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Alkadri S, Del Maestro RF, Driscoll M. Face, content, and construct validity of a novel VR/AR surgical simulator of a minimally invasive spine operation. Med Biol Eng Comput 2024; 62:1887-1897. [PMID: 38403863 DOI: 10.1007/s11517-024-03053-8] [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: 06/14/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
Mixed-reality surgical simulators are seen more objective than conventional training. The simulators' utility in training must be established through validation studies. Establish face-, content-, and construct-validity of a novel mixed-reality surgical simulator developed by McGill University, CAE-Healthcare, and DePuy Synthes. This study, approved by a Research Ethics Board, examined a simulated L4-L5 oblique lateral lumbar interbody fusion (OLLIF) scenario. A 5-point Likert scale questionnaire was used. Chi-square test verified validity consensus. Construct validity investigated 276 surgical performance metrics across three groups, using ANOVA, Welch-ANOVA, or Kruskal-Wallis tests. A post-hoc Dunn's test with a Bonferroni correction was used for further analysis on significant metrics. Musculoskeletal Biomechanics Research Lab, McGill University, Montreal, Canada. DePuy Synthes, Johnson & Johnson Family of Companies, research lab. Thirty-four participants were recruited: spine surgeons, fellows, neurosurgical, and orthopedic residents. Only seven surgeons out of the 34 were recruited in a side-by-side cadaver trial, where participants completed an OLLIF surgery first on a cadaver and then immediately on the simulator. Participants were separated a priori into three groups: post-, senior-, and junior-residents. Post-residents rated validity, median > 3, for 13/20 face-validity and 9/25 content-validity statements. Seven face-validity and 12 content-validity statements were rated neutral. Chi-square test indicated agreeability between group responses. Construct validity found eight metrics with significant differences (p < 0.05) between the three groups. Validity was established. Most face-validity statements were positively rated, with few neutrally rated pertaining to the simulation's graphics. Although fewer content-validity statements were validated, most were rated neutral (only four were negatively rated). The findings underscored the importance of using realistic physics-based forces in surgical simulations. Construct validity demonstrated the simulator's capacity to differentiate surgical expertise.
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Affiliation(s)
- Sami Alkadri
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, QC, H3A 2K7, Canada
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 2200 Leo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 2200 Leo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, QC, H3A 2K7, Canada.
- Orthopaedic Research Lab, Montreal General Hospital, 1650 Cedar Ave (LS1.409), Montreal, QC, H3G 1A4, Canada.
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Obayemi JE, Donkersloot J, Kim E, Thelander K, Byrnes M, Kim GJ. A needs assessment for simulation in African surgical education. Surg Endosc 2024; 38:1654-1661. [PMID: 38326586 DOI: 10.1007/s00464-023-10665-y] [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: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. METHODS A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. RESULTS The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. CONCLUSION Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.
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Affiliation(s)
- Joy E Obayemi
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA.
| | - John Donkersloot
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Erin Kim
- University of Michigan Medical School, University of Michigan, Ann Arbor, USA
| | - Keir Thelander
- Pan-African Academy of Christian Surgeons, Palatine, IL, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
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Trivedi S, Arora RD, Singh L, Sharma U. The Usefulness of Cadaveric Hands-on Workshop for Surgical Training in Head and Neck Surgeries. Indian J Otolaryngol Head Neck Surg 2024; 76:458-461. [PMID: 38440604 PMCID: PMC10908737 DOI: 10.1007/s12070-023-04182-6] [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: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 03/06/2024] Open
Abstract
Surgical approach to head and neck region requires in depth anatomical knowledge and refined surgical skills due to highly critical and complex anatomy of this region. To look for the benefit of cadaveric hands-on workshop on enhancing the surgical knowledge and confidence of the participants. Freshly frozen cadavers were used for this hands-on course in the department of Anatomy, AIIMS Raipur involving 32 residents and ENT specialists. This course involved the interactive lectures and live surgical demonstration on issues related to neck dissection, thyroid, and parotid surgery followed by a hands-on practice by the residents. A positive feedback was given by the participants in regards to the cadaveric hands-on workshop. Almost 4/5th of the participants found the present experience to be extremely helpful and all of them believed the cadaveric hands-on workshops should be conducted regularly as a learning tool and enhancement of surgical skills. Cadaveric hands-on dissection is a very effective practice for refining surgical skills. It can be used to study basic surgical procedures or extremely complex surgeries having intricate anatomy. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04182-6.
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Affiliation(s)
| | | | - Lokesh Singh
- Department of Psychiatry, AIIMS Raipur, Raipur, India
| | - Urvi Sharma
- Department of Anatomy, AIIMS Raipur, Raipur, India
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Howard T, Iyengar KP, Vaishya R, Ahluwalia R. High-fidelity virtual reality simulation training in enhancing competency assessment in orthopaedic training. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 37769263 DOI: 10.12968/hmed.2022.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Surgical competence is the ability to successfully apply academic knowledge, clinical skills and professional behaviour to inpatient care. Along with ensuring patient safety, the ability to communicate effectively, collaborative teamwork and probity, and achieving satisfactory competencies form the fundamental principles of good medical practice. Current strategies to develop surgical competencies include a range of formative and summative assessments. The cancellation of traditional face-to-face meetings and training opportunities during the COVID-19 pandemic had a profound impact on the delivery of medical education and opportunities to achieve surgical competencies. Simulation learning has been used since before the pandemic to deliver surgical training across all grades and specialities, including orthopaedic surgery. Simulation-based training provides a safe, controlled environment to develop skill acquisition. Simulated surgery using virtual reality has evolved following developments in software and hardware. This article explores the role of high-fidelity virtual reality simulation to assess competencies in orthopaedic training in the post-COVID-19 era, and examines whether simulation could be used within the curriculum to augment and improve training.
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Affiliation(s)
- Theodore Howard
- Department of Trauma and Orthopaedics, King's College Hospital, London, UK
- Department of Trauma and Orthopaedics, Imperial College London, London, UK
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Raju Ahluwalia
- Department of Trauma and Orthopaedics, King's College Hospital, London, UK
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Pedersen H, Ståhl D, Ekelund M, Anderberg M, Bäckström M, Bergenfelz A, Hagelsteen K. Visuospatial ability is associated to 2D laparoscopic simulator performance amongst surgical residents. Surg Open Sci 2022; 11:56-61. [PMID: 36545373 PMCID: PMC9761372 DOI: 10.1016/j.sopen.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/05/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of recruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuospatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents. Method Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator. Results A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028-1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparoscopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to laparoscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.
