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Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:254. [PMID: 38878229 PMCID: PMC11180031 DOI: 10.1007/s11701-024-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024]
Abstract
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
- Department of Plastic Surgery, Royal Free Hospital, London, UK.
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK.
| | - Benedict Reed
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Edward Bollen
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
| | - Benjamin J Langridge
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Sara Jasionowska
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Peter E M Butler
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Allan Ponniah
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Boal MWE, Anastasiou D, Tesfai F, Ghamrawi W, Mazomenos E, Curtis N, Collins JW, Sridhar A, Kelly J, Stoyanov D, Francis NK. Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. Br J Surg 2024; 111:znad331. [PMID: 37951600 PMCID: PMC10771126 DOI: 10.1093/bjs/znad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools for technical skills assessment, providing evaluation statuses to guide research and inform implementation into training curricula. METHODS A systematic literature search was conducted in accordance with the PRISMA guidelines. Ovid Embase/Medline, PubMed and Web of Science were searched. Inclusion criterion: robotic surgery technical skills tools. Exclusion criteria: non-technical, laparoscopy or open skills only. Manual tools and automated performance metrics (APMs) were analysed using Messick's concept of validity and the Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence and Recommendation (LoR). A bespoke tool analysed artificial intelligence (AI) studies. The Modified Downs-Black checklist was used to assess risk of bias. RESULTS Two hundred and forty-seven studies were analysed, identifying: 8 global rating scales, 26 procedure-/task-specific tools, 3 main error-based methods, 10 simulators, 28 studies analysing APMs and 53 AI studies. Global Evaluative Assessment of Robotic Skills and the da Vinci Skills Simulator were the most evaluated tools at LoR 1 (OCEBM). Three procedure-specific tools, 3 error-based methods and 1 non-simulator APMs reached LoR 2. AI models estimated outcomes (skill or clinical), demonstrating superior accuracy rates in the laboratory with 60 per cent of methods reporting accuracies over 90 per cent, compared to real surgery ranging from 67 to 100 per cent. CONCLUSIONS Manual and automated assessment tools for robotic surgery are not well validated and require further evaluation before use in accreditation processes.PROSPERO: registration ID CRD42022304901.
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Affiliation(s)
- Matthew W E Boal
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
| | - Dimitrios Anastasiou
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Freweini Tesfai
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
| | - Walaa Ghamrawi
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
| | - Evangelos Mazomenos
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Nathan Curtis
- Department of General Surgey, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Computer Science, UCL, London, UK
| | - Nader K Francis
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, Somerset, UK
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Olson B, Cahill E, Imanguli M. Feasibility and safety of the da Vinci Xi surgical robot for transoral robotic surgery. J Robot Surg 2022; 17:571-576. [PMID: 35972598 DOI: 10.1007/s11701-022-01449-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: 03/09/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
The collective experience supporting the safety and efficacy of transoral robotic surgery continues to grow. The surgical robot da Vinci Xi has been used successfully off-label for head and neck surgery, including transoral robotic surgery. We evaluated operative outcomes and efficacy of the da Vinci Xi surgical robot for transoral surgery and compared our experience with the da Vinci Si and published da Vinci Xi experiences in transoral surgery. Nineteen total cases were retrospectively reviewed, six with the Si and thirteen with the Xi. Our experience with the da Vinci Xi showed similar peri- and postoperative outcomes to our Si experience the available da Vinci Xi literature. We advocate for careful patient selection while also considering the surgical team's experience with TORS. Transoral robotic surgery with the da Vinci Xi has specific advantages, and support is accumulating for its use in TORS. However, this indication remains off-label, and we do not anticipate the manufacturer will seek approval for this indication given the ongoing development and regulatory approvals of da Vinci Single Port for similar indications.
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Affiliation(s)
- Birk Olson
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ellen Cahill
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matin Imanguli
- Division of Head and Neck Oncologic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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James J, Irace AL, A Drusin M, Kim AH, Gudis DA, Overdevest JB. Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training. Ann Otol Rhinol Laryngol 2022:34894221115753. [PMID: 35915918 DOI: 10.1177/00034894221115753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.
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Affiliation(s)
- Joel James
- City University of New York School of Medicine, New York, NY, USA
| | - Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Madeleine A Drusin
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ana H Kim
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Bondzi-Simpson A, Lindo CJ, Hoy M, Lui JT. The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery. J Otolaryngol Head Neck Surg 2022; 51:23. [PMID: 35659365 PMCID: PMC9167522 DOI: 10.1186/s40463-022-00583-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world. DATA SOURCES Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed. REVIEW METHODS Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees. RESULTS A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition. CONCLUSION Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.
