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Balvardi S, Kaneva P, Semsar-Kazerooni K, Vassiliou M, Al Mahroos M, Mueller C, Fiore JF, Schwartzman K, Feldman LS. Effect of video-based self-reflection on intraoperative skills: A pilot randomized controlled trial. Surgery 2024; 175:1021-1028. [PMID: 38154996 DOI: 10.1016/j.surg.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/13/2023] [Accepted: 11/26/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based self-assessment to improve surgical performance of laparoscopic cholecystectomy in trainees. METHODS This parallel pilot randomized controlled trial included general surgery trainees performing supervised laparoscopic cholecystectomy randomized 1:1 to control (traditional intraoperative teaching) or intervention group (traditional teaching plus video-based self-assessment). Operative performance was measured by the attending surgeon blinded to group assignment at the time of surgery using standardized assessment tools (Global Operative Assessment of Laparoscopic Skills and Operative Performance Rating System). The intervention group had access to their video recordings on a web-based platform for review and self-assessment using the same instruments. The primary outcome for the estimation of sample size was the difference in faculty-assessed final operative performance (third submitted case). Feasibility criteria included >85% participation, >85% adherence to case submission and >85% completion of self-assessment. RESULTS Of 37 eligible trainees approached, 32 consented and were randomized (86%). There were 16 in the intervention group, 15 in the control group (55% male, 55% junior trainees), and 1 was excluded for protocol violation. Twenty-four (75%) of participants submitted 3 cases. Thirteen trainees (81%) accessed the platform and completed 26 (63.2%) case self-assessments. Fifty-five trainees per arm will be needed to power a full-scale laparoscopic cholecystectomy with Global Operative Assessment of Laparoscopic Skills and 130 trainees per arm with Operative Performance Rating System as the assessment tool. CONCLUSION This pilot study contributes important data to inform the design of an adequately powered randomized controlled trial of video-based self-assessment to improve trainee performance of laparoscopic cholecystectomy. Although a priori trial feasibility criteria were not achieved, automated video capture and storage could significantly improve adherence in future trials.
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Affiliation(s)
- Saba Balvardi
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Koorosh Semsar-Kazerooni
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melina Vassiliou
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Carmen Mueller
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kevin Schwartzman
- Respiratory Division, Department of Medicine, McGill University and McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. Laparoscopic cholecystectomy critical view of safety (LC-CVS): a multi-national validation study of an objective, procedure-specific assessment using video-based assessment (VBA). Surg Endosc 2024; 38:922-930. [PMID: 37891369 DOI: 10.1007/s00464-023-10479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A novel 6-item objective, procedure-specific assessment for laparoscopic cholecystectomy incorporating the critical view of safety (LC-CVS OPSA) was developed to support trainee formative and summative assessments. The LC-CVS OPSA included two retraction items (fundus and infundibulum retraction) and four CVS items (hepatocystic triangle visualization, gallbladder-liver separation, cystic artery identification, and cystic duct identification). The scoring rubric for retraction consisted of poor (frequently outside of defined range), adequate (minimally outside of defined range) and excellent (consistently inside defined range) and for CVS items were "poor-unsafe", "adequate-safe", or "excellent-safe". METHODS A multi-national consortium of 12 expert LC surgeons applied the OPSA-LC CVS to 35 unique LC videos and one duplicate video. Primary outcome measure was inter-rater reliability as measured by Gwet's AC2, a weighted measure that adjusts for scales with high probability of random agreement. Analysis of the inter-rater reliability was conducted on a collapsed dichotomous scoring rubric of "poor-unsafe" vs. "adequate/excellent-safe". RESULTS Inter-rater reliability was high for all six items ranging from 0.76 (hepatocystic triangle visualization) to 0.86 (cystic duct identification). Intra-rater reliability for the single duplicate video was substantially higher across the six items ranging from 0.91 to 1.00. CONCLUSIONS The novel 6-item OPSA LC CVS demonstrated high inter-rater reliability when tested with a multi-national consortium of LC expert surgeons. This brief instrument focused on safe surgical practice was designed to support the implementation of entrustable professional activities into busy surgical training programs. Instrument use coupled with video-based assessments creates novel datasets with the potential for artificial intelligence development including computer vision to drive assessment automation.
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Affiliation(s)
- Gina Adrales
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Department of Surgery & LapSurgery, Monash University, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- University for Development Studies-School of Medicine and Health Sciences, Tamale Teaching Hospital, Tamales, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Cizmic A, Müller F, Wise PA, Häberle F, Gabel F, Kowalewski KF, Bintintan V, Müller-Stich BP, Nickel F. Telestration with augmented reality improves the performance of the first ten ex vivo porcine laparoscopic cholecystectomies: a randomized controlled study. Surg Endosc 2023; 37:7839-7848. [PMID: 37612445 PMCID: PMC10520207 DOI: 10.1007/s00464-023-10360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The learning curve in minimally invasive surgery (MIS) is steep compared to open surgery. One of the reasons is that training in the operating room in MIS is mainly limited to verbal instructions. The iSurgeon telestration device with augmented reality (AR) enables visual instructions, guidance, and feedback during MIS. This study aims to compare the effects of the iSurgeon on the training of novices performing repeated laparoscopic cholecystectomy (LC) on a porcine liver compared to traditional verbal instruction methods. METHODS Forty medical students were randomized into the iSurgeon and the control group. The iSurgeon group performed 10 LCs receiving interactive visual guidance. The control group performed 10 LCs receiving conventional verbal guidance. The performance assessment using Objective Structured Assessments of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores, the total operating time, and complications were compared between the two groups. RESULTS The iSurgeon group performed LCs significantly better (global GOALS 17.3 ± 2.6 vs. 16 ± 2.6, p ≤ 0.001, LC specific GOALS 7 ± 2 vs. 5.9 ± 2.1, p ≤ 0.001, global OSATS 25.3 ± 4.3 vs. 23.5 ± 3.9, p ≤ 0.001, LC specific OSATS scores 50.8 ± 11.1 vs. 41.2 ± 9.4, p ≤ 0.001) compared to the control group. The iSurgeon group had significantly fewer intraoperative complications in total (2.7 ± 2.0 vs. 3.6 ± 2.0, p ≤ 0.001) than the control group. There was no difference in operating time (79.6 ± 25.7 vs. 84.5 ± 33.2 min, p = 0.087). CONCLUSION Visual guidance using the telestration device with AR, iSurgeon, improves performance and lowers the complication rates in LCs in novices compared to conventional verbal expert guidance.
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Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Felix Müller
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Philipp A Wise
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Frida Häberle
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Felix Gabel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Vasile Bintintan
- Department of Surgery, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Clarunis - University Center for Gastrointestinal and Liver Diseases, St. Claraspital AG, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Rouhi AD, Roberson JL, Kindall E, Ghanem YK, Ndong A, Yi WS, Williams NN, Dumon KR. What are trainees watching? Assessing the educational quality of online laparoscopic cholecystectomy training videos using the LAP-VEGaS guidelines. Surgery 2023; 174:524-528. [PMID: 37357097 DOI: 10.1016/j.surg.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the most common laparoscopic procedure performed in the US and a key component of general surgery training. Surgical trainees frequently access YouTube for educational walkthroughs of surgical procedures. This study aims to evaluate the educational quality of YouTube video walkthroughs on laparoscopic cholecystectomy by using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool. METHODS A YouTube search was conducted using "laparoscopic cholecystectomy." Results were sorted by relevance, and the top 100 videos were gathered. Videos with patient education or concomitant procedures were excluded. Included videos were categorized as Physician (produced by an individual physician), Academic (produced by a university or medical school), Commercial (produced by a surgical company), and Society (produced by a professional surgical society) and were rated by 3 investigators using the LAP-VEGaS video assessment tool (0-18). RESULTS In all, 33 videos met the selection criteria. The average LAP-VEGaS score was 7.96 ± 3.95, and inter-rater reliability was .86. Academic videos demonstrated a significantly higher mean LAP-VEGaS score than Commercial (10.69 ± 3.54 vs 5.25 ± 2.38, P = .033). Most academic videos failed to provide formal case presentations (63%), patient positioning (50%), intraoperative findings (50%), graphic aids (63%), and operative time (75%). CONCLUSION This is the first study to evaluate the quality of YouTube video walkthroughs on LC using the LAP-VEGaS tool. Despite demonstrating higher LAP-VEGaS scores than other categories, video walkthroughs provided by academic institutions still lack several essential educational criteria for this procedure, highlighting areas of improvement for educators.
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Affiliation(s)
- Armaun D Rouhi
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. http://www.twitter.com/Armaun_Rouhi
| | - Jeffrey L Roberson
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. http://www.twitter.com/JLRobersonMD
| | - Emily Kindall
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. http://www.twitter.com/emilykindall
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Abdourahmane Ndong
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Saint-Louis, Senegal. http://www.twitter.com/DrNdong
| | - William S Yi
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Noel N Williams
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kristoffel R Dumon
- Division of Surgical Education, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Borie F, Sabbagh C, Fabre JM, Fuchshuber P, Gravié JF, Gugenheim J, Asbun H. SAGES SAFE CHOLE program changes surgeons practice in France-results of the FCVD implementation of SAFE CHOLE in France. Surg Endosc 2023; 37:6483-6490. [PMID: 37253869 DOI: 10.1007/s00464-023-10128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND With the Society of Gastrointestinal and Endoscopic Surgeons supervision, the Safe Cholecystectomy Task Force (SAFE CHOLE) was translated into French by the the Federation of Visceral and Digestive Surgery (FCVD) and adopted to run on its national e-learning platform for surgical continuing medical education (CME). The objective of this study was to assess the impact of the SAFE CHOLE (SF) program on the knowledge and practice of French surgeons performing cholecystectomy and participating in the FCVD lead CME activity. METHODS To obtain CME certification, each participant must fill out three FCVD validated questionnaires regarding (1) the participants' routine practice for cholecystectomy, (2) the participants' knowledge and practice after successful completion of the program, and (3) the educational value of the SC program. RESULTS From 2021 to 2022, 481 surgeons completed the program. The overall satisfaction rate for the program was 81%, and 53% of the surgeons were practicing routine cholangiography before the SC program. Eighty percent declared having acquired new knowledge. Fifty-six percent reported a change in their practice of cholecystectomy. Of those, 46% started routinely using the critical view of safety, 12% used a time-out prior transection of vital structures, and 11% adopted routine intraoperative cholangiography. Sixty-seven percent reported performing a sub-total cholecystectomy in case the CVS was unobtainable. If faced with BDI, 45% would transfer to a higher level of care, 33% would seek help from a colleague, and 10% would proceed with a repair. Ninety percent recommended adoption of SC by all general surgeons and 98% reported improvement of patient safety. CONCLUSIONS Large-scale implementation of the SC program in France is feasible within a broad group of diverse specialty surgeons and appears to have a significant impact on their practice. These data should encourage other surgeons and health systems to engage in this program.
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Affiliation(s)
- Frederic Borie
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France.
