51
|
Nakayama T, Numao N, Yoshida S, Ishioka J, Matsuoka Y, Saito K, Fujii Y, Kihara K. A novel interactive educational system in the operating room--the IE system. BMC MEDICAL EDUCATION 2016; 16:44. [PMID: 26842063 PMCID: PMC4738794 DOI: 10.1186/s12909-016-0561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. METHODS A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. RESULTS All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. CONCLUSIONS The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.
Collapse
Affiliation(s)
- Takayuki Nakayama
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| |
Collapse
|
52
|
Cundy TP, Marcus HJ, Hughes-Hallett A, MacKinnon T, Najmaldin AS, Yang GZ, Darzi A. Robotic versus non-robotic instruments in spatially constrained operating workspaces: a pre-clinical randomized crossover study. BJU Int 2015; 116:415-22. [DOI: 10.1111/bju.12987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Thomas P. Cundy
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Hani J. Marcus
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Archie Hughes-Hallett
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Thomas MacKinnon
- Department of Surgery and Cancer; Imperial College London; London UK
| | | | - Guang-Zhong Yang
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
| | - Ara Darzi
- Hamlyn Centre; Institute of Global Health Innovation; Imperial College London; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| |
Collapse
|
53
|
Passerotti CC, Franco F, Bissoli JCC, Tiseo B, Oliveira CM, Buchalla CAO, Inoue GNC, Sencan A, Sencan A, do Pardo RR, Nguyen HT. Comparison of the learning curves and frustration level in performing laparoscopic and robotic training skills by experts and novices. Int Urol Nephrol 2015; 47:1075-84. [DOI: 10.1007/s11255-015-0991-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
|
54
|
Sørensen SMD, Savran MM, Konge L, Bjerrum F. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review. Surg Endosc 2015; 30:11-23. [PMID: 25840896 DOI: 10.1007/s00464-015-4189-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/23/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction. RESULTS Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D. CONCLUSIONS Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
Collapse
Affiliation(s)
- Stine Maya Dreier Sørensen
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark.
| | - Mona Meral Savran
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region, Denmark
| | - Flemming Bjerrum
- Department of Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
55
|
Fuchs Weizman N, Manoucheri E, Vitonis AF, Hicks GJ, Einarsson JI, Cohen SL. Design and validation of a novel assessment tool for laparoscopic suturing of the vaginal cuff during hysterectomy. JOURNAL OF SURGICAL EDUCATION 2015; 72:212-219. [PMID: 25439178 DOI: 10.1016/j.jsurg.2014.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/15/2014] [Accepted: 08/31/2014] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to design and validate a new assessment tool for laparoscopic vaginal cuff suturing in a box trainer. DESIGN A primary grading tool was constructed including a novel checklist component and a previously validated global rating scale. A four-step validation process was then undertaken. Face validity was determined by a survey of a panel of experts in the field of minimally invasive gynecologic surgery. Content validity was assessed via analysis of consistency and variability of the experts' ratings, and items were removed or rephrased according to the experts' comments. PARTICIPANTS Overall, five novices and five expert laparoscopic surgeons were videotaped performing suture closure of a latex vaginal cuff model in a box trainer. The videotapes were reviewed by two raters. Discriminate validity, along with interrater and intrarater reliabilities, was assessed by analysis of the video ratings. SETTING The Simulation, Training, Research, and Technology Utilization System center at Brigham and Women's Hospital, a tertiary medical center in Boston, MA. RESULTS The final assessment tool is presented. CONCLUSION We have validated an assessment tool for vaginal cuff suturing in a box trainer.