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Affiliation(s)
- Hanne Pedersen
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Corresponding author at: Practicum Clinical Skills Centre, Barngatan 2, Skåne University Hospital, SE-221 85 Lund, Sweden.
| | - Darya Ståhl
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
| | - Mikael Ekelund
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Malmö, Sweden
| | - Magnus Anderberg
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Martin Bäckström
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Psychology, Lund University, Sweden
| | - Anders Bergenfelz
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Lund, Sweden
| | - Kristine Hagelsteen
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Lund, Sweden
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Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes N. Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review. JMIR Serious Games 2022; 10:e29594. [PMID: 35416789 PMCID: PMC9047880 DOI: 10.2196/29594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 12/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. OBJECTIVE Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education. METHODS We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%). CONCLUSIONS RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tatiana Erlikh Fox
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Internal Medicine, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdegurg, Germany.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra Kemp
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, Australia
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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Perron JE, Coffey MJ, Lovell-Simons A, Dominguez L, King ME, Ooi CY. Resuscitating Cardiopulmonary Resuscitation Training in a Virtual Reality: Prospective Interventional Study. J Med Internet Res 2021; 23:e22920. [PMID: 34326040 PMCID: PMC8367149 DOI: 10.2196/22920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/16/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background Simulation-based technologies are emerging to enhance medical education in the digital era. However, there is limited data for the use of virtual reality simulation in pediatric medical education. We developed Virtual Doc as a highly immersive virtual reality simulation to teach pediatric cardiopulmonary resuscitation skills to medical students. Objective The primary objectives of this study were to evaluate participant satisfaction and perceived educational efficacy of Virtual Doc. The secondary aim of this study was to assess the game play features of Virtual Doc. Methods We conducted a prospective closed beta-testing study at the University of New South Wales (Sydney, Australia) in 2018. All medical students from the 6-year undergraduate program were eligible to participate and were recruited through voluntary convenience sampling. Participants attended a 1-hour testing session and attempted at least one full resuscitation case using the virtual reality simulator. Following this, participants were asked to complete an anonymous postsession questionnaire. Responses were analyzed using descriptive statistics. Results A total of 26 participants were recruited, consented to participate in this study, and attended a 1-hour in-person closed beta-testing session, and 88% (23/26) of participants completed the anonymous questionnaire and were included in this study. Regarding participant satisfaction, Virtual Doc was enjoyed by 91% (21/23) of participants, with 74% (17/23) intending to recommend the simulation to a colleague and 66% (15/23) intending to recommend the simulation to a friend. In assessment of the perceived educational value of Virtual Doc, 70% (16/23) of participants agreed they had an improved understanding of cardiopulmonary resuscitation, and 78% (18/23) agreed that Virtual Doc will help prepare for and deal with real-life clinical scenarios. Furthermore, 91% (21/23) of participants agreed with the development of additional Virtual Doc cases as beneficial for learning. An evaluation of the game play features as our secondary objective revealed that 70% (16/23) of participants agreed with ease in understanding how to use Virtual Doc, and 74% (17/23) found the game play elements useful in understanding cardiopulmonary resuscitation. One-third (7/23, 30%) found it easy to work with the interactive elements. In addition, 74% (17/23) were interested in interacting with other students within the simulation. Conclusions Our study demonstrates a positive response regarding trainee satisfaction and perceived educational efficacy of Virtual Doc. The simulation was widely accepted by the majority of users and may have the potential to improve educational learning objectives.
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Affiliation(s)
- Janaya Elizabeth Perron
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Randwick, Australia
| | - Michael Jonathon Coffey
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Randwick, Australia
| | - Andrew Lovell-Simons
- Medicine Education Development Unit, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Luis Dominguez
- Educational Delivery Services, Office of the Pro Vice-Chancellor (Education), University of New South Wales, Sydney, Australia
| | - Mark E King
- Educational Delivery Services, Office of the Pro Vice-Chancellor (Education), University of New South Wales, Sydney, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Randwick, Australia
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Nillahoot N, Patel S, Suthakorn J. A Technique for Mimicking Soft Tissue Manipulation from Experimental Data to a Wave Equation Model for a New Laparoscopic Virtual Reality Training System. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background:
The difficulty of laparoscopic procedures and the specific psychomotor skills required support the need for a training system for intensive and repetitive practice to acquire the specific skills. The present VR training systems have some limitations with respect to the soft tissue models in the training system. This is associated with the need for a real-time simulation, which requires a balance between computational cost and accuracy.
Objective:
The primary objective of the study is to develop a two dimensional wave equation model that closely mimics the soft tissue manipulation in a laparoscopic procedure for a VR training system.
Methods:
A novel mathematical model based on the wave equation is prepared to represent the interaction between the laparoscopic tool and the soft tissue. The parameters within the model are determined through experimental analysis of a soft tissue phantom. The experimental setup involves a linear actuator applying force to the soft tissue phantom to generate deformation. Data acquisition is conducted through a camera and a robotic force acquisition system which measures force, displacement of the linear actuator and records a video. Through image processing, the displacements of the markers on the phantom’s x-y plane during its deformation are determined and these parameters are used to develop the model, which finally is validated through a comparative analysis.
Results:
The results from the developed model are observed and compared statistically as well as graphically with the finite element model based on deformation data. The results show that the deformation data between the developed model and the available model is significantly similar.
Conclusion:
This study demonstrates the adaptability of the wave equation to meet the needs of the specific surgical procedure through modification of the model based on the experimental data. Moreover, the comparative analysis further corroborates the relevance and validity of the model for the surgical training system.
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Taba JV, Cortez VS, Moraes WA, Iuamoto LR, Hsing WT, Suzuki MO, do Nascimento FS, Pipek LZ, de Mattos VC, D’Albuquerque EC, Carneiro-D’Albuquerque LA, Meyer A, Andraus W. The development of laparoscopic skills using virtual reality simulations: A systematic review. PLoS One 2021; 16:e0252609. [PMID: 34138901 PMCID: PMC8211221 DOI: 10.1371/journal.pone.0252609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Teaching based on virtual reality simulators in medicine has expanded in recent years due to the limitations of more traditional methods, especially for surgical procedures such as laparoscopy. Purpose of review To analyze the effects of using virtual reality simulations on the development of laparoscopic skills in medical students and physicians. Data sources The literature screening was done in April 2020 through Medline (PubMed), EMBASE and Database of the National Institute of Health. Eligibility criteria Randomized clinical trials that subjected medical students and physicians to training in laparoscopic skills in virtual reality simulators. Study appraisal Paired reviewers independently identified 1529 articles and included 7 trials that met the eligibility criteria. Findings In all studies, participants that trained in virtual simulators showed improvements in laparoscopic skills, although the articles that also had a physical model training group did not show better performance of one model compared to the other. Limitations No article beyond 2015 met the eligibility criteria, and the analyzed simulators have different versions and models, which might impact the results. Conclusion Virtual reality simulators are useful educational tools, but do not show proven significant advantages over traditional models. The lack of standardization and a scarcity of articles makes comparative analysis between simulators difficult, requiring more research in the area, according to the model suggested in this review. Systematic review registration number Registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020176479.
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Affiliation(s)
- João Victor Taba
- Faculty of Medicine FMUSP, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Leandro Ryuchi Iuamoto
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, SP, Brazil
| | - Wu Tu Hsing
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Alberto Meyer
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, SP, Brazil
- * E-mail:
| | - Wellington Andraus
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, São Paulo, SP, Brazil
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Olivas-Alanis LH, Calzada-Briseño RA, Segura-Ibarra V, Vázquez EV, Diaz-Elizondo JA, Flores-Villalba E, Rodriguez CA. LAPKaans: Tool-Motion Tracking and Gripping Force-Sensing Modular Smart Laparoscopic Training System. SENSORS 2020; 20:s20236937. [PMID: 33291631 PMCID: PMC7730101 DOI: 10.3390/s20236937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/22/2023]
Abstract
Laparoscopic surgery demands highly skilled surgeons. Traditionally, a surgeon's knowledge is acquired by operating under a mentor-trainee method. In recent years, laparoscopic simulators have gained ground as tools in skill acquisition. Despite the wide range of laparoscopic simulators available, few provide objective feedback to the trainee. Those systems with quantitative feedback tend to be high-end solutions with limited availability due to cost. A modular smart trainer was developed, combining tool-tracking and force-using employing commercially available sensors. Additionally, a force training system based on polydimethylsiloxane (PDMS) phantoms for sample stiffness differentiation is presented. This prototype was tested with 39 subjects, between novices (13), intermediates (13), and experts (13), evaluating execution differences among groups in training exercises. The estimated cost is USD $200 (components only), not including laparoscopic instruments. The motion system was tested for noise reduction and position validation with a mean error of 0.94 mm. Grasping force approximation showed a correlation of 0.9975. Furthermore, differences in phantoms stiffness effectively reflected user manipulation. Subject groups showed significant differences in execution time, accumulated distance, and mean and maximum applied grasping force. Accurate information was obtained regarding motion and force. The developed force-sensing tool can easily be transferred to a clinical setting. Further work will consist on a validation of the simulator on a wider range of tasks and a larger sample of volunteers.
