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Stott B, Driscoll M. Face and content validity of analog surgical instruments on a novel physics-driven minimally invasive spinal fusion surgical simulator. Med Biol Eng Comput 2022; 60:2771-2778. [DOI: 10.1007/s11517-022-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
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Gonzalez-Vargas J, Tzamaras H, Brown D, Moore J, Miller S. Preparing for the lasting effects of COVID-19 on medical training: The design and pilot study of a low-fidelity virtual reality prototype for Central Venous Catheterization training. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2022; 66:1877-1881. [PMID: 37304654 PMCID: PMC10249787 DOI: 10.1177/1071181322661255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over the last several decades we have seen a shift from in-person to online training that has been exasperated by the COVID-19 pandemic. Researchers believe that many of these effects will be lasting which makes it even more important that the Human Factors community seek to step back and understand how to best train complex skills in a virtual world. The current paper is focused on understanding the utility of Virtual Reality (VR) in medical education for a hands-on procedural heavy procedure - ultrasound-guided Internal Jugular Central Venous Catheterization. Specifically, the objective of this study is to identify the potential utility of VR in US-IJCVC training through the design of a low-fidelity prototype and user interviews with three subject-matter experts. Results showed that the VR prototype designed is useful and provides a depth of knowledge and educational value which can be used to design innovative VR training approaches.
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Affiliation(s)
| | | | - Dailen Brown
- Pennsylvania State University Mechanical Engineering
| | - Jason Moore
- Pennsylvania State University Mechanical Engineering
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Lee WJ, Kim YH, Hong SD, Rho TH, Kim YH, Dho YS, Hong CK, Kong DS. Development of 3-dimensional printed simulation surgical training models for endoscopic endonasal and transorbital surgery. Front Oncol 2022; 12:966051. [PMID: 35992880 PMCID: PMC9389537 DOI: 10.3389/fonc.2022.966051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEndoscopic skull base surgery (ESBS) is complex, requiring methodical and unremitting surgical training. Herein, we describe the development and evaluation of a novel three-dimensional (3D) printed simulation model for ESBS. We further validate the efficacy of this model as educational support in neurosurgical training.MethodsA patient-specific 3D printed simulation model using living human imaging data was established and evaluated in a task-based hands-on dissection program. Endoscopic endonasal and transorbital procedures were simulated on the model by neurosurgeons and otorhinolaryngology surgeons of varying experience. All procedures were recorded using a high-definition camera coupled with digital video recorder system. The participants were asked to complete a post-procedure questionnaire to validate the efficacy of the model.ResultsFourteen experts and 22 trainees participated in simulations, and the 32 participants completed the post-procedure survey. The anatomical realism was scored as 4.0/5.0. The participants rated the model as helpful in hand-eye coordination training (4.7/5.0) and improving surgical skills (4.6/5.0) for ESBS. All participants believed that the model was useful as educational support for trainees (4.7 [ ± 0.5]). However, the color (3.6/5.0) and soft tissue feedback parameters (2.8/5) scored low.ConclusionThis study shows that high-resolution 3D printed skull base models for ESBS can be generated with high anatomical accuracy and acceptable haptic feedback. The simulation program of ESBS using this model may be supplemental or provide an alternative training platform to cadaveric dissection.
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Affiliation(s)
- Won-Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Sang-Duk Hong
- Department of Otorhinolaryngology—Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Hoon Rho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, South Korea
| | - Young Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Doo-Sik Kong, /
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Cutting Simulation in Unity 3D Using Position Based Dynamics with Various Refinement Levels. ELECTRONICS 2022. [DOI: 10.3390/electronics11142139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Augmented and Virtual Reality-based surgical simulations have become some of the fastest-developing areas, due to the recent technological advances and changes, in surgical education. Cutting simulation is a crucial part of the virtual surgery simulation in which an incision operation is performed. It is a complex process that includes three main tasks: soft body simulation, collision detection and handling, and topological deformation of the soft body. In this paper, considering the content developer’s convenience, the deformable object simulation, using position-based dynamics (PBD), was applied in the Unity 3D environment. The proposed algorithm for fast collision detection and handling between the cutting tool and the deformable object uses a sweep surface. In case of incision, the algorithm updates the mesh topology by deleting intersected triangles, re-triangulation, and refinement. In the refinement part, the boundary edges threshold was used to match the resolution of new triangles to the existing mesh triangles. Additionally, current research is focused on triangle surface meshes, which help to reduce the computational costs of the topology modifications. It was found that the algorithm can successfully handle arbitrary cuts, keeping the framerate within interactive and, in some cases, in the real-time.
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Orejuela FJ, Aschkenazi SO, Howard DL, Jeppson PC, Balgobin S, Walter AJ, White A, Olivera CK, Sanses TV, Thompson J, Gala RB, Matteson K, Balk EM, Meriwether KV, Rahn DD. Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:29.e1-29.e24. [PMID: 35120886 DOI: 10.1016/j.ajog.2022.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/26/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries. DATA SOURCES PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, prospective comparative studies, and prospective single-group studies with pre- and posttraining assessments that reported surgical simulation-based training before gynecologic surgery were included. METHODS Reviewers independently identified the studies, obtained data, and assessed the study quality. The results were analyzed according to the type of gynecologic surgery, simulation, comparator, and outcome data, including clinical and patient-related outcomes. The maximum likelihood random effects model meta-analyses of the odds ratios and standardized mean differences were calculated with estimated 95% confidence intervals. RESULTS Twenty studies, including 13 randomized controlled trials, 1 randomized crossover trial, 5 nonrandomized comparative studies, and 1 prepost study were identified. Most of the included studies (14/21, 67%) were on laparoscopic simulators and had a moderate quality of evidence. Meta-analysis showed that compared with traditional surgical teaching, high- and low-fidelity simulators improved surgical technical skills in the operating room as measured by global rating scales, and high-fidelity simulators decreased the operative time. Moderate quality evidence was found favoring warm-up exercises before laparoscopic surgery. There was insufficient evidence to conduct a meta-analysis for other gynecologic procedures. CONCLUSION Current evidence supports incorporating simulation-based training for a variety of gynecologic surgeries to increase technical skills in the operating room, but data on patient-related outcomes are lacking.
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Affiliation(s)
- Francisco J Orejuela
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
| | | | - David L Howard
- Department of Obstetrics and Gynecology, University of Nevada, Las Vegas, NV
| | - Peter C Jeppson
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - Sunil Balgobin
- Department of Obstetrics and Gynecology, The University of Texas, Southwestern, Dallas, TX
| | - Andrew J Walter
- Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Roseville, CA
| | - Amanda White
- Department of Obstetrics and Gynecology, Dell Medical Center, The University of Texas at Austin, Austin, TX
| | - Cedric K Olivera
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tatiana V Sanses
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC
| | - Jennifer Thompson
- Department of Obstetrics and Gynecology, Northwest Kaiser Permanente, Portland, OR
| | - Rajiv B Gala
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA
| | - Kristen Matteson
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ethan M Balk
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Kate V Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - David D Rahn
- Department of Obstetrics and Gynecology, The University of Texas, Southwestern, Dallas, TX
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Bienstock J, Heuer A. A review on the evolution of simulation-based training to help build a safer future. Medicine (Baltimore) 2022; 101:e29503. [PMID: 35758389 PMCID: PMC9276079 DOI: 10.1097/md.0000000000029503] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Throughout history, simulation has been used to demonstrate various techniques, acquire skills, and maintain best practices in healthcare. Simulation has evolved significantly, primarily because of the extent to which it can enhance both clinical proficiency and patient care. Although simulation-based training (SBT) in healthcare has grown exponentially in the 21st century, it has been around for centuries. This paper aims to reflect on the history and evolution of simulation in healthcare and review its current applications in order to provide a foundation for developing new applications for future expanded use.
