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Feng L, Li W, Lai J, Yang W, Wu S, Liu J, Ma R, Lee S, Tian J. Validity of A Novel Simulator for Percutaneous Transforaminal Endoscopic Discectomy. World Neurosurg 2024:S1878-8750(24)00633-8. [PMID: 38641247 DOI: 10.1016/j.wneu.2024.04.070] [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: 04/04/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) has steep learning curves and a high incidence of complications, but currently, efficient and economical training methods are lacking. This study aimed to validate a novel simulator for PTED. METHODS The simulated PTED included puncturing and establishing the working channel (PEWC) and endoscopic discectomy, with the PEWC being the tested module. Eleven experts and 21 novices were included and introduced to the simulator and tasks; all participants completed the PEWC. Outcomes included: total operation time, number of fluoroscopy for positioning the working sheath, number of spinal risk region invasion, Global Rating Scale (GRS) and a modified GRS, etc. The Mann-Whitney U test was used to compare 2 groups. Spearman's correlation coefficient analyzed continuous variables. RESULTS Experts outperformed novices in total operation time (P = 0.001), requiring fewer number of fluoroscopies for positioning the working sheath (P = 0.003). Additionally, experts had a lower number of spinal risk region invasions (P = 0.016) and higher scores on both the GRS (P < 0.001) and modified GRS (P < 0.001). PTED experience correlated with GRS scores (P = 0.001) and modified GRS (P < 0.001). The overall realism scored a median of 4 (3.75-5), and educational value had a median of 4 (range 3-5). CONCLUSIONS This study demonstrates the validity of the novel simulator, revealing significant associations between PTED experience and performance metrics in a simulated PEWC setting. Furthermore, the PEWC module also offers a good realistic design and high education value according to experts.
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Affiliation(s)
- Lei Feng
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Lai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihao Yang
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shangxing Wu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiajia Liu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ruixin Ma
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Soomin Lee
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Foley D, Hardacker P, McCarthy M. Emerging Technologies within Spine Surgery. Life (Basel) 2023; 13:2028. [PMID: 37895410 PMCID: PMC10608700 DOI: 10.3390/life13102028] [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: 08/30/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons' understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.
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Affiliation(s)
- David Foley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Pierce Hardacker
- Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Farah GJ, Rogers JL, Lopez AM, Brown NJ, Pennington Z, Kuo C, Gold J, Bui NE, Koester SW, Gendreau JL, Diaz-Aguilar LD, Oh MY, Pham MH. Resident Training in Spine Surgery: A Systematic Review of Simulation-Based Educational Models. World Neurosurg 2023; 174:81-115. [PMID: 36921712 DOI: 10.1016/j.wneu.2023.03.032] [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: 12/19/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE With the increasing prevalence of spine surgery, ensuring effective resident training is becoming of increasing importance. Training safe, competent surgeons relies heavily on effective teaching of surgical indications and adequate practice to achieve a minimum level of technical proficiency before independent practice. American Council of Graduate Medical Education work-hour restrictions have complicated the latter, forcing programs to identify novel methods of surgical resident training. Simulation-based training is one such method that can be used to complement traditional training. The present review aims to evaluate the educational success of simulation-based models in the spine surgical training of residents. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Web of Science, and Google Scholar databases were systematically screened for English full-text studies examining simulation-based spine training curricula. Studies were categorized based on simulation model class, including animal-cadaveric, human-cadaveric, physical/3-dimensional, and computer-based/virtual reality. Outcomes studied included participant feedback regarding the simulator and competency metrics used to evaluate participant performance. RESULTS Seventy-two studies were identified. Simulators displayed high face validity and were useful for spine surgery training. Objective measures used to evaluate procedural performance included implant placement evaluation, procedural time, and technical skill assessment, with numerous simulators demonstrating a learning effect. CONCLUSIONS While simulation-based educational models are one potential means of training residents to perform spine surgery, traditional in-person operating room training remains pivotal. To establish the efficacy of simulators, future research should focus on improving study quality by leveraging longitudinal study designs and correlating simulation-based training with clinical outcome measures.