Collapse
Affiliation(s)
- Noga Fuchs Weizman
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elmira Manoucheri
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gloria J Hicks
- Simulation, Training, Research, and Technology Utilization System (STRATUS) Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
56
|
Anichini G, Evins AI, Boeris D, Stieg PE, Bernardo A. Three-Dimensional Endoscope-Assisted Surgical Approach to the Foramen Magnum and Craniovertebral Junction: Minimizing Bone Resection with the Aid of the Endoscope. World Neurosurg 2014; 82:e797-805. [DOI: 10.1016/j.wneu.2014.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/26/2014] [Accepted: 05/03/2014] [Indexed: 11/16/2022]
|
57
|
An assessment of the new generation three-dimensional high definition laparoscopic vision system on surgical skills: a randomized prospective study. Surg Endosc 2014; 29:2305-13. [DOI: 10.1007/s00464-014-3949-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
|
58
|
Barkhoudarian G, Del Carmen Becerra Romero A, Laws ER. Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. Neurosurgery 2014; 73:ons74-8; discussion ons78-9. [PMID: 23407288 DOI: 10.1227/neu.0b013e31828ba962] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice. OBJECTIVE Retrospective review of clinical factors and outcomes. METHODS All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion. RESULTS Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures. CONCLUSION The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.
Collapse
Affiliation(s)
- Garni Barkhoudarian
- Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
| | | | | |
Collapse
|
59
|
An analysis of the impact of previous laparoscopic hysterectomy experience on the learning curve for robotic hysterectomy. J Robot Surg 2013; 7:295-9. [PMID: 27000926 DOI: 10.1007/s11701-012-0388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Abstract
To analyze and compare the safety and perioperative outcomes of newly trained robotic surgeons with previous laparoscopic hysterectomy experience (TLH Exp) and those without previous laparoscopic hysterectomy experience (Non-TLH Exp). The purpose is to determine the effect of previous advanced laparoscopic skills on the performance in robotic assisted laparoscopic surgery. We will also compare the perioperative outcomes between the total laparoscopic hysterectomies (TLH), and robotic assisted laparoscopic hysterectomies (RALH) of a single experienced (TLH Exp) robotic surgeon. The purpose is to determine benefits and/or risks, if any, of one approach over the other in the hands of an experienced laparoscopic surgeon. Prospective data were collected on the first consecutive series of RALH performed by (TLH Exp) and (Non-TLH Exp) surgeons, with perioperative outcomes and morbidity being evaluated. In addition, retrsopective data were collected on a consecutive series of patients in a TLH group and compared with the outcomes in the robotic group for benign hysterectomies by the same surgeon. The parameters that were analyzed for associations with these two groups were estimated blood loss (EBL), Hb drop, length of hospital stay (LOS), procedure time, pain medication use, and complications. The (TLH Exp) group had 64 patients, and the (Non-TLH Exp) group had 72 patients. When comparing patients in the (TLH Exp) group with patients in (Non-TLH Exp) group, the mean age was 44 and 45 (P = 0.8), mean BMI was 27.7 and 29.5 kg/m(2) (P = 0.2), mean procedure time was 121 and 174 min (P < 0.05), mean console time was 70 and 119 min (P < 0.05), mean EBL was 64 and 84 ml (P = 0.3), with a Hb drop 1.7 and 1.33 (P = 0.2), uterine weight was 192 and 205 gms (P = 0.7), and length of stay was 1.07 and 1.33 days (P = 0.2), respectively. The (TLH Exp) surgeons had a lower OR, procedure and console time, but a higher hemoglobin drop, with no difference in EBL. There were no operative deaths, or conversions in either group. Morbidity occurred in two patients (3 %) in each group, with no statistically significant difference between the groups. In the (TLH Exp) group it included a blood transfusion and a readmission for a postoperative ileus. In the (Non-TLH Exp), the complications included a blood transfusion and a return to the OR for a vaginal cuff dehiscence. When comparing a single (TLH Exp) surgeon's own TLH versus RALH, there were 64 RALH and 49 TLH cases. There was a statistically significant difference in the mean procedure time 121.1 versus 88.8 min (P < 0.05), mean Hb drop 1.7 versus 2.3 (P < 0.05), and mean EBL 64.2 versus 158 ml (P < 0.05), respectively. The RALH group had a longer procedure time, but lower Hb drop, and less estimated blood loss. There were no operative deaths, or conversions in either group. Morbidity occurred in 2 patients in the robotic group, and included one blood transfusion, and one postoperative ileus. There were no complications noted in the laparoscopic hysterectomy group. Previous advanced laparoscopic skills appear to only significantly impact the length of the procedure, but not other variables. Robotic surgery may level the playing field between the basic and advanced laparoscopic surgeon for robotic assisted laparoscopic hysterectomy. In comparing the outcomes of RALH versus TLH by a single surgeon, the robotic assistance appeared to lengthen the procedure time, but reduce the amount of blood loss. Robotic surgery may offer a benefit of reduced blood loss at the expense of longer operating time. Similar studies including different surgeons are needed to validate these points, and thereby determine the risk-benefit balance between the two approaches for benign simple hysterectomies.