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Wu C, Lorenzo G, Hormuth DA, Lima EABF, Slavkova KP, DiCarlo JC, Virostko J, Phillips CM, Patt D, Chung C, Yankeelov TE. Integrating mechanism-based modeling with biomedical imaging to build practical digital twins for clinical oncology. BIOPHYSICS REVIEWS 2022; 3:021304. [PMID: 35602761 PMCID: PMC9119003 DOI: 10.1063/5.0086789] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Digital twins employ mathematical and computational models to virtually represent a physical object (e.g., planes and human organs), predict the behavior of the object, and enable decision-making to optimize the future behavior of the object. While digital twins have been widely used in engineering for decades, their applications to oncology are only just emerging. Due to advances in experimental techniques quantitatively characterizing cancer, as well as advances in the mathematical and computational sciences, the notion of building and applying digital twins to understand tumor dynamics and personalize the care of cancer patients has been increasingly appreciated. In this review, we present the opportunities and challenges of applying digital twins in clinical oncology, with a particular focus on integrating medical imaging with mechanism-based, tissue-scale mathematical modeling. Specifically, we first introduce the general digital twin framework and then illustrate existing applications of image-guided digital twins in healthcare. Next, we detail both the imaging and modeling techniques that provide practical opportunities to build patient-specific digital twins for oncology. We then describe the current challenges and limitations in developing image-guided, mechanism-based digital twins for oncology along with potential solutions. We conclude by outlining five fundamental questions that can serve as a roadmap when designing and building a practical digital twin for oncology and attempt to provide answers for a specific application to brain cancer. We hope that this contribution provides motivation for the imaging science, oncology, and computational communities to develop practical digital twin technologies to improve the care of patients battling cancer.
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Affiliation(s)
- Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas 78712, USA
| | | | | | | | - Kalina P. Slavkova
- Department of Physics, The University of Texas at Austin, Austin, Texas 78712, USA
| | | | | | - Caleb M. Phillips
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas 78712, USA
| | - Debra Patt
- Texas Oncology, Austin, Texas 78731, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA
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Preoperative Virtual Reality Surgical Rehearsal of Renal Access during Percutaneous Nephrolithotomy: A Pilot Study. ELECTRONICS 2022. [DOI: 10.3390/electronics11101562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Percutaneous Nephrolithotomy (PCNL) is a procedure used to treat kidney stones. In PCNL, a needle punctures the kidney through an incision in a patient’s back and thin tools are threaded through the incision to gain access to kidney stones for removal. Despite being one of the main endoscopic procedures for managing kidney stones, PCNL remains a difficult procedure to learn with a long and steep learning curve. Virtual reality simulation with haptic feedback is emerging as a new method for PCNL training. It offers benefits for both novices and experienced surgeons. In the first case, novices can practice and gain kidney access in a variety of simulation scenarios without offering any risk to patients. In the second case, surgeons can use the simulator for preoperative surgical rehearsal. This paper proposes the first preliminary study of PCNL surgical rehearsal using the Marion Surgical PCNL simulator. Preoperative CT scans of a patient scheduled to undergo PCNL are used in the simulator to create a 3D model of the renal system. An experienced surgeon then planned and practiced the procedure in the simulator before performing the surgery in the operating room. This is the first study involving survival rehearsal using a combination of VR and haptic feedback in PCNL before surgery. Preliminary results confirm that surgical rehearsal using a combination of virtual reality and haptic feedback strongly affects decision making during the procedure.
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Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R. Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir (Wien) 2022; 164:947-966. [PMID: 35122126 PMCID: PMC8815386 DOI: 10.1007/s00701-021-05003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. METHODS PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. RESULTS Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. CONCLUSION Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.
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Affiliation(s)
- Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Calvachi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Rueda-Esteban
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Universidad de los Andes School of Medicine, Bogotá, Colombia.
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Alsowaina KN, Atashzar SF, Pur DR, Eagleson R, Patel RV, Elnahas AI, Hawel JD, Alkhamesi NA, Schlachta CM. Video Context Improves Performance in Identifying Operative Planes on Static Surgical Images. JOURNAL OF SURGICAL EDUCATION 2022; 79:492-499. [PMID: 34702691 DOI: 10.1016/j.jsurg.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/10/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Correct identification of the surgical tissue planes of dissection is paramount at the operating room, and the needed skills seem to be improved with realistic dynamic models rather than mere still images. The objective is to assess the role of adding video prequels to still images taken from operations on the precision and accuracy of tissue plane identification using a validated simulation model, considering various levels of surgeons' experience. METHODS A prospective observational study was conducted involving 15 surgeons distributed to three equal groups, including a consultant group [C], a senior group [S], and a junior group [J]. Subjects were asked to identify and draw ideal tissue planes in 20 images selected at suitable operative moments of identification before and after showing a 10- second videoclip preceding the still image. A validated comparative metric (using a modified Hausdorff distance [%Hdu] for object matching) was used to measure the distance between lines. A precision analysis was carried out based on the difference in %Hdu between lines drawn before and after watching the videos, and between-group comparisons were analyzed using a one-way analysis of variance (ANOVA). The analysis of accuracy was done on the difference in %Hdu between lines drawn by the subjects and the ideal lines provided by an expert panel. The impact of videos on accuracy was assessed using a repeated-measures ANOVA. RESULTS The C group showed the highest preciseness as compared to the S and J groups (mean Hdu 9.17±11.86 versus 12.1±15.5 and 20.0±18.32, respectively, p <0.001) and significant differences between groups were found in 14 images (70%). Considering the expert panel as a reference, the interaction between time and experience level was significant ( F (2, 597) = 4.52, p <0.001). Although the subjects of the J group were significantly less accurate than other surgeons, only this group showed significant improvements in mean %Hdu values after watching the lead-in videos ( F (1, 597) = 6.04, p = 0.014). CONCLUSIONS Adding video context improved the ability of junior trainees to identify tissue planes of dissection. A realistic model is recommended considering experience-based differences in precision in training programs.
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Affiliation(s)
- Khalid N Alsowaina
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Seyed F Atashzar
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Roy Eagleson
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Rajni V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Ahmad I Elnahas
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Jeffrey D Hawel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Nawar A Alkhamesi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Christopher M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
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Saleem HY, Kaplan JL, Torres-Guzman RA, Avila FR, Forte AJ. Simulation in Hand Surgery: A Literature Review. World J Surg 2022; 46:718-724. [PMID: 34993601 DOI: 10.1007/s00268-021-06400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to duty hour regulations, patient safety and inadequate operative time simulation have become a necessary part of surgical education and training in residency. Currently, there is no formal adoption of simulators for the use of surgical education or assessment in hand surgery. This literature review analyzes that the simulation techniques established thus far in hand surgery. METHODS A comprehensive literature search was performed on PubMed. Search results were filtered by title and abstract to isolate articles that were relevant to simulation in hand surgery. Articles that were nonspecific to the hand, non-English and cadaveric were excluded. Additional articles were identified through references from the initial search. RESULTS A total of 1192 articles were yielded from the initial query. After the application of the inclusion criteria, this was narrowed down to 28 articles. Another 8 additional articles were excluded as they did not pertain to the hand although the simulators could be adapted for hand surgery. A total of 20 articles were included in this study. CONCLUSIONS Surgical simulation is a growing and essential field of surgical education. Simulators in hand surgery are limited and require further research and validation. Like other surgical subspecialties, hand surgery may benefit from the adoption of an official simulation curriculum for the assessment of residents and enhancement of technical skills.