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Affiliation(s)
- Adom Bondzi-Simpson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Lindo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
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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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Forte MP, Gourishetti R, Javot B, Engler T, Gomez ED, Kuchenbecker KJ. Design of interactive augmented reality functions for robotic surgery and evaluation in dry-lab lymphadenectomy. Int J Med Robot 2021; 18:e2351. [PMID: 34781414 DOI: 10.1002/rcs.2351] [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: 06/18/2021] [Revised: 10/28/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Augmented reality (AR) has been widely researched for use in healthcare. Prior AR for robot-assisted minimally invasive surgery has mainly focussed on superimposing preoperative three-dimensional (3D) images onto patient anatomy. This article presents alternative interactive AR tools for robotic surgery. METHODS We designed, built and evaluated four voice-controlled functions: viewing a live video of the operating room, viewing two-dimensional preoperative images, measuring 3D distances and warning about out-of-view instruments. This low-cost system was developed on a da Vinci Si, and it can be integrated into surgical robots equipped with a stereo camera and a stereo viewer. RESULTS Eight experienced surgeons performed dry-lab lymphadenectomies and reported that the functions improved the procedure. They particularly appreciated the possibility of accessing the patient's medical records on demand, measuring distances intraoperatively and interacting with the functions using voice commands. CONCLUSIONS The positive evaluations garnered by these alternative AR functions and interaction methods provide support for further exploration.
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Affiliation(s)
- Maria-Paola Forte
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Ravali Gourishetti
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Bernard Javot
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | | | - Ernest D Gomez
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine J Kuchenbecker
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
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Laloo R, Santhosh Karri R, Wanigasooriya K, Beedham W, Darr A, Layton GR, Logan P, Tan Y, Mittapalli D, Patel T, Mishra VD, Odeh OF, Prakash S, Elnoamany S, Peddinti SR, Daketsey EA, Gadgil S, Bouhuwaish A, Ozair A, Bansal S, Elhadi M, Godbole AA, Axiaq A, Rauf FA, Ashpak A. The perceived global impact of the COVID-19 pandemic on doctors' medical and surgical training: An international survey. Int J Clin Pract 2021; 75:e14314. [PMID: 33932265 PMCID: PMC8237016 DOI: 10.1111/ijcp.14314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to the medical and surgical training of doctors globally. AIMS AND OBJECTIVES This is the first international survey assessing the perceived impact of the COVID-19 pandemic on the training of doctors of all grades and specialties. METHODS An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data were collated anonymously with informed consent and analysed using univariate and adjusted multivariable analyses. RESULTS Seven hundred and forty-three doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n = 422) being male. Two-thirds of doctors were in a training post (66.5%, n = 494), 52.9% (n = 393) in a surgical specialty and 53.0% (n = 394) in low- and middle-income countries. Sixty-nine point two percent (n = 514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted amongst non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (P ≤ .05). Low or middle-income country doctors' training was associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (P ≤ .05). CONCLUSION In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, this international survey reports a widespread perceived overall negative impact on medical and surgical doctors' training globally. Ongoing adaptation and innovation will be required to enhance the approach to doctors' training and learning in order to ultimately improve patient care.
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Affiliation(s)
- Ryan Laloo
- The Master Surgeon TrustWorcestershireUK
- Leeds Vascular Institute, Leeds General InfirmaryLeedsUK
| | - Rama Santhosh Karri
- The Master Surgeon TrustWorcestershireUK
- The Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Kasun Wanigasooriya
- The Master Surgeon TrustWorcestershireUK
- College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - William Beedham
- The Master Surgeon TrustWorcestershireUK
- College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Adnan Darr
- The Master Surgeon TrustWorcestershireUK
- The Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Georgia R Layton
- The Master Surgeon TrustWorcestershireUK
- Department of Cardiac SurgeryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Peter Logan
- The Master Surgeon TrustWorcestershireUK
- Walsall Healthcare NHS TrustWalsallUK
| | - Yanyu Tan
- The Master Surgeon TrustWorcestershireUK
- North East DeaneryNewcastleUK
| | - Devender Mittapalli
- The Master Surgeon TrustWorcestershireUK
- University Hospitals Plymouth NHS TrustPlymouthUK
| | | | | | | | | | | | | | | | | | | | - Ahmad Ozair
- Faculty of MedicineKing George's Medical UniversityLucknowUttar PradeshIndia
| | - Sanchit Bansal
- Vardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | | | - Aditya Amit Godbole
- Bharati Vidyapeeth (Deemed to be University) Medical CollegeDhankawadi, PuneIndia
| | - Ariana Axiaq
- School of MedicineFaculty of Life SciencesQueen's University BelfastBelfastUK
| | | | - Ashna Ashpak
- School of MedicineUniversity of Central LancashirePrestonLancashireUK
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Thornblade LW, Fong Y. Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods. J Laparoendosc Adv Surg Tech A 2021; 31:556-560. [PMID: 33835885 DOI: 10.1089/lap.2021.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
While robotic surgery has grown in popularity and scope over the past decade, there is a persistent need for simulation-based training as surgeons adapt from the working at the bedside to the immersive and multisensory tasks at the console. From dry laboratory to virtual reality (VR) environments, simulation can be used to train surgeons in basic tasks, complex operative steps, and coordination of whole operations with members of the entire operating room (OR) staff. By integrating simulation into mentored training programs, surgeons can reduce the number of cases required to master a complex operation. Future VR based simulation will become essential to the adaptation of the surgical workforce to new technologies and adoption of emerging robotic platforms. Ultimately, robotic simulation will set standards for credentialing of new surgeons.