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Affiliation(s)
- Ghassan J Farah
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alexander M Lopez
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cathleen Kuo
- Department of Neurological Surgery, University at Buffalo Jacobs SOM, Buffalo, New York, USA
| | - Justin Gold
- Department of Neurological Surgery, Cooper Medical of Rowan University, Camden, New Jersey, USA
| | - Nicholas E Bui
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA.
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Cate G, Barnes CL, Dickinson KJ. Simulation training to retool practicing orthopedic surgeons is rare. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:57. [PMID: 38013868 PMCID: PMC10203688 DOI: 10.1007/s44186-023-00136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/05/2023] [Accepted: 05/14/2023] [Indexed: 11/29/2023]
Abstract
Purpose Modern surgical practice is continuously changing as technology develops. New techniques are often implemented after a surgeon has made the transition to independent clinical practice. There is therefore a need to 'retool' technical skills. Additionally, practicing surgeons must maintain and develop skills such as leadership, communication, critical thinking, teaching, and mentoring. Our aim was to perform a scoping review to assess the current status of simulation education for practicing Orthopedic Surgeons (OS). Methods A 10 year search of PubMed, ERIC, and Web of Science was performed with a medical librarian. Controlled vocabulary Medical Subject Headings terms and natural language were developed with subject matter experts describing simulation, training and OS. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were articles that did not assess simulation education involving practicing OS. Data were extracted from the included full text articles by two reviewers: details of study design, type of participants, type of simulation and role of OS in the educational event. Results Initial search identified 1824 articles of which 443 were duplicates, and 1381 articles were further screened. Of these, 1155 were excluded, 226 full text articles were assessed for eligibility and 80 included in analysis. Most were published in the last 6 years and from the United States. The majority (99%) described technical skill simulations (arthroscopy 56%, screw placement 23%, ligament reconstruction 19%). OS were rarely the only learners with 91% studies also having residents participate. OS were the targeted learner in 6% studies. OS provided content validity for 15 (19%) and construct validity in 59 (74%) studies. Conclusions Simulation training to educate practicing OS is rare. OS are often used to validate work rather than being the center of an educational endeavor. A refocusing is needed to provide adequate training for practicing surgeons to retool skills as new techniques become available.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
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Procedural simulation training in orthopaedics and traumatology: Nationwide survey among surgeon educators and residents in France. Orthop Traumatol Surg Res 2022; 108:103347. [PMID: 35688379 DOI: 10.1016/j.otsr.2022.103347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Simulation is among the tools used in France to train residents specialising in orthopaedic and trauma surgery (OTS). However, implementing simulation-based training (SBT) is complex and poorly reported. The objective of this study was to describe the use of simulation for OTS training in France. HYPOTHESIS Nationwide, SBT is not used to its full capacity for teaching OTS in France, and differences in opinions about SBT may exist between surgeon educators and residents. STUDY DESIGN Nationwide questionnaire survey in France. MATERIALS AND METHODS We built two specific self-questionnaires then e-mailed them between December 2020 and February 2021 to the surgeon educators who were members of the national university council and to the residents specialising in OTS during the current academic year. The questions were about the 2018-2019 academic year, before the COVID-19 pandemic. Two classes of residents who were still medical students during this period were not included, leaving three classes for the analysis. RESULTS The participation rates were 57% (67/117) for the educators and 24% (87/369) for the three classes of residents. Of the 67 educators, 47 (70%) reported being involved in SBT and identified the university (70%) and industry (53%) as the main funders of this teaching modality. The educators indicated that the mean number of SBT laboratories in their region was 1.4±0.9 (range, 0-4). The main types of simulators were saw bones (77%); cadavers (85%); and commercial simulators (74%), notably for the knee (87%) and shoulder (78%). The educators estimated that they had achieved a mean of 33%±23% (range, 0%-100%) of the teaching objectives set out in the OTS curriculum and that the main obstacles were insufficient funding (81%) and lack of time (67%). Only 21% of educators reported conducting SBT research. The residents reported that they accessed SBT via the OTS teaching module (28/87, 32%), local university degrees (23/87, 26%), their hospital department (17/87, 18%), or the industry (15/87, 17%); 25/87 (29%) had never received SBT. On a 0-10 scale (0, completely disagrees; 10, completely agrees), the mean score for SBT effectiveness was 8.6±2.1 for residents and 7.1±3.0 for educators (p<0.001); the corresponding values for the quality of SBT integration in the region were 1.5±1.8 and 3.8±2.6, respectively (p<0.001). CONCLUSION SBT is not yet used to its full potential for teaching OTS in France. Insufficient funding and lack of time were identified by the educators as the main obstacles to greater use of SBT. Both the residents and the educators felt that SBT mightbe beneficial for training. LEVEL OF EVIDENCE IV, nationwide survey.