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Affiliation(s)
- Humza Y Saleem
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jamie L Kaplan
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Kurazume R, Hiramatsu T, Kamei M, Inoue D, Kawamura A, Miyauchi S, An Q. Development of AR training systems for Humanitude dementia care. Adv Robot 2022. [DOI: 10.1080/01691864.2021.2017342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ryo Kurazume
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Tomoki Hiramatsu
- Graduate School of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Masaya Kamei
- Graduate School of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Daiji Inoue
- Graduate School of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Akihiro Kawamura
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Shoko Miyauchi
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Qi An
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
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Coelho G, Trigo L, Faig F, Vieira EV, da Silva HPG, Acácio G, Zagatto G, Teles S, Gasparetto TPD, Freitas LF, Zanon N, Lapa DA. The Potential Applications of Augmented Reality in Fetoscopic Surgery for Antenatal Treatment of Myelomeningocele. World Neurosurg 2021; 159:27-32. [PMID: 34922026 DOI: 10.1016/j.wneu.2021.11.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a preoperative planning method using augmented reality (AR) of a specific surgical procedure: fetoscopy for myelomeningocele repair. METHODS Imaging data were acquired of a pregnant woman at 27 weeks of gestation whose fetus was diagnosed with myelomeningocele. The patient was identified as a candidate for fetoscopic repair of the spine defect, and an AR application for mobile device simulation was developed. The virtual customized model was created by analysis of the presurgical magnetic resonance imaging. A real-time AR interface was developed by using an application that enhanced the anatomical aspects of both mother and fetus. RESULTS A virtual model for planning fetoscopy repair for myelomeningocele was developed. Preoperative and postoperative procedures were successfully carried out, emphasizing the beneficial role of the AR application. The use of the AR model allowed the multidisciplinary team to engage in discussion to determine the appropriate surgical approach. It also allowed a clearer explanation of the procedure to the parents enabling a better understanding of the parents regarding specifics characteristics of their baby's spine defect. CONCLUSIONS This new preoperative platform using a virtual model represents an important tool to improve patient's comprehension, multidisciplinary discussion, and surgical planning. In addition, it can be used worldwide as a teaching tool in the fetal surgery field.
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Affiliation(s)
- Giselle Coelho
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Lucas Trigo
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Fernanda Faig
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Eduardo Varjão Vieira
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil; Department of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | | | - Gregório Acácio
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Gustavo Zagatto
- Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil
| | - Sylker Teles
- Scientific Department, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Taísa Pallú Davaus Gasparetto
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Radiology, Diagnósticos da América SA, São Paulo, São Paulo, Brazil
| | | | - Nelci Zanon
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, CENEPE, Centro de Neurocirurgia Pediátrica, São Paulo, São Paulo, Brazil
| | - Denise Araújo Lapa
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Fetal Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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Prudhomme T, Karam G, Roumiguié M, Bardet F, Sallusto F, Soulié M, Gamé X, Kamar N, Phé V, Pradère B, Blancho G, Lechevallier É, Branchereau J. [Pedagogical impact of a MOOC on surgical technique of kidney transplantation]. Prog Urol 2021; 32:226-239. [PMID: 34920921 DOI: 10.1016/j.purol.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the educational impact of a pilot MOOC (Massive Open Online Course), validated by the French College of Urology Teachers (FCUT), on the surgical technique of kidney transplantation. MATERIALS AND METHODS We developed a MOOC on the surgical technique of kidney transplantation, based on a video of a surgical procedure, performed by an expert surgeon. The MOOC has been validated by the FCUT. We have created 2 student groups: 1) MOOC-pre-QCM group: visualization of the MOOC then answer to the MCQs and satisfaction questions; 2) MOOC-post-QCM group: answer to the MCQs then visualization of the MOOC then answers to the satisfaction questions. In total, 20 MCQs on the kidney transplantation technique were completed by the 2 groups. The answers were anonymous. RESULTS A total of 142 people answered the MCQs (MOOC-pre-QCM group (n=66) and MOOC-post-QCM group (n=76)). Twenty-nine percent (41/142) of the participants were fellows and 71 % (101/142) were residents. The proportion of fellows and residents was identical between the 2 groups. The rate of correct answers to the 20 MCQs was statistically higher in the MOOC-pre-QCM group, compared to the MOOC-post-QCM group (88.6 % versus 73.3 %, P<0.0001). Ninety-one percent of students found the MOOC "Very Useful" or "Useful". The median MOOC rating, given by students, was 8/10. CONCLUSION This study showed a positive impact of the MOOC on theoretical knowledge of kidney transplantation surgical technique. This MOOC could serve as a pilot project for the development of other MOOCs on urological surgery. LEVEL 3.
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Affiliation(s)
- Thomas Prudhomme
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France; Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France.
| | - Georges Karam
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France
| | - Mathieu Roumiguié
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | | | - Féderico Sallusto
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Michel Soulié
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Xavier Gamé
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Nassim Kamar
- Département de néphrologie et de transplantation d'organe, CHU de Toulouse, Toulouse, France
| | - Véronique Phé
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Benjamin Pradère
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Gilles Blancho
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France
| | - Éric Lechevallier
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Julien Branchereau
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France; Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
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A Novel Training and Collaboration Integrated Framework for Human-Agent Teleoperation. SENSORS 2021; 21:s21248341. [PMID: 34960435 PMCID: PMC8708703 DOI: 10.3390/s21248341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 12/21/2022]
Abstract
Human operators have the trend of increasing physical and mental workloads when performing teleoperation tasks in uncertain and dynamic environments. In addition, their performances are influenced by subjective factors, potentially leading to operational errors or task failure. Although agent-based methods offer a promising solution to the above problems, the human experience and intelligence are necessary for teleoperation scenarios. In this paper, a truncated quantile critics reinforcement learning-based integrated framework is proposed for human–agent teleoperation that encompasses training, assessment and agent-based arbitration. The proposed framework allows for an expert training agent, a bilateral training and cooperation process to realize the co-optimization of agent and human. It can provide efficient and quantifiable training feedback. Experiments have been conducted to train subjects with the developed algorithm. The performances of human–human and human–agent cooperation modes are also compared. The results have shown that subjects can complete the tasks of reaching and picking and placing with the assistance of an agent in a shorter operational time, with a higher success rate and less workload than human–human cooperation.
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66
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Murr AT, Lumley CJ, Feins RH, Hackman TG. Evaluation of a 3D-Printed Transoral Robotic Surgery Simulator Utilizing Artificial Tissue. Laryngoscope 2021; 132:1588-1593. [PMID: 34882806 PMCID: PMC9177903 DOI: 10.1002/lary.29981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) poses challenges for operators in training, with limited robot access on a platform requiring distinct surgical skills. Few simulators exist, and current virtual reality training modules exclude head and neck simulations. This study evaluates the construct validity for a novel low-cost TORS simulator. STUDY DESIGN Single institution prospective observational study. METHODS Using 3D-printed oral cavity structures and replaceable artificial tissue components, a modular TORS simulator was constructed for short-duration hands-on simulations with the da Vinci SI robot. Sixteen surgeons of differing robotic skill levels, no experience (novice), prior experience, and formal robot training, participated in simulated tonsil and tongue base tumor resections. Video recordings of each participant were graded by a blinded robotically trained surgeon using a 35-point Global Evaluative Assessment of Robotic Surgery (GEARS) criterion adapted for the TORS simulator. RESULTS Operators reporting formal robotic training or prior robot experience achieved significantly higher mean total GEARS scores compared to novice operators (32 vs. 20.5; P < .001). Overall, mean total GEARS scores correlated with reported experience level; novice operators scored 54% of total points at 19 (4.5), operators with prior experience scored 82.3% of total points at 28.8 (2.6), and robotically trained operators scored 97.1% of total points at 34 (1.7). CONCLUSION With a GEARS criterion, our simulator successfully differentiated novice from experienced and robotically trained operators of the da Vinci SI robot during simulated tonsillectomy and base of tongue resections. These findings support the construct validity of this prototype simulator and offer a foundation for further testing of predictive validity. LEVEL OF EVIDENCE 2 Laryngoscope, 2021.