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Affiliation(s)
- Luis H. Olivas-Alanis
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
| | - Ricardo A. Calzada-Briseño
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
| | - Victor Segura-Ibarra
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León 64710, Mexico;
| | - Elisa V. Vázquez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
| | - Jose A. Diaz-Elizondo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León 64710, Mexico;
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Correspondence: (E.F.-V.); (C.A.R.)
| | - Ciro A. Rodriguez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo León 64849, Mexico; (L.H.O.-A.); (R.A.C.-B.); (V.S.-I.); (E.V.V.)
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León 66629, Mexico
- Correspondence: (E.F.-V.); (C.A.R.)
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11
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Portelli M, Bianco SF, Bezzina T, Abela JE. Virtual reality training compared with apprenticeship training in laparoscopic surgery: a meta-analysis. Ann R Coll Surg Engl 2020; 102:672-684. [PMID: 32820649 DOI: 10.1308/rcsann.2020.0178] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Since its inception, laparoscopic surgery has evolved and new techniques have been developed due to technological advances. This requires a different and more complex skill set in comparison with open surgery. Reduced working hours, less training time and patient safety factors demand that such skills need to be achieved outside the operating theatre environment. Several studies have been published and have determined the effectiveness of virtual reality training. We aimed to compare virtual reality training with the traditional apprenticeship method of training and determine whether it can supplement or replace the traditional apprenticeship model. We also aimed to perform a meta-analysis of the literature and develop conclusions with respect to the benefits achieved by adding virtual reality training on a regular basis to surgical training programmes. METHODS A literature search was carried out on PubMed, MEDLINE, EMBASE and Google Scholar academic search engines using the MESH terms 'randomised controlled trials', 'virtual reality', 'laparoscopy', 'surgical education' and 'surgical training'. All randomised controlled trials published to January 2018 comparing virtual reality training to apprenticeship training were included. Data were collected on improved dexterity, operative performance and operating times. Each outcome was calculated with 95% confidence intervals and with intention-to-treat analysis; 24 randomised controlled trials were analysed. FINDINGS Meta-analytical data were extracted for time, path length, instrument handling, tissue handling, error scores and objective structure assessment of technical skills scoring. There was significant improvement in individual trainee skill in all meta-analyses (p < 0.0002). CONCLUSION This meta-analysis shows that virtual reality not only improves efficiency in the trainee's surgical practice but also improves quality with reduced error rates and improved tissue handling.
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Affiliation(s)
- M Portelli
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - S F Bianco
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - T Bezzina
- Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - J E Abela
- Department of Surgery, Mater Dei Hospital, Msida, Malta
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12
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The impact of intensive laparoscopic training course with structured assessment and immediate feedback on residents' operative performance in animal lab. Surg Endosc 2020; 35:3370-3378. [PMID: 32642846 DOI: 10.1007/s00464-020-07778-z] [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] [Received: 01/13/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The objective of this study was to examine the impact of an intensive laparoscopic training course incorporating structured assessment and immediate feedback on residents' operative performance in animal lab. METHODS Surgical residents participated in a 2-day intensive laparoscopic training course. They performed the same procedures on two consecutive days on live pigs. Junior residents (PGY1-2) performed laparoscopic cholecystectomy and incisional hernia repair and the senior residents (PGY3-5) performed laparoscopic Nissen fundoplication, splenectomy, and low anterior colon resection. Assessment tools with proven validity evidence (global and procedure-specific rating tools for operative assessment of laparoscopic skills) were used to assess their operative performance. Faculty assessment and self-assessments were completed immediately after each procedure on both days. The Wilcoxon rank test was used to examine the effect of training on resident performance after one repetition. RESULTS Forty surgical residents (20 junior and 20 senior residents) participated. There was a significant improvement in general laparoscopic skills during incisional hernia repair and Nissen fundoplication using global rating scales (p < 0.05). Moreover, there was an improvement in their performance during cholecystectomy, incisional hernia repair, and low anterior colectomy when procedure-specific skills assessments were used (p < 0.05). There was a positive correlation between residents' self-reported confidences and their operative performance CONCLUSION: Trainees showed significant improvements in performance in general and procedure-specific laparoscopic skills in a wide range of procedures after an intensive training course. This study demonstrates the benefit of a structured training curriculum in improving operative performance in basic and advanced laparoscopic skills in a simulated environment. Future studies are needed to examine the duration of training required to achieve skill retention and competency.
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13
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Lefor AK, Harada K, Kawahira H, Mitsuishi M. The effect of simulator fidelity on procedure skill training: a literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:97-106. [PMID: 32425176 PMCID: PMC7246118 DOI: 10.5116/ijme.5ea6.ae73] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the effect of simulator fidelity on procedure skill training through a review of existing studies. METHODS MEDLINE, OVID and EMBASE databases were searched between January 1990 and January 2019. Search terms included "simulator fidelity and comparison" and "low fidelity" and "high fidelity" and "comparison" and "simulator". Author classification of low- and high-fidelity was used for non-laparoscopic procedures. Laparoscopic simulators are classified using a proposed schema. All included studies used a randomized methodology with two or more groups and were written in English. Data was abstracted to a standard data sheet and critically appraised from 17 eligible full papers. RESULTS Of 17 studies, eight were for laparoscopic and nine for other skill training. Studies employed evaluation methodologies, including subjective and objective measures. The evaluation was conducted once in 13/17 studies and before-after in 4/17. Didactic training only or control groups were used in 5/17 studies, while 10/17 studies included two groups only. Skill acquisition and simulator fidelity were different for the level of training in 1/17 studies. Simulation training was followed by clinical evaluation or a live animal evaluation in 3/17 studies. Low-fidelity training was not inferior to training with a high-fidelity simulator in 15/17 studies. CONCLUSIONS Procedure skill after training with low fidelity simulators was not inferior to skill after training with high fidelity simulators in 15/17 studies. Some data suggest that the effectiveness of different fidelity simulators depends on the level of training of participants and requires further study.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Kanako Harada
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kawahira
- Jichi Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Mamoru Mitsuishi
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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14
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Pacilli M, Clarke SA. Simulation-based education for paediatric surgeons: Does it really improve technical skills? Semin Pediatr Surg 2020; 29:150905. [PMID: 32423599 DOI: 10.1016/j.sempedsurg.2020.150905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In recent years, there has been an increasing interest in employing simulation methodology for teaching surgical skills. Supposedly, skills achieved in the simulation arena, should lead to an improvement of surgical performance in the operating room. In this article we aim to summarise those areas of simulation-based research that relate to paediatric surgery; we present the current evidence behind low-fidelity simulation and computer-based simulation in improving the acquisition of surgical skills.
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Affiliation(s)
- Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simon A Clarke
- Department of Paediatric Surgery, Chelsea Children's Hospital, 369 Fulham Road, London SW10 9AH, United Kingdom; Imperial College, London, United Kingdom.