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Klinger S, Greinwald M, Augat P, Hollensteiner M. Mechanical and morphometric characterization of custom-made trabecular bone surrogates. J Mech Behav Biomed Mater 2022; 129:105146. [PMID: 35247861 DOI: 10.1016/j.jmbbm.2022.105146] [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: 08/09/2021] [Revised: 10/14/2021] [Accepted: 02/26/2022] [Indexed: 10/19/2022]
Abstract
Synthetic bones for biomechanical testing and surgeon training have become more important due to their numerous advantages compared to human bones. Several bone models are already available on the market, but most of them do not reflect the full range of versatile properties that characterize human bone like population-level influences, size, stiffness, bone-implant-interface or morphometry. Thus, the objectives of this study were to develop synthetic trabecular bone surrogates from polyurethane and varying additives and to determine their elastic and plastic mechanical compressive and additionally morphometric properties. Another aim was to investigate the influence of varying additives on aforementioned properties and finally compare the results with published data from human trabecular bone. Additives used were blowing agents to create a porous structure, mineral fillers to manipulate the basic polyurethane resin, and cell stabilizers to achieve an open porous composition. Mechanical properties were obtained from static compression tests until failure while morphometric analysis was carried out using microcomputed tomography. Thereby, the blowing agent showed the strongest influence on mechanical and morphometric properties with mean Young's moduli ranging from 627 ± 37 MPa (0% blowing agent) to 154 ± 15 MPa (0.25% blowing agent) while the variation of mineral filler content resulted in small standard deviations of approximately 10-20 MPa with a constant proportion of blowing agent. The achieved mechanical properties of the developed synthetic bones, such as the Young's modulus, ultimate stress and yield stress were in accordance with human trabecular bone, while yield strain for all groups was noticeably higher compared to human trabecular bone. Additionally, morphometric analysis showed results indicating similar morphometry of the custom-made synthetic bone and human cancellous bone. Although recreating bone structures in physiological conditions is not simple, the results of the current study show the possibility of developing synthetic bone materials with characteristics like human trabecular bone.
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Affiliation(s)
- Simon Klinger
- Institute for Biomechanics, BG Unfallklinik Murnau and Paracelsus Medical University Salzburg, Prof.-Küntscher-Straße 8, 82418, Murnau, Germany; Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053, Regensburg, Germany
| | - Markus Greinwald
- Institute for Biomechanics, BG Unfallklinik Murnau and Paracelsus Medical University Salzburg, Prof.-Küntscher-Straße 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau and Paracelsus Medical University Salzburg, Prof.-Küntscher-Straße 8, 82418, Murnau, Germany
| | - Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau and Paracelsus Medical University Salzburg, Prof.-Küntscher-Straße 8, 82418, Murnau, Germany.