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Affiliation(s)
- Alexander T Murr
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Catherine J Lumley
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Richard H Feins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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67
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Briggs SM. Expanding the Spectrum of Surgical Simulation Training. J Am Coll Surg 2021; 233:708-709. [PMID: 34823679 DOI: 10.1016/j.jamcollsurg.2021.08.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
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Ershad M, Rege R, Majewicz Fey A. Adaptive Surgical Robotic Training Using Real-Time Stylistic Behavior Feedback Through Haptic Cues. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2021; 3:959-969. [PMID: 38250511 PMCID: PMC10798657 DOI: 10.1109/tmrb.2021.3124128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Surgical skill directly affects surgical procedure outcomes; thus, effective training is needed to ensure satisfactory results. Many objective assessment metrics have been developed that provide the trainee with descriptive feedback about their performance however, often lack feedback on how to improve performance. The most effective training method is one that is intuitive, easy to understand, personalized to the user,and provided in a timely manner. We propose a framework to enable user-adaptive training using near real-time detection of performance, based on intuitive styles of surgical movements, and design a haptic feedback framework to assist with correcting styles of movement. We evaluate the ability of three types of force feedback (spring, damping, and spring plus damping feedback), computed based on prior user positions, to improve different stylistic behaviors of the user during kinematically constrained reaching movement tasks. The results indicate that five out of six styles studied here were improved using at least one of the three types of force feedback. Task performance metrics were compared in the presence of the three types of feedback. Task time was statistically significantly lower when applying spring feedback, compared to the other two types of feedback. Path straightness and targeting error were statistically significantly improved when using spring-damping feedback compared to the other two types of feedback. This study presents a groundwork for adaptive training in robotic surgery based on near real-time human-centric models of surgical behavior.
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Affiliation(s)
- Marzieh Ershad
- Department of Electrical Engineering, University of Texas at Dallas, Richardson, TX, 75080
| | - Robert Rege
- Department of Surgery at UT Southwestern Medical Center, Dallas, TX, 75390
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX 78712
- Department of Surgery at UT Southwestern Medical Center, Dallas, TX, 75390
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69
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Judy BF, Pennington Z, Botros D, Tsehay Y, Kopparapu S, Liu A, Theodore N, Zakaria HM. Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve. Int J Spine Surg 2021; 15:S28-S37. [PMID: 34675029 DOI: 10.14444/8138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David Botros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Nair D, Wells JM, Yi M, Beasley S. Is Technical Expertise Necessary to Assess Technical Expertise? Let's Ask the Kids. J Laparoendosc Adv Surg Tech A 2021; 31:1363-1366. [PMID: 34677094 DOI: 10.1089/lap.2021.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Simulation has an increasing role in surgical training; however, using validated tools such as the Objective Structured Assessment of Technical Skills (OSATS) is time-consuming, which may be a potential barrier to simulation-based training. This study tests the hypothesis that assessors with technical expertise are necessary to objectively score a technical task. Methods: Three tasks, ring transfer, needle pass, and atresia cut, were performed using a synthetic thoracoscopic simulator for esophageal atresia/tracheoesophageal fistula. Three pediatric surgeons, 6 novice adults, and 3 children aged 9-13 years scored each attempt using the overall global OSATS rating from 1 to 5 (1 "repeated or awkward movements" to 5 "fluid movement. No awkwardness"). Results: For the ring transfer, all assessors scored novice participants significantly less than expert and intermediate scores (surgeon P = .0004, nonsurgeon adults P = .0009 and children P = .0003). For the needle pass, all assessors gave significantly different scores between novices and experts (surgeon P = .0007, nonsurgeon adult P = .0008, and children P = .0040). For the atresia cut, surgeon assessors gave significantly higher scores for experts and intermediate and novice (P = .0004). Nonsurgeon assessors gave experts and intermediates significantly higher scores than novices (P = .0001). Surgeon assessors achieved good reliability for ring transfer (0.8252) and needle pass (0.7769) compared with nonsurgeon assessors who showed poor reliability for the ring transfer (0.3959) and moderate for the needle pass (0.6551). Conclusions: Expertise in performing these procedures is not a prerequisite for an assessor to evaluate the technical skill, hence assessors of skill acquisition can be nonexpert, a nonsurgeon, or even a child. The variability in all groups suggests that reliability overall is increased with multiple assessors. Although nonsurgeon assessors may be appropriate for formative assessments, they lack the reliability to provide assessment of competence for high stakes complex tasks. Summative assessment will likely require at least 1 surgeon/expert assessor to provide reliability.
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Affiliation(s)
- David Nair
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand
| | - Jonathan M Wells
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand.,University of Otago, Department of Surgery, Christchurch, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Department of Biostatistics, Christchurch, New Zealand
| | - Spencer Beasley
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand.,University of Otago, Department of Surgery, Christchurch, New Zealand
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Robb HD, Scrimgeour G, Boshier PR, Balyasnikova S, Brown G, Bello F, Kontovounisios C. Current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol. BMJ Open 2021; 11:e045546. [PMID: 34620652 PMCID: PMC8499311 DOI: 10.1136/bmjopen-2020-045546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Three-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training, as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research. METHODS AND ANALYSIS The protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy was developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1 June 2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789).Two independent reviewers will screen titles, abstracts and perform full-text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis will be performed. ETHICS AND DISSEMINATION Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences. REGISTRATION DETAILS The scoping review protocol has been registered on the Open Science Framework (https://osf.io/ta789).
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Affiliation(s)
| | - Gemma Scrimgeour
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Gina Brown
- Radiology Department, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Fernando Bello
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London, UK
- Gastrointestinal Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
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Mind the Gap: a Competency-Based Scoping Review of Aesthetic and Reconstructive Reported Simulation Training Models. Aesthetic Plast Surg 2021; 45:2483-2490. [PMID: 33483780 DOI: 10.1007/s00266-020-02089-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Sideris M, Nicolaides M, Jagiello J, Rallis KS, Emin E, Theodorou E, Hanrahan JG, Mallick R, Odejinmi F, Lymperopoulos N, Papalois A, Tsoulfas G. In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:995-1002. [PMID: 34512069 PMCID: PMC8416184 DOI: 10.2147/amep.s272185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students' inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.
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Affiliation(s)
- Michail Sideris
- Women’s Health Research Unit, Queen Mary University of London, London, UK
| | - Marios Nicolaides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kathrine S Rallis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elif Emin
- Women’s Health Research Unit, Queen Mary University of London, London, UK
| | - Efthymia Theodorou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK
| | - Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | | | - Apostolos Papalois
- Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Alsayegh A, Bakhaidar M, Winkler-Schwartz A, Yilmaz R, Del Maestro RF. Best Practices Using Ex Vivo Animal Brain Models in Neurosurgical Education to Assess Surgical Expertise. World Neurosurg 2021; 155:e369-e381. [PMID: 34419656 DOI: 10.1016/j.wneu.2021.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ex vivo animal brain simulation models are being increasingly used for neurosurgical training because these models can replicate human brain conditions. The goal of the present report is to provide the neurosurgical community interested in using ex vivo animal brain simulation models with guidelines for comprehensively and rigorously conducting, documenting, and assessing this type of research. METHODS In consultation with an interdisciplinary group of physicians and researchers involved in ex vivo models and a review of the literature on the best practices guidelines for simulation research, we developed the "ex vivo brain model to assess surgical expertise" (EVBMASE) checklist. The EVBMASE checklist provides a comprehensive quantitative framework for analyzing and reporting studies involving these models. We applied The EVBMASE checklist to the studies reported of ex vivo animal brain models to document how current ex vivo brain simulation models are used to train surgical expertise. RESULTS The EVBMASE checklist includes defined subsections and a total score of 20, which can help investigators improve studies and provide readers with techniques to better assess the quality and any deficiencies of the research. We classified 18 published ex vivo brain models into modified (group 1) and nonmodified (group 2) models. The mean total EVBMASE score was 11 (55%) for group 1 and 4.8 (24.2%) for group 2, a statistically significant difference (P = 0.006) mainly attributed to differences in the simulation study design section (P = 0.003). CONCLUSIONS The present findings should help contribute to more rigorous application, documentation, and assessment of ex vivo brain simulation research.
