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Saito S, Endo K, Sakuma Y, Sata N, Lefor AK. Simulator Fidelity Does Not Affect Training for Robot-Assisted Minimally Invasive Surgery. J Clin Med 2023; 12:jcm12072557. [PMID: 37048640 PMCID: PMC10095363 DOI: 10.3390/jcm12072557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
This study was undertaken to compare performance using a surgical robot after training with one of three simulators of varying fidelity. Methods: Eight novice operators and eight expert surgeons were randomly assigned to one of three simulators. Each participant performed two exercises using a simulator and then using a surgical robot. The primary outcome of this study is performance assessed by time and GEARS score. Results: Participants were randomly assigned to one of three simulators. Time to perform the suturing exercise (novices vs. experts) was significantly different for all 3 simulators. Using the da Vinci robot, peg transfer showed no significant difference between novices and experts and all participants combined (mean time novice 2.00, expert 2.21, p = 0.920). The suture exercise had significant differences in each group and all participants combined (novice 3.54, expert 1.90, p = 0.001). ANOVA showed p-Values for suturing (novice 0.523, expert 0.123) and peg transfer (novice 0.742, expert 0.131) are not significantly different. GEARS scores were different (p < 0.05) for novices and experts. Conclusion: Training with simulators of varying fidelity result in similar performance using the da Vinci robot. A dry box simulator may be as effective as a virtual reality simulator for training. Further studies are needed to validate these results.
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Joosten M, Hillemans V, Bökkerink GMJ, de Blaauw I, Verhoeven BH, Botden SMBI. The feasibility and benefit of unsupervised at-home training of minimally invasive surgical skills. Surg Endosc 2023; 37:180-188. [PMID: 35902403 PMCID: PMC9333054 DOI: 10.1007/s00464-022-09424-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Simulation-based training may be used to acquire MIS skills. While mostly done in a simulation center, it is proposed that this training can be undertaken at-home as well. The aim of this study is to evaluate whether unsupervised at-home training and assessment of MIS skills is feasible and results in increased MIS skills. METHODS Medical doctors and senior medical students were tested on their innate abilities by performing a pre-test on a take-home simulator. Henceforth, they followed a two-week interval training practicing two advanced MIS skills (an interrupted suture with knot tying task and a precise peg transfer task) and subsequently performed a post-test. Both tests and all training moments were performed at home. Performance was measured using motion analysis software (SurgTrac) and by expert-assessment and self-assessment using a competency assessment tool for MIS suturing (LS-CAT). RESULTS A total of 38 participants enrolled in the study. Participants improved significantly between the pre-test and the post-test for both tasks. They were faster (632 s vs. 213 s, p < 0.001) and more efficient (distance of instrument tips: 9.8 m vs. 3.4 m, p = 0.001) in the suturing task. Total LS-CAT scores, rated by an expert, improved significantly with a decrease from 36 at the pre-test to 20 at the post-test (p < 0.001) and showed a strong correlation with self-assessment scores (R 0.771, p < 0.001). The precise peg transfer task was completed faster (300 s vs. 163 s, p < 0.001) and more efficient as well (14.8 m vs. 5.7 m, p = 0.005). Additionally, they placed more rings correctly (7 vs. 12, p = 0.010). CONCLUSION Unsupervised at-home training and assessment of MIS skills is feasible and resulted in an evident increase in skills. Especially in times of less exposure in the clinical setting and less education on training locations this can aid in improving MIS skills.
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Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands.
- Department of Surgery, Zuyderland, Heerlen, The Netherlands.
- Department of Pediatric Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10 route 618, 6500 HB, Nijmegen, The Netherlands.
| | - Vera Hillemans
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Bas H Verhoeven
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
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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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Papanikolaou I, Haidopoulos D, Paschopoulos M, Chatzipapas I, Loutradis D, Vlahos N. Changing the way we train surgeons in the 21th century: A narrative comparative review focused on box trainers and virtual reality simulators. Eur J Obstet Gynecol Reprod Biol 2019; 235:13-18. [DOI: 10.1016/j.ejogrb.2019.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Theodoulou I, Nicolaides M, Athanasiou T, Papalois A, Sideris M. Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2018; 75:1374-1388. [PMID: 29422405 DOI: 10.1016/j.jsurg.2018.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. METHODS We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. RESULTS Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. CONCLUSIONS SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level.