Collapse
|
60
|
Angell J, Gomez MS, Baig MM, Abaza R. Contribution of Laparoscopic Training to Robotic Proficiency. J Endourol 2013; 27:1027-31. [DOI: 10.1089/end.2013.0082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordan Angell
- Department of Urology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael S. Gomez
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio
| | - Mirza M. Baig
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio
| | - Ronney Abaza
- Department of Urology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
61
|
Perez M, Perrenot C, Tran N, Hossu G, Felblinger J, Hubert J. Prior experience in micro-surgery may improve the surgeon's performance in robotic surgical training. Int J Med Robot 2013; 9:351-8. [DOI: 10.1002/rcs.1499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Manuela Perez
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- Department of Emergency and General Surgery, Central Hospital; University Hospital of Nancy; Avenue du Marechal de Lattre de Tassigny 54000 Nancy France
| | - Cyril Perrenot
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Nguyen Tran
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Gabriela Hossu
- CIC-IT Nancy,INSERM-CIT801- Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Jacques Felblinger
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
| | - Jacques Hubert
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
- Department of Urology, Brabois Hospital; University Hospital of Nancy; Allée du Morvan 54511 Vandoeuvre-les-Nancy France
| |
Collapse
|
62
|
|
63
|
|
64
|
De Wilde RL, Herrmann A. Robotic surgery - advance or gimmick? Best Pract Res Clin Obstet Gynaecol 2013; 27:457-69. [PMID: 23357200 DOI: 10.1016/j.bpobgyn.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/14/2012] [Indexed: 12/15/2022]
Abstract
Robotic surgery is increasingly implemented as a minimally invasive approach to a variety of gynaecological procedures. The use of conventional laparoscopy by a broad range of surgeons, especially in complex procedures, is hampered by several drawbacks. Robotic surgery was created with the aim of overcoming some of the limitations. Although robotic surgery has many advantages, it is also associated with clear disadvantages. At present, the proof of superiority over access by laparotomy or laparoscopy through large randomised- controlled trials is still lacking. Until results of such trials are present, a firm conclusion about the usefulness of robotic surgery cannot be drawn. Robotic surgery is promising, making the advantages of minimally invasive surgery potentially available to a large number of surgeons and patients in the future.
Collapse
Affiliation(s)
- Rudy L De Wilde
- Pius-Hospital, Department of Obstetrics, Gynecology and Gynecological Oncology, Carl-von-Ossietzky-University, Georgstraβe 12, 26121 Oldenburg, Germany.
| | | |
Collapse
|
65
|
Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA. Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc 2012; 26:2961-8. [PMID: 22580874 DOI: 10.1007/s00464-012-2295-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/02/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. METHODS In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. RESULTS Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P < 0.0001-0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001-0.015). CONCLUSIONS The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical method.
