arch Gynecol Obstet 2024; 309:1027-1033. [PMID: 38184803 DOI: 10.1007/s00404-023-07335-8] [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: 06/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE 2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. METHODS In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. RESULTS The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). CONCLUSION In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.
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Affiliation(s)
- Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Mustafa Can Sivas
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey
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Alkatout I, O’Sullivan O, Peters G, Maass N. Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:53. [PMID: 38256313 PMCID: PMC10818539 DOI: 10.3390/medicina60010053] [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: 11/24/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Odile O’Sullivan
- Distalmotion SA, Route de la Corniche 3b, 1066 Epalinges, Switzerland;
| | - Göntje Peters
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
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8
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Patel JS, Cyrus JW, Siff LN. Surgical education in urogynecology from low fidelity to virtual reality: Systematic review. Neurourol Urodyn 2023; 42:1777-1788. [PMID: 37522524 DOI: 10.1002/nau.25257] [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: 04/12/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
IMPORTANCE Increase dissemination of educational tools in urogynecology. OBJECTIVE Describe the effectiveness and public availability of published educational tools for urogynecologic surgery. STUDY DESIGN A systematic review was conducted by searching MEDLINE, EMBASE, Cochrane Library, and Web of Science from 1946 to 2023 for articles describing educational tools in urogynecology. There were no restrictions on study design or language. Data were extracted in duplicate using a standardized piloted extraction form, and outcomes were combined descriptively. RESULTS 2997 titles, 457 abstracts, and 97 full-text articles were analyzed. Of the 97 interventions included, 43 were manuscripts and 54 were conference abstracts. The median study quality was low, with a moderate risk of bias. Six intervention categories were identified: didactics, animal models, cadavers, static models, extended reality (XR), and multimodal workshops. Didactics were subjectively useful for teaching pelvic anatomy and diseases and improving surgical techniques. If good quality, animal models and cadavers provided visual and tactile learning and assessed performance in real-time. Animal models were also anatomically realistic and useful at half the cost of cadavers. Static models and XR improved confidence, knowledge, skills, and error rates despite lack of realism and accurate tissue texture in some models and steep learning curve with XR. Only four models were commercially accessible. Most studies did not assess long-term (>6 months) retention. CONCLUSION All educational modalities for urogynecologic surgery are largely realistic and increase participant satisfaction, preparedness, knowledge, skills, and likelihood of use. But only 40% advanced to manuscripts, and even fewer (<5%) were widely available.
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Affiliation(s)
- Jill S Patel
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John W Cyrus
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Lauren N Siff
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Division of Surgical Gynecology and Urogyncecology, Department of Surgery, Central Virginia VA Healthcare System, Richmond, Virginia, USA
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Patel M, Hugh TJ. A Comparison of Three-Dimensional Visualization Systems and Two-Dimensional Visualization Systems During Laparoscopic Cholecystectomy: A Narrative Review. J Laparoendosc Adv Surg Tech A 2023; 33:957-962. [PMID: 37486672 DOI: 10.1089/lap.2023.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background: Laparoscopic cholecystectomy is a common procedure for the definitive treatment for cholecystitis and symptomatic cholelithiasis. One advancement in minimally invasive surgery has been the development of three-dimensional (3D) visualization systems to provide stereopsis. It is yet to be determined whether this innovation is beneficial to the surgeon or simply just a gimmick. This narrative review aims to answer the following research question, what is the impact of 3D visualization systems on surgical efficiency compared with two-dimensional visualization systems in laparoscopic cholecystectomy? Methods: Through a broad literature search it was determined that operative time and intraoperative errors have been used in published research to assess intraoperative efficiency. Results: Studies published to date have used operative time, intraoperative errors, and intraoperative bleeding as current measures for intraoperative efficiency. Previous meta-analysis have shown a slight improvement in operative time for 3D visualization systems; however, subsequent randomized control trials have not shown a significant difference in operative time. Reporting of intraoperative errors has been quite subjective and a difference between visualisation modality has not been shown. Conclusion: 3D visualization systems have shown a minor improvement in operative time compared with traditional laparoscopic systems and it is unlikely to be of any clinical significance. Studies that measure intraoperative error vary greatly in what they report, and which assessment tool is used. Across existing literature, studies do not control for surgeon's experience, elective/emergent cases, and grade of gallbladder/difficulty. Further research is required, using novel tools for assessment in laparoscopic cholecystectomy to determine intraoperative differences through objective and quantitative variables.
