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Mahmud M, Sari DCR, Sari D, Arfian N, Zucha MA. The application of augmented reality for improving clinical skills: a scoping review. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:65-79. [PMID: 38462243 PMCID: PMC10925804 DOI: 10.3946/kjme.2024.285] [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: 07/26/2023] [Revised: 10/18/2023] [Accepted: 12/11/2023] [Indexed: 03/12/2024]
Abstract
Augmented reality technology had developed rapidly in recent years and had been applied in many fields, including medical education. Augmented reality had potential to improve students' knowledge and skills in medical education. This scoping review primarily aims to further elaborate the current studies on the implementation of augmented reality in advancing clinical skills. This study was conducted by utilizing electronic databases such as PubMed, Embase, and Web of Science in June 2022 for articles focusing on the use of augmented reality for improving clinical skills. The Rayyan website was used to screen the articles that met the inclusion criteria, which was the application of augmented reality as a learning method in medical education. Total of 37 articles met the inclusion criteria. These publications suggested that using augmented reality could improve clinical skills. The most researched topics explored were laparoscopic surgery skills and ophthalmology were the most studied topic. The research methods applied in the articles fall into two main categories: randomized control trial (RCT) (29.3%) and non-RCT (70.3%). Augmented reality has the potential to be integrated in medical education, particularly to boost clinical studies. Due to limited databases, however, any further studies on the implementation of augmented reality as a method to enhance skills in medical education need to be conducted.
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Affiliation(s)
- Mahmud Mahmud
- Department of Anesthesiology & Intensive Care Therapy, Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dwi Cahyani Ratna Sari
- Department of Anatomy, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Djayanti Sari
- Department of Anesthesiology & Intensive Care Therapy, Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nur Arfian
- Department of Anatomy, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Ary Zucha
- Department of Obstetrics and Gynecology, Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
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Boal MWE, Anastasiou D, Tesfai F, Ghamrawi W, Mazomenos E, Curtis N, Collins JW, Sridhar A, Kelly J, Stoyanov D, Francis NK. Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. Br J Surg 2024; 111:znad331. [PMID: 37951600 PMCID: PMC10771126 DOI: 10.1093/bjs/znad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools for technical skills assessment, providing evaluation statuses to guide research and inform implementation into training curricula. METHODS A systematic literature search was conducted in accordance with the PRISMA guidelines. Ovid Embase/Medline, PubMed and Web of Science were searched. Inclusion criterion: robotic surgery technical skills tools. Exclusion criteria: non-technical, laparoscopy or open skills only. Manual tools and automated performance metrics (APMs) were analysed using Messick's concept of validity and the Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence and Recommendation (LoR). A bespoke tool analysed artificial intelligence (AI) studies. The Modified Downs-Black checklist was used to assess risk of bias. RESULTS Two hundred and forty-seven studies were analysed, identifying: 8 global rating scales, 26 procedure-/task-specific tools, 3 main error-based methods, 10 simulators, 28 studies analysing APMs and 53 AI studies. Global Evaluative Assessment of Robotic Skills and the da Vinci Skills Simulator were the most evaluated tools at LoR 1 (OCEBM). Three procedure-specific tools, 3 error-based methods and 1 non-simulator APMs reached LoR 2. AI models estimated outcomes (skill or clinical), demonstrating superior accuracy rates in the laboratory with 60 per cent of methods reporting accuracies over 90 per cent, compared to real surgery ranging from 67 to 100 per cent. CONCLUSIONS Manual and automated assessment tools for robotic surgery are not well validated and require further evaluation before use in accreditation processes.PROSPERO: registration ID CRD42022304901.
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Affiliation(s)
- Matthew W E Boal
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
| | - Dimitrios Anastasiou
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Freweini Tesfai
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
| | - Walaa Ghamrawi
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
| | - Evangelos Mazomenos
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Nathan Curtis
- Department of General Surgey, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Computer Science, UCL, London, UK
| | - Nader K Francis
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, Somerset, UK
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Rudiman R, Mirbagheri A, Candrawinata VS. Assessment of robotic telesurgery system among surgeons: a single-center study. J Robot Surg 2023; 17:2757-2761. [PMID: 37710051 PMCID: PMC10678790 DOI: 10.1007/s11701-023-01709-5] [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: 05/24/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
The field of robotic-assisted surgery is expanding rapidly; therefore, future robotic surgeons will need to be trained in an organized manner. Here, we aimed to examine surgeon performance on the Sinaflex Robotic Telesurgery System for correlation with training hours spent in training program. This is a prospective study of a single-center experience at the Hasan Sadikin Hospital, Bandung City of West Java, Indonesia. We included 43 surgeons from 11 departments, all invited to train using the Sinaflex Robotic Telesurgery system at the Hasan Sadikin Hospital. All study cohorts have never performed a robotic surgery procedure beforehand and have had at least five years of field experience. The surgeons were free to choose their training duration and simulation. After finishing the training session, they were asked to perform several tasks with increasing difficulty levels. There were nine training tasks in total with increasing levels of difficulty. A total of 43 surgeons from 11 different department were included in this prospective study. Our study was separated into 3 different batches and most surgeons failed to pass the examination (n = 12, 8, and 9, for batches 1, 2, and 3, respectively). The "failed" surgeon, additionally, tended to be older than the "passed" cohort (49.3 ± 7.4 vs 42.1 ± 7.3 years old, p = 0.005). In terms of duration of hours spent training on the robot, there was little difference training hours between the cohort that passed and the cohort that failed cohort (10.0 [8.4-10.1] vs 10.0 [8.0-10.0], respectively) with a p value of 0.265. We found no correlation between the total hours spent in the training program and surgeon performance on the Sinaflex robotic telesurgery system. Structured robot surgical training courses must be incorporated into the training programs.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Hasan Sadikin Hospital, Universitas Padjadjaran, West Java, Bandung, Indonesia.
| | - Alireza Mirbagheri
- Department of Medical Physics and Biomedical Engineering, School of Medicine and also Research Center for Biomedical Technologies and Robotics (RCBTR), Advanced Medical Technologies and Equipment Institute (AMTEI), both at Tehran University of Medical Sciences, Tehran, Iran
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Wanderling C, Saxton A, Phan D, Sheppard L, Schuler N, Ghazi A. Recent Advances in Surgical Simulation For Resident Education. Curr Urol Rep 2023; 24:491-502. [PMID: 37736826 DOI: 10.1007/s11934-023-01178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE OF REVIEW Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks. RECENT FINDINGS Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations. Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.