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Affiliation(s)
- Iakovos Theodoulou
- Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital Great Maze Pond, London, United Kingdom.
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, London, United Kingdom
| | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
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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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Bur AM, Gomez ED, Newman JG, Weinstein GS, O'Malley BW, Rassekh CH, Kuchenbecker KJ. Evaluation of high-fidelity simulation as a training tool in transoral robotic surgery. Laryngoscope 2017; 127:2790-2795. [DOI: 10.1002/lary.26733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/15/2017] [Accepted: 05/09/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Andrés M. Bur
- Department of Otolaryngology-Head and Neck Surgery; University of Kansas; Kansas City Kansas U.S.A
| | - Ernest D. Gomez
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Jason G. Newman
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Gregory S. Weinstein
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Bert W. O'Malley
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Christopher H. Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Katherine J. Kuchenbecker
- Department of Mechanical Engineering and Applied Mechanics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
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A laparoscopic simulator - maybe it is worth making it yourself. Wideochir Inne Tech Maloinwazyjne 2014; 9:380-6. [PMID: 25337161 PMCID: PMC4198645 DOI: 10.5114/wiitm.2014.44139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 01/07/2014] [Accepted: 02/17/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills.
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Nagendran M, Toon CD, Davidson BR, Gurusamy KS. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Cochrane Database Syst Rev 2014; 2014:CD010479. [PMID: 24442763 PMCID: PMC10875404 DOI: 10.1002/14651858.cd010479.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator - either a video box or a mirrored box - is an option to supplement standard training. However, the impact of this modality on trainees with no prior laparoscopic experience is unknown. OBJECTIVES To compare the benefits and harms of box model training versus no training, another box model, animal model, or cadaveric model training for surgical trainees with no prior laparoscopic experience. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013. SELECTION CRITERIA We included all randomised clinical trials comparing box model trainers versus no training in surgical trainees with no prior laparoscopic experience. We also included trials comparing different methods of box model training. DATA COLLECTION AND ANALYSIS Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager for analysis. For each outcome, we calculated the standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible. MAIN RESULTS Twenty-five trials contributed data to the quantitative synthesis in this review. All but one trial were at high risk of bias. Overall, 16 trials (464 participants) provided data for meta-analysis of box training (248 participants) versus no supplementary training (216 participants). All the 16 trials in this comparison used video trainers. Overall, 14 trials (382 participants) provided data for quantitative comparison of different methods of box training. There were no trials comparing box model training versus animal model or cadaveric model training. Box model training versus no training: The meta-analysis showed that the time taken for task completion was significantly shorter in the box trainer group than the control group (8 trials; 249 participants; SMD -0.48 seconds; 95% CI -0.74 to -0.22). Compared with the control group, the box trainer group also had lower error score (3 trials; 69 participants; SMD -0.69; 95% CI -1.21 to -0.17), better accuracy score (3 trials; 73 participants; SMD 0.67; 95% CI 0.18 to 1.17), and better composite performance scores (SMD 0.65; 95% CI 0.42 to 0.88). Three trials reported movement distance but could not be meta-analysed as they were not in a format for meta-analysis. There was significantly lower movement distance in the box model training compared with no training in one trial, and there were no significant differences in the movement distance between the two groups in the other two trials. None of the remaining secondary outcomes such as mortality and morbidity were reported in the trials when animal models were used for assessment of training, error in movements, and trainee satisfaction. Different methods of box training: One trial (36 participants) found significantly shorter time taken to complete the task when box training was performed using a simple cardboard box trainer compared with the standard pelvic trainer (SMD -3.79 seconds; 95% CI -4.92 to -2.65). There was no significant difference in the time taken to complete the task in the