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Affiliation(s)
- Meet Patel
- Northern Clinical School, University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Northern Beaches Hospital, Frenches Forrest, Australia
| | - Thomas J Hugh
- Northern Clinical School, University of Sydney, Sydney, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, Australia
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10
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Restaino S, Scutiero G, Taliento C, Poli A, Bernardi G, Arcieri M, Santi E, Fanfani F, Chiantera V, Driul L, Scambia G, Greco P, Vizzielli G. Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis. Updates Surg 2023; 75:455-470. [PMID: 36811183 DOI: 10.1007/s13304-023-01465-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
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Affiliation(s)
- S Restaino
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scutiero
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy.
| | - A Poli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Bernardi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - M Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122, Messina, Italy
| | - E Santi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - V Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - L Driul
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - P Greco
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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11
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Ackermann J, Pahls J, Baumann J, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Laganà AS, Peters G, Pape J, Willer D, Westermann AM, Günther V, Maass N, Mettler L, Alkatout I. The pelvitrainer for training in laparoscopic surgery – A prospective, multicenter, interdisciplinary study: Experimental research. Int J Surg 2022; 101:106604. [DOI: 10.1016/j.ijsu.2022.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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12
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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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13
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Urner TM, Inman A, Lapid B, Jia S. Three-dimensional light-field microendoscopy with a GRIN lens array. BIOMEDICAL OPTICS EXPRESS 2022; 13:590-607. [PMID: 35284166 PMCID: PMC8884202 DOI: 10.1364/boe.447578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 05/12/2023]
Abstract
Optical endoscopy has emerged as an indispensable clinical tool for modern minimally invasive surgery. Most systems primarily capture a 2D projection of the 3D surgical field. Currently available 3D endoscopes can restore stereoscopic vision directly by projecting laterally shifted views of the operating field to each eye through 3D glasses. These tools provide surgeons with informative 3D visualizations, but they do not enable quantitative volumetric rendering of tissue. Therefore, advanced tools are desired to quantify tissue tomography for high precision microsurgery or medical robotics. Light-field imaging suggests itself as a promising solution to the challenge. The approach can capture both the spatial and angular information of optical signals, permitting the computational synthesis of the 3D volume of an object. In this work, we present GRIN lens array microendoscopy (GLAM), a single-shot, full-color, and quantitative 3D microendoscopy system. GLAM contains integrated fiber optics for illumination and a GRIN lens array to capture the reflected light field. The system exhibits a 3D resolution of ∼100 µm over an imaging depth of ∼22 mm and field of view up to 1 cm2. GLAM maintains a small form factor consistent with the clinically desirable design, making the system readily translatable to a clinical prototype.
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Affiliation(s)
- Tara M. Urner
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- These authors contributed equally to this work
| | - Andrew Inman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- These authors contributed equally to this work
| | - Benjamin Lapid
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- These authors contributed equally to this work
| | - Shu Jia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
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14
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Three-dimensional versus two-dimensional endoscopes in anatomical orientation of the middle ear and in simulated surgical tasks. The Journal of Laryngology & Otology 2022; 136:141-145. [DOI: 10.1017/s002221512200010x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThree-dimensional endoscopes provide a stereoscopic view of the operating field, facilitating depth perception compared to two-dimensional systems, but are not yet widely accepted. Existing research addresses performance and preference, but there are no studies that quantify anatomical orientation in endoscopic ear surgery.MethodsParticipants (n = 70) were randomised in starting with either the two-dimensional or three-dimensional endoscope system to perform one of two tasks: anatomical orientation using a labelled three-dimensional printed silicone model of the middle ear, or simulated endoscopic skills. Scores and time to task completion were recorded, as well as self-reported difficulty, confidence and preference.ResultsNovice surgeons scored significantly higher in a test of anatomical orientation using three-dimensional compared to two-dimensional endoscopy (p < 0.001), with no significant difference in the speed of simulated endoscopic skills task completion. For both tasks, there was lower self-reported difficulty and increased confidence when using the three-dimensional endoscope. Participants preferred three-dimensional over two-dimensional endoscopy for both tasks.ConclusionThe findings demonstrate the superiority of three-dimensional endoscopy in anatomical orientation, specific to endoscopic ear surgery, with statistically indistinguishable performance in a skills task using a simulated trainer.