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Affiliation(s)
| | - Aaron Saxton
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Dennis Phan
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Lauren Sheppard
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Nathan Schuler
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Ahmed Ghazi
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA.
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Bui DT, Barnett T, Hoang H, Chinthammit W. Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study. JMIR MEDICAL EDUCATION 2023; 9:e47228. [PMID: 37782533 PMCID: PMC10580139 DOI: 10.2196/47228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. OBJECTIVE This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. METHODS This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR's usability, mentorship effectiveness, and mentees' self-confidence and skill performance. RESULTS A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees' confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees' individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. CONCLUSIONS This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research.
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Affiliation(s)
- Dung T Bui
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Ha Hoang
- Centre for Rural Health, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Winyu Chinthammit
- Human Interface Technology Laboratory, School of Information and Communication Technology, College of Sciences and Engineering, University of Tasmania, Launceston, Australia
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Sinha A, West A, Vasdev N, Sooriakumaran P, Rane A, Dasgupta P, McKirdy M. Current practises and the future of robotic surgical training. Surgeon 2023; 21:314-322. [PMID: 36932015 DOI: 10.1016/j.surge.2023.02.006] [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: 11/15/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION This study reviews the current state of robotic surgery training for surgeons, including the various curricula, training methods, and tools available, as well as the challenges and limitations of these. METHODS The authors carried out a literature search across PubMed, MEDLINE, and Google Scholar using keywords related to 'robotic surgery', 'computer-assisted surgery', 'simulation', 'virtual reality', 'surgical training', and 'surgical education'. Full text analysis was performed on 112 articles. TRAINING PROGRAMMES The training program for robotic surgery should focus on proficiency, deliberation, and distribution principles. The curricula can be broadly split up into pre-console and console-side training. Pre-Console and Console-Side Training: Simulation training is an important aspect of robotic surgery training to improve technical skill acquisition and reduce mental workload, which helps prepare trainees for live procedures. OPERATIVE PERFORMANCE ASSESSMENT The study also discusses the various validated assessment tools used for operative performance assessments. FUTURE ADVANCES Finally, the authors propose potential future directions for robotic surgery training, including the use of emerging technologies such as AI and machine learning for real-time feedback, remote mentoring, and augmented reality platforms like Proximie to reduce costs and overcome geographic limitations. CONCLUSION Standardisation in trainee performance assessment is needed. Each of the robotic curricula and platforms has strengths and weaknesses. The ERUS Robotic Curriculum represents an evidence-based example of how to implement training from novice to expert. Remote mentoring and augmented reality platforms can overcome the challenges of high equipment costs and limited access to experts. Emerging technologies offer promising advancements for real-time feedback and immersive training environments, improving patient outcomes.
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Affiliation(s)
- Ankit Sinha
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK.
| | - Alexander West
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK.
| | - Nikhil Vasdev
- Lister Hospital, Hertfordshire and Bedfordshire Urological Cancer Centre, Stevenage, Hertfordshire, UK; University of Hertfordshire, School of Life and Medical Sciences, Hatfield, Hertfordshire, UK.
| | | | - Abhay Rane
- East Surrey Hospital, Redhill, Surrey, UK.
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, London, UK.
| | - Michael McKirdy
- Royal College of Physicians and Surgeons of Glasgow, Glasgow, UK.
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Suresh D, Aydin A, James S, Ahmed K, Dasgupta P. The Role of Augmented Reality in Surgical Training: A Systematic Review. Surg Innov 2023; 30:366-382. [PMID: 36412148 PMCID: PMC10331622 DOI: 10.1177/15533506221140506] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
This review aims to provide an update on the role of augmented reality (AR) in surgical training and investigate whether the use of AR improves performance measures compared to traditional approaches in surgical trainees. PUBMED, EMBASE, Google Scholar, Cochrane Library, British Library and Science Direct were searched following PRIMSA guidelines. All English language original studies pertaining to AR in surgical training were eligible for inclusion. Qualitative analysis was performed and results were categorised according to simulator models, subsequently being evaluated using Messick's framework for validity and McGaghie's translational outcomes for simulation-based learning. Of the 1132 results retrieved, 45 were included in the study. 29 platforms were identified, with the highest 'level of effectiveness' recorded as 3. In terms of validity parameters, 10 AR models received a strong 'content validity' score of 2.15 models had a 'response processes' score ≥ 1. 'Internal structure' and 'consequences' were largely not discussed. 'Relations to other variables' was the best assessed criterion, with 9 platforms achieving a high score of 2. Overall, the Microsoft HoloLens received the highest level of recommendation for both validity and level of effectiveness. Augmented reality in surgical education is feasible and effective as an adjunct to traditional training. The Microsoft HoloLens has shown the most promising results across all parameters and produced improved performance measures in surgical trainees. In terms of the other simulator models, further research is required with stronger study designs, in order to validate the use of AR in surgical training.