- Research Unit INSERM University of Montpellier, IDESP Institute Desbrest of Epidemiology and Public Health, Montpellier, France.
| | - Charles Sabbagh
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Jean-Michel Fabre
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | | | - Jean-François Gravié
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Jean Gugenheim
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Horacio Asbun
- Baptist Health Miami Cancer Institute, Miami, FL, USA
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Humm G, Peckham-Cooper A, Hamade A, Wood C, Dawas K, Stoyanov D, Lovat LB. Automated analysis of intraoperative phase in laparoscopic cholecystectomy: A comparison of one attending surgeon and their residents. J Surg Educ 2023; 80:994-1004. [PMID: 37164903 PMCID: PMC10664073 DOI: 10.1016/j.jsurg.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/12/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study compares the intraoperative phase times in laparoscopic cholecystectomy performed by an attending surgeon and supervised residents over 10-years to assess operative times as a marker of performance and any impact of case severity on times. DESIGN Laparoscopic cholecystectomy videos were uploaded to Touch Surgery™ Enterprise, a combined software and hardware solution for securely recording, storing, and analysing surgical videos, which provide analytics of intraoperative phase times. Case severity and visualisation of the critical view of safety (CVS) were manually assessed using modified 10-point intraoperative gallbladder scoring system (mG10) and CVS scores, respectively. Attending and residents' times were compared unmatched and matched by mG10. SETTING Secondary analysis of anonymized laparoscopic cholecystectomy video, recorded as standard of care. PARTICIPANTS Adult patients who underwent elective laparoscopic cholecystectomy a single UK hospital. Cases were performed by one attending and their residents. RESULTS 159 (attending=96, resident=63) laparoscopic cholecystectomy videos and intraoperative phase times were reviewed on Touch Surgery™ Enterprise and analyzed. Attending cases were more challenging (p=0.037). Residents achieved higher CVS scores (p=0.034) and showed longer dissection of hepatocystic triangle (HCT) times (p=0.012) in more challenging cases. Residents' total operative time (p=0.001) and dissection of HCT (p=0.002) times exceeded the attending's in low-severity matched cases (mG10=1). Residents' total operative times (p<0.001), port insertion/gallbladder exposure (p=0.032), and dissection of HCT (p<0.001) exceeded the attending's in matched cases (mG10=2). Residents' total operative (p<0.001), dissection of HCT (p<0.001), and gallbladder dissection (p=0.010) times exceeded the attendings in unmatched cases. CONCLUSIONS Residents' total operative and dissection of HCT times significantly exceeded the attending's unmatched cases and low-severity matched cases which could suggest training need, however, also reflects an expected assessment of competence, and validates time as a marker of performance.
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Affiliation(s)
- Gemma Humm
- Wellcome/ Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom; UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Adam Peckham-Cooper
- Leeds Institute of Emergency General Surgery, St James University Hospital, Leeds, United Kingdom
| | - Ayman Hamade
- Department of General and Colorectal Surgery. East Kent University Hospitals NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, United Kingdom
| | - Christopher Wood
- UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Khaled Dawas
- UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Danail Stoyanov
- Wellcome/ Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Laurence B Lovat
- Wellcome/ Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom; UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Wu S, Chen Z, Liu R, Li A, Cao Y, Wei A, Liu Q, Liu J, Wang Y, Jiang J, Ying Z, An J, Peng B, Wang X. SurgSmart: an artificial intelligent system for quality control in laparoscopic cholecystectomy: an observational study. Int J Surg 2023; 109:1105-1114. [PMID: 37039533 PMCID: PMC10389595 DOI: 10.1097/js9.0000000000000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The rate of bile duct injury in laparoscopic cholecystectomy (LC) continues to be high due to low critical view of safety (CVS) achievement and the absence of an effective quality control system. The development of an intelligent system enables the automatic quality control of LC surgery and, eventually, the mitigation of bile duct injury. This study aims to develop an intelligent surgical quality control system for LC and using the system to evaluate LC videos and investigate factors associated with CVS achievement. MATERIALS AND METHODS SurgSmart, an intelligent system capable of recognizing surgical phases, disease severity, critical division action, and CVS automatically, was developed using training datasets. SurgSmart was also applied in another multicenter dataset to validate its application and investigate factors associated with CVS achievement. RESULTS SurgSmart performed well in all models, with the critical division action model achieving the highest overall accuracy (98.49%), followed by the disease severity model (95.45%) and surgical phases model (88.61%). CVSI, CVSII, and CVSIII had an accuracy of 80.64, 97.62, and 78.87%, respectively. CVS was achieved in 4.33% in the system application dataset. In addition, the analysis indicated that surgeons at a higher hospital level had a higher CVS achievement rate. However, there was still considerable variation in CVS achievement among surgeons in the same hospital. CONCLUSIONS SurgSmart, the surgical quality control system, performed admirably in our study. In addition, the system's initial application demonstrated its broad potential for use in surgical quality control.
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Affiliation(s)
- Shangdi Wu
- Division of Pancreatic Surgery, Department of General Surgery
- West China School of Medicine
| | - Zixin Chen
- Division of Pancreatic Surgery, Department of General Surgery
- West China School of Medicine
| | - Runwen Liu
- ChengDu Withai Innovations Technology Company
| | - Ang Li
- Division of Pancreatic Surgery, Department of General Surgery
- Guang’an People’s Hospital, Guang’an, Sichuan Province, China
| | - Yu Cao
- Operating Room
- West China School of Nursing, Sichuan University
| | - Ailin Wei
- Guang’an People’s Hospital, Guang’an, Sichuan Province, China
| | | | - Jie Liu
- ChengDu Withai Innovations Technology Company
| | - Yuxian Wang
- ChengDu Withai Innovations Technology Company
| | - Jingwen Jiang
- West China Biomedical Big Data Center, West China Hospital of Sichuan University
- Med-X Center for Informatics, Sichuan University, Chengdu
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital of Sichuan University
- Med-X Center for Informatics, Sichuan University, Chengdu
| | - Jingjing An
- Operating Room
- West China School of Nursing, Sichuan University
| | - Bing Peng
- Division of Pancreatic Surgery, Department of General Surgery
- West China School of Medicine
| | - Xin Wang
- Division of Pancreatic Surgery, Department of General Surgery
- West China School of Medicine
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Felinska EA, Fuchs TE, Kogkas A, Chen ZW, Otto B, Kowalewski KF, Petersen J, Müller-Stich BP, Mylonas G, Nickel F. Telestration with augmented reality improves surgical performance through gaze guidance. Surg Endosc 2023; 37:3557-3566. [PMID: 36609924 PMCID: PMC10156835 DOI: 10.1007/s00464-022-09859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In minimally invasive surgery (MIS), trainees need to learn how to interpret the operative field displayed on the laparoscopic screen. Experts currently guide trainees mainly verbally during laparoscopic procedures. A newly developed telestration system with augmented reality (iSurgeon) allows the instructor to display hand gestures in real-time on the laparoscopic screen in augmented reality to provide visual expert guidance (telestration). This study analysed the effect of telestration guided instructions on gaze behaviour during MIS training. METHODS In a randomized-controlled crossover study, 40 MIS naive medical students performed 8 laparoscopic tasks with telestration or with verbal instructions only. Pupil Core eye-tracking glasses were used to capture the instructor's and trainees' gazes. Gaze behaviour measures for tasks 1-7 were gaze latency, gaze convergence and collaborative gaze convergence. Performance measures included the number of errors in tasks 1-7 and trainee's ratings in structured and standardized performance scores in task 8 (ex vivo porcine laparoscopic cholecystectomy). RESULTS There was a significant improvement 1-7 on gaze latency [F(1,39) = 762.5, p < 0.01, ηp2 = 0.95], gaze convergence [F(1,39) = 482.8, p < 0.01, ηp2 = 0.93] and collaborative gaze convergence [F(1,39) = 408.4, p < 0.01, ηp2 = 0.91] upon instruction with iSurgeon. The number of errors was significantly lower in tasks 1-7 (0.18 ± 0.56 vs. 1.94 ± 1.80, p < 0.01) and the score ratings for laparoscopic cholecystectomy were significantly higher with telestration (global OSATS: 29 ± 2.5 vs. 25 ± 5.5, p < 0.01; task-specific OSATS: 60 ± 3 vs. 50 ± 6, p < 0.01). CONCLUSIONS Telestration with augmented reality successfully improved surgical performance. The trainee's gaze behaviour was improved by reducing the time from instruction to fixation on targets and leading to a higher convergence of the instructor's and the trainee's gazes. Also, the convergence of trainee's gaze and target areas increased with telestration. This confirms augmented reality-based telestration works by means of gaze guidance in MIS and could be used to improve training outcomes.
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Affiliation(s)
- Eleni Amelia Felinska
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Thomas Ewald Fuchs
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Alexandros Kogkas
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Zi-Wei Chen
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Benjamin Otto
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Jens Petersen
- Department of Medical Image Computing, German Cancer Research Center, 69120, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - George Mylonas
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany.
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Kojima Y, Wong HJ, Kuchta K, Denham W, Haggerty S, Linn J, Ujiki M. Resident performance in simulation module is associated with operating room performance for laparoscopic cholecystectomy. Surg Endosc 2022; 36:9273-9280. [PMID: 35312848 DOI: 10.1007/s00464-022-09152-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Simulation is an important tool in surgical training. However, the transferability of skills obtained in the simulation setting to the operating room (OR) is uncertain. This study explores the association between resident simulation performance and OR performance in a laparoscopic cholecystectomy (LC) simulation module. METHODS A simulation module focused on LC utilizing a virtual reality simulator was completed by general surgery residents. Simulation performance was evaluated using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Technical Skills (OSATS), as well as a LC-specific simulation assessment form (LC-SIM). Resident subsequent OR performances of LC were measured by the Surgical Training and Assessment Tool (STAT), an online mobile-based evaluation completed by attending surgeons. RESULTS Twenty-one residents who completed the simulation module and also with STAT data on LC from 2016 to 2020 were included. Higher scores on incision/port placement on LC-SIM is associated with better tissue handling (coefficient 0.20, p = 0.048) and better time & economy of motion on STAT (coefficient 0.22, p = 0.037). However, higher scores on time and motion on OSATS are associated with worse tissue handling (- 0.28, p = 0.046), worse time & economy of motion (- 0.37, p = 0.009), and worse overall grade (- 0.21, p = 0.044). Higher scores on overall performance on OSATS is associated with worse time & economy of motion (- 0.80, p = 0.008). Higher scores on depth perception on GOALS are associated with worse tissue handling (- 0.28, p = 0.044). CONCLUSION We found significant positive and negative associations between resident simulation performance and OR performance, particularly in tissue handling and economy of motion. This could suggest that simulation performance does not reliably predict OR performance. However, this could highlight the concept of excessive caution in the real OR environment and longer operative time which could be interpreted as worse time and economy of motion by the attending surgeons.
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Affiliation(s)
- Yohei Kojima
- Department of Surgery, Kyorin University, Tokyo, Japan
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Harry J Wong
- Department of Surgery, Kyorin University, Tokyo, Japan.
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Stephen Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - John Linn
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Michael Ujiki
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
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Wild C, Lang F, Gerhäuser AS, Schmidt MW, Kowalewski KF, Petersen J, Kenngott HG, Müller-Stich BP, Nickel F. Telestration with augmented reality for visual presentation of intraoperative target structures in minimally invasive surgery: a randomized controlled study. Surg Endosc 2022; 36:7453-7461. [PMID: 35266048 PMCID: PMC9485092 DOI: 10.1007/s00464-022-09158-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
AIMS In minimally invasive surgery (MIS), intraoperative guidance has been limited to verbal communication without direct visual guidance. Communication issues and mistaken instructions in training procedures can hinder correct identification of anatomical structures on the MIS screen. The iSurgeon system was developed to provide visual guidance in the operating room by telestration with augmented reality (AR). METHODS Laparoscopic novices (n = 60) were randomized in two groups in a cross-over design: group 1 trained only with verbal guidance first and then with additional telestration with AR on the operative screen and vice versa for group 2. Training consisted of laparoscopic basic training and subsequently a specifically designed training course, including a porcine laparoscopic cholecystectomy (LC). Outcome included time needed for training, performance with Global Operative Assessment of Laparoscopic Skills (GOALS), and Objective Structured Assessment of Technical Skills (OSATS) score for LC, complications, and subjective workload (NASA-TLX questionnaire). RESULTS Telestration with AR led to significantly faster total training time (1163 ± 275 vs. 1658 ± 375 s, p < 0.001) and reduced error rates. LC on a porcine liver was performed significantly better (GOALS 21 ± 5 vs. 18 ± 4, p < 0.007 and OSATS 67 ± 11 vs. 61 ± 8, p < 0.015) and with less complications (13.3% vs. 40%, p < 0.020) with AR. Subjective workload and stress were significantly reduced during training with AR (33.6 ± 12.0 vs. 30.6 ± 12.9, p < 0.022). CONCLUSION Telestration with AR improves training success and safety in MIS. The next step will be the clinical application of telestration with AR and the development of a mobile version for remote guidance.