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Restaino S, Vargiu V, Rosati A, Bruno M, Dinoi G, Cola E, Moroni R, Scambia G, Fanfani F. 4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial. Facts Views Vis Obgyn 2021; 13:221-229. [PMID: 34555876 PMCID: PMC8823275 DOI: 10.52054/fvvo.13.3.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The introduction of ultra-high-definition laparoscopic cameras (4K), by providing stronger monocular depth perception, could challenge the existing 3D technology. There are few available studies on this topic, especially in gynaecological setting. Objectives Prospective, single institution, randomised clinical trial (NCT04209036). Materials and Methods The two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD by Olympus. The surgeons were all trainees and in their last year of residency and who had obtained the certificate of first or second level of the Gynaecological Endoscopic Surgical Education and Assessment program - GESEA program. Twenty-nine patients with benign uterine pathology were enrolled. Main outcome measures To compare if the use three-dimensional (3D) versus ultra-high-definition laparoscopic vision system (4K) for total laparoscopic hysterectomy performed by trainees was associated with a shorter operative time. Results The 3D vision system did not prove to be superior to the 4K vision system. Operators reported significantly more vision-related side effects when using 3D than 4K. Completing the GESEA training program was the only factor with a positive and statistically significant impact on the overall time of the procedure, especially when greater dexterity and tissue handling were required. Conclusions Neither technology used proved superior to the other, although operators showed a preference for 4K over 3D due to the lower number of visual side effects. Attendance at courses on laparoscopic simulators and training programs allowed trainees to demonstrate excellent surgical skills.
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16
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Costa G, Fransvea P, Lepre L, Rondelli F, Costa A, Campanelli M, Lisi G, Mastrangeli MR, Laracca GG, Garbarino GM, Ceccarelli G. 2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis. World J Gastrointest Surg 2021; 13:597-619. [PMID: 34194617 PMCID: PMC8223707 DOI: 10.4240/wjgs.v13.i6.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.
AIM To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.
METHODS A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy.
RESULTS In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time (P < 0.001) and the anastomotic time (P < 0.001) while no differences were identified between groups in terms of blood loss (P = 0.827), LNH yield (P = 0.243), time to first flatus (P = 0.333), postoperative complications (P = 0.718) and length of stay (P = 0.835).
CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.
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Affiliation(s)
| | - Pietro Fransvea
- Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, Rome 00193, Italy
| | - Fabio Rondelli
- Department of Surgical Science, University of Perugia, Santa Maria Teaching Hospital, Terni 05100, Italy
| | - Alessandro Costa
- Catholic University “Our Lady of Good Council” School of Medicine, Tirane 1023, Albania
| | - Michela Campanelli
- Department of Emergency Surgery, Tor Vergata University Hospital, Rome 00133, Italy
| | - Giorgio Lisi
- Department of General Surgery, Sant'Eugenio Hospital, Rome 00144, Italy
| | | | - Giovanni Guglielmo Laracca
- Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome 00189, Italy
| | - Giovanni Maria Garbarino
- Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome 00189, Italy
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Comparative Analysis of Three-Versus Two-dimensional Imaging in Laparoscopic Cholecystectomy. World J Surg 2021; 45:1370-1375. [PMID: 33475802 DOI: 10.1007/s00268-020-05934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging has been suggested to improve learning and performance of laparoscopy. We sought to investigate whether 3D imaging could improve the outcomes after laparoscopic cholecystectomy. MATERIALS AND METHODS Two-hundred and forty-one consecutive patients underwent elective or urgent laparoscopic cholecystectomy using 2D (n = 111) and 3D (n = 130) imaging equipments from March 2017 to March 2019 at the Kainuu Central Hospital, Finland. The main outcomes of this study were biliary tract injury, conversion to open procedure and procedure duration. RESULTS In the overall series, there were 5 cases of biliary tract injury (2.1%). When compared to 3D imaging, 2D was associated with increased risk of biliary tract injury in the overall series (0% in 3D vs. 4.7% in 2D, p = 0.026) in addition to a subgroup of acute cholecystitis patients operated by senior surgeons (n = 92), 0% in 3D group (n = 60) vs. 10.0% in 2D group (n = 32), p = 0.037 in univariate analysis. The rates of conversion to open surgery did not differ between the groups in the overall series (5.3 vs 5.7%, p = 0.909) or any of the subgroups. Duration of surgery with 3D vs. 2D imaging were comparable in the elective (57.0 ± 16.3 vs. 54.1 ± 18.9 min, p = 0.228) and urgent setting (66.9 ± 15.1 vs. 67.4 ± 16.6 min, p = 0.805). Such differences were not significant in multivariate analysis. CONCLUSIONS The present study suggests that the use of 3D imaging is significantly associated with a reduced risk of intraoperative biliary tract injury during laparoscopic cholecystectomy especially in acute cholecystitis.