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Affiliation(s)
- Dhivya Suresh
- Guy’s, King’s and St Thomas’ School of Medical Education, King’s College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
| | - Stuart James
- Department of General Surgery, Princess Royal University Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK
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Tokuno J, Carver TE, Fried GM. Measurement and Management of Cognitive Load in Surgical Education: A Narrative Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:208-215. [PMID: 36335034 DOI: 10.1016/j.jsurg.2022.10.001] [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: 04/19/2022] [Revised: 08/18/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive load should be considered in designing optimal educational programs in health care. Despite the highly demanding nature of surgery and surgical education, a consensus on how to manage cognitive load has not been established. The objective of this review is to map out how recent surgical education research incorporates cognitive load. METHODS A literature search was performed using keywords related to cognitive load and digital education up to December 2021. Studies published in English relevant to assessment and management of cognitive load in surgical education were included. Terminology, assessment tools, association with different surgical procedures and training modalities, and programs considering cognitive load were reported. RESULTS We identified several terms to describe cognitive load. Cognitive load was measured by subjective, self-reported questionnaires and by objective measurements, such as physiological parameters or estimated by reaction time to secondary tasks. Subjective measurements reported cognitive load in one or multiple dimensions. Correlations between subjective and objective measurements were shown in multiple studies. Overall, higher cognitive load was observed in training for more complex tasks and high-fidelity modalities, and among less experienced trainees. Cognitive load theory has been lately incorporated into designing teaching programs. CONCLUSIONS A broad range of terms and assessment tools were identified for cognitive load. To maximize the learning outcome, management of cognitive load is necessary in surgical education. This review summarizes the current knowledge in assessment and management of cognitive load in surgical education and provides suggestions for future studies.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Tamara E Carver
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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Moawad G, Rahman S, Saridogan E. The case for standardising robotic curriculum globally. Facts Views Vis Obgyn 2022; 14:99-102. [DOI: 10.52054/fvvo.14.2.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Butterworth J, Sadry M, Julian D, Haig F. Assessment of the training program for Versius, a new innovative robotic system for use in minimal access surgery. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 3:e000057. [PMID: 35051252 PMCID: PMC8647592 DOI: 10.1136/bmjsit-2020-000057] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program. Design A 3.5-day program following 10 hours of online didactic training. Participants were assessed during the technical training using the Global Evaluative Assessment of Robotic Skills (GEARS). Setting Dry box exercises were conducted in classrooms, and wet lab sessions simulated an operating room environment using cadaveric specimens. Participants Seventeen surgical teams participated; surgeons represented general, colorectal, obstetrics/gynecology, and urology specialties. All surgeons had previous laparoscopic MAS experience, while experience with robotics varied. Main outcomes measures Participants were scored on a five-point Likert Scale for each of six validated GEARS domains (depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control). Additional metrics used to chart surgeon performance included: combined instrument path length; combined instrument angular path; and time taken to complete each task. Results Participants demonstrated an overall improvement in performance during the study, with a mean GEARS Score of 21.0 (SD: 1.9) in Assessment 1 increasing to 23.4 (SD: 2.9) in Validation. Greatest improvements were observed in the depth perception and robotic control domains. Greatest differences were observed when stratifying by robotic experience; those with extensive experience consistently scored higher than those with some or no experience. Conclusions The Versius training program is effective; participants were able to successfully operate the system by program completion, and more surgeons achieved intermediate-level and expert-level GEARS scores in Validation compared with Assessment 1.
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Affiliation(s)
| | | | - Danielle Julian
- Nicholson Center, AdventHealth University, Altamonte Springs, Florida, USA
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Augmented Reality in Professional Training: A Review of the Literature from 2001 to 2020. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study presents a systematic review of literature on the application of augmented reality (AR) in professional training contexts published between 2001 and 2020. A total of 49 articles were selected after a two-stage screening process, and key research findings were analyzed and synthesized using a coding scheme comprising five inter-related aspects: basic information, instructional contexts, technology features, instructional design, and research results. The review results depict the trend patterns in AR-supported professional training in terms of publication, research paradigm, and technological affordances, and report the contextual differences in AR pedagogies and instructional functions over time. Furthermore, a meta-analysis was conducted in the present study to examine the overall effectiveness of AR application in professional training, with the results indicating an overall small effect size (g = 0.268) and nine significant moderating factors. Informed by the review and meta-analysis results, a set of implications for facilitating and investigating AR-supported professional training are proposed and discussed.
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Design and Testing of Two Haptic Devices Based on Reconfigurable 2R Joints. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app12010339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents the design and testing of two haptic devices, based on reconfigurable 2R joints: an active 2R spherical mechanism-based joint and a differential gear-based joint. Based on our previous works, in which the design and kinematic analysis of both reconfigurable joints were developed, the experimental setup and the various tasks intended to test the reconfigurability, precision, force feedback system and general performance, are presented herein. Two control modes for the haptic device operation are proposed and studied. The statistical analysis tools and their selection principles are described. The mechanical design of two experimental setups and the main elements are considered in detail. The Robot Operating System nodes and the topics that are used in the software component of the experimental setup are presented and explained. The experimental testing was carried out with a number of participants and the corresponding results were analyzed with the selected statistical tools. A detailed interpretation and discussion on of the results is provided.
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Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
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Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
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14
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Araujo SEA, Perez RO, Klajner S. Role of Simulation-Based Training in Minimally Invasive and Robotic Colorectal Surgery. Clin Colon Rectal Surg 2021; 34:136-143. [PMID: 33814994 DOI: 10.1055/s-0040-1718687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Properly performing minimally invasive colorectal procedures requires specific skills. With a focus on patient safety, the training of surgeons on patients is only accepted under exceptionally controlled, expensive, and challenging conditions. Moreover, many new techniques in colorectal surgery have been developed. Therefore, undertaking minimally invasive colorectal surgery in modern times requires specific psychomotor skills that trainee surgeons must gather in less time. In addition, there are not enough proctors with sufficient expertise for such an expressive number of new different techniques likes transanal and robotic procedures. Studies that have demonstrated an improvement in minimally invasive surgery skills to the actual operating room in general surgery and a stepwise approach to surgical simulation with a combination of various training methods appears to be useful in colorectal surgery training programs. However, the scientific evidence on the transfer of skills specifically for colorectal surgery is extremely scarce and very variable. Thus, the evaluation of the results remains quite difficult. In this review, we present the best available evidence on the types of training based on simulation, their characteristics, advantages and disadvantages, and finally the results available on their adoption. Nevertheless, scientific evidence about the benefit of simulation training in minimally invasive colorectal surgery is limited and there is a need to build more robust evidence.