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15
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Virtual Operating Room Simulation Setup (VORSS) for Procedural Training in Minimally Invasive Surgery – a Pilot Study. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AbstractVirtual reality (VR) training is widely used in several minimal invasive surgery (MIS) training curricula for procedural training. However, VR training in its current state lack immersive training environments, such as using head-mounted displays that is implemented in military or aviation training and even entertainment. The virtual operating room simulation setup (VORSS) is explored in this study to determine the effectiveness of immersive training in MIS. Twenty-eight surgeons and surgical trainees performed a laparoscopic cholecystectomy on the VORSS comprising of a head-mounted 360-degree realistic OR surrounding on a VR laparoscopic simulator. The VORSS replicated a full setup of instruments and surgical team-members as well as some of the distractions occurring during surgical procedures. Questionnaires were followed by semi-structured interviews to collect the data. Experts and novices found the VORSS to be intuitive and easy to use (p = 0.001). The outcome of the usability test, applying QUESI and NASA-TLX, reflected the usability of the VORSS (p < 0.05), at the cognitive level, which indicates a good sense of immersion and satisfaction, when performing the procedure within VORSS. The need for personalized experience within the setup was strongly noted from most of the participants. The VORSS for procedural training has the potential to become a useful tool to provide immersive training in MIS surgery. Further optimizing of the VORSS realism and introduction of distractors in the OR should result in an improvement of the system.
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16
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Raison N, Gavazzi A, Abe T, Ahmed K, Dasgupta P. Virtually Competent: A Comparative Analysis of Virtual Reality and Dry-Lab Robotic Simulation Training. J Endourol 2020; 34:379-384. [DOI: 10.1089/end.2019.0541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nicholas Raison
- Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Andrea Gavazzi
- Department of Urology, Azienda Usl Toscana Centro, Florence, Italy
| | - Takashige Abe
- Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, MRC Centre for Transplantation, King's College London, London, United Kingdom
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kamran Ahmed
- Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Prokar Dasgupta
- Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, MRC Centre for Transplantation, King's College London, London, United Kingdom
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17
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Paydar S, Akbarialiabad H. Utilizing Novel Assessment and Instructional Methodologies of Trauma for Residents; A Case of Blended Learning in Shiraz Medical School. Bull Emerg Trauma 2020; 8:1-3. [PMID: 32201695 PMCID: PMC7071931 DOI: 10.29252/beat-080101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Ganni S, Botden SMBI, Chmarra M, Li M, Goossens RHM, Jakimowicz JJ. Validation of Motion Tracking Software for Evaluation of Surgical Performance in Laparoscopic Cholecystectomy. J Med Syst 2020; 44:56. [PMID: 31980955 PMCID: PMC6981315 DOI: 10.1007/s10916-020-1525-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/16/2020] [Indexed: 01/22/2023]
Abstract
Motion tracking software for assessing laparoscopic surgical proficiency has been proven to be effective in differentiating between expert and novice performances. However, with several indices that can be generated from the software, there is no set threshold that can be used to benchmark performances. The aim of this study was to identify the best possible algorithm that can be used to benchmark expert, intermediate and novice performances for objective evaluation of psychomotor skills. 12 video recordings of various surgeons were collected in a blinded fashion. Data from our previous study of 6 experts and 23 novices was also included in the analysis to determine thresholds for performance. Video recording were analyzed both by the Kinovea 0.8.15 software and a blinded expert observer using the CAT form. Multiple algorithms were tested to accurately identify expert and novice performances. ½ L + [Formula: see text] A + [Formula: see text] J scoring of path length, average movement and jerk index respectively resulted in identifying 23/24 performances. Comparing the algorithm to CAT assessment yielded in a linear regression coefficient R2 of 0.844. The value of motion tracking software in providing objective clinical evaluation and retrospective analysis is evident. Given the prospective use of this tool the algorithm developed in this study proves to be effective in benchmarking performances for psychomotor skills evaluation.
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Affiliation(s)
- Sandeep Ganni
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands.
- GSL Medical College, Department of Surgery, Rajahmundry, India.
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Magdalena Chmarra
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Meng Li
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
| | - Richard H M Goossens
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Jack J Jakimowicz
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Catharina Hospital, Research and Education, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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19
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Nurczyk K, Perez AJ, Murty NS, Patti MG. A Novel University of North Carolina Laparoscopic Ventral Hernia Repair Simulator. J Laparoendosc Adv Surg Tech A 2020; 30:608-611. [PMID: 31928496 DOI: 10.1089/lap.2019.0770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Simulation plays an important role in surgical training. We developed a simulator for laparoscopic ventral hernia repair (LVHR) surgery based on porcine tissue, characterized by low cost and high reality. Methods: Our LVHR model is based on porcine tissue mounted in a human mannequin. The anterior abdominal wall is constructed to allow laparoscopic training. Training sessions are conducted in a simulated operating room environment. Results: During preliminary tests, the LVHR simulator was found to be highly realistic in terms of tissue feedback, instrumentation usage, and performing the key steps of the LVHR procedure. The model was evaluated as a very useful tool for residents' training allowing to gain laparoscopic skills, learn the key steps of LVHR, and practice team work. Conclusions: Our simulator, based on porcine tissue mounted in a mannequin, offers a very realistic and cost-effective model for simulating LVHR surgery.
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Affiliation(s)
- Kamil Nurczyk
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,2nd Department of General and Gastrointestinal Surgery, and Surgical Oncology of Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Arielle J Perez
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,University of North Carolina Health Care Hernia Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neal S Murty
- Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marco G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Balogun OS, Osinowo AO, Bode CO, Atoyebi OA. Survey of Basic Laparoscopic Training Exposure of Nigerian Postgraduate Trainees. Niger J Surg 2019; 25:172-176. [PMID: 31579372 PMCID: PMC6771176 DOI: 10.4103/njs.njs_38_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The practice of laparoscopy involves the use of training models that are different from conventional open surgery. These concepts are not captured in the traditional models of surgical residency training. Residency training in surgery has been seen as an ample opportunity for early introduction and training in laparoscopy. Objectives: This study aimed to assess the level of exposure and training experience of some surgical resident doctors in accredited training institutions in Nigeria on laparoscopy. Methodology: A cross-sectional survey was conducted among the resident doctors undergoing revision course in surgery at the National Orthopaedic Hospital, Igbobi, Lagos, and Lagos University Teaching Hospital, Lagos, in March 2018. Using the quantitative method of data collection, a pre-tested structured questionnaire was used to collect information on the demography and training exposure of the residents in laparoscopy. Results: A total of 54 of 96 residents surveyed returned the questionnaire, giving a response rate of 56%. There were 53 (98.1%) males and 1 (1.9%) female. The age range of the respondents was between 30 and 46 years, with a mean of 34.2 ± 3.96 years. Thirty-two (59.3%) respondents had spent at least 2 years training in surgery. Thirty-six (66.7%) respondents had not participated in more than four laparoscopic procedures during their rotation. Forty-six percent of respondents reported that their experience in laparoscopy was mainly by observation of the procedures. Forty-nine (90.7%) of respondents surveyed had not attended any training program in laparoscopy. Eighty-one (81.0%) of respondents had a strong motivation and desire for future practice of laparoscopy. Conclusion: This study revealed that few Nigerian postgraduate trainees sampled in the survey were exposed and had training experience in laparoscopy.
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Affiliation(s)
- Olanrewaju Samuel Balogun
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedapo Olumide Osinowo
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Christopher O Bode
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwole A Atoyebi
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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21
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Breimer GE, Haji FA, Bodani V, Cunningham MS, Lopez-Rios AL, Okrainec A, Drake JM. Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models. Oper Neurosurg (Hagerstown) 2019; 13:89-95. [PMID: 28931258 DOI: 10.1227/neu.0000000000001317] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." OBJECTIVE To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. METHODS Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. RESULTS The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P < .001 and 3.9; SD = 0.8 vs 4.2, SD = 0.6; P = .02, respectively). Overall task fidelity across the 2 simulators was not perceived as significantly different. CONCLUSION Simulation model selection should be based on educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model.