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Affiliation(s)
- C Wild
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - F Lang
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - A S Gerhäuser
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - M W Schmidt
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - K F Kowalewski
- Department of Urology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - J Petersen
- German Cancer Research Center, 69120, Heidelberg, Germany
| | - H G Kenngott
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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11
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Kojima Y, Wong HJ, Kuchta K, Linn JG, Haggerty SP, Denham W, Ujiki MB. Subjective vs. objective assessment of simulation performance on laparoscopic cholecystectomy: are we evaluating the right things? Surg Endosc 2022; 36:6661-6671. [PMID: 35106638 DOI: 10.1007/s00464-021-08936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Simulation using virtual reality (VR) simulators is an important tool in surgical training. VR laparoscopic simulators can provide immediate objective performance assessment without observer evaluation. This study aims to explore the correlation between subjective observer evaluation and VR laparoscopic simulator performance metrics in a laparoscopic cholecystectomy (LC) simulation module. METHODS A LC simulation module using a VR laparoscopic simulator was completed by PGY2-3 general surgery residents at a single institution. Simulation performance was recorded and evaluated by a trained evaluator using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) form, the Objective Structured Assessment of Technical Skills (OSATS) form, and a LC-specific simulation assessment form (LC-SIM). Objective performance metrics were also obtained from the simulator system. Performance before the curriculum (pre-test) and after the curriculum (post-test) were compared. RESULTS Fourteen residents were included in the study. There were significant improvements from pre-test to post-test on each component of GOALS, OSATS, and LC-SIM scores (all p values < 0.05). In terms of objective simulator metrics, significant improvements were noted in time to extract gallbladder (481 ± 221 vs 909 ± 366 min, p = 0.019), total number of movements (475 ± 264 vs 839 ± 324 min, p = 0.012), and total path length (955 ± 475 vs 1775 ± 632 cm, p = 0.012) from pre-test to post-test. While number of movements and total path lengths of both hands decreased, speed of right instrument also decreased from 4.1 + 2.7 to 3.0 ± 0.7 cm/sec (p = 0.007). Average speed of left instrument was associated with respect for tissue (r = 0.60, p < 0.05) and depth perception (r = 0.68, p < 0.05) on post-test evaluations. CONCLUSION Our study demonstrated significant improvement in technical skills based on subjective evaluator assessment as well as objective simulator metrics after simulation. The few correlations identified between the subjective evaluator and the objective simulator assessments suggest the two evaluation modalities were measuring different aspects of the technical skills and should both be considered in the evaluation process.
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Affiliation(s)
- Yohei Kojima
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, Kyorin University, Tokyo, Japan
| | - Harry J Wong
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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12
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Cheung KT, An V, Sorensen JC, Lin OM, Lie E, Mercier LL, Marguccio SA, Gumulia EN, Goonawardena J, Chan LH, Wong E. Elective Laparoscopic Cholecystectomy as an Entrustable Professional Activity (EPA) for General Surgical Trainees in Australia. J Surg Educ 2022; 79:655-660. [PMID: 35123911 DOI: 10.1016/j.jsurg.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To evaluate the operation time and surgical outcomes of elective laparoscopic cholecystectomy performed by surgical trainees at different levels of training at Eastern health and hence, to establish the efficacy and safety of elective laparoscopic cholecystectomy as an Entrustable Professional Activity for surgical trainees in general surgery. OBJECTIVE Elective laparoscopic cholecystectomies performed at our institution between January 2018 and January 2019 were included. Analyses were divided among three groups - consultants (C), fellows (F) and registrars (R). Standard technique with critical view of safety was used. RESULTS A total of 592 patients was included, with a mean age of 54 ± 63 years old. The average operation time was 84 ± 51 minutes. Surgical education and training (SET) 2 trainees took significantly longer when compared to their SET3 and above counterparts as a primary operator (SET2: 131 ± 32 min, Reference; SET3: 78 ± 21 min, p = 0.003; SET4: 80 ± 33 min, p = 0.004; SET5: 77 ± 28 min, p = 0.003; F: 93 ± 77 min, p = 0.036; C: 85 ± 59 min; p = 0.007). Consultant primary operators took an average of 15 minutes longer to complete the operation when assisted by a SET trainee compared to the non-SET registrars (p = 0.03). The overall complication rate was 3.2% and was not significantly different among all three groups (p = 0.17). No death was recorded during the study period. The readmission and return to theatre rates were 7.8% and 0.8% respectively and were not significantly different among the groups (p-values = 0.61 and 0.69). All conversion to open were performed by the consultant primary operator. CONCLUSIONS Elective laparoscopic cholecystectomy can be safely performed by surgical trainees at all SET levels when under appropriate supervision, although junior surgical trainees that is SET 2 took longer to complete the procedure. This operation seems to have a steep, but relatively short, learning curve and it may be broken down into various components. These components, with the addition of time, may be suitable as an Entrustable Professional Activity tool for assessing the competency of early SET trainees.
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Affiliation(s)
- King Tung Cheung
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia.
| | - Vinna An
- Department of Colorectal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - James C Sorensen
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Olivia Miki Lin
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Elisa Lie
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Laura Le Mercier
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | | | | | - Janindu Goonawardena
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Lok Hang Chan
- Department of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Enoch Wong
- Department of Upper Gastrointestinal Surgery, Box Hill Hospital, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
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13
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Affiliation(s)
- James J Jung
- From the Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA
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14
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Karic B, Moino V, Nolin A, Andrews A, Brisson P. Evaluation of surgical educational videos available for third year medical students. Med Educ Online 2020; 25:1714197. [PMID: 31920174 PMCID: PMC6968551 DOI: 10.1080/10872981.2020.1714197] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/04/2019] [Accepted: 12/30/2019] [Indexed: 06/09/2023]
Abstract
Objectives: In this study we evaluated 40, top recommended, laparoscopic appendectomy and laparoscopic cholecystectomy videos located on public domain websites using eight criteria created by a panel of third year medical students and general surgeons. We hypothesized that there is a lack of quality, thorough educational laparoscopic surgical videos appropriate for third year medical students to review in preparation for the Surgery rotation.Methods: Utilizing a panel, which included four third year medical students and two general surgeons, we created an 'ideal medical student educational video checklist.' This checklist included 8 vital criteria. We selected 40, top recommended, videos available on YouTube and Google Video search engines, using 'laparoscopic cholecystectomy' and 'laparoscopic appendectomy' as key terms. Each video was evaluated by four third year medical students individually, using a binary system 'meets' or 'does not meet' each criterion. Individual scores were averaged, producing a single score for each video.Results: 0/40 (0%) of the videos met all eight of the criteria. 26/40 (65%) of the videos did not meet half of the criteria. The top performing videos 7/40 (17%) only met 5/8 criteria. Conclusions: We identified a lack of quality and thorough educational surgical videos appropriate for third year medical students and a need for improved online video based instruction. Our checklist can be utilized as a guide for anyone creating surgical videos for medical student education in the future.
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Affiliation(s)
- Berina Karic
- Department of Surgery, Edward Via College of Osteopathic Medicine, Auburn, AL, USA
| | - Veronica Moino
- Department of Surgery, Edward Via College of Osteopathic Medicine, Auburn, AL, USA
| | - Andrew Nolin
- Department of Surgery, Edward Via College of Osteopathic Medicine, Auburn, AL, USA
| | - Ashley Andrews
- Department of Surgery, Edward Via College of Osteopathic Medicine, Auburn, AL, USA
| | - Paul Brisson
- Department of Surgery, Edward Via College of Osteopathic Medicine, Auburn, AL, USA
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Abstract
Introduction Due to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence-based learning technique of surgical skills is the sub-step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi-center trial was to determine the status quo of the sub-step concept in Germany. Methods Over 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus-preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub-steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub-step concept was performed before and after the study. Results In total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub-steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub-steps (43.3%). Reasons for not assisting sub-steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub-steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub-step concept. The number of resident procedures was overestimated, and the number of performed sub-steps was underestimated. After the study, these estimations were more realistic. Conclusion Even though the sub-step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed. Electronic supplementary material The online version of this article (10.1007/s00268-020-05539-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Huber
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany.
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - I Richardsen
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - C Klinger
- German Society for General and Visceral Surgery (DGAV), Berlin, Germany
| | - M Mille
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - A A Roeth
- Young Surgeons Working Group (CAJC) of the German Society for General and Visceral Surgery (DGAV), Berlin, Germany
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Isreb S, Attwood S, Hesselgreaves H, McLachlan J, Illing J. The Development of an Online Standalone Cognitive Hazard Training for Laparoscopic Cholecystectomy: A Feasibility Study. J Surg Educ 2020; 77:1-8. [PMID: 31558427 DOI: 10.1016/j.jsurg.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In the UK, surgical training is under pressure due to reductions in training time and training opportunities, which pose patient safety risks. Cognitive, nontechnical, training has been suggested as a possible solution inspired by the identified benefits in aviation industry. A recent review article highlighted the need for such training despite its high cost and the need for expert trainers. AIM This study aimed to design and test the feasibility of an online standalone module to address the current gap in cognitive surgical training. METHOD An online standalone, Cognitive Hazard Training module for laparoscopic cholecystectomy was created. It combined multiple choice questions, extended matching items, and single-line free text questions. It contained relevant sketch images and real life hazards video clips, highlighting potential mistakes to enhance: Safety knowledge, reduce bias, and improve self-limitation awareness. Two experts were invited to validate the prototype before testing its feasibility in one English Deanery training environment. RESULTS In total 93 candidates signed up to review the training. However only 47 (50%) later participated and 33 completed the Module. Those included 3 juniors, 20 higher trainees, and 10 consultants. Candidates' answers were quantitatively analysed. Qualitative feedback was also collected from 27 candidates, via semi-structured interviews. The overall feedback from the feasibility study was positive. Results supported this online resource value in enhancing knowledge and awareness. Interview data also suggested the module's potential to change trainees' practice by being more cautious and adhering to the safety steps of dissection. DISCUSSION This new training module overcomes some of the previously reported problems in surgical cognitive training. It is a stand-alone online resource with low running cost and does not require expert trainers. The feasibility study supported the aim to enhance hazard awareness and create an attitude shift towards adherence to safety steps during the procedure.
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Affiliation(s)
- Siddek Isreb
- Durham University, Department of Health Services Research, Durham, United kingdom.
| | - Stephen Attwood
- Durham University, Department of Health Services Research, Durham, United kingdom
| | - Hannah Hesselgreaves
- Northumbria University, Newcastle Business School, Newcastle upon Tyne, United Kingdom
| | - John McLachlan
- University of Central Lancashire, Preston, United Kingdom
| | - Jan Illing
- Newcastle University, Newcastle upon Tyne, United Kingdom
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Dedhia PH, Barrett M, Ives G, Magas CP, Varban OA, Wong SL, Sandhu G. Intraoperative Feedback: A Video-BasedAnalysis of Faculty and Resident Perceptions. J Surg Educ 2019; 76:906-915. [PMID: 30826263 DOI: 10.1016/j.jsurg.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Residents and faculty identify intraoperative feedback as a critical component of surgical education. Studies have demonstrated that residents perceive lower quality and frequency of intraoperative feedback compared to faculty. These differences in perception may be due to dissimilar identification of feedback. The purpose of this study was to determine if residents and faculty differently identify intraoperative interactions as feedback. DESIGN Residents and faculty viewed a segment of a laparoscopic cholecystectomy video and then timestamped the video where they perceived moments of intraoperative feedback. Validated surveys on timing, amount, specificity, and satisfaction with operative feedback were administered. SETTING Viewing of the video and survey administration was conducted at the University of Michigan. PARTICIPANTS A total of 23 of 41 residents (56%) and 29 of 33 faculty (88%) participated in this study. RESULTS Survey analysis demonstrated that residents perceived operative feedback to occur with less immediacy, specificity, and frequency compared to faculty. During the 10-minute video, residents and faculty identified feedback 21 and 29 times, respectively (p = 0.13). Ten-second interval analysis demonstrated 7 statistically significant intervals (p < 0.05) where residents identified feedback less frequently than faculty. Analysis of these 7 intervals revealed that faculty were more likely to identify interactions, especially nonverbal ones, as feedback. Review of free-text comments confirmed these findings and suggested that residents may be more receptive to feedback at the conclusion of the case. CONCLUSIONS Using video review, we show that residents and faculty identify different intraoperative interactions as feedback. This disparity in identification of feedback may limit resident satisfaction and effective intraoperative learning. Timing and labeling of feedback, continued use of video review, and structured teaching models may overcome these differences and improve surgical education.