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Affiliation(s)
| | - Rodrigo Oliva Perez
- Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Sidney Klajner
- Colorectal Surgery Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
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15
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Kovoor JG, Gupta AK, Gladman MA. Validity and effectiveness of augmented reality in surgical education: A systematic review. Surgery 2021; 170:88-98. [PMID: 33744003 DOI: 10.1016/j.surg.2021.01.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current challenges in surgical training have led to the investigation of augmented reality as a potential method of supplementary education. However, its value for this purpose remains uncertain. The aim of this study was to perform a systematic review of the published literature to evaluate the validity and effectiveness of augmented reality in surgical education, and to compare it with other simulation modalities. METHODS Electronic literature searches were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two authors independently extracted pertinent data and assessed study quality. The primary outcome measures of interest were the validity and effectiveness of augmented reality as an educational tool. RESULTS Of 6,500 articles, 24 studies met eligibility criteria for inclusion, of which 2 were randomized. Ten studies investigated validity, with 7 establishing both face and content validity and an additional 1 just content validity. Construct validity was demonstrated in 9 of 11 studies. Of the 11 studies that examined the effectiveness of augmented reality in skills acquisition, 9 demonstrated enhanced learning. Of the 5 studies in which the effectiveness of augmented reality as an educational tool was compared with other modes of simulation, augmented reality was found to be superior in 2 and equivalent in the others. CONCLUSION Overall, the majority, including 2 high-quality randomized controlled trials, demonstrated the validity and effectiveness of augmented reality in surgical education. However, the quality of published studies was poor with marked heterogeneity. Although these results are encouraging, additional high-quality studies, preferably in the real-life environment, are required before the widespread implementation of augmented reality within surgical curricula can be recommended.
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Affiliation(s)
- Joshua G Kovoor
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia
| | - Aashray K Gupta
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia
| | - Marc A Gladman
- Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, South Australia.
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Higuchi M, Abe T, Hotta K, Morita K, Miyata H, Furumido J, Iwahara N, Kon M, Osawa T, Matsumoto R, Kikuchi H, Kurashima Y, Murai S, Aydin A, Raison N, Ahmed K, Khan MS, Dasgupta P, Shinohara N. Development and validation of a porcine organ model for training in essential laparoscopic surgical skills. Int J Urol 2020; 27:929-938. [PMID: 32743896 PMCID: PMC7589398 DOI: 10.1111/iju.14315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To develop a wet laboratory training model for learning core laparoscopic surgical skills and evaluating learners' competency level outside the operating room. METHODS Participants completed three tasks (task 1: tissue dissection around the aorta; task 2: tissue dissection and division of the renal artery; task 3: renal parenchymal closure). Each performance was video recorded and subsequently evaluated by two experts, according to the Global Operative Assessment of Laparoscopic Skills and task-specific metrics that we developed (Assessment Sheet of Laparoscopic Skills in Wet Lab score). Mean scores were used for analyses. The subjective mental workload was also assessed (NASA Task Load Index). RESULTS The 54 participants included 32 urologists, eight young trainees and 14 medical students. A total of 13 participants were categorized as experts (≥50 laparoscopic surgeries), eight as intermediates (10-49) and 33 as novices (0-9). There were significant differences in the Global Operative Assessment of Laparoscopic Skills and Assessment Sheet of Laparoscopic Skills in Wet Lab scores among the three groups in all three tasks. Higher NASA Task Load Index scores were observed in novices, and there were significant differences in tasks 1 (Kruskal-Wallis test, P = 0.0004) and 2 (P = 0.0002), and marginal differences in task 3 (P = 0.0745) among the three groups. CONCLUSIONS Our training model has good construct validity, and differences in the NASA Task Load Index score reflect previous laparoscopic surgical experiences. Our findings show the ability to assess both laparoscopic surgical skills and mental workloads, which could help educators comprehend trainees' level outside the operating room. Given the decreasing opportunity to carry out pure laparoscopic surgeries because of the dissemination of robotic surgery, especially in urology, our model can offer practical training opportunities.
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Affiliation(s)
- Madoka Higuchi
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Takashige Abe
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Kiyohiko Hotta
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Ken Morita
- Department of UrologyKushiro City General HospitalKushiroHokkaidoJapan
| | - Haruka Miyata
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Jun Furumido
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Naoya Iwahara
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Masafumi Kon
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Takahiro Osawa
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Ryuji Matsumoto
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Hiroshi Kikuchi
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Yo Kurashima
- Hokkaido University Clinical Simulation CenterHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Sachiyo Murai
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Abdullatif Aydin
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Nicholas Raison
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Kamran Ahmed
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Muhammad Shamim Khan
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Prokar Dasgupta
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Nobuo Shinohara
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
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Abstract
Augmented reality (AR) is used to enhance the perception of the real world by integrating virtual objects to an image sequence acquired from various camera technologies. Numerous AR applications in robotics have been developed in recent years. The aim of this paper is to provide an overview of AR research in robotics during the five year period from 2015 to 2019. We classified these works in terms of application areas into four categories: (1) Medical robotics: Robot-Assisted surgery (RAS), prosthetics, rehabilitation, and training systems; (2) Motion planning and control: trajectory generation, robot programming, simulation, and manipulation; (3) Human-robot interaction (HRI): teleoperation, collaborative interfaces, wearable robots, haptic interfaces, brain-computer interfaces (BCIs), and gaming; (4) Multi-agent systems: use of visual feedback to remotely control drones, robot swarms, and robots with shared workspace. Recent developments in AR technology are discussed followed by the challenges met in AR due to issues of camera localization, environment mapping, and registration. We explore AR applications in terms of how AR was integrated and which improvements it introduced to corresponding fields of robotics. In addition, we summarize the major limitations of the presented applications in each category. Finally, we conclude our review with future directions of AR research in robotics. The survey covers over 100 research works published over the last five years.