Collapse
Affiliation(s)
- O J Wagner
- Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
| | | | | | | | | | | |
Collapse
|
66
|
Hashimoto DA, Gomez ED, Danzer E, Edelson PK, Morris JB, Williams NN, Dumon KR. Intraoperative resident education for robotic laparoscopic gastric banding surgery: a pilot study on the safety of stepwise education. J Am Coll Surg 2012; 214:990-6. [PMID: 22521438 DOI: 10.1016/j.jamcollsurg.2012.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incorporation of robotic surgery into resident education poses questions regarding intraoperative teaching and patient care. This study aimed to evaluate the impact of gradually increasing resident console responsibility on resident competency and patient safety, in the presence of a proctor and bedside surgeon, for robotic laparoscopic-assisted gastric banding (R-LAGB) compared with the classical training model (CTM) of residents as first assistant. STUDY DESIGN Eight clinical year 4 (CY4) residents completed 60 R-LAGB using a one-to-one proctored training model (PTM). R-LAGB was distilled into 7 key steps: gastroesophageal-junction dissection, gastrohepatic ligament dissection, retrogastric space creation, band placement, band closure, gastrogastric suturing, and port placement. Residents performed more complex steps after each case to gain competency in all aspects of the operation. Patient demographics, comorbidities, operative complications, operating times, and clinical outcomes were compared with a control group of 287 R-LAGB cases completed using the CTM (n = 15 CY4 residents). RESULTS All residents using the PTM were able to successfully complete an R-LAGB as primary surgeon after a median of 8 operations (range 5 to 11); no residents in the CTM completed an R-LAGB as primary surgeon. Mean operative time was statistically greater in the PTM group (99.3 ± 22.1 minutes) vs CTM (91.5 ± 21.1 minutes) (p = 0.001). There were no intraoperative complications in either group; incidence of postoperative complications was similar between groups. CONCLUSIONS All residents in the proctored setting claimed competence and have persistent console experience without significantly increasing procedure complications. PTM, otherwise known as stepwise education, is a safe, standardized method to train surgical residents in R-LAGB.
Collapse
Affiliation(s)
- Daniel A Hashimoto
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | | | | | | |
Collapse
|
67
|
Robotic surgery in otolaryngology and head and neck surgery: a review. Minim Invasive Surg 2012; 2012:286563. [PMID: 22567225 PMCID: PMC3337488 DOI: 10.1155/2012/286563] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/04/2012] [Indexed: 01/12/2023] Open
Abstract
Recent advancements in robotics technology have allowed more complex surgical procedures to be performed using minimally invasive approaches. In this article, we reviewed the role of robotic assistance in Otolaryngology and Head and Neck Surgery. We highlight the advantages of robot-assisted surgery and its clinical application in this field.
Collapse
|
68
|
Sumi Y, Dhumane PW, Komeda K, Dallemagne B, Kuroda D, Marescaux J. Learning curves in expert and non-expert laparoscopic surgeons for robotic suturing with the da Vinci(®) Surgical System. J Robot Surg 2012; 7:29-34. [PMID: 27000889 DOI: 10.1007/s11701-012-0336-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/17/2012] [Indexed: 11/30/2022]
Abstract
We investigated learning curves for robotic suturing of expert and non-expert laparoscopic surgeons to explore the length of time required to reach an acceptable plateau of technical skills. Laparoscopic suturing skills were evaluated in a training box with conventional laparoscopic instrumentation in phase 1. In phase 2, robotic suturing skills were evaluated during a training program on non-surviving animals by analyzing time required for five intracorporal stitches on the small bowel. Learning curves were plotted. A significant difference in technical skills between the expert and non-expert surgeons was demonstrated in phase 1 and at the beginning of phase 2. Both surgeons reached a learning-curve plateau exhibiting similar robotic suturing skills at the end of 90 min of training. Skills were subsequently retained equally by both surgeons. Short duration of training was sufficient for the non-expert laparoscopic surgeon to match the robotic suturing performance of the expert laparoscopic surgeon.