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Affiliation(s)
- Priya H Dedhia
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Graham Ives
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
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18
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Melmer PD, Chaconas C, Taylor R, Verrico E, Cockcroft A, Pinnola A, Holmes S, Sciarretta JD, Davis JM. Impact of Laparoscopy on Training: Are Open Appendectomy and Cholecystectomy on the Brink of Extinction? Am Surg 2019; 85:761-763. [PMID: 31405424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi-postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.
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19
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Gawad N, Fowler A, Mimeault R, Raiche I. The Inter-Rater Reliability of Technical Skills Assessment and Retention of Rater Training. J Surg Educ 2019; 76:1088-1093. [PMID: 30709756 DOI: 10.1016/j.jsurg.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/02/2018] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The inter-rater reliability (IRR) of laparoscopic skills assessment is usually determined in the context of motivated raters from a single subspecialty practice group with significant experience using similar tools. The purpose of this study was to determine the IRR among attending surgeons of different experience and practices, the extent of rater training that is necessary to achieve good IRR, and if rater training is retained over periods of nonuse. METHODS In Part 1, 5 surgeons of different practice backgrounds assessed 3 laparoscopic cholecystectomy videos using the Global Operative Assessment of Laparoscopic Skills instrument. In Part 2, 2 of the surgeons assessed a total of 33 videos over 5 scoring sessions distributed across 6 months. They participated in 2 different training sessions, and retention was tested in the other 3 sessions. IRR was calculated for Parts 1 and 2 with an intraclass correlation (ICC) in a 2-way random-effects model. RESULTS The ICC for Part 1 was poor (ICC = 0.26). In Part 2, the ICC was highest after each training session (scoring #1 ICC = 0.76, scoring #3 ICC = 0.74). The ICC was not retained 1.5 months after the brief video-based training session (scoring #2 ICC = -0.17). The ICC was retained 2.5 months after the in-depth discussion training session (scoring #4 ICC = 0.70), but not 4.5 months later (scoring #5 ICC = 0.04). CONCLUSIONS Good IRR is not implicit among surgeons with varying backgrounds and experience. Good IRR can be achieved with different types of rater training, but the impact of rater training is lost in periods of nonuse. This suggests the need for further study of the IRR of technical skills assessment when performed by the wide variety of surgeon raters as is commonly encountered in the environment of postgraduate resident assessment.
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Affiliation(s)
- Nada Gawad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, Ontario, Canada.
| | - Amanda Fowler
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, Ontario, Canada.
| | - Richard Mimeault
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabelle Raiche
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, Ontario, Canada
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Binkley J, Bukoski AD, Doty J, Crane M, Barnes SL, Quick JA. Surgical Simulation: Markers of Proficiency. J Surg Educ 2019; 76:234-241. [PMID: 29983346 DOI: 10.1016/j.jsurg.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Surgical simulation has become an integral component of surgical training. Simulation proficiency determination has been traditionally based upon time to completion of various simulated tasks. We aimed to determine objective markers of proficiency in surgical simulation by comparing novel assessments with conventional evaluations of technical skill. DESIGN Categorical general surgery residents completed 10 laparoscopic cholecystectomy modules using a high-fidelity simulator. We recorded and analyzed simulation task times, as well as number of hand movements, instrument path length, instrument acceleration, and participant affective engagement during each simulation. Comparisons were made to Objective Structured Assessment of Technical Skill (OSATS) and Accreditation Council for Graduate Medical Education Milestones, as well as previous laparoscopic experience, duration of laparoscopic cholecystectomies performed by participants, and postgraduate year. Comparisons were also made to Fundamentals of Laparoscopic Surgery task times. Spearman's rho was utilized for comparisons, significance set at >0.50. SETTING University of Missouri, Columbia, Missouri, an academic tertiary care facility. PARTICIPANTS Fourteen categorical general surgery residents (postgraduate year 1-5) were prospectively enrolled. RESULTS One hundred forty simulations were included. The number of hand movements and instrument path lengths strongly correlated with simulation task times (ρ 0.62-0.87, p < 0.0001), FLS task completion times (ρ 0.50-0.53, p < 0.0001), and prior real-world laparoscopic cholecystectomy experience (ρ -0.51 to -0.53, p < 0.0001). No significant correlations were identified between any of the studied markers with Accreditation Council for Graduate Medical Education Milestones, Objective Structured Assessment of Technical Skill evaluations, total previous laparoscopic experience, or postgraduate year level. Neither instrument acceleration nor participant engagement showed significant correlation with any of the conventional markers of real-world or simulation skill proficiency. CONCLUSIONS Simulation proficiency, measured by instrument and hand motion, is more representative of simulation skill than simulation task time, instrument acceleration, or participant engagement.
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Affiliation(s)
- Jana Binkley
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Alex D Bukoski
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Jennifer Doty
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Megan Crane
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Stephen L Barnes
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, Missouri.
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Amado L, Salinas SA, Pimentel A. Proposal for a New Training Exercise for Single Port Laparoscopic Cholecystectomy. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1644-1647. [PMID: 30440709 DOI: 10.1109/embc.2018.8512647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents the design and implementation of a new training exercise to improve technical textbfskills in the surgeons who performtextbf Single Port Laparoscopic Cholecystectomy (SPLC), a technique that requires active improvements to overcome the lack of triangulation and collision of instruments both within and outside the abdominal cavity. The proposed mechanisms were developed based on peg transfer tests, performed by an expert surgeon in SPLC, with straight forceps and SILS$^{\mathbf {TM}}$ access in a pelvictrainer afterwards an unstructured interview was showed to the surgeon. These methodological tools provided the characteristics of the type of movement required by the peg transfer test at the time of performing the training task, which was taken as a reference to propose a new protocol to be implemented. The mentioned structure was tested by an expert surgeon, who performed 5 tasks, within an average running time of 170 seconds. At the end of the tests, a semi-structured interview was carried out again to the surgeon, where the improvement of the technique was tested.
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Carr BD, Matusko N, Sandhu G, Varban OA. Cut or Do Not Cut? Assessing Perceptions of Safety During Laparoscopic Cholecystectomy Using Surgical Videos. J Surg Educ 2018; 75:1583-1588. [PMID: 29929815 DOI: 10.1016/j.jsurg.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/31/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Bile duct injury remains a serious complication of laparoscopic cholecystectomy despite established criteria for the critical view of safety (CVS). Using surgical videos, we compared surgeons' willingness to divide critical structures based on their assessment of the CVS dissection. DESIGN Participants reviewed 20 operative videos lasting 1 minute each, edited at various points of the CVS dissection. Participants stated whether the structures were safe to divide, and if not, what steps they would take to achieve an adequate dissection. Videos were independently scored using a validated scale and categorized as an "adequate" or "inadequate" dissection based on the score. Participants were blinded to CVS score and adequacy. Cohen's kappa statistic was used to evaluate inter-rater agreement and responses were compared by univariate analysis. SETTING University of Michigan, Ann Arbor, Michigan. Tertiary care university hospital. PARTICIPANTS General surgery residents (n = 13) and faculty (n = 13) at the study institution. RESULTS There was minimal agreement on willingness to divide critical structures among all participants (κ = 0.25), among faculty (κ = 0.30), and among residents (κ = 0.21). Participants were more willing to divide critical structures when videos showed an adequate CVS dissection (CVS score ≥ 4) than an inadequate dissection (CVS score ≤ 3) (60.4% vs. 16.3%, p = 0.043). For inadequate dissections, participants most commonly recommended further dissection of the hepatocystic triangle (30.8%). There was no significant difference in the rate of unsafe practices (choosing to divide critical structures for videos with an "inadequate" dissection) between faculty and residents (14.2% vs. 18.3%, p = 0.781). CONCLUSIONS There was minimal agreement on what constituted a safe CVS dissection and there was no difference in the rate of unsafe practices between trainees and faculty. Education may play a more important role than experience when building a culture of safety for laparoscopic cholecystectomy.
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Affiliation(s)
- Benjamin D Carr
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Niki Matusko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Sujka JA, Safcsak K, Bhullar IS, Havron WS. Simulation-Based Testing of Pager Interruptions During Laparoscopic Cholecystectomy. J Surg Educ 2018; 75:1351-1356. [PMID: 29396277 DOI: 10.1016/j.jsurg.2018.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. DESIGN Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). SETTING Level I trauma center; Simulation laboratory. PARTICIPANTS Twelve general surgery residents. RESULTS There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. CONCLUSION Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study.
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Affiliation(s)
- Joseph A Sujka
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Karen Safcsak
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Indermeet S Bhullar
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - William S Havron
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Harrington CM, Kavanagh DO, Wright Ballester G, Wright Ballester A, Dicker P, Traynor O, Hill A, Tierney S. 360° Operative Videos: A Randomised Cross-Over Study Evaluating Attentiveness and Information Retention. J Surg Educ 2018; 75:993-1000. [PMID: 29122571 DOI: 10.1016/j.jsurg.2017.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 10/09/2017] [Accepted: 10/13/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Although two-dimensional (2D) and three-dimensional videos have traditionally provided foundations for reviewing operative procedures, the recent 360º format may provide new dimensions to surgical education. This study sought to describe the production of a high quality 360º video for an index-operation (augmented with educational material), while evaluating for variances in attentiveness, information retention, and appraisal compared to 2D. DESIGN A 6-camera synchronised array (GoPro Omni, [California, United States]) was suspended inverted and recorded an elective laparoscopic cholecystectomy in 2016. A single-blinded randomised cross-over study was performed to evaluate this video in 360º vs 2D formats. Group A experienced the 360º video using Samsung (Suwon, South-Korea) GearVR virtual-reality headsets, followed by the 2D experience on a 75-inch television. Group B were reversed. Each video was probed at designated time points for engagement levels and task-unrelated images or thoughts. Alternating question banks were administered following each video experience. Feedback was obtained via a short survey at study completion. SETTING The New Academic and Education Building (NAEB) in Dublin, Royal College of Surgeons in Ireland, July 2017. PARTICIPANTS Preclinical undergraduate students from a medical university in Ireland. RESULTS Forty students participated with a mean age of 23.2 ± 4.5 years and equal sex involvement. The 360º video demonstrated significantly higher engagement (p < 0.01) throughout the experience and lower task-unrelated images or thoughts (p < 0.01). Significant variances in information retention between the 2 groups were absent (p = 0.143) but most (65%) reported the 360º video as their learning platform of choice. Mean appraisal levels for the 360º platform were positive with mean responses of >8/10 for the platform for learning, immersion, and entertainment. CONCLUSIONS This study describes the successful development and evaluation of a 360º operative video. This new video format demonstrated significant engagement and attentiveness benefits compared to traditional 2D formats. This requires further evaluation in the field of technology enhanced learning.