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18
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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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Video Feedback and Video Modeling in Teaching Laparoscopic Surgery: A Visionary Concept from Kiel. J Clin Med 2021; 10:jcm10010163. [PMID: 33466531 PMCID: PMC7796509 DOI: 10.3390/jcm10010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/17/2022] Open
Abstract
Learning curves for endoscopic surgery are long and flat. Various techniques and methods are now available for surgical endoscopic training, such as pelvitrainers, virtual trainers, and body donor surgery. Video modeling and video feedback are commonly used in professional training. We report, for the first time, the application of video modeling and video feedback for endoscopic training in gynecology. The purpose is to present an innovative method of training. Attendees (residents and specialists) of minimally invasive surgery courses were asked to perform specific tasks, which were video recorded in a multimodular concept. Feedback was given later by an expert at a joint meeting. The attendees were asked to fill a questionnaire in order to assess video feedback given by the expert. The advantages of video feedback and video modeling for the development of surgical skills were given a high rating (median 84%, interquartile ranges (IQR) 72.5–97.5%, n = 37). The question as to whether the attendees would recommend such training was also answered very positively (median 100%, IQR 89.5–100%, n = 37). We noted a clear difference between subjective perception and objective feedback (58%, IQR 40.5–76%, n = 37). Video feedback and video modeling are easy to implement in surgical training setups, and help trainees at all levels of education.
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Nogueira JF, de Sousa Lobo Ferreira Querido R, Gonçalves da Silva Leite J, Cabral da Costa T. Future of Endoscopic Ear Surgery. Otolaryngol Clin North Am 2020; 54:221-231. [PMID: 33153734 DOI: 10.1016/j.otc.2020.09.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endoscopic ear surgery has gained popularity in recent years, becoming standard practice in otology centers around the world as an adjunct to conventional microscopic surgery and as a sole tool for limited disease. During the last years, technical improvements and growing expertise in the handling of the endoscope allowed introducing an exclusive endoscopic approach to the middle ear, lateral skull base, middle cranial fossa, and posterior fossa/cerebellopontine angle pathologies. Endoscopic instrumentation, techniques, and knowledge have improved during the last few years, and in the future, endoscopic surgical techniques will gain even more importance in otologic surgery.
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Affiliation(s)
- Joao Flavio Nogueira
- Medicine Faculty, State University of Ceará, Dr. Silas Munguba Av., 1700, Fortaleza 60741-000, Brazil.