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Affiliation(s)
- Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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Intelligent Tutoring for Surgical Decision Making: a Planning-Based Approach. INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE IN EDUCATION 2021. [DOI: 10.1007/s40593-021-00261-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tanaka T, Shimada Y, Furumoto H, Makino Y, Kudo Y, Maehara S, Hagiwara M, Kakihana M, Kajiwara N, Ohira T, Ikeda N. Comparative analysis of the results of video-assisted thoracic surgery lobectomy simulation using the three-dimensional-printed Biotexture wet-lung model and surgeons' experience. Interact Cardiovasc Thorac Surg 2021; 32:284-290. [PMID: 33212508 DOI: 10.1093/icvts/ivaa240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We performed a comparative analysis of the performance of video-assisted thoracic surgery (VATS) lobectomy simulation using three-dimensional-printed Biotexture lung models by surgeons classified according to their level of expertise. The aim of this study was to investigate the association between surgeons' experience and time to complete the VATS lobectomy simulation. METHODS Participants were divided into 3 groups: group A included those who had no experience of actual VATS lobectomy (n = 11), group B included those who had performed 5-10 VATS lobectomies (n = 12) and group C included those who had performed >100 VATS lobectomies (n = 6). Their performances were assessed based on total procedure time, duration to the exposure of the vessels, ligation of the arteries and stapling of the fissures. After the simulation, a questionnaire survey was performed. RESULTS The median total procedure time was significantly shorter in the group of surgeons with more experience (A vs B, P < 0.001; B vs C, P = 0.034; A vs C, P < 0.001). Regarding 'the exposure of all the vessels to be resected' and 'ligation of the arteries', group B completed these steps in less time than group A (P = 0.024 and P = 0.012, respectively). In the questionnaire, all groups answered that this simulation was useful for novices to improve their skills. CONCLUSIONS Although time to complete the VATS lobectomy simulation is only a part of evaluation points for real skills, this model can facilitate basic skill acquisitions for novices.
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Affiliation(s)
- Takahiko Tanaka
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | | | - Yojiro Makino
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yujin Kudo
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Sachio Maehara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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Mao RQ, Lan L, Kay J, Lohre R, Ayeni OR, Goel DP, Sa DD. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res 2021; 268:40-58. [PMID: 34284320 DOI: 10.1016/j.jss.2021.06.045] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons. METHODS A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated. RESULTS The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I2=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control. CONCLUSIONS Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
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Affiliation(s)
- Randi Q Mao
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Lucy Lan
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Ryan Lohre
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
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Dang J, Lal A, Flurin L, James A, Gajic O, Rabinstein AA. Predictive modeling in neurocritical care using causal artificial intelligence. World J Crit Care Med 2021; 10:112-119. [PMID: 34316446 PMCID: PMC8291004 DOI: 10.5492/wjccm.v10.i4.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/17/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) and digital twin models of various systems have long been used in industry to test products quickly and efficiently. Use of digital twins in clinical medicine caught attention with the development of Archimedes, an AI model of diabetes, in 2003. More recently, AI models have been applied to the fields of cardiology, endocrinology, and undergraduate medical education. The use of digital twins and AI thus far has focused mainly on chronic disease management, their application in the field of critical care medicine remains much less explored. In neurocritical care, current AI technology focuses on interpreting electroencephalography, monitoring intracranial pressure, and prognosticating outcomes. AI models have been developed to interpret electroencephalograms by helping to annotate the tracings, detecting seizures, and identifying brain activation in unresponsive patients. In this mini-review we describe the challenges and opportunities in building an actionable AI model pertinent to neurocritical care that can be used to educate the newer generation of clinicians and augment clinical decision making.
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Affiliation(s)
- Johnny Dang
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN 55905, United States
| | - Laure Flurin
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Amy James
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN 55905, United States
| | - Alejandro A Rabinstein
- Department of Medicine, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
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Raja U, Amin MSA, Soualhi A. Twelve tips to maximise medical student exposure during surgical placements. MEDICAL TEACHER 2021; 43:637-641. [PMID: 33073656 DOI: 10.1080/0142159x.2020.1831465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Surgery is a highly competitive specialty that offers a wide range of subspecialties. The presence of surgical education and rotations in the medical school curriculum is often lacking, and for this reason many medical students have little experience of surgery during their time in medical school. This paper presents twelve tips for medical students who are interested in pursuing a career in surgery, offering different ways of exposure into activities related to surgical care. Understanding the practice of surgery and self-reflecting on one's personality and suitability for a career in surgery are key. Moreover, surgical care is not only limited to the surgeon's table-other opportunities to learn more about surgery exist outside of the operating room. Extra-curricular activities in research and leadership are also vital in developing an interest in surgery and competitive edge in medical students.
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Affiliation(s)
- Usman Raja
- GKT School of Medical Education, King's College London, London, UK
| | | | - Ahmed Soualhi
- GKT School of Medical Education, King's College London, London, UK
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80
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Nair AG, Ahiwalay C, Bacchav AE, Sheth T, Lansingh VC, Vedula SS, Bhatt V, Reddy JC, Vadavalli PK, Praveen S, Wairagade NA, Pettey J. Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial. Sci Rep 2021; 11:10945. [PMID: 34040056 PMCID: PMC8155014 DOI: 10.1038/s41598-021-90410-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0–18.95) in the EG and 17.56 (95% CI 6.63–28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13–9.59) in the EG and 10.09 (95% CI 4.76–15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0–9.75) in the EG and 7.47 (95% CI 1.43–13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.
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Affiliation(s)
- Akshay Gopinathan Nair
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India.
| | - Chetan Ahiwalay
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Ashish E Bacchav
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Tejas Sheth
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | | | - S Swaroop Vedula
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Venudhar Bhatt
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | | | | | | | | | - Jeff Pettey
- John A. Moran Eye Center, Salt Lake City, UT, USA
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81
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Effectiveness Assessment of CAD Simulation in Complex Orthopedic Surgery Practices. Symmetry (Basel) 2021. [DOI: 10.3390/sym13050850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This experimental study defines the usage of a computer-aided surgical simulation process that is effective, safe, user-friendly, and low-cost, that achieves a detailed and realistic representation of the anatomical region of interest. The chosen tools for this purpose are state-of-the-art Computer Aided Design (CAD) software for mechanical design, and are the fundamental application dedicated to parametric modeling. These tools support different work environments, each one is for a specific type of modeling, and they allow the simulation of surgery. The result will be a faithful representation of the anatomical part both before and after the surgical procedure, screening all the intermediate phases. The doctor will assess different lines of action according to the results, then he will communicate them to the engineer who, consequently, will correct the antisymmetric issue and regenerate the model. Exact measurements of the mutual positions of the various components, skeletal and synthetic, can be achieved; all the osteosynthesis tools, necessary for the surgeon, can be included in the project according to different types of fracture to perfectly match the morphology of the bone to be treated. The method has been tested on seven clinical cases of different complexity and nature and the results of the simulations have been found to be of great effectiveness in the phase of diagnosis and of preoperative planning for the doctors and surgeons; therefore, allowing a lower risk medical operation with a better outcome. This work delivers experimental results in line with theoretical research findings in detail; moreover, full experimental and/or methodical details are provided, so that outcomes could be obtained.
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Byvaltsev V, Polkin R, Bereznyak D, Giers MB, Hernandez PA, Shepelev V, Aliyev M. 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery. Surg Neurol Int 2021; 12:213. [PMID: 34084640 PMCID: PMC8168712 DOI: 10.25259/sni_849_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The skills required for neurosurgical operations using microsurgical techniques in a deep operating field are difficult to master in the operating room without risk to patients. Although there are many microsurgical training models, most do not use a skull model to simulate a deep field. To solve this problem, 3D models were created to provide increased training in the laboratory before the operating room, improving patient safety. METHODS A patient's head was scanned using computed tomography. The data were reconstructed and converted into a standard 3D printing file. The skull was printed with several openings to simulate common surgical approaches. These models were then used to create a deep operating field while practicing on a chicken thigh (femoral artery anastomosis) and on a rat (abdominal aortic anastomosis). RESULTS The advantages of practicing with the 3D printed models were clearly demonstrated by our trainees, including appropriate hand position on the skull, becoming comfortable with the depth of the anastomosis, and simulating proper skull angle and rigid fixation. One limitation is the absence of intracranial structures, which is being explored in future work. CONCLUSION This neurosurgical model can improve microsurgery training by recapitulating the depth of a real operating field. Improved training can lead to increased accuracy and efficiency of surgical procedures, thereby minimizing the risk to patients.