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Affiliation(s)
- Gerben E Breimer
- Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Faizal A Haji
- Division of Clinical Neurological Sci-ences, Western University, London, Ontario, Canada.,SickKids Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Bodani
- Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa S Cunningham
- Temerty/Chang International Centre for Telesimulation and Innovation Medical Education, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Adriana-Lucia Lopez-Rios
- Temerty/Chang International Centre for Telesimulation and Innovation Medical Education, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Allan Okrainec
- Temerty/Chang International Centre for Telesimulation and Innovation Medical Education, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada.,Division of General Surgery, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - James M Drake
- Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neuro-surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Våpenstad C, Fagertun Hofstad E, Eivind Bernstein T, Aadahl P, Johnsen G, Mårvik R. Optimal timing of assessment tasks depending on experience level of surgical trainees. MINIM INVASIV THER 2019; 29:161-169. [DOI: 10.1080/13645706.2019.1612441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Health Research, SINTEF Digital AS, Trondheim, Norway
| | | | - Tor Eivind Bernstein
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Aadahl
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gjermund Johnsen
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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23
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Williams CL, Kovtun KA. The Future of Virtual Reality in Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 102:1162-1164. [PMID: 30353871 DOI: 10.1016/j.ijrobp.2018.07.2011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Christopher L Williams
- Brigham and Women's Hospital & Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Konstantin A Kovtun
- Brigham and Women's Hospital & Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
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24
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Validation of a virtual intracorporeal suturing simulator. Surg Endosc 2018; 33:2468-2472. [PMID: 30334151 DOI: 10.1007/s00464-018-6531-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/11/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intracorporeal suturing is one of the most important and difficult procedures in laparoscopic surgery. Practicing on a FLS trainer box is effective but requires large number of consumables, and the scoring is somewhat subjective and not immediate. A virtualbasic laparoscopic skill trainer (VBLaST©) was developed to simulate the five tasks of the FLS Trainer Box. The purpose of this study is to evaluate the face and content validity of the VBLaST suturing simulator (VBLaST-SS©). METHODS Twenty-five medical students and residents completed an evaluation of the simulator. The participants were asked to perform the standard intracorporeal suturing task on both VBLaST-SS© and the traditional FLS box trainer. The performance scores on each system were calculated based on time (s), deviations to the black dots (mm), and incision gap (mm). The participants were then asked to finish a 13-item questionnaire with ratings from 1 (not realistic/useful) to 5 (very realistic/useful) regarding the face validity of the simulator. A Wilcoxon signed rank test was performed to identify differences in performance on the VBLaST-SS© compared to that of the traditional FLS box trainer. RESULTS Three questions from the face validity questionnaire were excluded due to lack of response. Ratings to 8 of the remaining 10 questions (80%) averaged above 3.0 out of 5. Average intracorporeal suturing completion time on the VBLaST-SS© was 421 (SD = 168 s) seconds compared to 406 (175 s) seconds on the box trainer (p = 0.620). There was a significant difference between systems for the incision gap (p = 0.048). Deviation in needle insertion from the black dot was smaller for the box trainer than the virtual simulator (1.68 vs. 7.12, p < 0.001). CONCLUSION Participants showed comparable performance on the VBLaST-SS© and traditional box trainer. Overall, the VBLaST-SS© system showed face validity and has the potential to support training for the suturing skills.
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25
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Causby R, McDonnell M, Reed L, Hillier S. Measuring dexterity in the podiatrist population: a cross-sectional comparison of novice students and experienced podiatrists. BMC MEDICAL EDUCATION 2018; 18:181. [PMID: 30071848 PMCID: PMC6090916 DOI: 10.1186/s12909-018-1276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is no 'gold-standard' for the evaluation of dexterity for the health professional or podiatrist populations. This has resulted in a broad array of generalised tests to evaluate dexterity. Thus, the aim was to determine which objective generalised dexterity tests are best suited to evaluating dexterity in a podiatry student population. METHODS A cohort of Novice podiatry students and Experienced podiatrists were recruited and evaluated on a battery of dexterity tests selected to evaluate a variety of different elements. Group differences were evaluated statistically and regression undertaken on significant test outcomes. RESULTS A total of 108 participants were recruited with 54 participants in each of the Novice and Experienced groups. Five of the eight tests were able to discriminate dexterous ability of participants in the Novice and Experienced groups. These included the Grip-lift task, GPT, P-MVC, G-MVC and the AsTex® sensory discrimination test. These tests comprised a total of 11 significant dependent variables (p < 0.05). From the test battery, outcomes were able to predict 79% of the group membership. Age and experience did not explain within-group variability for the Experienced group. CONCLUSION Whilst the Experienced group displayed superior performance in strength and speed, the Novice group showed superior coordination and sensory ability. From these findings, we would recommend that outcomes from the Grooved Pegboard Test, Grip-lift task, Grip Strength test and Pinch Grip strength test be used to evaluate elements of dexterity in this population.
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Affiliation(s)
- Ryan Causby
- Sansom Institute for Health Research, University of South Australia, North Terrace, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Michelle McDonnell
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Qld Australia
| | - Susan Hillier
- Sansom Institute for Health Research, University of South Australia, North Terrace, GPO Box 2471, Adelaide, SA 5001 Australia
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A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery. Int J Comput Assist Radiol Surg 2018; 13:1949-1957. [PMID: 30054776 PMCID: PMC6223750 DOI: 10.1007/s11548-018-1822-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Smaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors. METHODS Face and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario. RESULTS The trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill. CONCLUSION The developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.
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A Low-Cost Simulator for Training in Endoscopic-Assisted Transaxillary Dual-Plane Breast Augmentation. Ann Plast Surg 2018; 79:525-528. [PMID: 29053519 DOI: 10.1097/sap.0000000000001239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endoscopic-assisted transaxillary dual-plane (EATD) technique is a popular procedure for breast augmentation, especially for Chinese women. However, frustration is often expressed by plastic surgeons when first attempting EATD surgery. Simulation-based teaching is beneficial for EATD training, but it is expensive. This study presents a low-cost simulator to help plastic surgeons exercise psychomotor skills during EATD surgery. METHODS The low-cost simulator was invented by Dr Jie Luan (the senior author) and made of some easily available materials including a mannequin, a T-shirt printed the bottom anatomical structure of the chest, the order of dissection, and the potential bleeding spot, and an elastic compression garment printed the upper anatomical structure and the cut-off position to sever the pectoralis major muscle. The first-year residents of plastic surgery assessed their improvement by completing a 5-item evaluation questionnaire at the beginning and at the end of the simulation. RESULTS Fifty participants enrolled in this study. There was a significant difference (P < 0.05) before and after the training regarding candidate confidence, anatomical awareness, and endoscope control including the dexterity and hand-to-eye coordination. CONCLUSIONS The low-cost and simple maintenance simulator may help plastic surgeons, especially those in developing countries, to improve gradually their EATD breast augmentation skills with no risks in a way. Further randomized controlled trials are needed to test its validity and reliability.
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Vergis A, Steigerwald S. Skill Acquisition, Assessment, and Simulation in Minimal Access Surgery: An Evolution of Technical Training in Surgery. Cureus 2018; 10:e2969. [PMID: 30221097 PMCID: PMC6136887 DOI: 10.7759/cureus.2969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diminishing resources and expanding technologies, such as minimal access surgery, have complicated the acquisition and assessment of technical skills in surgical training programs. However, these challenges have been met with both innovation and an evolution in our understanding of how learners develop technical competence and how to better measure it. As these skills continue to grow in breadth and complexity, so too must the surgical education systems’ ability. This literature review examines and describes the pressures placed on surgical education programs and the development of methods to ameliorate them with a focus on surgical simulation.
