Novel Low-Cost, Low-Fidelity Hemorrhoidectomy Task Trainers

Surgical trainee education in benign anorectal disease: a scoping review

Background

Benign anorectal diseases such as haemorrhoids, perianal abscesses and fistulas are prevalent and disabling conditions that can be difficult to diagnose and treat.This review aims to evaluate current education for training doctors around these diseases to inform the revision and development of surgical curricula.

Materials and methods

A literature search was conducted in MEDLINE, Embase and Google Scholar and data from included articles were charted in a semi-structured table. Quantitative outcomes were presented using simple descriptive statistics. Qualitative data were analysed using a reflexive thematic analysis framework.

Results

Ten studies were included. Most education was centred around haemorrhoids and delivered in the format of lectures and simulations. Harnessing the benefits of both on-demand and in-person content was key to optimising education delivery. In simulation studies, low-fidelity models were generally sufficient to meet educational objectives. There was universal agreement that the purpose of education was to supplement or prepare for clinical exposure, rather than to replace or 'bridge gaps' in experience. Education was found to be most useful and relevant when delivered to junior surgical or non-surgical cohorts.

Conclusions

This review elucidates gaps in current literature on benign anorectal disease education and provides recommendations for the development and implementation of future education for surgical trainees. There is a need for education that addresses a broader range of anorectal conditions and has a greater focus on the retention and clinical translation of acquired knowledge and skills. Interventions should be designed to enhance clinical exposure and maintain relevance throughout training progression.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

OBJECTIVE

The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research.

INTRODUCTION

Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests.

INCLUSION CRITERIA

Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review.

METHODS

This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats.

RESULTS

Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values.

CONCLUSIONS

This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards.

REVIEW REGISTRATION

Open Science Framework https://osf.io/fgb34.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available.

INTRODUCTION

Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers.

INCLUSION CRITERIA

This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings.

METHODS

This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results.

SCOPING REVIEW PROTOCOL REGISTRATION

Open Science Framework https://osf.io/fgb34.

Simulation for Colorectal Surgery

Introduction: Colorectal surgery is a highly specialized field in surgery that deals with the surgical intervention of disease processes of the colon, rectum, and anus. Gaining proficiency in this field requires training both inside and outside of the operating room. Simulation plays a key role in training surgeons in colorectal surgery. The goal of this study is to review the currently available simulators for training in the field of colorectal surgery. Methods: A review of the literature was conducted to identify simulators that are both physical such as benchtop, live animal, and cadaver, as wells as virtual reality (VR) simulators. Any reported validity evidence for these simulators were also presented. Results: There are several benchtop physical models made of silicone for training in basic colorectal tasks, such as hand-sewn and stapled anastomosis. To improve realism, explanted animal and cadaveric specimens were also used for training. To improve repeatability, objective assessment, both commercial and VR simulators also exist for training in both open and laparoscopic colorectal surgery and emerging areas such as endoscopic submucosal dissection. Conclusion: Simulation-based training in colorectal surgery is here to stay and is going to play a significant role in training, credentialing, and quality improvements.