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Affiliation(s)
- Vadim Byvaltsev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Roman Polkin
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Dmitry Bereznyak
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Morgan B. Giers
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Phillip A. Hernandez
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Valery Shepelev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat Aliyev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
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Cragg J, Mushtaq F, Lal N, Garnham A, Hallissey M, Graham T, Shiralkar U. Surgical cognitive simulation improves real-world surgical performance: randomized study. BJS Open 2021; 5:6280341. [PMID: 34021326 PMCID: PMC8140200 DOI: 10.1093/bjsopen/zrab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the acknowledgement of human factors, application of psychological methods by surgeons to improve surgical performance is sparse. This may reflect the paucity of evidence that would help surgeons to use psychological techniques effectively. There is a need for novel approaches to see how cognitive training might be used to address these challenges. METHODS Surgical trainees were divided into intervention and control groups. The intervention group received training in surgical cognitive simulation (SCS) and was asked to apply the techniques while working in operating theatres. Both groups underwent procedure-based assessment based on the UK and Ireland Intercollegiate Surgical Curriculum Programme (ISCP) before the training and 4 months afterwards. Subjective evaluations of SCS application were obtained from the intervention group participants. RESULTS Among 21 participants in the study, there was a statistically significant improvement in 11 of 16 procedure-based assessment domains (P < 0.050) as well as a statistically significant mean reduction in time to complete the procedure in the intervention group (-15.98 versus -1.14 min; P = 0.024). Subjectively, the intervention group experienced various benefits with SCS, especially in preoperative preparedness, intraoperative focus, and overall performance. CONCLUSION SCS training has a statistically significant impact in improving surgical performance. Subjective feedback suggests that surgeons are able to apply it in practice. SCS may prove a vital adjunct for skill acquisition in surgical training.
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Affiliation(s)
- J Cragg
- Correspondence to: Department of Vascular Surgery, Russells Hall Hospital, Pensett Road, Dudley DY1 2HQ, UK (e-mail: )
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - N Lal
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - A Garnham
- Department of Vascular Surgery, New Cross Hospital, Wolverhampton, UK
| | - M Hallissey
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - T Graham
- Postgraduate School of Surgery, West Midlands Deanery, UK
| | - U Shiralkar
- Worcestershire Health and Care NHS trust, Worcestershire, UK
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84
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Coelho G, Vieira EV, Rabelo NN, Marie T, Brito D, Del Massa EC, Mendes K, Zagatto G, Maschietto AC, Peixoto R, Sérgio de Souza J, Calil Z, Yoshida M. Preoperative Planning Modalities for Meningoencephalocele: New Proof of Concept. World Neurosurg 2021; 151:124-131. [PMID: 33964493 DOI: 10.1016/j.wneu.2021.04.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Late surgical correction of meningoencephalocele is a rare scenario that remains challenging for surgeons. Three-dimensional models can mimic the correct anatomical relationships, and technological systems have brought advances to medicine. This study aims to present a novel preoperative planning modality that combines augmented reality with a hybrid model for complex malformation associated with late correction. METHODS The present report describes a case of frontoethmoidal encephalocele of a 10-year-old girl. Two different methods for planning the approach were developed: 1) a hybrid hands-on model and 2) augmented reality, using a cell phone app and headset display. The customized hybrid model was created based on patient's imaging. The augmented reality app was developed with a real-time interface. RESULTS The hybrid model recreated anatomic alterations, thereby allowing a multidisciplinary team to determine an appropriate surgical approach. All aspects of the surgical procedure were simulated. A pre- to postoperative comparison was made, which emphasized benefit of tridimensional anatomical relationships using augmented reality tool and its role in preoperative planning. CONCLUSIONS The authors believe this new multimodality preoperative platform could be a useful method to improve multidisciplinary discussion as well as a powerful tool for teaching and planning.
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Affiliation(s)
- Giselle Coelho
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil; Scientific Board, EDUCSIM Institute, São Paulo, São Paulo, Brazil; Division of Neurosurgery, São Paulo University, USP, São Paulo, São Paulo, Brazil; Division of Craniofacial Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil.
| | - Eduardo Varjão Vieira
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil; Division of Neurosurgery, São Paulo University, USP, São Paulo, São Paulo, Brazil; Division of Craniofacial Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | | | - Thailane Marie
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | - Daniella Brito
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | - Emilio C Del Massa
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil; Division of Anesthesiology, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | - Kid Mendes
- Technology Department, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Gustavo Zagatto
- Division of Neurosurgery, São Paulo University, USP, São Paulo, São Paulo, Brazil; Telemedicine Department, São Paulo University, USP, São Paulo, São Paulo, Brazil
| | | | - Rian Peixoto
- Faculty of Medicine, Santa Marcelina Faculty, São Paulo, São Paulo, Brazil
| | | | - Zacharias Calil
- Surgery Department, Goiania Materno Infantil Hospital, Goiânia, Goiás, Brazil; Surgery Department, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
| | - Mauricio Yoshida
- Division of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil; Division of Craniofacial Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Faculty of Medicine, Federal University of ABC, Santo André, São Paulo, São Paulo, Brazil; Division of Plastic Surgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
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Elnikety S, Badr E, Abdelaal A. Surgical training fit for the future: the need for a change. Postgrad Med J 2021; 98:820-823. [PMID: 33941663 PMCID: PMC9613864 DOI: 10.1136/postgradmedj-2021-139862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
Postgraduate training in surgical specialties is one of the longest training programmes in the medical field. Most of the surgical training programmes require 5–6 years of postgraduate training to become qualified. This is usually followed by 1–2 years of fellowship training in a subspecialised interest. This has been the case for the last 20–30 years with no significant change. The surgical practice is transforming quickly due to the advances in medical technology. This transformation is not matched in the postgraduate training, there is minimal exposure to the new technological advances in early years of postgraduate training. The current postgraduate training in surgical specialties is not fit for the future. Early exposure to robotic and artificial intelligence technologies is required. To achieve this, a significant transformation of surgical training is necessary, which requires a new vision and involves significant investment. We discuss the need for this transformation in the postgraduate surgical specialties training and analyse the threats and opportunities in relation to this transformation.
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Affiliation(s)
- Sherif Elnikety
- College of Medicine and Health Science, Department of Surgery, United Arab Emirates University, Al Ain, UAE
| | - Eman Badr
- Medical Education, University of Buckingham, Buckingham, UK
| | - Ahmed Abdelaal
- Trauma and Orthopaedics Department, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
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Iglesias NJ, Williams TP, Snyder CL, Sommerhalder C, Perez A. Value Analysis of Central Line Simulation-Based Education. Am Surg 2021; 88:2678-2685. [PMID: 33877936 DOI: 10.1177/00031348211011134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE. METHODS A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning "Cost and CLABSI," "Cost and Central line Associated Bloodstream Infections," and "Cost and Central Line" in their abstract and article body. Articles chosen for qualitative synthesis mentioned "simulation" in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis. RESULTS Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs. CONCLUSION Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.
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Affiliation(s)
| | | | | | | | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, TX, USA
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Bielsa VF. Virtual reality simulation in plastic surgery training. Literature review. J Plast Reconstr Aesthet Surg 2021; 74:2372-2378. [PMID: 33972199 DOI: 10.1016/j.bjps.2021.03.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 11/07/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Major changes have occurred in the medical environment leading to an evolution from the traditional residency programmes to competency-based ones. Virtual reality (VR) represents a promising simulation resource for surgical training. Several types of VR simulators can be considered, depending on the level of immersion they offer. The goal of the article is to review the progress of VR simulation in plastic surgery (PS) training. A systematic search of the literature was performed on PUBMED/MEDLINE with the following key words: (Simulation OR Virtual Reality) AND (Education OR Training) AND Plastic Surgery from January 1998 to September 2019. A total of 244 results were found, and 80 of them were selected for abstract review. Sixty-four articles were selected for complete reading. Several attempts have been made to create VR simulators and most of them are non-immersive or partially immersive. The main conclusions of them are summarized. VR simulation has been proven to have a role in PS training, offering many advantages. Furthermore, VR simulation can be used for safety training, team interaction and decision-making education. Validation is a key point for acceptance of simulators. Further efforts are required to include simulation in PS curricula.