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Lin CC, Huang SC, Lin HH, Huang WJ, Chen WS, Yang SH. Naked-eye box trainer and training box games have similar training effect as conventional video-based box trainer for novices: A randomized controlled trial. Am J Surg 2018; 216:1022-1027. [PMID: 29859628 DOI: 10.1016/j.amjsurg.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 04/26/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laparoscopic surgery has become a well-established technique for management of various surgical problems. A more efficient training methods are of upmost importance for current surgery residents. METHODS This is a prospective, randomized, 3-arm trial to compare the training efficient of the naked-eye box trainer, training box games and conventional video-based box trainer in training laparoscopic suturing skill. RESULTS The three training models were well acceptable and all could improve the acquisition of laparoscopic suturing and knotting skill in novices. The completion time was 604 ± 298 s in the box trainer games, 617 ± 335 s in the naked-eye training module, and 491 ± 334 s in the video-based box trainer (p = 0.322). Using the structured procedure-specific checklist, there was no significant difference in scores between these three groups (p = 0.977). CONCLUSIONS Naked-eye box trainer and training box games produce similar training effect as the conventional video-based box trainer. The naked-eye box trainer may serve as a convenient way for novice trainees to acquire laparoscopic suturing technique skills before video-based simulation.
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Affiliation(s)
- Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Chieh Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology and Physiology, School of Medicine, Shu-Tien Urological Research Center, National Yang-Ming University, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Frountzas M, Pergialiotis V, Prodromidou A, Kontzoglou K, Perrea DN, Nikiteas N. Familiarization of undergraduate medical students with the two-dimensional vision of laparoscopic surgery: Preliminary results of a prospective follow-up study. J Gynecol Obstet Hum Reprod 2018; 47:237-240. [PMID: 29604429 DOI: 10.1016/j.jogoh.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND To date, the feasibility of pre-graduate training in 2D vision has not been studied thoroughly. The purpose of this pilot study is to present the preliminary results of a pre-graduate laparoscopic training program. MATERIALS AND METHODS We invited pre-graduate medical students to participate in an experimental training program which strengthened their essential skills in 2D-vision. An easy-to-use, cost-effective, hand-made laparoscopic training box was constructed and used. RESULTS Twenty-four pre-graduate students participated in our study. The ability of medical students to co-ordinate their movements on the 2D-space was strengthened from the first to the fourth time of performing the easiest tasks (bead transfer and rope cutting) (P<.001). This was not observed in the case of the two harder tasks (necklace formation and intracorporeal knot), despite the fact that time to fulfillment differed (P=.058 & P=.082) respectively. The overall assessment of the simulator in terms of portability, imaging, light, camera convenience to use and significance ranked from high to very high. CONCLUSION Familiarization with the 2D environment of laparoscopic surgery is extremely important for medical students. The results of our study seem to be promising, as they show that basic tasks are easy to learn with the use of relatively inexpensive equipment.
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Affiliation(s)
- Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece.
| | - Anastasia Prodromidou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
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Ganni S, Botden SMBI, Chmarra M, Goossens RHM, Jakimowicz JJ. A software-based tool for video motion tracking in the surgical skills assessment landscape. Surg Endosc 2018; 32:2994-2999. [PMID: 29340824 PMCID: PMC5956097 DOI: 10.1007/s00464-018-6023-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data. METHODS 6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The recorded videos were analysed using Kinovea 0.8.15 and the following parameters calculated the path length, average instrument movement and number of sudden or extreme movements. RESULTS The analysed data showed that experts had significantly shorter path length (median 127 cm vs. 187 cm, p = 0.01), smaller average movements (median 0.40 cm vs. 0.32 cm, p = 0.002) and fewer sudden movements (median 14.00 vs. 21.61, p = 0.001) than their novice counterparts. CONCLUSION The use of software-based video motion tracking of laparoscopic cholecystectomy is a simple and viable method enabling objective assessment of surgical performance. It provides clear discrimination between expert and novice performance.
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Affiliation(s)
- Sandeep Ganni
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands. .,Department of Surgery, GSL Medical College, Rajahmundry, India. .,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Magdalena Chmarra
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Richard H M Goossens
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jack J Jakimowicz
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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Yılmaz EM, Soyder A, Aksu M, Bozdağ AD, Boylu Ş, Edizsoy A, Ballı Ş, Tekindal MA. Contribution of an educational video to surgical education in laparoscopic appendectomy. Turk J Surg 2017; 33:237-242. [PMID: 29260126 DOI: 10.5152/turkjsurg.2017.3610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
Objective With recent widespread advances in laparoscopy, providing education on this subject has become a significant challenge. The aim of this study was to determine the degree of contribution made by surgeons to laparoscopic education through an educational video. Material and Methods A total of 40 volunteer general surgery residents and specialists participated in our study. Before watching the approximately six-minute educational video prepared for laparoscopic appendectomy, the participants were asked to fill out participant information forms and information measurement questionnaire forms. After the video, the participants were asked to fill out the information measurement questionnaire forms a second time; additionally, attitude evaluation forms and education evaluation questionnaire forms were presented to the participants for completion, and statistical analysis was performed. Furthermore, the total watching duration and the number of times the video was paused were recorded. Results A total of 40 surgeons participated in the study (75% residents and 25% specialists). When the results of the information determination questionnaire forms filled out by the resident and specialist groups before and after the video were compared, it was observed that the scores of both groups significantly increased after watching the video (p=0.001). A statistical significance was identified between the length of time the video was watched and the education evaluation form scores of the participants (p<0.01). It was observed that the longer the video was watched, the greater the increase in the education evaluation scores. The results of the attitude evaluation forms implied that the video could be produced more professionally. Conclusion Although education is an inevitable requirement of laparoscopic surgery, many teaching methods are available. Awareness-enhancing videos prepared on this topic can be efficient in providing laparoscopic education.
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Affiliation(s)
- Eyüp Murat Yılmaz
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Aykut Soyder
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Murat Aksu
- Department of Ethics, İzmir University School of Medicine, İzmir, Turkey
| | - Ali Doğan Bozdağ
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Şükrü Boylu
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Akay Edizsoy
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Şadi Ballı
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
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Lencioni RD, Ragle CA, Kinser ML, Coffey T, Fransson BA. Effect of simulator orientation during skills training on performance of basic laparoscopic tasks by veterinary students. J Am Vet Med Assoc 2017; 251:1196-1201. [DOI: 10.2460/javma.251.10.1196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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MacCormick MRA, Kilkenny JJ, Walker M, Zur Linden A, Singh A. Investigating the impact of innate dexterity skills and visuospatial aptitude on the performance of baseline laparoscopic skills in veterinary students. Vet Surg 2017; 46:1175-1186. [PMID: 28892186 DOI: 10.1111/vsu.12682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/14/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if manual dexterity and visuospatial skills can be used to predict baseline laparoscopic surgery skills in veterinary students. STUDY DESIGN Pilot study. METHODS Veterinary students (n = 45) from years 1-4 volunteered for this study. An hour-long electronic questionnaire was completed by participants. The first section was used to collect demographics and information about prior nonsurgical experiences. The second section included 3 tests of visuospatial skills, including the Purdue Visualization of Rotations Test, Mental Rotations Test, and Raven's Advanced Progressive Matrices Test. Multiple tests were administered to assess innate dexterity, including the grooved pegboard test, indirect and direct zigzag tracking tests, and the 3Dconnexion proficiency test. Each dexterity test was performed once with the left hand and once with the right hand. The order of task performance was randomized. Basic laparoscopic skills were assessed using the validated fundamentals of laparoscopic surgery (FLS) peg transfer task. RESULTS There was an association between left-handed grooved pegboard scores (95% CI -10046.36 to -1636.53, P-value = .008) and left-handed indirect zigzag tracking task (95% CI -35.78 to -8.20, P-value = .003) with FLS peg transfer scores. Individuals who reported playing videogames achieved higher scores on the FLS peg transfer task than those without videogame experience (95% CI 583.59 to 3509.97, P-value = .007). CONCLUSION The results of this study suggest that dexterity was a better predictor of baseline laparoscopic skills than visuospatial skills in veterinary students.