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Affiliation(s)
- Cuan M Harrington
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin.
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin
| | | | | | - Patrick Dicker
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin
| | - Arnold Hill
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sean Tierney
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin
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Goff T, Cull JD. Improved Intraoperative Communication after Utilization of Navigational Grids during Laparoscopic Cholecystectomies. Am Surg 2018; 84:727-731. [PMID: 29966575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Efficient intraoperative communication (IC) between an attending and resident during surgery is highly valuable. Few tools, however, have been developed to improve IC. This study evaluates IC between residents and attendings after utilization of a navigational grid (NG) during laparoscopic cholecystectomies. Attendings and surgery residents completed a 10-question survey after performing a laparoscopic cholecystectomy. Surveys were collected for 12 weeks: six weeks before use of NGs and six weeks with use of NGs. The NGs were constructed to fit our 26-surgical monitors and allowed the monitors to be divided into a 7 × 4 grid. Hunderd and fifteen surveys were collected: 50 from attendings (pre-NG: 31 vs NG: 19) and 65 from residents (42 vs 23). Before NGs, attendings were less likely than residents to perceive attending instructions to be clear (64.5 vs 93.0%, P = 0.0001) and less likely to believe IC left little room for confusion during the procedure (64.5 vs 90.5%, P = 0.007). After NGs, attendings believed intraoperative directional guidance was more concise and clear (64.5 vs 89.5%, P = 0.062); they also reported that NGs left little room for IC confusion during the procedure (64.5 vs 94.7%, P = 0.039). Surveys showed the grid's utility to be inversely correlated with years of experience. Residents (<two years) and attendings (<10 years) with less experience had the highest median in reported usefulness (7 out of 10). Our findings show that NGs can be a useful tool for improving IC, especially in residents and attendings with less experience.
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Affiliation(s)
- Tyler Goff
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
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26
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Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 2018; 32:1683-1688. [PMID: 28916877 DOI: 10.1007/s00464-017-5847-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bile duct injury (BDI) remains the most dreaded complication following cholecystectomy with serious repercussions for the surgeon, patient and entire healthcare system. In the absence of registries, the true incidence of BDI in the United States remains unknown. We aim to identify the incidence of BDI requiring operative intervention and overall complications after cholecystectomy. METHODS Utilizing the Truven Marketscan® research database, 554,806 patients who underwent cholecystectomy in calendar years 2011-2014 were identified using ICD-9 procedure and diagnosis codes. The final study population consisted of 319,184 patients with at least 1 year of continuous enrollment and who met inclusion criteria. Patients were tracked for BDI and other complications. Hospital cost information was obtained from 2015 Premier data. RESULTS Of the 319,184 patients who were included in the study, there were a total of 741 (0.23%) BDI identified requiring operative intervention. The majority of injuries were identified at the time of the index procedure (n = 533, 72.9%), with 102 (13.8%) identified within 30-days of surgery and the remainder (n = 106, 14.3%) between 31 and 365 days. The operative cumulative complication rate within 30 days of surgery was 9.84%. The most common complications occurring at the index procedure were intestinal disorders (1.2%), infectious (1%), and shock (0.8%). The most common complications identified within 30-days of surgery included infection (1.5%), intestinal disorders (0.7%) and systemic inflammatory response syndrome (SIRS) (0.7%) for cumulative rates of infection, intestinal disorders, shock, and SIRS of 2.0, 1.9, 1.0, and 0.8%, respectively. CONCLUSION BDI rate requiring operative intervention have plateaued and remains at 0.23% despite increased experience with laparoscopy. Moreover, cholecystectomy is associated with a 9.84% 30-day morbidity rate. A clear opportunity is identified to improve the quality and safety of this operation. Continued attention to educational programs and techniques aimed at reducing patient harm and improving surgeon skill are imperative.
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Affiliation(s)
- Meredith Barrett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | | | - Hung-Lung Chien
- Minimally Invasive Therapy Group, Medtronic, Minneapolis, MA, USA
| | - L Michael Brunt
- Department of Surgery, Washington University, Saint Louis, MO, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Ganni S, Botden SMBI, Schaap DP, Verhoeven BH, Goossens RHM, Jakimowicz JJ. "Reflection-Before-Practice" Improves Self-Assessment and End-Performance in Laparoscopic Surgical Skills Training. J Surg Educ 2018; 75:527-533. [PMID: 28822819 DOI: 10.1016/j.jsurg.2017.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/05/2017] [Accepted: 07/30/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To establish whether a systematized approach to self-assessment in a laparoscopic surgical skills course improves accordance between expert- and self-assessment. DESIGN A systematic training course in self-assessment using Competency Assessment Tool was introduced into the normal course of evaluation within a Laparoscopic Surgical Skills training course for the test group (n = 30). Differences between these and a control group (n = 30) who did not receive the additional training were assessed. SETTING Catharina Hospital, Eindhoven, The Netherlands (n = 27), and GSL Medical College, Rajahmundry, India (n = 33). PARTICIPANTS Sixty postgraduate year 2 and 3 surgical residents who attended the 2-day Laparoscopic Surgical Skills grade 1 level 1 curriculum were invited to participate. RESULTS The test group (n = 30) showed better accordance between expert- and self-assessment (difference of 1.5, standard deviation [SD] = 0.2 versus 3.83, SD = 0.6, p = 0.009) as well as half the number (7 versus 14) of cases of overreporting. Furthermore, the test group also showed higher overall mean performance (mean = 38.1, SD = 0.7 versus mean = 31.8, SD = 1.0, p < 0.001) than the control group (n = 30). The systematic approach to self-assessment can be viewed as responsible for this and can be seen as "reflection-before-practice" within the framework of reflective practice as defined by Donald Schon. CONCLUSION Our results suggest that "reflection-before-practice" in implementing self-assessment is an important step in the development of surgical skills, yielding both better understanding of one's strengths and weaknesses and also improving overall performance.
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Affiliation(s)
- Sandeep Ganni
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands; Department of Surgery, GSL Medical College, Rajahmundry, India; Research and Education, Catharina Hospital, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Paediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Dennis P Schaap
- Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Bas H Verhoeven
- Department of Paediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Richard H M Goossens
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jack J Jakimowicz
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands; Research and Education, Catharina Hospital, Eindhoven, The Netherlands
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Buescher JF, Mehdorn AS, Neumann PA, Becker F, Eichelmann AK, Pankratius U, Bahde R, Foell D, Senninger N, Rijcken E. Effect of Continuous Motion Parameter Feedback on Laparoscopic Simulation Training: A Prospective Randomized Controlled Trial on Skill Acquisition and Retention. J Surg Educ 2018; 75:516-526. [PMID: 28864265 DOI: 10.1016/j.jsurg.2017.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/06/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum. DESIGN A Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy. SETTING Muenster University Hospital Training Center, Muenster, Germany. PARTICIPANTS Medical students without previous surgical experience. RESULTS Laparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention. CONCLUSION Simulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.
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Affiliation(s)
| | - Anne-Sophie Mehdorn
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Felix Becker
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ulrich Pankratius
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ralf Bahde
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Daniel Foell
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Emile Rijcken
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
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Tafazal H, Spreadborough P, Zakai D, Shastri-Hurst N, Ayaani S, Hanif M. Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity. Ann R Coll Surg Engl 2018; 100:178-184. [PMID: 29484945 PMCID: PMC5930083 DOI: 10.1308/rcsann.2017.0171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. Material and methods A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. Results A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant-led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. Conclusions Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.
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Affiliation(s)
- H Tafazal
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - P Spreadborough
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - D Zakai
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - N Shastri-Hurst
- Department of Trauma and Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ayaani
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - M Hanif
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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30
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Lau JW, Yang T, Toe KK, Huang W, Chang SK. Can Robots Accelerate the Learning Curve for Surgical Training? An Analysis of Residents and Medical Students. Ann Acad Med Singap 2018; 47:29-35. [PMID: 29493708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Surgical traineeship has traditionally been based on a master apprentice model where learning takes place in the operating theatre. This approach has changed over the past few years with greater emphasis on surgical training taking place within the surgical skills laboratory. We developed a high fidelity simulator, the Image-guided Robotic Assisted Surgical simulator (IRAS) with an incorporated robotic guidance feature. The robot system is developed to mimic the process of an experienced surgeon physically holding a trainee's hands to demonstrate maneuvering of the laparoscopic instruments. We aimed to assess the efficacy of incorporating robotic guidance into this high fidelity surgical simulator. Forty-two participants (13 surgical residents and 29 medical students) were recruited. Participants had one practice run for familiarisation and subsequently performed the virtual laparoscopic cholecystectomy (LC) once. Among the medical students, they were ransomised to either a control or intervention group. They were tasked to perform a second- and third-timed LC assessment. Participants were asked to rate the simulator using a 5-point Likert scale Questionnaire. IRAS rated favourably in hand-eye coordination and training bimanual dexterity (mean score: 4.1 and 4.0 among students, 3.4 and 3.4 among residents) though it faired suboptimally in realism. At baseline, residents were statistically faster compared to students (overall time: 418.9 vs 586.8 seconds, P = 0.001). Participants randomised to the intervention group consistently scored better. However, their overall time were not statistically significant from the control group. The robotic guidance capability of the IRAS is a key advantage of this simulator platform over the conventional platform.
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Affiliation(s)
- Joel Wl Lau
- Department of Surgery, National University Health System, Singapore
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Caskey RC, Owei L, Rao R, Riddle EW, Brooks AD, Dempsey DT, Morris JB, Neylan CJ, Williams NN, Dumon KR. Integration of Hands-On Team Training into Existing Curriculum Improves Both Technical and Nontechnical Skills in Laparoscopic Cholecystectomy. J Surg Educ 2017; 74:915-920. [PMID: 28566217 DOI: 10.1016/j.jsurg.2017.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/12/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Nontechnical skills are an essential component of surgical education and a major competency assessed by the ACGME milestones project. However, the optimal way to integrate nontechnical skills training into existing curricula and then objectively evaluate the outcome is still unknown. The aim of this study was to determine the effect laparoscopic team-based task training would have on the nontechnical skills needed for laparoscopic surgery. DESIGN 9 PGY-1 residents underwent an established training curriculum for teaching the knowledge and technical skills involved in laparoscopic cholecystectomy. Initial training involved a didactic session, expert-led practice on a porcine model in a simulated operating room and laparoscopic skills practice on a virtual reality trainer. Residents then performed a laparoscopic cholecystectomy on the same porcine model as a preintervention test. Three to four months following this, residents were subjected to specific nontechnical skills training involving 2 simple team-based laparoscopic tasks. They then practiced a further 4 to 6 hours on the virtual reality trainer. A repeat postintervention laparoscopic cholecystectomy was then performed 3 to 4 months after nontechnical skills training. Both the preintervention and postintervention laparoscopic cholecystectomies were audiovisually recorded and then evaluated by 2 independent surgeons in a blinded fashion. Technical skills were assessed using objective structured assessment of technical skills (OSATS) and a technique specific rating scale (TRS) that we developed for laparoscopic cholecystectomy. Nontechnical skills were assessed using nontechnical skills for surgeons (NOTSS). Residents also completed a survey at the beginning and end of the training. SETTING Tertiary care, university based teaching institution. PARTICIPANTS A total of 9 general surgery residents at the intern level. RESULTS The mean OSATS score improved from 13.7 ± 1.24 to 26.7 ± 0.31 (p < 0.001), the mean TRS score improved from 6 ± 0.46 to 13.1 ± 0.36 (p < 0.001) and the mean NOTSS score improved from 21.7 ± 1.83 to 36.3 ± 0.87 (p < 0.001) following the training. There was a strong correlation between OSATS and NOTSS scores (Pearson's R = 0.98) and TRS and NOTSS (R = 0.94). The inter-rater agreement was 0.79 for NOTSS, 0.9 for OSATS, and 0.82 for TRS. Following completion of the training, residents self-reported improvements in exchanging information (p < 0.01), coordinating activities (p < 0.01) and coping with pressure in the operating room (p < 0.001). CONCLUSION Simple, team-based nontechnical skills training for laparoscopic cholecystectomy that was separate from technical skills training led to a sustained increase in residents' nontechnical skills 3 to 4 months after training. This was associated with a self-reported improvement in many nontechnical skills based on resident survey. Based on these results, we recommend that such designated nontechnical skills training is a valid alternative to other methods such as coaching and debriefing. We, therefore, plan to continue our efforts to develop team-based simulation tasks aimed at improving nontechnical skills for multiple surgical modalities.