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Affiliation(s)
- V Fuertes Bielsa
- Plastic Surgery Department University Hospital Miguel Servet Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
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Kilgore MD, Scullen T, Mathkour M, Dindial R, Carr C, Zeoli T, Werner C, Kahn L, Bui CJ, Keen JR, Maulucci CM, Dumont AS. Effects of the COVID-19 Pandemic on Operative Volume and Residency Training at Two Academic Neurosurgery Centers in New Orleans. World Neurosurg 2021; 151:e68-e77. [PMID: 33812067 DOI: 10.1016/j.wneu.2021.03.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Medical subspecialties including neurosurgery have seen a dramatic shift in operative volume in the wake of the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to quantify the effects of the COVID-19 pandemic on operative volume at 2 academic neurosurgery centers in New Orleans, Louisiana, USA from equivalent periods before and during the COVID-19 pandemic. METHODS A retrospective review was conducted analyzing neurosurgical case records for 2 tertiary academic centers from March to June 2020 and March to June 2019. The records were reviewed for variables including institution and physician coverage, operative volume by month and year, cases per subspecialty, patient demographics, mortality, and morbidity. RESULTS Comparison of groups showed a 34% reduction in monthly neurosurgical volume per institution during the pandemic compared with earlier time points, including a 77% decrease during April 2020. There was no change in mortality and morbidity across institutions during the pandemic. CONCLUSIONS The COVID-19 pandemic has had a significant impact on neurosurgical practice and will likely continue to have long-term effects on patients at a time when global gross domestic products decrease and relative health expenditures increase. Clinicians must anticipate and actively prepare for these impacts in the future.
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Affiliation(s)
- Mitchell D Kilgore
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Department of Surgery, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Rishawn Dindial
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Christopher Carr
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Tyler Zeoli
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Cassidy Werner
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Lora Kahn
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Cuong J Bui
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Joseph R Keen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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Thiong'o GM, Bernstein M, Drake JM. 3D printing in neurosurgery education: a review. 3D Print Med 2021; 7:9. [PMID: 33759067 PMCID: PMC7989093 DOI: 10.1186/s41205-021-00099-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objectives of this manuscript were to review the literature concerning 3D printing of brain and cranial vault pathology and use these data to define the gaps in global utilization of 3D printing technology for neurosurgical education. METHODS Using specified criteria, literature searching was conducted to identify publications describing engineered neurosurgical simulators. Included in the study were manuscripts highlighting designs validated for neurosurgical skill transfer. Purely anatomical designs, lacking aspects of surgical simulation, were excluded. Eligible manuscripts were analyzed. Data on the types of simulators, representing the various modelled neurosurgical pathologies, were recorded. Authors' countries of affiliation were also recorded. RESULTS A total of thirty-six articles, representing ten countries in five continents were identified. Geographically, Africa as a continent was not represented in any of the publications. The simulation-modelling encompassed a variety of neurosurgical subspecialties including: vascular, skull base, ventriculoscopy / ventriculostomy, craniosynostosis, skull lesions / skull defects, intrinsic brain tumor and other. Finally, the vascular and skull base categories together accounted for over half (52.8 %) of the 3D printed simulated neurosurgical pathology. CONCLUSIONS Despite the growing body of literature supporting 3D printing in neurosurgical education, its full potential has not been maximized. Unexplored areas of 3D printing for neurosurgical simulation include models simulating the resection of intrinsic brain tumors or of epilepsy surgery lesions, as these require complex models to accurately simulate fine dissection techniques. 3D printed surgical phantoms offer an avenue for the advancement of global-surgery education initiatives.
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Affiliation(s)
- Grace M Thiong'o
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada.
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada.
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Toronto, Canada
| | - James M Drake
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada
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91
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De Witte B, Barnouin C, Moreau R, Lelevé A, Martin X, Collet C, Hoyek N. A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results. BMC Surg 2021; 21:139. [PMID: 33736639 PMCID: PMC7977247 DOI: 10.1186/s12893-021-01128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/01/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.
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Affiliation(s)
- Benjamin De Witte
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Charles Barnouin
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Richard Moreau
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Arnaud Lelevé
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France.
| | - Xavier Martin
- Faculty of Medicine, Surgery School, Univ Lyon, University Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Service d'Urologie et de chirurgie de la Transplantation, Hôpital Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Christian Collet
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Nady Hoyek
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
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92
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Augmented Reality, Mixed Reality, and Hybrid Approach in Healthcare Simulation: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients.
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Davies S, Lucas A, Ricolfe-Viala C, Di Nuovo A. A Database for Learning Numbers by Visual Finger Recognition in Developmental Neuro-Robotics. Front Neurorobot 2021; 15:619504. [PMID: 33737873 PMCID: PMC7960766 DOI: 10.3389/fnbot.2021.619504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Numerical cognition is a fundamental component of human intelligence that has not been fully understood yet. Indeed, it is a subject of research in many disciplines, e.g., neuroscience, education, cognitive and developmental psychology, philosophy of mathematics, linguistics. In Artificial Intelligence, aspects of numerical cognition have been modelled through neural networks to replicate and analytically study children behaviours. However, artificial models need to incorporate realistic sensory-motor information from the body to fully mimic the children's learning behaviours, e.g., the use of fingers to learn and manipulate numbers. To this end, this article presents a database of images, focused on number representation with fingers using both human and robot hands, which can constitute the base for building new realistic models of numerical cognition in humanoid robots, enabling a grounded learning approach in developmental autonomous agents. The article provides a benchmark analysis of the datasets in the database that are used to train, validate, and test five state-of-the art deep neural networks, which are compared for classification accuracy together with an analysis of the computational requirements of each network. The discussion highlights the trade-off between speed and precision in the detection, which is required for realistic applications in robotics.
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Affiliation(s)
- Sergio Davies
- Department of Computing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Alexandr Lucas
- Department of Computing, Sheffield Hallam University, Sheffield, United Kingdom.,Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
| | - Carlos Ricolfe-Viala
- Instituto de Automàtica e Informàtica Industrial, Universitat Politecnica de Valencia, Valencia, Spain
| | - Alessandro Di Nuovo
- Department of Computing, Sheffield Hallam University, Sheffield, United Kingdom
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Luzzi A, Hellwinkel J, O'Connor M, Crutchfield C, Lynch TS. The Efficacy of Arthroscopic Simulation Training on Clinical Ability: A Systematic Review. Arthroscopy 2021; 37:1000-1007.e1. [PMID: 33220467 DOI: 10.1016/j.arthro.2020.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effect of arthroscopic simulator training on technical performance in a human model. METHODS A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches of PubMed, Embase, and Cochrane Library were conducted using combinations of the terms virtual, digital, computer, reality, simulation, arthroscopy, training, learning, and education. Studies were considered for inclusion if they tested the effect of arthroscopic simulator training in a randomized controlled fashion, performed testing in a cadaver or live patient, and used explicit outcome measures of technical skill. Data from studies were extracted and study characteristics and outcomes were reviewed. The primary outcome measure was the number of studies in which the simulation trained group had significantly improved performance results relative to the control group in ≥50% of all measured outcomes. Risk of bias was assessed with Cochrane's Collaboration Tool. RESULTS Twelve studies, including 340 total study participants, were included for review. Eight studies showed improved performance of the simulation trained group relative to the control group in ≥50% of assessed outcomes. Six of ten studies reporting completion time, three of six studies reporting task checklist completion, 3 of 7 studies reporting global rating scales, and 1 of 4 studies reporting Arthroscopic Surgical Skill Evaluation Tool scores showed improved performance of the simulation group relative to the control group for the respective outcome measures. CONCLUSIONS The literature is limited due to heterogeneity, both in type and merit, of the outcome measures that have been used to assess the transfer validity of arthroscopic simulator training to clinical performance. Despite the limitations of the literature, this review demonstrates that arthroscopic simulator training has potential to improve clinical performance. LEVEL OF EVIDENCE II, systematic review of Level II studies.