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Affiliation(s)
- Mathew R A MacCormick
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jessica J Kilkenny
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Meagan Walker
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Alex Zur Linden
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Liu W, Zheng X, Wu R, Jin Y, Kong S, Li J, Lu J, Yang H, Xu X, Lv Y, Zhang X. Novel laparoscopic training system with continuously perfused ex-vivo porcine liver for hepatobiliary surgery. Surg Endosc 2017; 32:743-750. [PMID: 28733731 DOI: 10.1007/s00464-017-5731-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/13/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To introduce a novel laparoscopic training system with a continuously perfused ex-vivo porcine liver for hepatobiliary surgery. BACKGROUND Existing models for laparoscopic training, such as box trainers and virtual reality simulators, often fail to provide holistic training and real haptic feedback. We have formulated a new training system that addresses these problems. METHODS Real-Liver Laptrainer consists of a porcine liver, customized mannequin, ex-vivo machine perfusion system, and monitoring software. We made a detailed comparison of Real-Liver Laptrainer with the LapSim virtual reality simulator and the FLS Trainer Box systems. Five laparoscopic surgeons assessed the new system on multiple features. We assessed the performances of 43 trainees who used the new system to perform laparoscopic cholecystectomy (LC) three times. RESULTS Real-Liver Laptrainer offered more functions and better tactile feedback than the FLS or LapSim system. All five surgeons graded the quality of the new system as realistic. The utility of the system for training was scored as 3.6 ± 1.1 on a scale of 1-5. Between the first and third attempts, the number of successfully performed LCs increased (9 vs 14 vs 23; P = .011), while the numbers of liver damage incidents (25 vs. 21 vs. 18, P = .303) and gallbladder perforations decreased (17 vs. 12 vs. 9, P = .163). The mean LC operation time significantly decreased (63 vs. 50 vs. 44, P < .0001). CONCLUSION Real-Liver Laptrainer is a feasible, stable, and practical training model that has potential for improving the laparoscopic skills of surgeons.
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Affiliation(s)
- Wenyan Liu
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xinglong Zheng
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Rongqian Wu
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yinbin Jin
- College of Electrical Engineering, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Shu Kong
- Institute of Medical Engineering, Medical School of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianpeng Li
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jianwen Lu
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Huan Yang
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xianghua Xu
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yi Lv
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
| | - Xiaogang Zhang
- Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
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Schlottmann F, Murty NS, Patti MG. Simulation Model for Laparoscopic Foregut Surgery: The University of North Carolina Foregut Model. J Laparoendosc Adv Surg Tech A 2017; 27:661-665. [DOI: 10.1089/lap.2017.0138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neal S. Murty
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marco G. Patti
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:51. [PMID: 28567070 PMCID: PMC5426099 DOI: 10.4103/jrms.jrms_809_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.
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Affiliation(s)
- Antonello Forgione
- Department of Surgical Oncology and Minimally Invasive Surgery, AIMS Academy, Niguarda Hospital, Milan, Italy
| | - Salman Y Guraya
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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Owlia M, Khabbazan M, Mirbagheri MM, Mirbagheri A. Real-time tracking of laparoscopic instruments using kinect for training in virtual reality. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3945-3948. [PMID: 28269148 DOI: 10.1109/embc.2016.7591590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Training of laparoscopic surgery in Virtual Reality (VR) environment has been proved as an effective step before clinical practice. Tracking the position of instruments in realtime is an essential part of developing a VR trainer. In this study, we used Microsoft Kinect and color markers instead of using similar traditional means such as mechanical sensors. The orientation and position of instruments were determined and compared with the results obtained using the SinaSim commercial laparoscopic surgery trainer, which measures these values using encoders. The final results indicated that even though the newly developed systems possess an inferior accuracy compared to the mechanical sensors, low cost and portability makes it capable of replacing traditional methods of tracking.
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Yiasemidou M, de Siqueira J, Tomlinson J, Glassman D, Stock S, Gough M. "Take-home" box trainers are an effective alternative to virtual reality simulators. J Surg Res 2017; 213:69-74. [PMID: 28601335 DOI: 10.1016/j.jss.2017.02.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/17/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practice on virtual reality simulators (VRSs) has been shown to improve surgical performance. However, VRSs are expensive and usually housed in surgical skills centers that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers (BT) are inexpensive and can be used anywhere at anytime. This study assesses "take-home" BTs as an alternative to VRS. METHODS After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT), 25 surgical trainees were randomized to two groups. Trainees were asked to practice three basic laparoscopic tasks for 6 wk (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centers). After the practice period, all performed two laparoscopic cholecystectomy, one on a VRS and one on a BT; (i.e., posttraining assessment). VRS provided metrics (total time [TT], number of movements instrument tip path length), and expert video assessment of cholecystectomy in a BT (Global Operative Assessment of Laparoscopic Skills [GOALS] score) were recorded. Performance during pretraining and posttraining assessment was compared. RESULTS The BT group showed a significant improvement for all VRS metrics (P = 0.008) and the efficiency category of GOALS score (P = 0.03). Only TT improved in the VRS group, and none of the GOALS categories demonstrated a statistically significant improvement after training. Finally, the improvement in VRS metrics in the BT group was significantly greater than in the VR group (TT P = 0.005, number of movements P = 0.042, path length P = 0.031), although there were no differences in the GOALS scores between the groups. CONCLUSIONS This study suggests that a basic "take-home" BT is a suitable alternative to VRS.
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Affiliation(s)
- Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | | | - James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Simon Stock
- World Mate Emergency Hospital, Battambang, Cambodia
| | - Michael Gough
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
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Broekema TH, Talsma AK, Wevers KP, Pierie JPEN. Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves. JOURNAL OF SURGICAL EDUCATION 2017; 74:91-99. [PMID: 27553762 DOI: 10.1016/j.jsurg.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. DESIGN After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups. SETTING Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands. PARTICIPANTS Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course. RESULTS In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group. CONCLUSION No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand.