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Affiliation(s)
- Lucas W Thornblade
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
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Mendelsohn AH, Kim C, Song J, Singh A, Le T, Abiri A, Berke GS, Geoghegan R. Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System. Laryngoscope 2020; 130 Suppl 6:S1-S17. [PMID: 32865822 DOI: 10.1002/lary.29034] [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: 05/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. METHODS Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). RESULTS Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor resection grading. Tumor resection scores was significantly (P = .02) improved with collision awareness system activated than trials without collision awareness. CONCLUSION In order to test our primary hypothesis, a novel TORS training platform was successfully developed that provides collision force measurements including frequency, severity, and duration of anatomic collisions. Additionally, the platform was modulated to provide real-time tactile feedback of the occurrence of out-of-field collisions. Utilizing this custom platform, our hypothesis that anatomic collisions during TORS diminishes surgical performance was supported. Additionally, our secondary hypothesis that subsequent reduction of anatomic collisions improves TORS proficiency was supported by the surgical trial. Dedicated investigation to characterize the effect size and clinical impact is required in order to translate this finding into training curriculums and into clinical utilization. LEVEL OF EVIDENCE II (Randomized trial) Laryngoscope, 130:S1-S17, 2020.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.,Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Christine Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jonathan Song
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Aadesh Singh
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tyler Le
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ahmad Abiri
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Rory Geoghegan
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
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11
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Givi B, Moore MG, Bewley AF, Coffey CS, Cohen MA, Hessel AC, Jalisi S, Kang S, Newman JG, Puscas L, Shindo M, Shuman A, Thakkar P, Weed DT, Chalian A. Advanced head and neck surgery training during the
COVID
‐19 pandemic. Head Neck 2020; 42:1411-1417. [DOI: 10.1002/hed.26252] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Babak Givi
- Department of OtolaryngologyNYU Langone Health New York New York USA
| | - Michael G. Moore
- Department of OtolaryngologyIndiana University Indianapolis Indiana USA
| | - Arnaud F. Bewley
- Department of OtolaryngologyUniversity of California Davis California USA
| | - Charles S. Coffey
- Department of Surgery, Division of OtolaryngologyUniversity of California San Diego California USA
| | - Marc A. Cohen
- Head and Neck ServiceMemorial Sloan‐Kettering Cancer Center New York New York USA
| | - Amy C. Hessel
- Department of Head and Neck SurgeryMD Anderson Cancer Center Houston Texas USA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Steven Kang
- Department of OtolaryngologyOhio State University Columbus Ohio USA
| | - Jason G. Newman
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Liana Puscas
- Department of Head and Neck SurgeryDuke University Durham North Carolina USA
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health and Science University Portland Oregon USA
| | - Andrew Shuman
- Department of OtolaryngologyUniversity of Michigan Ann Arbor Michigan USA
| | - Punam Thakkar
- Division of OtolaryngologyThe George Washington University Washington DC USA
| | - Donald T. Weed
- Department of OtolaryngologyUniversity of Miami Coral Gables Florida USA
| | - Ara Chalian
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
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12
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Zhao B, Lam J, Hollandsworth HM, Lee AM, Lopez NE, Abbadessa B, Eisenstein S, Cosman BC, Ramamoorthy SL, Parry LA. General surgery training in the era of robotic surgery: a qualitative analysis of perceptions from resident and attending surgeons. Surg Endosc 2020; 34:1712-1721. [PMID: 31286248 PMCID: PMC6946889 DOI: 10.1007/s00464-019-06954-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of the surgical robot has increased annually since its introduction, especially in general surgery. Despite the tremendous increase in utilization, there are currently no validated curricula to train residents in robotic surgery, and the effects of robotic surgery on general surgery residency training are not well defined. In this study, we aim to explore the perceptions of resident and attending surgeons toward robotic surgery education in general surgery residency training. METHODS We performed a qualitative thematic analysis of in-person, one-on-one, semi-structured interviews with general surgery residents and attending surgeons at a