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Kozan AA, Chan LH, Biyani CS. Current Status of Simulation Training in Urology: A Non-Systematic Review. Res Rep Urol 2020; 12:111-128. [PMID: 32232016 PMCID: PMC7085342 DOI: 10.2147/rru.s237808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon's initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-free environment whilst focusing on patient safety. The cost of simulation is not insignificant and requires commitment in funding, human resources and logistics. It is therefore important for trainers to have evidence when selecting various simulators or devices. Our non-systematic review aims to provide a comprehensive up-to-date picture on urology simulators and the evidence for their validity. It also discusses emerging technologies and future directions. Urologists should embed evidence-based simulation in training programs to shorten learning curves while maintaining patient safety and work should be directed toward a validated and agreed curriculum.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Luke Huiming Chan
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Chandra Shekhar Biyani
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
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19
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Tang KS, Cheng DL, Mi E, Greenberg PB. Augmented reality in medical education: a systematic review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e81-e96. [PMID: 32215146 PMCID: PMC7082471 DOI: 10.36834/cmej.61705] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION The field of augmented reality (AR) is rapidly growing with many new potential applications in medical education. This systematic review investigated the current state of augmented reality applications (ARAs) and developed an analytical model to guide future research in assessing ARAs as teaching tools in medical education. METHODS A literature search was conducted using PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. This review followed PRISMA guidelines and included publications from January 1, 2000 to June 18, 2018. Inclusion criteria were experimental studies evaluating ARAs implemented in healthcare education published in English. Our review evaluated study quality and determined whether studies assessed ARA validity using criteria established by the GRADE Working Group and Gallagher et al., respectively. These findings were used to formulate an analytical model to assess the readiness of ARAs for implementation in medical education. RESULTS We identified 100,807 articles in the initial literature search; 36 met inclusion criteria for final review and were categorized into three categories: Surgery (23), Anatomy (9), and Other (4). The overall quality of the studies was poor and no ARA was tested for all five stages of validity. Our analytical model evaluates the importance of research quality, application content, outcomes, and feasibility of an ARA to gauge its readiness for implementation. CONCLUSION While AR technology is growing at a rapid rate, the current quality and breadth of AR research in medical training is insufficient to recommend the adoption into educational curricula. We hope our analytical model will help standardize AR assessment methods and define the role of AR technology in medical education.
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Affiliation(s)
- Kevin S. Tang
- The Program in Liberal Medical Education of Brown University, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Rhode Island, USA
- Division of Ophthalmology, Warren Alpert Medical School, Rhode Island, USA
- Section of Ophthalmology, Providence VA Medical Center, Rhode Island, USA
| | - Derrick L. Cheng
- The Program in Liberal Medical Education of Brown University, Rhode Island, USA
- The Warren Alpert Medical School of Brown University, Rhode Island, USA
- Lifespan Clinical Research Center, Rhode Island, USA
| | - Eric Mi
- The Program in Liberal Medical Education of Brown University, Rhode Island, USA
| | - Paul B. Greenberg
- Division of Ophthalmology, Warren Alpert Medical School, Rhode Island, USA
- Section of Ophthalmology, Providence VA Medical Center, Rhode Island, USA
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Canalichio KL, Berrondo C, Lendvay TS. Simulation Training in Urology: State of the Art and Future Directions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:391-396. [PMID: 32581620 PMCID: PMC7276194 DOI: 10.2147/amep.s198941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/10/2020] [Indexed: 05/08/2023]
Abstract
There has been a major shift from the old paradigm of 'see one, do one, teach one' in medical training due in large part to resident work-hour restrictions and required oversight in the operating room. In response to this, advancements in technology have allowed for the introduction of more objective measures to assess the skill competency and proficiency of surgical trainees. Patient safety and trainee well-being are important drivers for this new model, and so surgical training programs are adopting simulation into their curriculum. Urology is uniquely positioned at the forefront of new emerging technologies in surgery, because of the field's commitment to safe and efficient minimally invasive surgery and endourological procedures. Due to these technically challenging procedures, urological training must incorporate these educational technologies to allow for objective skills assessment, skills transfer, and ultimately providing optimal patient care with the production of proficient and competent urological trainees.
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Affiliation(s)
- Katie Lynn Canalichio
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
- Correspondence: Katie Lynn Canalichio Pediatric Urology, Seattle Children’s Hospital, OA.9.220 PO Box 5371, Seattle, WA98145-5005, USATel +1 206 987 6913Fax +1 206 987 3155 Email
| | - Claudia Berrondo
- Pediatric Urology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thomas S Lendvay
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
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21
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Koo G, Lee N, Kwon O. Combining object detection and causality mining for efficient development of augmented reality-based on-the-job training systems in hotel management. NEW REV HYPERMEDIA M 2019. [DOI: 10.1080/13614568.2019.1694594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gukwon Koo
- School of Management, Kyung Hee University, Seoul, Republic of Korea
| | - Namyeon Lee
- Department of IT Management, Hanshin University, Osan, Republic of Korea
| | - Ohbyung Kwon
- School of Management, Kyung Hee University, Dongdaemun-gu, Republic of Korea
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23
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Chen R, Rodrigues Armijo P, Krause C, Siu KC, Oleynikov D. A comprehensive review of robotic surgery curriculum and training for residents, fellows, and postgraduate surgical education. Surg Endosc 2019; 34:361-367. [PMID: 30953199 DOI: 10.1007/s00464-019-06775-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/28/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND In 2017, the utilization of robotic-assisted surgery had grown 10-40-fold relative to laparoscopic surgery in common general surgery procedures. The rapid rise in the utilization of robotic-assisted surgery has necessitated a standardized training curriculum. Many curricula are currently being developed and validated. Additionally, advancements in virtual reality simulators have facilitated their integration into robotic-assisted surgery training. This review aims to highlight and discuss the features of existing curricula and robotic-assisted surgery training simulators and to provide updates on their respective validation process. MATERIALS AND METHODS A literature review was conducted using PubMed from 2000-2019 and commercial websites. Information regarding availability, content, and status of validation was collected for each current robotic-assisted surgery curriculum. This review did not qualify as human subjects research, so institutional review board approval was not required. RESULTS The daVinci Technology Training Pathway and Fundamentals of Robotic Surgery are purely web-based and self-paced robotic-assisted surgery training. The Society of American Gastrointestinal and Endoscopic Surgeon Robotic Masters Series, Fundamental Skills of Robot-Assisted Surgery training program, and the Robotics Training Network curriculum require trainees to be on site in order to provide expert feedback on surgical techniques and robot maintenance. Currently, there are few virtual reality simulators for robotic-assisted surgical training available on the market. CONCLUSIONS Didactic courses are available in all of these training programs, but their contents are inconsistent. Furthermore, the availability and nature of hands-on training offered by these curriculums are widely variable.