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Affiliation(s)
- Andrew Luzzi
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Justin Hellwinkel
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Michaela O'Connor
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | | | - T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, U.S.A..
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95
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Michaels R, Witsberger CA, Powell AR, Koka K, Cohen K, Nourmohammadi Z, Green GE, Zopf DA. 3D printing in surgical simulation: emphasized importance in the COVID-19 pandemic era. JOURNAL OF 3D PRINTING IN MEDICINE 2021. [PMCID: PMC8111930 DOI: 10.2217/3dp-2021-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Ross Michaels
- Medical School, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Allison R Powell
- Medical School, University of Michigan, Ann Arbor, MI 48109, USA
| | - Krishna Koka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Katheryn Cohen
- Washington University in St Louis, St Louis, MO 63130, USA
| | - Zahra Nourmohammadi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Glen E Green
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - David A Zopf
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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A live porcine model for surgical training in tracheostomy, neck dissection, and total laryngectomy. Eur Arch Otorhinolaryngol 2021; 278:3081-3090. [PMID: 33598732 DOI: 10.1007/s00405-021-06613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Head and neck surgery is associated with a steep learning curve, creating a need for effective training methods. Live animal models can be useful in acquiring the required skills and techniques to perform tracheostomy, neck dissection, and laryngectomy. The aim of this study is to assess the feasibility and usefulness of a porcine model to teach tracheostomy, neck dissection, and laryngectomy, describing the similarities between a swine head and neck surgical model and the human cervical area. METHODS Twelve surgical training sessions were held with the use of a live porcine model maintained under general anaesthesia; a total of 39 procedures were performed. In each session, one otolaryngology resident per year performed a procedure to acquire the targeted competencies for their respective year of training. Each procedure was time recorded and evaluated based on a modified Objective Structured Assessment of Technical Skills. Linear regression was used to analyse the data and express the results as percentages. RESULTS Training exercises were performed in shorter times over the study period. A 9% reduction in the time spent was observed. There was a global improvement in the evaluation made by OSATS score of 6% in the first period (2018-2019) and 58% in the second period (2019-2020). CONCLUSION The porcine model was both manageable and helpful in providing training despite slight anatomical differences between human beings and pigs. However, more studies are necessary to guarantee that the competencies acquired with this type of training are transferable to real-life interventions. LEVEL OF EVIDENCE Level 5.
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97
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Davids J, Makariou SG, Ashrafian H, Darzi A, Marcus HJ, Giannarou S. Automated Vision-Based Microsurgical Skill Analysis in Neurosurgery Using Deep Learning: Development and Preclinical Validation. World Neurosurg 2021; 149:e669-e686. [PMID: 33588081 DOI: 10.1016/j.wneu.2021.01.117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill. METHODS Videos were obtained from 1 expert, 6 intermediate, and 12 novice surgeons performing arachnoid dissection in a validated clinical model using a standard operating microscope. A mask region convolutional neural network framework was used to segment the tools present within the operative field in a recorded video frame. Tool motion analysis was achieved using novel triangulation metrics. Performance of the framework in classifying skill levels was evaluated using the area under the curve and accuracy. Objective measures of classifying the surgeons' skill level were also compared using the Mann-Whitney U test, and a value of P < 0.05 was considered statistically significant. RESULTS The area under the curve was 0.977 and the accuracy was 84.21%. A number of differences were found, which included experts having a lower median dissector velocity (P = 0.0004; 190.38 ms-1 vs. 116.38 ms-1), and a smaller inter-tool tip distance (median 46.78 vs. 75.92; P = 0.0002) compared with novices. CONCLUSIONS Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
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Affiliation(s)
- Joseph Davids
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Savvas-George Makariou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Hani J Marcus
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Stamatia Giannarou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Solomon AJ, England RW, Kolarich AR, Liddell RP. Disrupting the Education Paradigm: An Opportunity to Advance Simulation Training in Radiology- Radiology In Training. Radiology 2021; 298:292-294. [PMID: 33258747 DOI: 10.1148/radiol.2020203534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex J Solomon
- From the Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins School of Medicine, 1800 Orleans St, Zayed 7203, Baltimore, MD 21287
| | - Ryan W England
- From the Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins School of Medicine, 1800 Orleans St, Zayed 7203, Baltimore, MD 21287
| | - Andrew R Kolarich
- From the Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins School of Medicine, 1800 Orleans St, Zayed 7203, Baltimore, MD 21287
| | - Robert P Liddell
- From the Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins School of Medicine, 1800 Orleans St, Zayed 7203, Baltimore, MD 21287
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Boitano TKL, Smith HJ, Cohen JG, Rossi EC, Kim KH. Implementation and evaluation of a novel subspecialty society fellows robotic surgical course: the SGO minimally invasive academy surgical curriculum. J Gynecol Oncol 2021; 32:e26. [PMID: 33470068 PMCID: PMC7930459 DOI: 10.3802/jgo.2021.32.e26] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/18/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the utility of a society-based robotic surgery training program for fellows in gynecologic oncology. METHODS All participants underwent a 2-day robotic surgery training course between 2015-2017. The course included interactive didactic sessions with video, dry labs, and robotic cadaver labs. The labs encompassed a wide range of subject matter including troubleshooting, instrument variation, radical hysterectomies, and lymph node dissections. Participants completed a pre- and post-course survey using a 5-point Likert scale ranging from "not confident" to "extremely confident" on various measures. Statistical analysis was performed using SPSS Statistics v. 24. RESULTS The response rate was high with 86% of the 70 participants completing the survey. Sixteen (26.7%) of these individuals were attending physicians and 44 (73.3%) were fellows. In general, there was a significant increase in confidence in more complex procedures and concepts such as radical hysterectomy (p=0.01), lymph node dissection (p=0.01), troubleshooting (p=0.001), and managing complications (p=0.004). Faculty comfort and practice patterns were cited as the primary reason (58.9%) for limitations during robotic procedures followed secondarily by surgical resources (34.0%). CONCLUSION In both gynecologic oncology fellows and attendings, this educational theory-based curriculum significantly improved confidence in the majority of procedures and concepts taught, emphasizing the value of hands-on skill labs.
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Affiliation(s)
- Teresa K L Boitano
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Haller J Smith
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emma C Rossi
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth H Kim
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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Zemanova MA, Knight A. The Educational Efficacy of Humane Teaching Methods: A Systematic Review of the Evidence. Animals (Basel) 2021; 11:E114. [PMID: 33430457 PMCID: PMC7827170 DOI: 10.3390/ani11010114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023] Open
Abstract
Humane alternatives to harmful educational animal use include ethically-sourced cadavers, models, mannequins, mechanical simulators, videos, computer and virtual reality simulations, and supervised clinical and surgical experiences. In many life and health sciences courses, however, traditional animal use persists, often due to uncertainty about the educational efficacy of humane alternatives. The most recent comprehensive reviews assessing learning outcomes of humane teaching methods, in comparison to harmful animal use, were published more than 10 years ago. Therefore, we aimed to collate and analyse the combined evidence from recent and older studies about the efficacy of humane teaching methods. Using specific search terms, we systematically searched the Web of Science, SCOPUS, and EMBASE databases for relevant educational studies. We extracted information on publication years, the country in which the study was conducted, field, humane teaching methods, form of learning outcome assessment, and the learning outcome of the humane teaching methods, in comparison with harmful animal use. We found 50 relevant studies published from 1968-2020, primarily stemming from the USA, UK, and Canada. Humane teaching methods produced learning outcomes superior (30%), equivalent (60%), or inferior (10%) to those produced by traditional harmful animal use. In conclusion, a wide-spread implementation of humane teaching methods would not only preserve learning outcomes, but may in fact be beneficial for animals, students, educators, and institutions.
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Affiliation(s)
- Miriam A. Zemanova
- Animalfree Research, Postgasse 15, 3011 Bern, Switzerland
- Centre for Compassionate Conservation, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Oxford Centre for Animal Ethics, 91 Iffley Road, Oxford OX4 1EG, UK
| | - Andrew Knight
- Centre for Animal Welfare, University of Winchester, Winchester SO22 4NR, UK;
- School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
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