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21
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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: 0.4] [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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Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
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Gluck O, Blaganje M, Veit-Rubin N, Phillips C, Deprest J, O'reilly B, But I, Moore R, Jeffery S, Haddad JM, Deval B. Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol 2019; 245:94-101. [PMID: 31891897 DOI: 10.1016/j.ejogrb.2019.12.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
Sacrocolpopexy is considered the preferred treatment for vaginal vault. However, numerous technical variants are being practiced. We aimed to summarize the recent literature in relation to technical aspects of laparoscopic sacrocolpopexy (LSC). We focused on surgical technique, mesh type, concomitant surgeries, and training aspects. We performed 2 independent literature searches in Medline, Scopus, the Cochrane library, and Embase electronic databases including the keywords: 'sacrocolpopexy', 'sacral colpopexy' and 'promontofixation'. Full text English-language studies of human patients, who underwent LSC, published from January 1, 2008 to February 26, 2019, were included. Levels of evidence using the modified Oxford grading system were assessed in order to establish a report of the available literature of highest level of evidence. Initially, 953 articles were identified. After excluding duplicates and abstracts screening, 35 articles were included. Vaginal fixation of the mesh can be performed with barbed or non-barbed (level 1), absorbable or non-absorbable sutures (level 2). Fixation of the mesh to the promontory can be performed with non-absorbable sutures or non-absorbable tackers (level 2). The current literature supports using type 1 mesh (level 2). Ventral mesh rectopexy can safely be performed with LSC while concurrent posterior repair has no additional benefit (level 2). There is no consensus regarding the preferred type of hysterectomy or the benefit of an additional anti urinary incontinence procedure. A structured learning program, as well as the number of procedures needed in order to be qualified for performing LSC is yet to be established. There are numerous variants for performing LSC. For many of its technical aspects there is little consensus.
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Affiliation(s)
- Ohad Gluck
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Mija Blaganje
- Department of Gynecology, University Medical Center, Ljubljana, Slovenia
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christian Phillips
- Department of Gynecology and Urogynecology, Hampshire Hospitals NHS Trust & University of Winchester, Hampshire, United Kingdom
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Unit Pelvic Floor Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Barry O'reilly
- Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Igor But
- Department of General Gynecology and Gynecologic Urology, University Medical Center, Maribor, Slovenia
| | - Robert Moore
- Department of Obstetrics and Gynecology, Emory School of Medicine, Atlanta, USA
| | - Stephen Jeffery
- Department of Gynecology and Obstetrics, University of Cape Town, Cape Town, South Africa
| | - Jorge Milhem Haddad
- Urogynaecology Division, Hospital das clinicas da faculdade de medicina da universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Deval
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
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Koppatz HE, Harju JI, Sirén JE, Mentula PJ, Scheinin TM, Sallinen VJ. Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study. Surg Endosc 2019; 34:4857-4865. [PMID: 31754852 PMCID: PMC7572346 DOI: 10.1007/s00464-019-07266-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Three-dimensional (3D) laparoscopy improves technical efficacy in laboratory environment, but evidence for clinical benefit is lacking. The aim of this study was to determine whether the 3D laparoscopy is beneficial in transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP). METHOD In this prospective, single-blinded, single-center, superior randomized trial, patients scheduled for TAPP were randomly allocated to either 3D or two-dimensional (2D) TAPP laparoscopic approaches. Patients were excluded if secondary operation was planned, the risk of conversion was high, or the surgeon had less than five previous 3D laparoscopic procedures. Patients were operated on by 13 residents and 3 attendings. The primary endpoint was operation time. The study was registered in ClinicalTrials.gov (NCT02367573). RESULTS Total 278 patients were randomized between 5th February 2015 and 23rd October 2017. Median operation time was shorter in the 3D group (56.0 min vs. 68.0 min, p < 0.001). 10 (8%) patients in 3D group and 6 (5%) patients in 2D group had clinically significant complications (Clavien-Dindo 2 or higher) (p = 0.440). Rate of hernia recurrence was similar between groups at 1-year follow-up. In the subgroup analyses, operation time was shorter in 3D laparoscopy among attendings, residents, female surgeons, surgeons with perfect stereovision, surgeons with > 50 3D laparoscopic procedures, surgeons with any experience in TAPP, patients with body mass indices < 30, and bilateral inguinal hernia repairs. CONCLUSION 3D laparoscopy is beneficial and shortens operation time but does not affect safety or long-term outcomes of TAPP.
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Affiliation(s)
- Hanna E Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Jukka I Harju
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Jukka E Sirén
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Panu J Mentula
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Tom M Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Ville J Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland. .,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Wehr F, Held J. Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator. APPLIED ERGONOMICS 2019; 77:40-49. [PMID: 30832777 DOI: 10.1016/j.apergo.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/18/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.