Collapse
Affiliation(s)
- Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan.
| | - Parag W Dhumane
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, Hopitaux Universitaires, University of Strasbourg, 1, Place de l'hôpital, 67091, Strasbourg, France
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakucho, Takatsukishi, Osaka, 5698686, Japan
| | - Bernard Dallemagne
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, Hopitaux Universitaires, University of Strasbourg, 1, Place de l'hôpital, 67091, Strasbourg, France
| | - Daisuke Kuroda
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan
| | - Jacques Marescaux
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, Hopitaux Universitaires, University of Strasbourg, 1, Place de l'hôpital, 67091, Strasbourg, France
| |
Collapse
|
69
|
Kenngott HG, Fischer L, Nickel F, Rom J, Rassweiler J, Müller-Stich BP. Status of robotic assistance--a less traumatic and more accurate minimally invasive surgery? Langenbecks Arch Surg 2011; 397:333-41. [PMID: 22038293 DOI: 10.1007/s00423-011-0859-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact. METHODS The Medline database was searched for the terms "robot, telemanipulat, and laparoscop." A total of 2,573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. RESULTS In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers. CONCLUSION Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.
Collapse
Affiliation(s)
- H G Kenngott
- Department of General, Abdominal and Transplant Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
70
|
Schreuder HWR, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RHM. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 2011; 119:137-49. [PMID: 21981104 DOI: 10.1111/j.1471-0528.2011.03139.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. OBJECTIVES To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. SEARCH STRATEGY A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed. SELECTION CRITERIA We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism. DATA COLLECTION AND ANALYSIS Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation. MAIN RESULTS We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme. AUTHORS' CONCLUSIONS Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes.
Collapse
Affiliation(s)
- H W R Schreuder
- Division of Women and Baby, Department of Gynaecological Oncology, University Medical Centre Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
71
|
Comparison of Robotic-Assisted Laparoscopy Versus Conventional Laparoscopy on Skill Acquisition and Performance. Clin Obstet Gynecol 2011; 54:376-81. [PMID: 21857168 DOI: 10.1097/grf.0b013e31822b46f6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
72
|
Jiménez Rodríguez RM, Díaz Pavón JM, de La Portilla de Juan F, Prendes Sillero E, Hisnard Cadet Dussort JM, Padillo J. Prospective Randomised Study: Robotic-Assisted Versus Conventional Laparoscopic Surgery in Colorectal Cancer Resection. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.cireng.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
73
|
Estudio prospectivo, aleatorizado: cirugía laparoscópica con asistencia robótica versus cirugía laparoscópica convencional en la resección del cáncer colorrectal. Cir Esp 2011; 89:432-8. [DOI: 10.1016/j.ciresp.2011.01.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/12/2011] [Accepted: 01/30/2011] [Indexed: 11/19/2022]
|
74
|
Roth J, Fraser JF, Singh A, Bernardo A, Anand VK, Schwartz TH. Surgical approaches to the orbital apex: comparison of endoscopic endonasal and transcranial approaches using a novel 3D endoscope. Orbit 2011; 30:43-8. [PMID: 21281081 DOI: 10.3109/01676830.2010.543004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Extended endoscopic endonasal approaches are increasingly applied to treat a variety of orbital pathologies. We performed a cadaveric study, comparing the endonasal approach with a transcranial approach to the orbital apex, using a two-dimensional (2D) and novel three-dimensional (3D) endoscope. MATERIALS AND METHODS Dissection was performed on two fresh cadaver heads using a novel 3D endoscope for the endonasal approach to the orbit and orbital apex. On the same heads, a fronto-orbito-zygomatic (FOZ) approach was performed to expose the orbital apex region. Anatomical boundaries and limitations of each exposure were noted. 2D and 3D images of the approaches and anatomical dissections were captured and recorded. RESULTS The endonasal endoscopic approach achieved direct exposure to the inferior and medial aspects of the orbit. The FOZ approach, on the other hand, provided excellent access to the superior and lateral aspects of the orbit. Appreciation of the spatial relationships of the intracranial skull base anatomy was significantly improved using the 3D endoscope compared with the 2D endoscope. CONCLUSIONS The endoscopic endonasal approach achieves direct exposure to the inferomedial aspect of the orbit and orbital apex, which is not exposed using the transcranial approach, hence the two approaches are complementary. 3D endoscopes augment the spatial orientation of extracranial and intracranial anatomical structures. This may improve patient's safety and hasten the learning curve for endoscopic approaches to the midline skull base.