remaining three comparisons (reverse alignment versus forward alignment box training; box trainer suturing versus box trainer drills; and single incision versus multiport box model training). There were no significant differences in the error score between the two groups in any of the comparisons (box trainer suturing versus box trainer drills; single incision versus multiport box model training; Z-maze box training versus U-maze box training). The only trial that reported accuracy score found significantly higher accuracy score with Z-maze box training than U-maze box training (1 trial; 16 participants; SMD 1.55; 95% CI 0.39 to 2.71). One trial (36 participants) found significantly higher composite score with simple cardboard box trainer compared with conventional pelvic trainer (SMD 0.87; 95% CI 0.19 to 1.56). Another trial (22 participants) found significantly higher composite score with reverse alignment compared with forward alignment box training (SMD 1.82; 95% CI 0.79 to 2.84). There were no significant differences in the composite score between the intervention and control groups in any of the remaining comparisons. None of the secondary outcomes were adequately reported in the trials. AUTHORS' CONCLUSIONS The results of this review are threatened by both risks of systematic errors (bias) and risks of random errors (play of chance). Laparoscopic box model training appears to improve technical skills compared with no training in trainees with no previous laparoscopic experience. The impacts of this decreased time on patients and healthcare funders in terms of improved outcomes or decreased costs are unknown. There appears to be no significant differences in the improvement of technical skills between different methods of box model training. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the impacts of box model training on surgical skills in both the short and long term, as well as clinical outcomes when the trainee becomes competent to operate on patients.
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Affiliation(s)
- Myura Nagendran
- Department of SurgeryUCL Division of Surgery and Interventional Science9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Clare D Toon
- West Sussex County CouncilPublic Health1st Floor, The GrangeTower StreetChichesterWest SussexUKPO19 1QT
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
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Nguyen T, Braga LH, Hoogenes J, Matsumoto ED. Commercial Video Laparoscopic Trainers versus Less Expensive, Simple Laparoscopic Trainers: A Systematic Review and Meta-Analysis. J Urol 2013; 190:894-9. [DOI: 10.1016/j.juro.2013.03.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Nguyen
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
| | - Luis H. Braga
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
| | - Jen Hoogenes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Edward D. Matsumoto
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
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The virtual reality simulator dV-Trainer(®) is a valid assessment tool for robotic surgical skills. Surg Endosc 2012; 26:2587-93. [PMID: 22476836 DOI: 10.1007/s00464-012-2237-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Exponential development of minimally invasive techniques, such as robotic-assisted devices, raises the question of how to assess robotic surgery skills. Early development of virtual simulators has provided efficient tools for laparoscopic skills certification based on objective scoring, high availability, and lower cost. However, similar evaluation is lacking for robotic training. The purpose of this study was to assess several criteria, such as reliability, face, content, construct, and concurrent validity of a new virtual robotic surgery simulator. METHODS This prospective study was conducted from December 2009 to April 2010 using three simulators dV-Trainers(®) (MIMIC Technologies(®)) and one Da Vinci S(®) (Intuitive Surgical(®)). Seventy-five subjects, divided into five groups according to their initial surgical training, were evaluated based on five representative exercises of robotic specific skills: 3D perception, clutching, visual force feedback, EndoWrist(®) manipulation, and camera control. Analysis was extracted from (1) questionnaires (realism and interest), (2) automatically generated data from simulators, and (3) subjective scoring by two experts of depersonalized videos of similar exercises with robot. RESULTS Face and content validity were generally considered high (77 %). Five levels of ability were clearly identified by the simulator (ANOVA; p = 0.0024). There was a strong correlation between automatic data from dV-Trainer and subjective evaluation with robot (r = 0.822). Reliability of scoring was high (r = 0.851). The most relevant criteria were time and economy of motion. The most relevant exercises were Pick and Place and Ring and Rail. CONCLUSIONS The dV-Trainer(®) simulator proves to be a valid tool to assess basic skills of robotic surgery.