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Affiliation(s)
- Franka Wehr
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
| | - Jürgen Held
- University of Applied Sciences Schwäbisch Gmünd, Rektor-Klaus Str. 100, Schwäbisch Gmünd, 73525, Germany.
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The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Arezzo A, Vettoretto N, Francis NK, Bonino MA, Curtis NJ, Amparore D, Arolfo S, Barberio M, Boni L, Brodie R, Bouvy N, Cassinotti E, Carus T, Checcucci E, Custers P, Diana M, Jansen M, Jaspers J, Marom G, Momose K, Müller-Stich BP, Nakajima K, Nickel F, Perretta S, Porpiglia F, Sánchez-Margallo F, Sánchez-Margallo JA, Schijven M, Silecchia G, Passera R, Mintz Y. The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018. Surg Endosc 2018; 33:3251-3274. [PMID: 30515610 DOI: 10.1007/s00464-018-06612-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of 3D laparoscopic systems is expanding. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS Systematic reviews of the PubMed and Embase libraries were performed to identify evidence on potential benefits of 3D on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by an international surgical and engineering expert panel which were presented and voted at the EAES annual congress, London, May 2018. RESULTS 9967 abstracts were screened with 138 articles included. 18 statements and two recommendations were generated and approved. 3D significantly shortened operative time (mean difference 11 min (8% [95% CI 20.29-1.72], I2 96%)). A significant reduction in complications was observed when 3D systems were used (RR 0.75, [95 CI% 0.60-0.94], I2 0%) particularly for cases involving laparoscopic suturing (RR 0.57 [95% CI 0.35-0.90], I2 0%). In 69 box trainer or simulator studies, 64% concluded trainees were significant faster and 62% performed fewer errors when using 3D. CONCLUSION We recommend the use of 3D vision in laparoscopy to reduce the operative time (grade of recommendation: low). Future robust clinical research is required to specifically investigate the potential benefit of 3D laparoscopy system on complication rates (grade of recommendation: high).
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, Italy
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marco Augusto Bonino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Nathan J Curtis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Daniele Amparore
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Manuel Barberio
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Ronit Brodie
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Cà Granda, Policlinico Hospital, University of Milan, Milan, Italy
| | - Thomas Carus
- Department of Surgery, Center for Minimally Invasive Surgery, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Enrico Checcucci
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Petra Custers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Marilou Jansen
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Joris Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gadi Marom
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kota Momose
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Beat P Müller-Stich
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Kyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Felix Nickel
- General-, Visceral-and Transplant Surgery, University of Heidelberg Hospital, Heidelberg, Germany
| | - Silvana Perretta
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Francesco Porpiglia
- Division of Urology, ESUT Research Group, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | | | | | - Marlies Schijven
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Yoav Mintz
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Educational training in laparoscopic gynecological surgery based on ethanol-glycerol-lysoformin-preserved body donors. Ann Anat 2018; 221:157-164. [PMID: 30312766 DOI: 10.1016/j.aanat.2018.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Educational training of laparoscopic skills performed on body donors is considered the gold standard prior to surgery in living patients. Appropriate, safe, and feasible fixation of body donors, reflecting true-to-life conditions of tissues, is an essential prerequisite for training workshops. MATERIALS AND METHODS Here we describe and evaluate a modified ethanol-glycerol-lysoformin-based fixation technique. Body donors were fixed by perfusion (70% ethanol, 30% glycerol, 0.3% lysoformin; ca. 20l) via femoral artery and stored in a humid atmosphere (1% thymol) at 4°C. Technical equipment included a mobile operating table, endoscopy system with gas insufflation, suction/irrigation pump, standard and electrosurgical instruments. The tissue properties of ethanol-glycerol-lysoformin-fixed body donors and their suitability for laparoscopic surgery were tested and compared to the in vivo situation. RESULTS Modified ethanol-glycerol-lysoformin fixation was a simple, cost-efficient and hazard-free procedure, resulting in near-to-life tissue conditions regarding consistency and flexibility, with moderate discoloration and greater viscosity of organs. Key laparoscopic procedures (trocar handling, pneumoperitoneum, blunt/sharp dissection, partial/total removal of organs, bi- or monopolar electrosurgery, suturing techniques) could be performed without difficulty. Multiple reuse of body donors was feasible over one year. Compared to the in vivo situation, the investigation of body donors required a greater degree of gas insufflation and more energy for electrosurgery. CONCLUSIONS Modified ethanol-glycerol-lysoformin fixation applied to body donors permitted laparoscopic surgery in a realistic and practical manner. Due to its logistic advantages, this technique provides appropriate conditions to train laparoscopic skills and implement novel minimally invasive approaches.