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Affiliation(s)
- Richard Chen
- College of Medicine, University of Nebraska Medical Center, Nebraska Medical Center, 986245, Omaha, NE, 68198-6245, USA
| | - Priscila Rodrigues Armijo
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Nebraska Medical Center, 986246, Omaha, NE, 68198-6246, USA
| | - Crystal Krause
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Nebraska Medical Center, 986246, Omaha, NE, 68198-6246, USA
| | | | - Ka-Chun Siu
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Nebraska Medical Center, 986246, Omaha, NE, 68198-6246, USA.,College of Allied Health Professions, University of Nebraska Medical Center, Nebraska Medical Center, 984420, Omaha, NE, 68198-4420, USA
| | - Dmitry Oleynikov
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Nebraska Medical Center, 986246, Omaha, NE, 68198-6246, USA. .,Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, 986245, Omaha, NE, 68198-6245, USA.
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24
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Shee K, Koo K, Wu X, Ghali FM, Halter RJ, Hyams ES. A novel ex vivo trainer for robotic vesicourethral anastomosis. J Robot Surg 2019; 14:21-27. [DOI: 10.1007/s11701-019-00926-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
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25
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Checcucci E, Amparore D, De Luca S, Autorino R, Fiori C, Porpiglia F. Precision prostate cancer surgery: an overview of new technologies and techniques. MINERVA UROL NEFROL 2019; 71:487-501. [PMID: 30700084 DOI: 10.23736/s0393-2249.19.03365-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past few years several new technologies have become available for the management of PCa. The implementation of robotic surgery allowed an unprecedented refinement of surgical techniques, and the RARP procedure is constantly evolving. Nowadays research is mainly focused towards a "tailored" case-specific surgical approach that might allow to achieve PCa control while preserving urinary continence and erectile function. Therefore, in contemporary urology era, several new tools have been introduced to optimize surgical planning, to aid surgical navigation, and to refine surgical execution. In this non-systematic review emerges that a better imaging technique in the preoperative setting can facilitate surgical planning. Moreover, in the intraoperative setting, new tools for image-guided surgical navigation are promising and will allow real time understanding of surgical anatomy. In the next future, a more personalized approach for the minimally invasive surgical treatment of PCa will be available, and the achievement of the best oncological and functional outcomes will be obtained.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Corrêa CG, Nunes FL, Ranzini E, Nakamura R, Tori R. Haptic interaction for needle insertion training in medical applications: The state-of-the-art. Med Eng Phys 2019; 63:6-25. [DOI: 10.1016/j.medengphy.2018.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
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Kwong JC, Lee JY, Goldenberg MG. Understanding and Assessing Nontechnical Skills in Robotic Urological Surgery: A Systematic Review and Synthesis of the Validity Evidence. JOURNAL OF SURGICAL EDUCATION 2019; 76:193-200. [PMID: 29958854 DOI: 10.1016/j.jsurg.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Robotic urological surgery (RUS) has seen widespread adoption across institutions in the last decade. To match this rapid growth, it is imperative to develop a structured RUS curriculum that addresses both technical and nontechnical competencies. Emerging evidence has shown that nontechnical skills form a critical component of RUS training. The purpose of this review is to examine the validity evidence of available nontechnical skills assessment tools in RUS. METHODS A literature search of MEDLINE, EMBASE, and PsycINFO was conducted to identify primary articles using nontechnical skills assessment tools in RUS. Messick's validity framework and the Medical Education Research Study Quality Instrument were utilized to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Of the 566 articles identified, 12 used nontechnical skills assessment tools in RUS. The metrics used ranged from self-assessment using global rating scales, to objective measures such as electroencephalography. The setting of these evaluations ranged from immersive and virtual reality-based simulators to live surgery. CONCLUSIONS Limited effort has been made to develop nontechnical skills assessment tools in RUS. Recently, there has been a shift from subjective to objective measures of nontechnical performance, as well as the development of assessments specific to RUS. However, the validity evidence supporting these nontechnical assessments is limited at this time, including their relationship to technical skills, and their impact on surgical outcomes.