large academic health system. Convenient and purposeful sampling was performed in order to ensure diverse demographics, experiences, and opinions were represented. Data were analyzed continuously, and interviews were conducted until thematic saturation was reached, which occurred after 20 residents and seven attendings. RESULTS All interviewees agreed that dual consoles are necessary to maximize the teaching potential of the robotic platform, and the importance of simulation and simulators in robotic surgery education is paramount. However, further work to ensure proper access to simulation resources for residents is necessary. While most recognize that bedside-assist skills are essential, most think its educational value plateaus quickly. Lastly, residents believe that earlier exposure to robotic surgery is necessary and that almost every case has a portion that is level-appropriate for residents to perform on the robot. CONCLUSIONS As robotic surgery transitions from novelty to ubiquity, the importance of effective general surgery robotic surgery training during residency is paramount. Through in-depth interviews, this study provides examples of effective educational tools and techniques, highlights the importance of simulation, and explores opinions regarding the role of the resident in robotic surgery education. We hope the insights gained from this study can be used to develop and/or refine robotic surgery curricula.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA.
| | - Jenny Lam
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Hannah M Hollandsworth
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Arielle M Lee
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Nicole E Lopez
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Benjamin Abbadessa
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Samuel Eisenstein
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Bard C Cosman
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Sonia L Ramamoorthy
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
| | - Lisa A Parry
- Department of Surgery, University of California, San Diego, 9300 Campus Point Drive, Mail Code 7220, La Jolla, CA, 92037, USA
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13
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Kovatch KJ, Wertz AP, Carle TR, Harvey RS, Bohm LA, Thorne MC, Malloy KM. Optimal Timing of Entry-Level Otolaryngology Simulation. OTO Open 2019; 3:2473974X19845851. [PMID: 31428725 PMCID: PMC6684146 DOI: 10.1177/2473974x19845851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 11/26/2018] [Accepted: 04/03/2019] [Indexed: 11/16/2022] Open
Abstract
Objective Appropriate timing of subspecialty simulation is critical to maximize learner benefit and guide resource utilization. We aimed to determine optimal timing of a simulation-based curriculum designed to teach entry-level procedural skills for otolaryngology residency. Study Design Simulation curriculum intervention tested among 3 comparison groups of varying clinical levels. Setting Academic otolaryngology training program and medical school. Subjects and Methods We developed a simulation-based technical skills curriculum incorporating the following task trainers: flexible laryngoscopy, peritonsillar abscess drainage, and myringotomy and tube insertion. Preclinical medical students (n = 40), subintern rotators (n = 35), and midyear interns (n = 8) completed the simulation-based curriculum. Pre- and postintervention knowledge/confidence and “level appropriateness” were rated on a 5-point Likert scale, and effect size was calculated. Results Overall self-reported knowledge/confidence levels improved in all 3 groups preintervention (1.05, 2.15, 3.17) to postintervention (2.79, 3.45, 4.38, respectively; all P < .01). Preclinical medical students uniformly reported very little to no familiarity with the procedures prior to the curriculum, while interns approached independence following the intervention. Large effect sizes were seen in all tasks for preclinical students (d = 3.13), subinterns (d = 1.46), and interns (d = 2.14). Five-point Likert scale measures of level appropriateness (1 = too challenging, 5 = too easy) for preclinical students, subinterns, and interns were 2.70 (95% CI, 2.56-2.84), 3.11 (95% CI, 2.97-3.25), and 3.75 (95% CI, 3.35-4.15), respectively. Conclusion Subinternship may represent the optimal timing for entry-level skills simulation training. The proposed curriculum shows utility for clinical levels ranging from medical students to postgraduate year 1 resident levels, with large effect sizes for all tested groups.
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Affiliation(s)
- Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aileen P Wertz
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Taylor R Carle
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca S Harvey
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lauren A Bohm
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Marc C Thorne
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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