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Effective home laparoscopic simulation training: a preliminary evaluation of an improved training paradigm. Am J Surg 2012; 203:1-7. [DOI: 10.1016/j.amjsurg.2011.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 07/12/2011] [Accepted: 07/14/2011] [Indexed: 01/22/2023]
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Khine M, Leung E, Morran C, Muthukumarasamy G. Homemade laparoscopic simulators for surgical trainees. CLINICAL TEACHER 2011; 8:118-21. [PMID: 21585673 DOI: 10.1111/j.1743-498x.2011.00441.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Laparoscopic surgery has become increasingly popular in recent times. Laparoscopic skills and dexterity can be improved by using simulators. We provide a step-by-step guide with diagrams to build an individual homemade laparoscopic trainer box, which is easily available and affordable. METHODS We collected the required material for our homemade trainer box from a local DIY shop and purchased a high-definition (HD) webcam online. We used a 12-litre plastic storage box and mounted the webcam inside the lid of the plastic box. The ultraslim energy-saving fluorescent light was mounted behind the webcam. Holes were made in the plastic lid and patched with circular pieces of Neoprene to accommodate the insertion of laparoscopic instruments. RESULTS The trainer box can be built in 3 hours. The trainer box weighs 1.2 kg with a light source, and is easily portable. It was demonstrated to a cohort of surgical trainees and they were very receptive, and liked the idea of an easy to assemble, low-cost trainer box with high-quality images. DISCUSSION Our homemade trainer box offers HD vision that can be viewed on a personal computer, and the webcam is adjustable so it gives hands-free stability. It is built with a lightweight plastic box so it can be easily carried around by a trainee. This simple, inexpensive, easy-to-build trainer box makes a perfect solution for individuals who want to practise basic laparoscopic skills at home or in the workplace.
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Affiliation(s)
- Myo Khine
- Department of Surgery, Crosshouse Hospital, Kilmarnock, UK.
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Salin A, Gaujoux S, Sarnacki S, Hardy P, Frileux P. Teaching laparoscopic techniques: The Surgical School of Paris experience. J Visc Surg 2010; 147:e385-8. [DOI: 10.1016/j.jviscsurg.2010.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Review of available methods of simulation training to facilitate surgical education. Surg Endosc 2010; 25:28-35. [PMID: 20552373 DOI: 10.1007/s00464-010-1123-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 05/03/2010] [Indexed: 02/07/2023]
Abstract
The old paradigm of "see one, do one, teach one" has now changed to "see several, learn the skills and simulation, do one, teach one." Modern medicine over the past 30 years has undergone significant revolutions from earlier models made possible by significant technological advances. Scientific and technological progress has made these advances possible not only by increasing the complexity of procedures, but also by increasing the ability to have complex methods of training to perform these sophisticated procedures. Simulators in training labs have been much more embraced outside the operating room, with advanced cardiac life support using hands-on models (CPR "dummy") as well as a fusion with computer-based testing for examinations ranging from the United States medical licensure exam to the examinations administered by the American Board of Surgery and the American Board of Colon and Rectal Surgery. Thus, the development of training methods that test both technical skills and clinical acumen may be essential to help achieve both safety and financial goals.
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Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0594-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 2009:CD006575. [PMID: 19160288 DOI: 10.1002/14651858.cd006575.pub2] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. OBJECTIVES To determine whether virtual reality training can supplement or replace conventional laparoscopic surgical training (apprenticeship) in surgical trainees with limited or no prior laparoscopic experience. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and grey literature until March 2008. SELECTION CRITERIA We included all randomised clinical trials comparing virtual reality training versus other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the standardised mean difference with 95% confidence intervals based on intention-to-treat analysis. MAIN RESULTS We included 23 trials with 612 participants. Four trials compared virtual reality versus video trainer training. Twelve trials compared virtual reality versus no training or standard laparoscopic training. Four trials compared virtual reality, video trainer training and no training, or standard laparoscopic training. Three trials compared different methods of virtual reality training. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors compared with no training; virtual reality group was more accurate than video trainer training group. In the participants with limited laparoscopic experience, virtual reality training reduces operating time and error better than standard in the laparoscopic training group; composite operative performance score was better in the virtual reality group than in the video trainer group. AUTHORS' CONCLUSIONS Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training. Further research of better methodological quality and more patient-relevant outcomes are needed.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
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Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R. Feasibility and construct validity of a novel laparoscopic skills testing and training model. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0391-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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