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Affiliation(s)
- Robert C Caskey
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily Owei
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raghavendra Rao
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elijah W Riddle
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ari D Brooks
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Neylan
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Brinkmann C, Fritz M, Pankratius U, Bahde R, Neumann P, Schlueter S, Senninger N, Rijcken E. Box- or Virtual-Reality Trainer: Which Tool Results in Better Transfer of Laparoscopic Basic Skills?-A Prospective Randomized Trial. J Surg Educ 2017; 74:724-735. [PMID: 28089473 DOI: 10.1016/j.jsurg.2016.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Simulation training improves laparoscopic performance. Laparoscopic basic skills can be learned in simulators as box- or virtual-reality (VR) trainers. However, there is no clear recommendation for either box or VR trainers as the most appropriate tool for the transfer of acquired laparoscopic basic skills into a surgical procedure. DESIGN Both training tools were compared, using validated and well-established curricula in the acquirement of basic skills, in a prospective randomized trial in a 5-day structured laparoscopic training course. Participants completed either a box- or VR-trainer curriculum and then applied the learned skills performing an ex situ laparoscopic cholecystectomy on a pig liver. The performance was recorded on video and evaluated offline by 4 blinded observers using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. Learning curves of the various exercises included in the training course were compared and the improvement in each exercise was analyzed. SETTING Surgical Skills Lab of the Department of General and Visceral Surgery, University Hospital Muenster. PARTICIPANTS Surgical novices without prior surgical experience (medical students, n = 36). RESULTS Posttraining evaluation showed significant improvement compared with baseline in both groups, indicating acquisition of laparoscopic basic skills. Learning curves showed almost the same progression with no significant differences. In simulated laparoscopic cholecystectomy, total GOALS score was significantly higher for the box-trained group than the VR-trained group (box: 15.31 ± 3.61 vs. VR: 12.92 ± 3.06; p = 0.039; Hedge׳s g* = 0.699), indicating higher technical skill levels. CONCLUSIONS Despite both systems having advantages and disadvantages, they can both be used for simulation training for laparoscopic skills. In the setting with 2 structured, validated and almost identical curricula, the box-trained group appears to be superior in the better transfer of basic skills into an experimental but structured surgical procedure.
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Affiliation(s)
- Christian Brinkmann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Mathias Fritz
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ulrich Pankratius
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ralf Bahde
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp Neumann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Steffen Schlueter
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Emile Rijcken
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
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Quick JA, Bukoski AD, Doty J, Bennett BJ, Crane M, Barnes SL. Objective Measurement of Clinical Competency in Surgical Education Using Electrodermal Activity. J Surg Educ 2017; 74:674-680. [PMID: 28373078 DOI: 10.1016/j.jsurg.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Within the realm of surgical education, there is a need for objective means to determine surgical competence and resident readiness to operate independently. We propose a novel, objective method of assessing resident confidence and clinical competence based on measurement of electrodermal activity (EDA) during live surgical procedures. We hypothesized that with progressive training, EDA responses to the stress of performing surgery would exhibit decline, elucidating an objective correlate of clinical competence. DESIGN EDA was measured using galvanic skin response sensors worn by residents performing laparoscopic cholecystectomy on sequential live human patients over an 8-month period. Baseline, phasic (peak) and tonic EDA responses were measured as a fractional change from baseline. SETTING University of Missouri, Columbia, Missouri, an academic tertiary care facility. PARTICIPANTS Fourteen categorical general surgery residents and 5 faculty surgeons were voluntarily enrolled and participated through completion. RESULTS Tonic fractional change (FCTONIC) was highest in PGY3 residents compared with postgraduate year (PGY) 1 and 2 residents (7.199 vs. 2.100, p = 0.004, 95% CI: 8.58-1.61 and PGY4 and 5 residents (7.199 vs. 2.079, p = 0.002, 95% CI: 8.38-0.29). Phasic fractional change in EDA (FCPHASIC) exhibited a progressive decline across resident training levels, with PGY1 and 2 residents having the highest response, and faculty displaying the lowest FCPHASIC responses. Statistical differences were seen between FCPHASIC faculty and PGY4 and 5 (3.596 vs. 6.180, p = 0.004, 95% CI: 0.80-4.36), PGY4 and 5, and PGY3 (6.180 vs. 15.998, p = 0.003, 95% CI: 3.33-16.3), as well as among all residents and faculty (13.057 vs. 3.596, p = 0.004, 95% CI: 15.8-3.1). CONCLUSION Phasic EDA changes decrease with increasing clinical competence. For those participants with the lowest and highest levels of competence, tonic EDA changes are minimal. Tonic EDA changes follow an inverse-U shape with differing levels of clinical competence.
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Affiliation(s)
- Jacob A Quick
- Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri
| | - Alex D Bukoski
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Jennifer Doty
- Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri
| | - Bethany J Bennett
- Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri
| | - Megan Crane
- Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri
| | - Stephen L Barnes
- Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri
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Ganni S, Chmarra MK, Goossens RHM, Jakimowicz JJ. Self-assessment in laparoscopic surgical skills training: Is it reliable? Surg Endosc 2017; 31:2451-2456. [PMID: 27655377 PMCID: PMC5443853 DOI: 10.1007/s00464-016-5246-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The concept of self-assessment has been widely acclaimed for its role in the professional development cycle and self-regulation. In the field of medical education, self-assessment has been most used to evaluate the cognitive knowledge of students. The complexity of training and evaluation in laparoscopic surgery has previously acted as a barrier in determining the benefits self-assessment has to offer in comparison with other fields of medical education. METHODS Thirty-five surgical residents who attended the 2-day Laparoscopic Surgical Skills Grade 1 Level 1 curriculum were invited to participate from The Netherlands, India and Romania. The competency assessment tool (CAT) for laparoscopic cholecystectomy was used for self- and expert-assessment and the resulting distributions assessed. RESULTS A comparison between the expert- and self-assessed aggregates of scores from the CAT agreed with previous studies. Uniquely to this study, the aggregates of individual sub-categories-'use of instruments'; 'tissue handling'; and errors 'within the component tasks' and the 'end product' from both self- and expert-assessments-were investigated. There was strong positive correlation (r s > 0.5; p < 0.001) between the expert- and self-assessment in all categories with only the 'tissue handling' having a weaker correlation (r s = 0.3; p = 0.04). The distribution of the mean of the differences between self-assessment and expert-assessment suggested no significant difference between the scores of experts and the residents in all categories except the 'end product' evaluation where the difference was significant (W = 119, p = 0.03). CONCLUSION Self-assessment using the CAT form gives results that are consistently not different from expert-assessment when assessing one's proficiency in surgical skills. Areas where there was less agreement could be explained by variations in the level of training and understanding of the assessment criteria.
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Affiliation(s)
- Sandeep Ganni
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands.
- Department of Surgery, GSL Medical College, Rajahmundry, India.
- Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Magdalena K Chmarra
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Richard H M Goossens
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Jack J Jakimowicz
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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Lindlohr C, Lefering R, Saad S, Heiss MM, Pape-Köhler C. Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial. Langenbecks Arch Surg 2017; 402:645-653. [PMID: 28238058 DOI: 10.1007/s00423-017-1567-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. METHODS This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. RESULTS In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. CONCLUSION The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
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Affiliation(s)
- Cornelia Lindlohr
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - S Saad
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany
| | - M M Heiss
- Department for Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - C Pape-Köhler
- Department for General and Abdominal Surgery, Protestant Hospital, Cologne-Weyertal, Germany
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da Cruz JAS, Dos Reis ST, Cunha Frati RM, Duarte RJ, Nguyen H, Srougi M, Passerotti CC. Does Warm-Up Training in a Virtual Reality Simulator Improve Surgical Performance? A Prospective Randomized Analysis. J Surg Educ 2016; 73:974-978. [PMID: 27233673 DOI: 10.1016/j.jsurg.2016.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/02/2016] [Accepted: 04/19/2016] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Virtual reality surgical simulators (VRSS) have been showing themselves as a valuable tool in laparoscopy training and education. Taking in consideration the effectiveness of the VRSS, new uses for this tool have been purposed. In sports, warming up before exercise clearly shows benefit in performance. It is hypothesized that warming up in the VRSS before going to the operating room may show benefit in surgical performance. OBJECTIVE Verify whether there is benefit in surgical performance with preoperatory warm-up using a VRSS. MATERIALS AND METHODS A total of 20 medical students with basic knowledge in laparoscopy were divided in 2 groups (I and II). Group I performed a laparoscopic cholecystectomy in a porcine model. Group II performed preoperative warm-up in a VRSS and then performed a laparoscopic cholecystectomy in a porcine model. The performance between both groups was compared regarding quantitative parameters (time for dissection of the gallbladder pedicle, time for clipping the pedicle, time for cutting the pedicle, time for gallbladder removal, total operative time, and aspirated blood loss) and qualitative parameters (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) based on a previously validated score system, in which the higher the score, the better the result. Data were analyzed with level of significance of 5%. RESULTS The group that underwent preoperative warm-up (group II) showed significantly superior results as to the time for dissection of the gallbladder pedicle (11.91 ± 9.85 vs. 4.52 ± 2.89min, p = 0.012), time for clipping the pedicle (5.51 ± 2.36 vs. 2.89 ± 2.76min, p = 0.004), time for cutting the pedicle (1.84 ± 0.7 vs. 1.13 ± 0.51, p = 0.019), aspirated blood loss (171 ± 112 vs. 57 ± 27.8ml, p = 0.006), depth perception (4.5 ± 0.7 vs. 3.3 ± 0.67, p = 0.004), bianual dexterity (4.2 ± 0.78 vs. 3.3 ± 0.67, p = 0.004), tissue handling (4.2 ± 0.91 vs. 3.6 ± 0.66, p = 0.012), and autonomy (4.9 ± 0.31 vs. 3.6 ± 0.96, p = 0.028). There was no difference in time for gallbladder removal (11.58 ± 4.31 vs. 15.08 ± 4.51min, p = 0.096), total operative time (30.8 ± 11.07 vs. 25.60 ± 5.10min, p = 0.188), and efficiency (4 ± 0.66 vs. 3.6 ± 0.69, p = 0.320). CONCLUSION The practice of preoperative warm-up training seems to benefit surgical performance even in subject with mild laparoscopic experience.
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Affiliation(s)
- José Arnaldo Shiomi da Cruz
- Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil.
| | | | | | - Ricardo Jordão Duarte
- Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Hiep Nguyen
- Urology Department, Cardon Children Medical Center, Mesa, Arizona
| | - Miguel Srougi
- Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlo Camargo Passerotti
- Urology Department, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil
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Maqsood H, Buddensick TJ, Patel K, Ferdosi H, Sautter A, Setiawan L, Sill AM, Kowdley GC, Cunningham SC. Effect of Residents on Operative Time and Complications: Focus on Laparoscopic Cholecystectomy in the Community. J Surg Educ 2016; 73:836-843. [PMID: 27209031 DOI: 10.1016/j.jsurg.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/27/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To better understand important aspects of resident education in the perioperative setting, given that there are conflicting data regarding resident training and outcomes (e.g., operative times and complications). To study continuity of care in a resident-run outpatient hospital clinic. DESIGN Retrospective analysis of 2 databases. SETTING The study was set up in a community teaching hospital. RESULTS Of 4603 cases in a cholecystectomy database, 3302 (72%) were assisted by residents, with operative times ranging from 19 to 383 minutes, and 1576 (22.9%) were assisted by nonresidents. The average times were 93 and 77 minutes for resident- and non-resident-assisted cases, respectively. Complications were almost 3 times more likely for urgent vs. elective but were similar for resident-assisted vs. non-resident-assisted cases. The operative time was similar across PGY levels. Of 149 cases in a resident-run outpatient clinic, 100 (67%) of the residents participated in preoperative, intraoperative, and postoperative phases of case, but in only 4% of cases was it the same resident. CONCLUSION Resident assistance increased operative times but not complications. Counterbalanced effects of increasing skill and increasing participation may explain this time stability across PGY levels. Continuity of care is preserved in the era of the 80-hour workweek, but not to a patient-specific degree.