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Zundel S, Lehnick D, Heyne-Pietschmann M, Trück M, Szavay P. A Suggestion on How to Compare 2D and 3D Laparoscopy: A Qualitative Analysis of the Literature and Randomized Pilot Study. J Laparoendosc Adv Surg Tech A 2018; 29:114-120. [PMID: 30256710 DOI: 10.1089/lap.2018.0164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS The results of studies comparing two-dimensional (2D) and three-dimensional (3D) laparoscopy have shown variable results. We aimed to review the literature and develop an appropriate instrument to compare 2D and 3D laparoscopy. We further aimed to use the data extracted to perform a pilot study. METHODS Sixty-seven recent articles on 3D laparoscopy were reviewed and data extracted on factors influencing outcome variables. These variables were used to design a pilot study of 28 novices using a randomized crossover design. The results were analyzed using descriptive statistics and the Wilcoxon signed-rank tests. RESULTS Seven themes were identified to influence the outcome of 3D studies: applied technique (1), experience of subjects (2), study design (3), learning curve (4), subjective qualitative reports (5), laparoscopic tasks (6), and chosen outcome variables (7). The consecutively developed five laparoscopic simulation tasks contained placing a rubber band over hooks, ring and pearl transfer, threading a pipe cleaner through loops, and placing a suturise. The pilot study showed a primary benefit of 3D laparoscopy that was unrelated to repetition. Two tasks served well to assess first-time performance, and two tasks promise to serve well to assess a learning curve if performed repeatedly. CONCLUSION We were able to identify important issues influencing the outcome of studies analyzing 3D laparoscopy. These may help evaluate future studies. The developed tasks resulted in meaningful data in favor of 3D visualization, but further studies are necessary to confirm the pilot test results.
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Affiliation(s)
- Sabine Zundel
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
| | - Dirk Lehnick
- 2 Faculty of Humanities and Social Sciences, Department of Health Sciences and Health Policy, University of Lucerne, Luzern, Switzerland
| | | | - Mike Trück
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
| | - Philipp Szavay
- 1 Department of Pediatric Surgery, Children's Hospital, Lucerne, Switzerland
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Alkatout I. An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery. MINIM INVASIV THER 2018; 27:265-271. [PMID: 29457928 DOI: 10.1080/13645706.2018.1440244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The removal of obstacles from the surgical field is a crucial aspect of any procedure in gynecological, urological or visceral laparoscopic surgery. Reliable instruments and skilled assistance are essential for the smooth execution of procedures. Blunt forceps are commonly used to keep tissue away from the operating field. The range of existing instruments has been enhanced by the introduction of laparoscopic retractors. However, no laparoscopic retractor can be used without causing tissue damage. MATERIAL AND METHODS We describe the ALKATOUT retractor, an innovative laparoscopic retractor designed for atraumatic assistance in any laparoscopic procedure including robotic surgery. The advantages of this laparoscopic instrument were evaluated in a single-center study. RESULTS The retractor has been used successfully in a variety of gynecological procedures and tested in laparoscopic procedures on human body donors. CONCLUSIONS The results of a single-center questionnaire completed by 25 operating room staff (surgical nurses, residents, and specialists) confirm the advantages of the ALKATOUT retractor.
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Affiliation(s)
- Ibrahim Alkatout
- a Kiel School of Gynecological Endoscopy, Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
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3D endoscopic ear surgery: a clinical pilot study. Eur Arch Otorhinolaryngol 2017; 275:379-384. [DOI: 10.1007/s00405-017-4839-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/02/2017] [Indexed: 12/17/2022]
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