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Simulation on synthetic bone: A tool for teaching thoracolumbar pedicle screw placement. Orthop Traumatol Surg Res 2021; 107:103056. [PMID: 34536595 DOI: 10.1016/j.otsr.2021.103056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/11/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery. HYPOTHESIS The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone. METHODS Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm). RESULTS Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents. DISCUSSION Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement. LEVEL OF EVIDENCE II.
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Sayari AJ, Chen O, Harada GK, Lopez GD. Success of Surgical Simulation in Orthopedic Training and Applications in Spine Surgery. Clin Spine Surg 2021; 34:82-86. [PMID: 33044270 DOI: 10.1097/bsd.0000000000001070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE This study aimed to review the current literature on surgical simulation in orthopedics and its application to spine surgery. SUMMARY OF BACKGROUND DATA As orthopedic surgery increases in complexity, training becomes more relevant. There have been mandates in the United States for training orthopedic residents the fundamentals of surgical skills; however, few studies have examined the various training options available. Lack of funding, availability, and time are major constraints to surgical simulation options. METHODS A PubMed review of the current literature was performed on all relevant articles that examined orthopedic trainees using surgical simulation options. Studies were examined for their thoroughness and application of simulation options to orthopedic surgery. RESULTS Twenty-three studies have explored orthopedic surgical simulation in a setting that objectively assessed trainee performance, most in the field of trauma and arthroscopy. However, there was a lack of consistency in measurements made and skills tested by these simulators. There has only been one study exploring surgical simulation in spine surgery. CONCLUSIONS While there has been a growing number of surgical simulators to train orthopedic residents the fundamentals of surgical skills, most of these simulators are not feasible, reproducible, or available to the majority of training centers. Furthermore, the lack of consistency in the objective measurements of these studies makes interpretation of their results difficult. There is a need for more simulation in spine surgery, and future simulators and their respective studies should be reproducible, affordable, applicable to the surgical setting, and easily assembled by various programs across the world.
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Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Díez N, Pacheco S, Llorente M, Fernández S. Validation of a Sensor-Fitted Simulator for Upper Airway Examination. Otolaryngol Head Neck Surg 2020; 164:339-345. [PMID: 32689875 DOI: 10.1177/0194599820941017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. STUDY DESIGN Validation study. SETTING Undergraduate medical education. SUBJECTS AND METHODS A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. RESULTS For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's ρ was 0.828 (P < .001). For construct validity, the group of students differed from the group of specialists in damage scores (P = .027) and in technical procedures (P < .001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. CONCLUSION Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
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Affiliation(s)
- Nieves Díez
- Simulation Center, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Sofía Pacheco
- Simulation Center, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Marcos Llorente
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - Secundino Fernández
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Advancing Simulation-Based Orthopaedic Surgical Skills Training: An Analysis of the Challenges to Implementation. Adv Orthop 2019; 2019:2586034. [PMID: 31565441 PMCID: PMC6745149 DOI: 10.1155/2019/2586034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/10/2019] [Accepted: 08/03/2019] [Indexed: 01/18/2023] Open
Abstract
Simulation-based surgical skills training is recognized as a valuable method to improve trainees' performance and broadly perceived as essential for the establishment of a comprehensive curriculum in surgical education. However, there needs to be improvement in several areas for meaningful integration of simulation into surgical education. The purpose of this focused review is to summarize the obstacles to a comprehensive integration of simulation-based surgical skills training into surgical education and board certification and suggest potential solutions for those obstacles. First and foremost, validated simulators need to be rigorously assessed to ensure their feasibility and cost-effectiveness. All simulation-based courses should include clear objectives and outcome measures (with metrics) for the skills to be practiced by trainees. Furthermore, these courses should address a wide range of issues, including assessment of trainees' problem-solving and decision-making abilities and remediation of poor performance. Finally, which simulation-based surgical skills courses will become a standard part of the curriculum across training programs and which will be of value in board certification should be precisely defined. Sufficient progress in these areas will prevent excessive development of training and assessment tools with duplicative effort and large variability in quality.