Collapse
Affiliation(s)
- Jonathan Roth
- Department of Neurosurgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA
| | | | | | | | | | | |
Collapse
|
75
|
Marzano E, Ntourakis D, Addeo P, Oussoultzoglou E, Jaeck D, Pessaux P. Robotic resection of duodenal adenoma. Int J Med Robot 2011; 7:66-70. [PMID: 21341365 DOI: 10.1002/rcs.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Duodenal sporadic adenomatous polyps are rare findings during upper endoscopy. Resection is indicated due to their malignant potential. METHODS A 55 year-old male patient was diagnosed with a 3 cm duodenal adenomatous polyp with low-grade dysplasia, which could not be safely resected by endoscopy. A transduodenal submucosal robotic-assisted polypectomy was performed. RESULTS The operative time was 4.5 h, with an estimated blood loss of 200 ml. The patient had a normal bowel transit on postoperative day 3 and he was discharged on postoperative day 7. Three months follow-up was uneventful. The final histological finding revealed a completely resected duodenal adenomatous polyp without signs of malignancy. CONCLUSION Robotic-assisted resection of duodenal polyps is a feasible technique that may be indicated for the local excision of duodenal lesions that cannot be endoscopically resected. Compared to the open and laparoscopic approach, it offers many technical advantages.
Collapse
Affiliation(s)
- Ettore Marzano
- Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, Strasbourg, France
| | | | | | | | | | | |
Collapse
|
76
|
Robotic surgery in head and neck cancer: A review. Oral Oncol 2010; 46:571-6. [DOI: 10.1016/j.oraloncology.2010.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/12/2010] [Accepted: 04/13/2010] [Indexed: 11/18/2022]
|
77
|
Lee PS, Bland A, Valea FA, Havrilesky LJ, Berchuck A, Secord AA. Robotic-assisted laparoscopic gynecologic procedures in a fellowship training program. JSLS 2010; 13:467-72. [PMID: 20202385 PMCID: PMC3030777 DOI: 10.4293/108680809x12589998403921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
An early evaluation of the feasibility of training fellows in robotic surgery suggests that it is feasible to incorporate a systematic approach to robotic-assisted laparoscopic training at the onset of incorporating this technology into current practice. Background and Objective: The robotic surgical platform is an alternative technique to traditional laparoscopy and requires the development of new surgical skills for both the experienced surgeon and trainee. Our goal was to perform an early evaluation of the feasibility of training fellows in robotic-assisted gynecologic procedures at the outset of our incorporation of this technology into clinical practice. Methods: A systematic approach to fellow training included (1) didactic and hands-on training with the robotic system, (2) instructional videos, (3) assistance at the operating table, and (4) performance of segments of gynecologic procedures in tandem with the attending physician. Time to complete the entire procedure, individual segments, rate of conversion to laparotomy, and complications were recorded. Results: Twenty-one robotic-assisted gynecologic procedures were performed from April 2006 to January 2007. Fellows participated as the console surgeon in 14/21 cases. Thirteen patients (62%) had prior abdominal surgery. Median values with ranges were age 51 years (range, 33 to 90); BMI 28 (range, 19.4 to 43.8); EBL 25 mL (range, 25 to 250); and hospital stay 1 day (range, 1 to 4). No significant difference existed between fellow and attending mean total operative and individual segment times. One conversion to laparotomy was necessary. No major surgical complications occurred. Conclusion: These data suggest that it is feasible to incorporate a systematic approach to robotic-assisted laparoscopic training for trainees at the outset of incorporation of this technology into current practice.
Collapse
Affiliation(s)
- Paula S Lee
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | |
Collapse
|
78
|
From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve. ACTA ACUST UNITED AC 2010; 7:253-258. [PMID: 20700514 PMCID: PMC2914863 DOI: 10.1007/s10397-010-0572-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 02/12/2010] [Indexed: 11/29/2022]
Abstract
We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery.