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Affiliation(s)
- Theo H Broekema
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
| | - Aaldert K Talsma
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin P Wevers
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Jean-Pierre E N Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands; University Groningen, Groningen, The Netherlands
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Chellali A, Mentis H, Miller A, Ahn W, Arikatla VS, Sankaranarayanan G, De S, Schwaitzberg SD, Cao CGL. Achieving Interface and Environment Fidelity in the Virtual Basic Laparoscopic Surgical Trainer. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER STUDIES 2016; 96:22-37. [PMID: 30393449 PMCID: PMC6214218 DOI: 10.1016/j.ijhcs.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Virtual reality trainers are educational tools with great potential for laparoscopic surgery. They can provide basic skills training in a controlled environment and free of risks for patients. They can also offer objective performance assessment without the need for proctors. However, designing effective user interfaces that allow the acquisition of the appropriate technical skills on these systems remains a challenge. This paper aims to examine a process for achieving interface and environment fidelity during the development of the Virtual Basic Laparoscopic Surgical Trainer (VBLaST). Two iterations of the design process were conducted and evaluated. For that purpose, a total of 42 subjects participated in two experimental studies in which two versions of the VBLaST were compared to the accepted standard in the surgical community for training and assessing basic laparoscopic skills in North America, the FLS box-trainer. Participants performed 10 trials of the peg transfer task on each trainer. The assessment of task performance was based on the validated FLS scoring method. Moreover, a subjective evaluation questionnaire was used to assess the fidelity aspects of the VBLaST relative to the FLS trainer. Finally, a focus group session with expert surgeons was conducted as a comparative situated evaluation after the first design iteration. This session aimed to assess the fidelity aspects of the early VBLaST prototype as compared to the FLS trainer. The results indicate that user performance on the earlier version of the VBLaST resulting from the first design iteration was significantly lower than the performance on the standard FLS box-trainer. The comparative situated evaluation with domain experts permitted us to identify some issues related to the visual, haptic and interface fidelity on this early prototype. Results of the second experiment indicate that the performance on the second generation VBLaST was significantly improved as compared to the first generation and not significantly different from that of the standard FLS box-trainer. Furthermore, the subjects rated the fidelity features of the modified VBLaST version higher than the early version. These findings demonstrate the value of the comparative situated evaluation sessions entailing hands on reflection by domain experts to achieve the environment and interface fidelity and training objectives when designing a virtual reality laparoscopic trainer. This suggests that this method could be used successfully in the future to enhance the value of VR systems as an alternative to physical trainers for laparoscopic surgery skills. Some recommendations on how to use this method to achieve the environment and interface fidelity of a VR laparoscopic surgical trainer are identified.
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Affiliation(s)
- Amine Chellali
- Department of Computer Engineering, IBISC Laboratory, University of Evry, Evry, France
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Helena Mentis
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Amie Miller
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Surgery, Wright State University, Dayton, OH, USA
| | - Woojin Ahn
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, NY, USA
| | - Venkata S. Arikatla
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, NY, USA
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, NY, USA
| | - Steven D. Schwaitzberg
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Caroline G. L. Cao
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, USA
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Torricelli FCM, Barbosa JABA, Marchini GS. Impact of laparoscopic surgery training laboratory on surgeon's performance. World J Gastrointest Surg 2016; 8:735-743. [PMID: 27933135 PMCID: PMC5124702 DOI: 10.4240/wjgs.v8.i11.735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/02/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.
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Development of a novel simulation model for assessment of laparoscopic camera navigation. Surg Endosc 2016; 31:3033-3039. [PMID: 27826776 DOI: 10.1007/s00464-016-5323-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic camera navigation is vital to laparoscopic surgery, yet often falls to the most junior member of the surgical team who has limited laparoscopic operating experience. Previously published reports on simulation models fail to address qualitative scoring of movement, method of communication and correct physician location with respect to patient position. The purpose of this study was to develop and evaluate a novel laparoscopic camera navigation simulation model that addresses these deficiencies. METHODS A novel, low-cost laparoscopic camera navigational maze was constructed from pliable foam for use in a standard laparoscopic surgery box trainer. Participants (n = 37) completed a camera navigation exercise by following a pre-recorded set of verbal instructions using correct anatomic terminology that is used in the operating room, to simulate an actual operating room experience of receiving verbal cues from senior surgeons. The sample group consisted of participants at various levels of Obstetrics and Gynecology training, representing novice to expert laparoscopists. Each trial was recorded with a multi-channel video camera. Performances were scored by a blinded evaluator for excess gross and fine camera movements as well as overt errors, including camera collisions and failure to follow directions. RESULTS Our model demonstrated evidence of validity by discriminating performance by level of laparoscopic experience with a statistically significant decrease in number of movements and errors in experts compared to novices. A trend emerged toward improvement with each additional year of training, with reduced variability among performances in more experienced participants. CONCLUSIONS This novel, low-cost box-trainer simulation model for laparoscopic camera navigation offers a mechanism for assessment of laparoscopic camera operation skills. Moreover, this model closely replicates operating room logistics and communication. Given the necessity for improved laparoscopic camera operation education, our model represents a unique, complementary tool to other laparoscopic simulation curricula.
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Waxberg SL, Goodell KH, Avgerinos DV, Schwaitzberg SD, Cao CGL. Evaluation of Physical versus Virtual Surgical Training Simulators. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120404801510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With the recent attention on patient safety, there is an increased interest in standardized training for laparoscopic surgeons. Studies have shown that laparoscopic simulators can be used to train surgical skills. A comparison of two popular systems (a real physical model and a virtual model) was conducted to determine the relative effectiveness of the systems for training purposes. Twenty-two medical students and surgical residents were tested on both simulators. Time to task completion and errors committed were recorded and compared. Our results showed that the physical training system was more sensitive to the experience levels of the subjects than the virtual system, and may be more effective as a tool for standardized training. However, as virtual reality technology becomes better developed, and surgeons become more familiar with the technology, we may see a change.
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Affiliation(s)
- S. L. Waxberg
- Department of Mechanical Engineering, School of Engineering, Tufts University, Medford, MA
| | - K. H. Goodell
- Department of Surgery, Center of Minimally Invasive Surgery, Tufts-New England Medical Center, Boston, MA
| | - D. V. Avgerinos
- Department of Mechanical Engineering, School of Engineering, Tufts University, Medford, MA
| | - S. D. Schwaitzberg
- Department of Surgery, Center of Minimally Invasive Surgery, Tufts-New England Medical Center, Boston, MA
| | - C. G. L. Cao
- Department of Mechanical Engineering, School of Engineering, Tufts University, Medford, MA
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Goyal S, Radi MA, Ramadan IKA, Said HG. Arthroscopic skills assessment and use of box model for training in arthroscopic surgery using Sawbones - "FAST" workstation. SICOT J 2016; 2:37. [PMID: 27801643 PMCID: PMC5089855 DOI: 10.1051/sicotj/2016024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/10/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules. METHODS Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES "FAST" arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; "Novice", "Beginner", "Intermediate" and "Advanced" based on previous arthroscopy experience, for analyses of performance. RESULTS The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice - 166 s, Beginner - 135.5 s, Intermediate - 100 s, Advance - 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks. CONCLUSION Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.
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Affiliation(s)
- Saumitra Goyal
- Orthopaedics Department, Faculty of Medicine, Assiut University Hospital, Assiut 71515, Egypt - G.G. Medical Institute and Research Centre, 106/2 Sanjay Place, Agra 282004, India
| | - Mohamed Abdel Radi
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Islam Karam-Allah Ramadan
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hatem Galal Said
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Brunette V, Thibodeau-Jarry N. Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit. Can J Cardiol 2016; 33:119-127. [PMID: 28024550 DOI: 10.1016/j.cjca.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
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Affiliation(s)
- Véronique Brunette
- Critical Care Department, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
| | - Nicolas Thibodeau-Jarry
- Masters of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, Massachusetts, USA
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Laparoscopic training by use of a physical simulator and its application in the general surgery residency. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Matthews AH, Abdelrahman T, Powell AGMT, Lewis WG. Surgical Education's 100 Most Cited Articles: A Bibliometric Analysis. JOURNAL OF SURGICAL EDUCATION 2016; 73:919-929. [PMID: 27344302 DOI: 10.1016/j.jsurg.2016.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/03/2016] [Accepted: 05/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed. METHODS Thomson Reuters Web of Science was interrogated using the keyword search terms "surgery" and ("learning" or "skills" or "competence" or "assessment" or "training" or "procedure-based assessments" or "performance" or "technical skills" or "curriculum" or "education" or "mentoring"] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin. RESULTS A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40). CONCLUSION Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education.
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Affiliation(s)
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Wyn G Lewis
- Department of Surgery, University Hospital of Wales, Cardiff, United Kingdom.
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