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Pfandler M, Stefan P, Wucherer P, Lazarovici M, Weigl M. Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty. Adv Simul (Lond) 2018; 3:18. [PMID: 30275986 PMCID: PMC6158852 DOI: 10.1186/s41077-018-0077-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background Despite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. Specifically, our objective was to introduce a guideline for development and application of a modified CTA to obtain task demands of surgical procedures for all three OR professions with comprehensive definitions of OR teams’ technical and non-technical skills. Methods To demonstrate our methodological approach, we applied it in vertebroplasty, a minimally invasive spine procedure. We used a CTA consisting of document reviews, in situ OR observations, expert interviews, and an expert consensus panel. Interviews included five surgeons, four OR nurses, and four anesthetists. Ten procedures were observed. Data collection was carried out in five OR theaters in Germany. Results After compiling data from interviews and observations, we identified 6 procedural steps with 21 sub-steps for surgeons, 20 sub-steps for nurses, and 22 sub-steps for anesthetists. Additionally, we obtained information on 16 predefined categories of intra-operative skills and requirements for all three OR professions. Finally, simulation requirements for intra-operative demands were derived and specified in the expert panel. Conclusions Our CTA approach is a feasible and effective way to elicit information on intra-operative demands and to define requirements of medical team simulation. Our approach contributes as a guideline to future endeavors developing simulation training of technical and non-technical skills for multidisciplinary OR teams. Electronic supplementary material The online version of this article (10.1186/s41077-018-0077-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Pfandler
- 1Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Philipp Stefan
- 2Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, TU Munich, Boltzmannstrasse 3, 85748 Garching, Germany
| | - Patrick Wucherer
- 2Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, TU Munich, Boltzmannstrasse 3, 85748 Garching, Germany
| | - Marc Lazarovici
- 3Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig-Maximilians-University Munich, Schillerstraße 53, 80336 Munich, Germany
| | - Matthias Weigl
- 1Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany
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Hollensteiner M, Fürst D, Augat P, Schrödl F, Esterer B, Gabauer S, Hunger S, Malek M, Stephan D, Schrempf A. Characterization of an artificial skull cap for cranio-maxillofacial surgery training. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:135. [PMID: 30120585 PMCID: PMC6105196 DOI: 10.1007/s10856-018-6143-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
Cranial grafts are favored to reconstruct skeletal defects because of their reduced resorption and their histocompatibility. Training possibilities for novice surgeons include the "learning by doing" on the patient, specimens or simulators. Although the acceptance of simulators is growing, the major drawback is the lack of validated bone models. The aim of this study was to create and validate a realistic skull cap model and to show superiority compared to a commercially available skull model. Characteristic forces during machinery procedures were recorded and thickness parameters from the bony layers were obtained. The thickness values of the bone layers of the developed parietal bone were comparable to the human ones. Differences between drilling and sawing forces of human and artificial bones were not detected using statistical analysis. In contrast the parameters of the commercially available skull model were significantly different. However, as a result, a model-based simulator for tabula externa graft lift training, consisting of a brain, skull bone cap and covering soft tissues was created. This simulator enables the training of all procedural steps of a "split thickness graft lift". In conclusion, an artificial skull cap suitable for parietal graft lift training was manufactured and validated against human parietal bones.
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Affiliation(s)
- Marianne Hollensteiner
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria.
- Institue of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medical University Salzburg, Murnau, Germany.
| | - David Fürst
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
| | - Peter Augat
- Institue of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medical University Salzburg, Murnau, Germany
| | - Falk Schrödl
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Benjamin Esterer
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
- Institue of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau and Paracelsus Medical University Salzburg, Murnau, Germany
| | - Stefan Gabauer
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
| | - Stefan Hunger
- Department for Oral and Maxillofacial Surgery, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Michael Malek
- Department for Oral and Maxillofacial Surgery, Kepler University Hospital, Med Campus III, Linz, Austria
| | | | - Andreas Schrempf
- Research Group for Surgical Simulators Linz, Upper Austria University of Applied Sciences, Linz, Austria
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