Collapse
|
79
|
Anderberg M, Larsson J, Kockum CC, Arnbjörnsson E. Robotics versus laparoscopy--an experimental study of the transfer effect in maiden users. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2010; 4:3. [PMID: 20370924 PMCID: PMC2857839 DOI: 10.1186/1750-1164-4-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 04/06/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Robot-assisted laparoscopy (RL) is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL) remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique. METHODS 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study. RESULTS The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results. CONCLUSION The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females.
Collapse
Affiliation(s)
- Magnus Anderberg
- Department of Paediatric Surgery, Children's Hospital Lund, Skåne University Hospital and Lund University, Lund, Sweden.
| | | | | | | |
Collapse
|
80
|
Marecik SJ, deSouza AL, Prasad LM. Robotic Colorectal Surgery—Teaching and Skill Acquisition. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
81
|
Blavier A, Nyssen AS. Influence of 2D and 3D view on performance and time estimation in minimal invasive surgery. ERGONOMICS 2009; 52:1342-9. [PMID: 19851902 DOI: 10.1080/00140130903137277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study aimed to evaluate the impact of two-dimensional (2D) and three-dimensional (3D) images on time performance and time estimation during a surgical motor task. A total of 60 subjects without any surgical experience (nurses) and 20 expert surgeons performed a fine surgical task with a new laparoscopic technology (da Vinci robotic system). The 80 subjects were divided into two groups, one using 3D view option and the other using 2D view option. We measured time performance and asked subjects to verbally estimate their time performance. Our results showed faster performance in 3D than in 2D view for novice subjects while the performance in 2D and 3D was similar in the expert group. We obtained a significant interaction between time performance and time evaluation: in 2D condition, all subjects accurately estimated their time performance while they overestimated it in the 3D condition. Our results emphasise the role of 3D in improving performance and the contradictory feeling about time evaluation in 2D and 3D. This finding is discussed in regard with the retrospective paradigm and suggests that 2D and 3D images are differently processed and memorised.
Collapse
|
82
|
Tabaee A, Anand VK, Fraser JF, Brown SM, Singh A, Schwartz TH. Three-dimensional endoscopic pituitary surgery. Neurosurgery 2009; 64:288-93; discussion 294-5. [PMID: 19404107 DOI: 10.1227/01.neu.0000338069.51023.3c] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery. METHODS Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0- and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on "compound eye" technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded. RESULTS The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes. CONCLUSION In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.
Collapse
Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA
| | | | | | | | | | | |
Collapse
|
83
|
Kenngott HG, Müller‐Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: Technique and benefit in advanced laparoscopic surgery. MINIM INVASIV THER 2009; 17:160-7. [DOI: 10.1080/13645700802103381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
84
|
|
85
|
Ohuchida K, Kenmotsu H, Yamamoto A, Sawada K, Hayami T, Morooka K, Hoshino H, Uemura M, Konishi K, Yoshida D, Maeda T, Ieiri S, Tanoue K, Tanaka M, Hashizume M. The effect of CyberDome, a novel 3-dimensional dome-shaped display system, on laparoscopic procedures. Int J Comput Assist Radiol Surg 2009; 4:125-32. [PMID: 20033610 DOI: 10.1007/s11548-009-0282-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 12/29/2008] [Indexed: 01/12/2023]
Abstract
BACKGROUND Laparoscopic surgeons require extended experience of cases to overcome the lack of depth perception on a two-dimensional (2D) display. Although a three-dimensional (3D) display was reported to be useful over two decades ago, 3D systems have not been widely used. Recently, we developed a novel 3D dome-shaped display (3DD) system, CyberDome. STUDY DESIGN In the present study, a total of 23 students volunteered. We evaluated the effects of the 3DD system on depth perception and laparoscopic procedures in comparison with the 2D, a conventional 3D (3DP) or the 2D high definition (HD) systems using seven tasks. RESULTS The 3DD system significantly improved depth perception and laparoscopic performance compared with the 2D system in six new tasks. We further found that the 3DD system shortened the execution time and reduced the number of errors during suturing and knot tying. The 3DD system also provided more depth perception than the 3DP and 2D HD systems. CONCLUSIONS The novel 3DD system is a promising tool for providing depth perception with high resolution to laparoscopic surgeons.