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Affiliation(s)
- Hadia Maqsood
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | | | - Kalpesh Patel
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Hamid Ferdosi
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Amanda Sautter
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Lisa Setiawan
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Anne M Sill
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Gopal C Kowdley
- The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
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Kramp KH, van Det MJ, Veeger NJGM, Pierie JPEN. The Pareto Analysis for Establishing Content Criteria in Surgical Training. J Surg Educ 2016; 73:892-901. [PMID: 27267561 DOI: 10.1016/j.jsurg.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Current surgical training is still highly dependent on expensive operating room (OR) experience. Although there have been many attempts to transfer more training to the skills laboratory, little research is focused on which technical behaviors can lead to the highest profit when they are trained outside the OR. The Pareto principle states that in any population that contributes to a common effect, a few account for the bulk of the effect. This principle has been widely used in business management to increase company profits. This study uses the Pareto principle for establishing content criteria for more efficient surgical training. METHOD A retrospective study was conducted to assess verbal guidance provided by 9 supervising surgeons to 12 trainees performing 64 laparoscopic cholecystectomies in the OR. The verbal corrections were documented, tallied, and clustered according to the aimed change in novice behavior. The corrections were rank ordered, and a cumulative distribution curve was used to calculate which corrections accounted for 80% of the total number of verbal corrections. RESULTS In total, 253 different verbal corrections were uttered 1587 times and were categorized into 40 different clusters of aimed changes in novice behaviors. The 35 highest-ranking verbal corrections (14%) and the 11 highest-ranking clusters (28%) accounted for 80% of the total number of given verbal corrections. CONCLUSIONS Following the Pareto principle, we were able to identify the aspects of trainee behavior that account for most corrections given by supervisors during a laparoscopic cholecystectomy on humans. This strategy can be used for the development of new training programs to prepare the trainee in advance for the challenges encountered in the clinical setting in an OR.
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Affiliation(s)
- Kelvin H Kramp
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.
| | - Marc J van Det
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Nic J G M Veeger
- Department of Epidemiology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Jean-Pierre E N Pierie
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Madani A, Watanabe Y, Bilgic E, Pucher PH, Vassiliou MC, Aggarwal R, Fried GM, Mitmaker EJ, Feldman LS. Measuring intra-operative decision-making during laparoscopic cholecystectomy: validity evidence for a novel interactive Web-based assessment tool. Surg Endosc 2016; 31:1203-1212. [PMID: 27412125 DOI: 10.1007/s00464-016-5091-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/05/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Errors in judgment during laparoscopic cholecystectomy can lead to bile duct injuries and other complications. Despite correlations between outcomes, expertise and advanced cognitive skills, current methods to evaluate these skills remain subjective, rater- and situation-dependent and non-systematic. The purpose of this study was to develop objective metrics using a Web-based platform and to obtain validity evidence for their assessment of decision-making during laparoscopic cholecystectomy. METHODS An interactive online learning platform was developed ( www.thinklikeasurgeon.com ). Trainees and surgeons from six institutions completed a 12-item assessment, developed based on a cognitive task analysis. Five items required subjects to draw their answer on the surgical field, and accuracy scores were calculated based on an algorithm derived from experts' responses ("visual concordance test", VCT). Test-retest reliability, internal consistency, and correlation with self-reported experience, Global Operative Assessment of Laparoscopic Skills (GOALS) score and Objective Performance Rating Scale (OPRS) score were calculated. Questionnaires were administered to evaluate the platform's usability, feasibility and educational value. RESULTS Thirty-nine subjects (17 surgeons, 22 trainees) participated. There was high test-retest reliability (intraclass correlation coefficient = 0.95; n = 10) and internal consistency (Cronbach's α = 0.87). The assessment demonstrated significant differences between novices, intermediates and experts in total score (p < 0.01) and VCT score (p < 0.01). There was high correlation between total case number and total score (ρ = 0.83, p < 0.01) and between total case number and VCT (ρ = 0.82, p < 0.01), and moderate to high correlations between total score and GOALS (ρ = 0.66, p = 0.05), VCT and GOALS (ρ = 0.83, p < 0.01), total score and OPRS (ρ = 0.67, p = 0.04), and VCT and OPRS (ρ = 0.78, p = 0.01). Most subjects agreed or strongly agreed that the platform and assessment was easy to use [n = 29 (78 %)], facilitates learning intra-operative decision-making [n = 28 (81 %)], and should be integrated into surgical training [n = 28 (76 %)]. CONCLUSION This study provides preliminary validity evidence for a novel interactive platform to objectively assess decision-making during laparoscopic cholecystectomy.
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Affiliation(s)
- Amin Madani
- Department of Surgery, McGill University, Montreal, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.
| | - Yusuke Watanabe
- Department of Gastroenterological Surgery II, Hokkaido University, Sapporo, Japan
| | - Elif Bilgic
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
| | - Philip H Pucher
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melina C Vassiliou
- Department of Surgery, McGill University, Montreal, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
| | - Rajesh Aggarwal
- Department of Surgery, McGill University, Montreal, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Faculty of Medicine, Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada
| | - Gerald M Fried
- Department of Surgery, McGill University, Montreal, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
- Faculty of Medicine, Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada
| | | | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada
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Nijssen MAJ, Schreinemakers JMJ, van der Schelling GP, Crolla RMPH, Rijken AM. Improving Critical View of Safety in Laparoscopic Cholecystectomy by Teaching Interventions. J Surg Educ 2016; 73:442-7. [PMID: 26868305 DOI: 10.1016/j.jsurg.2015.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/29/2015] [Accepted: 11/24/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Guidelines recommend obtaining a critical view of safety (CVS) during laparoscopic cholecystectomies to prevent serious bile duct injuries. We sought to evaluate the results of a teaching intervention for surgeons and residents about achieving CVS. METHODS The intervention consisted of a lecture followed by a handout on CVS along with a teaching video on how to perform a laparoscopic cholecystectomy and common pitfalls encountered. After 9 months, the whole intervention was repeated. We retrospectively collected demographic data, details about the procedure, and complications for 316 consecutive patients who underwent laparoscopic cholecystectomy and reviewed available videos of laparoscopic cholecystectomy for 229 of these patients. Videos before and after the teaching interventions were reviewed by 2 gastrointestinal surgeons regarding whether CVS was reached, and Kappa statistics were calculated to measure inter-rater agreement. RESULTS Most patients (average age 51 years) underwent laparoscopic cholecystectomy for symptomatic cholelithiasis (n = 171, 75%). CVS was reached in 69% of the preteaching intervention patients (n = 54), in 73% after the first teaching intervention (n = 75) and in 82% after the second intervention (n = 100) (not significant, overall p = 0.070). The complication rates were 24% (n = 13) before the intervention, 19% (n = 14) after the first teaching intervention, and 17% (n = 17) after the second intervention (not significant). In these groups, 1, 3, and 5 cases, correspondingly, with biliary injury were identified. All but 1 complication was related to a type A biliary injury. CONCLUSION After the teaching interventions, the complication rate and the rate of reaching CVS did not improve significantly. To improve surgeons' success in reaching CVS, more personal interventions may be more effective than the group intervention we used in this study. The next step may be to present surgeons and residents who have a low CVS rate directly with their personal results.
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Affiliation(s)
| | | | | | | | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
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YU A, DEMIREL D, HALIC T, KOCKARA S. Virtual Intraoperative Cholangiogram Using WebCL. Stud Health Technol Inform 2016; 220:459-464. [PMID: 27046623 PMCID: PMC5039042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this paper, we propose a Virtual Intraoperative Cholangiogram (VIC) training platform. Intraoperative Cholangiogram (IC) is an imaging technique of biliary anatomy with using fluorescent fluids sensitive to the X-Rays. The procedure is often employed to diagnose the difficult cases such as abnormal anatomy or choledocholithiasis during the laparoscopic cholecystectomy. The major challenge in cholangiogram is accurate interpretation of the X-Ray image, which requires extensive case training. However, the training platforms that support generation of various IC cases have been lacking. In this study, we developed a web based platform to generate IC images from any virtual bile duct anatomy. As the generation of X-Ray image from 3D scene is a computationally intensive task, we utilized WebCL technology to parallelize the computation for achieving real-time rates. In this work, we present details of our WebCL IC generation algorithm and benchmark results.
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Affiliation(s)
- Alexander YU
- Department of Computer Science, University of Central Arkansas
| | - Doga DEMIREL
- Department of Computer Science, University of Central Arkansas
| | - Tansel HALIC
- Department of Computer Science, University of Central Arkansas
| | - Sinan KOCKARA
- Department of Computer Science, University of Central Arkansas
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Pernar LIM, Peyre SE, Hasson RM, Lipsitz S, Corso K, Ashley SW, Breen EM. Exploring the Content of Intraoperative Teaching. J Surg Educ 2016; 73:79-84. [PMID: 26489601 DOI: 10.1016/j.jsurg.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/12/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature. METHODS A checklist of necessary technical and decision-making steps to be executed during performance of LCs, anchored in the previously published CTA, was developed. A convenience sample of LCs was identified over a 12-month period from February 2011 to February 2012. Using the checklist, a trained observer recorded explicit teaching that occurred regarding these steps during each observed case. All observations were tallied and analyzed. RESULTS In all, 51 LCs were observed; 14 surgery attendings and 33 residents participated in the observed cases. Of 1042 observable teaching points, only 560 (53.7%) were observed during the study period. As a proportion of all observable steps, technical steps were observed more frequently, 377 (67.3%), than decision-making steps, 183 (32.7%). Also when focusing on technical and decision-making steps alone, technical steps were taught more frequently (60.9% vs 43.3%). CONCLUSIONS Only approximately half of all possible observable teaching steps were explicitly taught during LCs in this study. Technical steps were more frequently taught than decision-making steps. These findings may have important implications: a better understanding of the content of intraoperative teaching would allow educators to steer residents' preoperative preparation, modulate intraoperative instruction by members of the surgical faculty, and guide residents to the most appropriate teaching venues.
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Affiliation(s)
- Luise I M Pernar
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sarah E Peyre
- Center for Experiential Learning, University of Rochester Medical Center, Rochester, New York
| | - Rian M Hasson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine Corso
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth M Breen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Steigerwald SN, Park J, Hardy KM, Gillman L, Vergis AS. The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort. Med Educ Online 2015; 20:30024. [PMID: 26641071 PMCID: PMC4671314 DOI: 10.3402/meo.v20.30024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/28/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Considerable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience. METHODS Fourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale. RESULTS Overall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy. CONCLUSIONS Neither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes.