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Affiliation(s)
- Jethro Cc Kwong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Chen J, Oh PJ, Cheng N, Shah A, Montez J, Jarc A, Guo L, Gill IS, Hung AJ. Use of Automated Performance Metrics to Measure Surgeon Performance during Robotic Vesicourethral Anastomosis and Methodical Development of a Training Tutorial. J Urol 2018; 200:895-902. [PMID: 29792882 DOI: 10.1016/j.juro.2018.05.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE We sought to develop and validate automated performance metrics to measure surgeon performance of vesicourethral anastomosis during robotic assisted radical prostatectomy. Furthermore, we sought to methodically develop a standardized training tutorial for robotic vesicourethral anastomosis. MATERIALS AND METHODS We captured automated performance metrics for motion tracking and system events data, and synchronized surgical video during robotic assisted radical prostatectomy. Nonautomated performance metrics were manually annotated by video review. Automated and nonautomated performance metrics were compared between experts with 100 or more console cases and novices with fewer than 100 cases. Needle driving gestures were classified and compared. We then applied task deconstruction, cognitive task analysis and Delphi methodology to develop a standardized robotic vesicourethral anastomosis tutorial. RESULTS We analyzed 70 vesicourethral anastomoses with a total of 1,745 stitches. For automated performance metrics experts outperformed novices in completion time (p <0.01), EndoWrist® articulation (p <0.03), instrument movement efficiency (p <0.02) and camera manipulation (p <0.01). For nonautomated performance metrics experts had more optimal needle to needle driver positioning, fewer needle driving attempts, a more optimal needle entry angle and less tissue trauma (each p <0.01). We identified 14 common robotic needle driving gestures. Random gestures were associated with lower efficiency (p <0.01), more attempts (p <0.04) and more trauma (p <0.01). The finalized tutorial contained 66 statements and figures. Consensus among 8 expert surgeons was achieved after 2 rounds, including among 58 (88%) after round 1 and 8 (12%) after round 2. CONCLUSIONS Automated performance metrics can distinguish surgeon expertise during vesicourethral anastomosis. The expert vesicourethral anastomosis technique was associated with more efficient movement and less tissue trauma. Standardizing robotic vesicourethral anastomosis and using a methodically developed tutorial may help improve robotic surgical training.
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Affiliation(s)
- Jian Chen
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Paul J Oh
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Nathan Cheng
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Ankeet Shah
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Jeremy Montez
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Anthony Jarc
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Liheng Guo
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Inderbir S Gill
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, University of Southern California, Los Angeles, California; Medical Research, Intuitive Surgical, Inc. (AJ, LG), Norcross, Georgia.
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Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 2018; 122:501-519. [PMID: 29603869 DOI: 10.1111/bju.14219] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. MATERIALS AND METHODS A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. RESULTS Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. CONCLUSION There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present.
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Affiliation(s)
| | - Jason Y Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anthony Costello
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Abstract
PURPOSE OF REVIEW Robot-assisted radical prostatectomy (RARP) has been embraced by urologists and has become a treatment standard in many countries already. Learning how to perform a RARP is challenging and has not yet been standardized. The current review summarizes the latest concepts regarding the most effective way of training for RARP. RECENT FINDINGS The strategy to learn RARP should comprise didactic activities, skills lab training, participating in surgeries and mentorship. Skills lab and virtual simulators are valuable tools to develop manual abilities and to overcome the initial technical learning curve. Participating in surgeries is crucial for familiarization with the robot installation, steps of the surgical procedure and is essential for troubleshooting. Mentorship improves learning and is the safest way to initiate real practice. Innate and individual background variances were suggested to influence the learning process; however, there is paucity of robust evidence correlating previous surgical experience and, for example videogame playing with faster learning of RARP. Structured curricula were proposed to orient the training for robotic surgery; currently, only one is focused exclusively on urology. SUMMARY Systematic training is the most effective way to learn and surpass the possibly intense learning curve of RARP. Training activities should focus on developing cognitive and manual abilities. The existing curricula for robotic surgery training still require constant refinement; however, they offer good and structured guidance to train for RARP.
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Dias RD, Ngo-Howard MC, Boskovski MT, Zenati MA, Yule SJ. Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload. Br J Surg 2018; 105:491-501. [PMID: 29465749 PMCID: PMC5878696 DOI: 10.1002/bjs.10795] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/09/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics. METHODS A search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score. RESULTS Of 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent). CONCLUSION Self-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition.
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Affiliation(s)
- R D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M C Ngo-Howard
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - M T Boskovski
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M A Zenati
- Harvard Medical School, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - S J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Correspondence to: Dr S. J. Yule, STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 10 Vining Street, Boston, Massachusetts 02115, USA (e-mail: ; @RogerDaglius; @BWH_STRATUS)
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Amirabdollahian F, Livatino S, Vahedi B, Gudipati R, Sheen P, Gawrie-Mohan S, Vasdev N. Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature. J Robot Surg 2017; 12:11-25. [PMID: 29196867 DOI: 10.1007/s11701-017-0763-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023]
Abstract
With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.
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Affiliation(s)
| | - Salvatore Livatino
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Behrad Vahedi
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Radhika Gudipati
- School of Computer Science, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Patrick Sheen
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | | | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
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Abstract
PURPOSE OF REVIEW There has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks was conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon. RECENT FINDINGS A structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of basic robotic skills in the dry and wet lab setting along with achievement of individual and team-based non-technical skills, modular console training under supervision, and finally independent practice. Robotic surgical training must be based on demonstration of proficiency and safety in executing basic robotic skills and procedural tasks prior to independent practice.