Collapse
Affiliation(s)
- Kenoki Ohuchida
- Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 2009:CD006575. [PMID: 19160288 DOI: 10.1002/14651858.cd006575.pub2] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. OBJECTIVES To determine whether virtual reality training can supplement or replace conventional laparoscopic surgical training (apprenticeship) in surgical trainees with limited or no prior laparoscopic experience. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and grey literature until March 2008. SELECTION CRITERIA We included all randomised clinical trials comparing virtual reality training versus other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the standardised mean difference with 95% confidence intervals based on intention-to-treat analysis. MAIN RESULTS We included 23 trials with 612 participants. Four trials compared virtual reality versus video trainer training. Twelve trials compared virtual reality versus no training or standard laparoscopic training. Four trials compared virtual reality, video trainer training and no training, or standard laparoscopic training. Three trials compared different methods of virtual reality training. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors compared with no training; virtual reality group was more accurate than video trainer training group. In the participants with limited laparoscopic experience, virtual reality training reduces operating time and error better than standard in the laparoscopic training group; composite operative performance score was better in the virtual reality group than in the video trainer group. AUTHORS' CONCLUSIONS Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training. Further research of better methodological quality and more patient-relevant outcomes are needed.
Collapse
Affiliation(s)
- Kurinchi Selvan Gurusamy
- University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
| | | | | | | |
Collapse
|
87
|
|
88
|
Nejat G, Yiyuan Sun, Nies M. Assistive Robots in Health Care Settings. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2008. [DOI: 10.1177/1084822308325695] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Excellence in patient care is achieved through the very latest in technological advancements such as assistive robots. The purpose of this article is to review the literature on the use of assistive robots in various health care settings. The article includes a discussion of the strengths and limitations for noninteractive and interactive robots in health care and a summary of the implications for practice.
Collapse
Affiliation(s)
| | - Yiyuan Sun
- University of North Carolina, Charlotte, NC
| | - Mary Nies
- University of North Carolina, Charlotte, NC
| |
Collapse
|
89
|
Bittner JG, Hathaway CA, Brown JA. Three-dimensional visualisation and articulating instrumentation: Impact on simulated laparoscopic tasks. J Minim Access Surg 2008; 4:31-8. [PMID: 19547678 PMCID: PMC2699064 DOI: 10.4103/0972-9941.41938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/18/2008] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Laparoscopy requires the development of technical skills distinct from those used in open procedures. Several factors extending the learning curve of laparoscopy include ergonomic and technical difficulties, such as the fulcrum effect and limited degrees of freedom. This study aimed to establish the impact of four variables on performance of two simulated laparoscopic tasks. METHODS Six subjects including novice (n=2), intermediate (n=2) and expert surgeons completed two tasks: 1) four running sutures, 2) simple suture followed by surgeon's knot plus four square knots. Task variables were suturing angle (left/right), needle holder type (standard/articulating) and visualisation (2D/3D). Each task with a given set of variables was completed twice in random order. The endpoints included suturing task completion time, average and maximum distance from marks and knot tying task completion time. RESULTS Suturing task completion time was prolonged by 45-degree right angle suturing, articulating needle holder use and lower skill levels (all P < 0.0001). Accuracy also decreased with articulating needle holder use (both P < 0.0001). 3D vision affected only maximum distance (P=0.0108). For the knot tying task, completion time was greater with 45-degree right angle suturing (P=0.0015), articulating needle holder use (P < 0.0001), 3D vision (P=0.0014) and novice skill level (P=0.0003). Participants felt that 3D visualisation offered subjective advantages during training. CONCLUSIONS Results suggest construct validity. A 3D personal head display and articulating needle holder do not immediately improve task completion times or accuracy and may increase the training burden of laparoscopic suturing and knot tying.
Collapse
Affiliation(s)
- James G Bittner
- Virtual Education and Surgical Simulation Laboratory (VESSL), Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - Christopher A Hathaway
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| | - James A Brown
- Section of Urology, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia, USA
| |
Collapse
|