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Affiliation(s)
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Krista M Hardy
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Gillman
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley S Vergis
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Hashimoto DA, Gomez ED, Beyer-Berjot L, Khajuria A, Williams NN, Darzi A, Aggarwal R. A Randomized Controlled Trial to Assess the Effects of Competition on the Development of Laparoscopic Surgical Skills. J Surg Educ 2015; 72:1077-1084. [PMID: 26169566 PMCID: PMC4662877 DOI: 10.1016/j.jsurg.2015.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Serious games have demonstrated efficacy in improving participation in surgical training activities, but studies have not yet demonstrated the effect of serious gaming on performance. This study investigated whether competitive training (CT) affects laparoscopic surgical performance. METHODS A total of 20 novices were recruited, and 18 (2 dropouts) were randomized into control or CT groups to perform 10 virtual reality laparoscopic cholecystectomies (LCs). Competitiveness of each participant was assessed. The CT group members were informed they were competing to outperform one another for a prize; performance ranking was shown before each session. The control group did not compete. Performance was assessed on time, movements, and instrument path length. Quality of performance was assessed with a global rating scale score. RESULTS There were no significant intergroup differences in baseline skill or measured competitiveness. Time and global rating scale score, at final LC, were not significantly different between groups; however, the CT group was significantly more dexterous than control and had significantly lower variance in number of movements and instrument path length at the final LC (p = 0.019). Contentiousness was inversely related to time in the CT group. CONCLUSION This was the first randomized controlled trial to investigate if CT can enhance performance in laparoscopic surgery. CT may lead to improved dexterity in laparoscopic surgery but yields otherwise similar performance to that of standard training in novices. Competition may have different effects on novices vs experienced surgeons, and subsequent research should investigate CT in experienced surgeons as well.
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Affiliation(s)
- Daniel A Hashimoto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biosurgery and Surgical Technology, St. Mary׳s Hospital, Imperial College London, London, United Kingdom.
| | - Ernest D Gomez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Beyer-Berjot
- Center for Surgical Teaching and Research (CERC), Université de la Méditerranée, Marseille, France
| | - Ankur Khajuria
- Department of Biosurgery and Surgical Technology, St. Mary׳s Hospital, Imperial College London, London, United Kingdom
| | - Noel N Williams
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ara Darzi
- Department of Biosurgery and Surgical Technology, St. Mary׳s Hospital, Imperial College London, London, United Kingdom
| | - Rajesh Aggarwal
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Arnold and Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Alameddine MB, Claflin J, Scally CP, Noble DM, Reames BN, Englesbe MJ, Wong SL. Resident Surgeons Underrate Their Laparoscopic Skills and Comfort Level When Compared With the Rating by Attending Surgeons. J Surg Educ 2015; 72:1240-6. [PMID: 26395401 PMCID: PMC4662891 DOI: 10.1016/j.jsurg.2015.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The development of operative skills during general surgery residency depends largely on the resident surgeons' (residents) ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skills and comfort level of residents from both the residents' and attending surgeons' (attendings') perspectives. DESIGN We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both residents and attendings completed a survey in which they rated the residents' operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Residents' and attendings' evaluations of residents' performance were compared using 2-sided t tests. SETTING The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution. PARTICIPANTS All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1 and August 31, 2013. Data were collected for 28 of the institution's 54 trainees. RESULTS Attendings rated residents higher than what residents rated themselves on a 5-point Likert-type scale regarding depth perception (3.86 vs. 3.38, p < 0.005), bimanual dexterity (3.75 vs. 3.36, p = 0.005), efficiency (3.58 vs. 3.18, p < 0.005), tissue handling (3.69 vs. 3.23, p < 0.005), and comfort while performing a case (3.86 vs. 3.38, p < 0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p = 0.85), the level of difficulty of the case (2.98 vs. 2.85, p = 0.443), and the degree of teaching done by the attending during the case (3.61 vs. 3.54, p = 0.701). CONCLUSIONS A gap exists between residents' and attendings' perception of residents' laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess and be in general agreement with attendings on their level of laparoscopic skills and comfort level while performing a case.
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Affiliation(s)
| | - Jake Claflin
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Christopher P Scally
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
| | - David M Noble
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Bradley N Reames
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
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Farach SM, Danielson PD, Amankwah EK, Chandler NM. Impact of Experience on Quality Outcomes in Single-incision Cholecystectomy in Children. Am Surg 2015; 81:839-843. [PMID: 26350657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe in children; however, factors that impact outcomes are not well understood. We report a retrospective review of 151 patients who underwent SILC between 2009 and 2013. Regression analysis was used to determine inflection of learning curve. Patients were grouped by early cases, late cases, and late case with surgical trainees. Mean age for all patients was 15 ± 3 years (5-20.5 year), and mean weight was 66.5 ± 21.3 kg (15-117 kg). There was a decrease in operative times between the early group (n = 15) and the late group (n = 100) (75.3 vs 56.1 minutes, P < 0.05). Surgical trainees were involved in 36 cases, and their introduction did not significantly increase operative times (56.1 vs 60.4 minutes, P = NS (Non-significant)). No difference in operative times between early cases and cases with trainees was identified (75.3 vs 60.4 minutes, P = NS). The complication was 6 per cent, with no significant differences between the groups. There were five conversions (3.3%). During the adoption of SILC, significantly decreased operative times were achieved after a short learning curve, and these were maintained with surgical trainees. Our results show that SILC can be safely introduced into a pediatric surgical practice.
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Affiliation(s)
- Sandra M Farach
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida, USA
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Lavy R, Halevy A, Hershkovitz Y. The Effect of Afternoon Operative Sessions of Laparoscopic Cholecystectomy Performed by Senior Surgeons on the General Surgery Residency Program: A Comparative Study. J Surg Educ 2015; 72:1014-1017. [PMID: 25980825 DOI: 10.1016/j.jsurg.2015.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/23/2015] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Laparoscopic cholecystectomy (LC) has been the gold standard for surgical treatment of gallbladder disease since 1980. This laparoscopic surgical procedure is one of the first to be performed by general surgery residents. There is a learning curve required to excel at performing LC. During this period, the operation needs to be performed under the supervision of a senior surgeon. The purpose of this study was to compare LC performed by residents with that performed by senior surgeons using the following parameters: operative time, conversion rate, complication rate, and mean length of hospital stay. METHODS This retrospective study included 1219 patients who underwent elective LC in our institute-788 operated on by a senior surgeon and 431 by a resident. RESULTS The mean operative time was 39 ± 19 minutes. There was a significant difference between the groups, as the mean operative time for the resident group was 49.9 ± 13 compared with 33.7 ± 6 for the senior surgeon group. The overall conversion rate was 2.1%, the complication rate was 2.2%, and the mean length of hospital stay was 1.5 days. There were no statistically significant differences between the groups for these parameters. CONCLUSIONS The only significant difference between the groups was a longer operative time, as the conversion rate, complication rate, and mean length of stay were the same. Therefore, it is safe for LC to be performed by residents supervised by a senior surgeon.
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Affiliation(s)
- Ron Lavy
- Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ariel Halevy
- Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
| | - Yehuda Hershkovitz
- Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Nguyen N, Elliott JO, Watson WD, Dominguez E. Simulation Improves Nontechnical Skills Performance of Residents During the Perioperative and Intraoperative Phases of Surgery. J Surg Educ 2015; 72:957-963. [PMID: 25911460 DOI: 10.1016/j.jsurg.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Failures in nontechnical skills (NTS) rather than technical expertise are frequently at the root of medical errors in the operating room (OR). NTS are the cognitive (decision making and situation awareness) and interpersonal (communication and teamwork) skills that are recognized but are not formally addressed in surgical training. The purpose of the study was to examine the effect of simulation-based training (SBT) on NTS performance of surgical residents during simulated laparoscopic cholecystectomy (LC). SETTING The study was performed in a simulated OR at the Center for Medical Education and Innovation at Riverside Methodist Hospital, Columbus, OH. The simulated OR was arranged with standard equipment for LC, a high-fidelity patient simulator, and a real OR team. DESIGN General surgical residents completed 2 identical SBT sessions. For each session, residents were briefed on the LC case, completed the case in the simulated OR, and debriefed their videotaped simulation performance with a content expert. The video recordings were reviewed and the residents' NTS were scored using a perioperative time-out checklist and an intraoperative checklist for LC by 4 raters who were blinded to both the residents' postgraduate year level and the order of the videotaped simulation sessions. RESULTS Residents showed a significant improvement in completeness of the perioperative time-out checklist from session 1 (mean score = 1.27 ± 1.00) to session 2 (mean score = 5.00 ± 1.28), p < 0.001. Residents' scores on the intraoperative checklist also improved from session 1 to session 2, p < 0.05. Overall, residents felt that the simulation was a valuable teaching and training tool and recommend that it be incorporated into residency training. CONCLUSION SBT appears to be an effective technique for improving NTS of surgical residents during the perioperative and intraoperative phases of surgery. As surgical proficiency is 75% nontechnical and 25% technical, it could be reasonably argued that improved NTS of surgeons could improve surgical outcomes.
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Affiliation(s)
- Ngan Nguyen
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - John O Elliott
- Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio
| | - William D Watson
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - Edward Dominguez
- Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio.
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Paige JT, Yu Q, Hunt JP, Marr AB, Stuke LE. Thinking it through: mental rehearsal and performance on 2 types of laparoscopic cholecystectomy simulators. J Surg Educ 2015; 72:740-8. [PMID: 26073476 DOI: 10.1016/j.jsurg.2015.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Simulation-based training (SBT) in laparoscopic cholecystectomy (LCCY) provides an opportunity for junior residents to learn the procedure in a safe, nonthreatening environment. Mental rehearsal (MR) has the potential of augmenting skill acquisition. This project investigated the correlation between MR of LCCY with performance on 2 different types of simulators: a procedural task (PT) training model and virtual reality (VR) machine. DESIGN Prospective, quasi-experimental design with purposeful sampling. Postgraduate years (PGYs) 1 through 3 general surgical residents underwent standardized, distributed SBT in LCCY on either a PT trainer or a VR machine with group-based MR undertaken before 2 SBT sessions. Participants completed a pre-MR and post-MR session mental imagery questionnaire (MIQ) containing 8-items using a 7-point Likert-type scale. Data related to VR objective measures and PT video-based performances were also collected. Total scale mean scores were calculated for the first MR session and the second MR session and were compared using the t test. Pearson correlation analysis of MIQ scores with performance scores was determined. SETTING Louisiana State University Health New Orleans Health Sciences Center in New Orleans, Louisiana. This health sciences center is a tertiary care, academic state institution located in the Southeastern United States. PARTICIPANTS A total of 21 PGYs 1 through 3 general surgery residents participated. They were purposefully divided into the PT and VR training groups to allow for even PGY distribution. Of the 21 participants, 19 completed both training sessions (n = 10 for PT [PGY1 = 4, PGY2 = 4, PGY3 = 2] and n = 9 for VR [PGY1 = 4, PGY2 = 3, PGY3 = 2]). RESULTS After the Bonferroni adjustment, significant gains in the MIQ items related to confidence, visual imagery, and knowledge of the procedure were found. VR performance data demonstrated some statistically significant improvements. A significant negative correlation was present between the two-handed clip-and-cut VR task and MIQ gains. CONCLUSIONS Group MR in LCCY before SBT on a VR machine is related to improved performance time for the VR two-handed clip-and-cut task. MR may be a useful adjunct to SBT LCCY. Future work will look at the translation of these skills to clinical practice.
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Affiliation(s)
- John T Paige
- Department of Surgery, School of Medicine, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana.
| | - Qingzhao Yu
- School of Public Health, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana
| | - John P Hunt
- Department of Surgery, School of Medicine, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana
| | - Alan B Marr
- Department of Surgery, School of Medicine, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana
| | - Lance E Stuke
- Department of Surgery, School of Medicine, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana
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Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Müller-Stich BP. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 2015; 94:e764. [PMID: 25997044 PMCID: PMC4602875 DOI: 10.1097/md.0000000000000764] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.
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Affiliation(s)
- Felix Nickel
- From the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (FN, JAB, HMR, JC, HGK, GRL, MK, LF, BPM-S); and Department of Psychology, University of Copenhagen, Copenhagen, Denmark (MG)
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