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Affiliation(s)
- Ashwin N. Sridhar
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Tim P. Briggs
- Department of Urology, University College London Hospital NHS Trust, London, UK
| | - John D. Kelly
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Senthil Nathan
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
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35
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Song PH. Current status of simulation-based training and assessment in urological robot-assisted surgery. Investig Clin Urol 2016; 57:375-376. [PMID: 27847910 PMCID: PMC5109792 DOI: 10.4111/icu.2016.57.6.375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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37
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Affiliation(s)
| | - Declan G. Murphy
- Peter MacCallum Cancer Centre; Melbourne and Australian Prostate Cancer Research Centre; Epworth Healthcare; Richmond Vic. Australia
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38
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Aydin A, Shafi AM, Shamim Khan M, Dasgupta P, Ahmed K. Current Status of Simulation and Training Models in Urological Surgery: A Systematic Review. J Urol 2016; 196:312-20. [DOI: 10.1016/j.juro.2016.01.131] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Ahmed M.A. Shafi
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
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Bruckheimer E, Rotschild C, Dagan T, Amir G, Kaufman A, Gelman S, Birk E. Computer-generated real-time digital holography: first time use in clinical medical imaging. Eur Heart J Cardiovasc Imaging 2016; 17:845-9. [DOI: 10.1093/ehjci/jew087] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/12/2022] Open
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40
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Virtual Reality Simulators for Robot-assisted Surgery. Eur Urol 2015; 69:1081-2. [PMID: 26688370 DOI: 10.1016/j.eururo.2015.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/22/2015] [Indexed: 11/24/2022]
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A Systematic Review of Virtual Reality Simulators for Robot-assisted Surgery. Eur Urol 2015; 69:1065-80. [PMID: 26433570 DOI: 10.1016/j.eururo.2015.09.021] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023]
Abstract
CONTEXT No single large published randomized controlled trial (RCT) has confirmed the efficacy of virtual simulators in the acquisition of skills to the standard required for safe clinical robotic surgery. This remains the main obstacle for the adoption of these virtual simulators in surgical residency curricula. OBJECTIVE To evaluate the level of evidence in published studies on the efficacy of training on virtual simulators for robotic surgery. EVIDENCE ACQUISITION In April 2015 a literature search was conducted on PubMed, Web of Science, Scopus, Cochrane Library, the Clinical Trials Database (US) and the Meta Register of Controlled Trials. All publications were scrutinized for relevance to the review and for assessment of the levels of evidence provided using the classification developed by the Oxford Centre for Evidence-Based Medicine. EVIDENCE SYNTHESIS The publications included in the review consisted of one RCT and 28 cohort studies on validity, and seven RCTs and two cohort studies on skills transfer from virtual simulators to robot-assisted surgery. Simulators were rated good for realism (face validity) and for usefulness as a training tool (content validity). However, the studies included used various simulation training methodologies, limiting the assessment of construct validity. The review confirms the absence of any consensus on which tasks and metrics are the most effective for the da Vinci Skills Simulator and dV-Trainer, the most widely investigated systems. Although there is consensus for the RoSS simulator, this is based on only two studies on construct validity involving four exercises. One study on initial evaluation of an augmented reality module for partial nephrectomy using the dV-Trainer reported high correlation (r=0.8) between in vivo porcine nephrectomy and a virtual renorrhaphy task according to the overall Global Evaluation Assessment of Robotic Surgery (GEARS) score. In one RCT on skills transfer, the experimental group outperformed the control group, with a significant difference in overall GEARS score (p=0.012) during performance of urethrovesical anastomosis on an inanimate model. Only one study included assessment of a surgical procedure on real patients: subjects trained on a virtual simulator outperformed the control group following traditional training. However, besides the small numbers, this study was not randomized. CONCLUSIONS There is an urgent need for a large, well-designed, preferably multicenter RCT to study the efficacy of virtual simulation for acquisition competence in and safe execution of clinical robotic-assisted surgery. PATIENT SUMMARY We reviewed the literature on virtual simulators for robot-assisted surgery. Validity studies used various simulation training methodologies. It is not clear which exercises and metrics are the most effective in distinguishing different levels of experience on the da Vinci robot. There is no reported evidence of skills transfer from simulation to clinical surgery on real patients.
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Guru KA, Shafiei SB, Khan A, Hussein AA, Sharif M, Esfahani ET. Understanding Cognitive Performance During Robot-Assisted Surgery. Urology 2015; 86:751-7. [PMID: 26255037 DOI: 10.1016/j.urology.2015.07.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/26/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand cognitive function of an expert surgeon in various surgical scenarios while performing robot-assisted surgery. MATERIALS AND METHODS In an Internal Review Board approved study, National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire with surgical field notes were simultaneously completed. A wireless electroencephalography (EEG) headset was used to monitor brain activity during all procedures. Three key portions were evaluated: lysis of adhesions, extended lymph node dissection, and urethro-vesical anastomosis (UVA). Cognitive metrics extracted were distraction, mental workload, and mental state. RESULTS In evaluating lysis of adhesions, mental state (EEG) was associated with better performance (NASA-TLX). Utilizing more mental resources resulted in better performance as self-reported. Outcomes of lysis were highly dependent on cognitive function and decision-making skills. In evaluating extended lymph node dissection, there was a negative correlation between distraction level (EEG) and mental demand, physical demand and effort (NASA-TLX). Similar to lysis of adhesion, utilizing more mental resources resulted in better performance (NASA-TLX). Lastly, with UVA, workload (EEG) negatively correlated with mental and temporal demand and was associated with better performance (NASA-TLX). The EEG recorded workload as seen here was a combination of both cognitive performance (finding solution) and motor workload (execution). Majority of workload was contributed by motor workload of an expert surgeon. During UVA, muscle memory and motor skills of expert are keys to completing the UVA. CONCLUSION Cognitive analysis shows that expert surgeons utilized different mental resources based on their need.
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Affiliation(s)
- Khurshid A Guru
- Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY.
| | - Somayeh B Shafiei
- Department of Mechanical and Aerospace Engineering, Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY
| | - Atif Khan
- Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY
| | - Ahmed A Hussein
- Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Cairo, Egypt
| | - Mohamed Sharif
- Department of Urology, Applied Technology Laboratory for Advanced Surgery (ATLAS) Program at Roswell Park Cancer Institute, Buffalo, NY
| | - Ehsan T Esfahani
- Department of Mechanical and Aerospace Engineering, Human in the Loop System Laboratory, University at Buffalo, Buffalo, NY
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Hanzly MI, Al-Tartir T, Raza SJ, Khan A, Durrani MM, Fiorica T, Ginsberg P, Mohler JL, Kuvshinoff B, Guru KA. Simulation-Based Training in Robot-Assisted Surgery: Current Evidence of Value and Potential Trends for the Future. Curr Urol Rep 2015; 16:41. [DOI: 10.1007/s11934-015-0508-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K. Simulation-based training for prostate surgery. BJU Int 2015; 116:665-74. [DOI: 10.1111/bju.12721] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Raheej Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
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