1
|
Ershad Langroodi M, Liu X, Tousignant MR, Jarc AM. Objective performance indicators versus GEARS: an opportunity for more accurate assessment of surgical skill. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03248-2. [PMID: 39320413 DOI: 10.1007/s11548-024-03248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/29/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE Surgical skill evaluation that relies on subjective scoring of surgical videos can be time-consuming and inconsistent across raters. We demonstrate differentiated opportunities for objective evaluation to improve surgeon training and performance. METHODS Subjective evaluation was performed using the Global evaluative assessment of robotic skills (GEARS) from both expert and crowd raters; whereas, objective evaluation used objective performance indicators (OPIs) derived from da Vinci surgical systems. Classifiers were trained for each evaluation method to distinguish between surgical expertise levels. This study includes one clinical task from a case series of robotic-assisted sleeve gastrectomy procedures performed by a single surgeon, and two training tasks performed by novice and expert surgeons, i.e., surgeons with no experience in robotic-assisted surgery (RAS) and those with more than 500 RAS procedures. RESULTS When comparing expert and novice skill levels, OPI-based classifier showed significantly higher accuracy than GEARS-based classifier on the more complex dissection task (OPI 0.93 ± 0.08 vs. GEARS 0.67 ± 0.18; 95% CI, 0.16-0.37; p = 0.02), but no significant difference was shown on the simpler suturing task. For the single-surgeon case series, both classifiers performed well when differentiating between early and late group cases with smaller group sizes and larger intervals between groups (OPI 0.9 ± 0.08; GEARS 0.87 ± 0.12; 95% CI, 0.02-0.04; p = 0.67). When increasing the group size to include more cases, thereby having smaller intervals between groups, OPIs demonstrated significantly higher accuracy (OPI 0.97 ± 0.06; GEARS 0.76 ± 0.07; 95% CI, 0.12-0.28; p = 0.004) in differentiating between the early/late cases. CONCLUSIONS Objective methods for skill evaluation in RAS outperform subjective methods when (1) differentiating expertise in a technically challenging training task, and (2) identifying more granular differences along early versus late phases of a surgeon learning curve within a clinical task. Objective methods offer an opportunity for more accessible and scalable skill evaluation in RAS.
Collapse
Affiliation(s)
| | - Xi Liu
- Research and Development, Intuitive Surgical, Inc, 5655 Spalding Dr, Norcross, GA, 30092, USA
| | - Mark R Tousignant
- Research and Development, Intuitive Surgical, Inc, 5655 Spalding Dr, Norcross, GA, 30092, USA
| | - Anthony M Jarc
- Research and Development, Intuitive Surgical, Inc, 5655 Spalding Dr, Norcross, GA, 30092, USA
| |
Collapse
|
2
|
Trac J, Lee J, Fok KH, Carrillo B, Farcas M. Development of a synchronous motion-tracking and video capture tool for flexible ureteroscopy. Can Urol Assoc J 2024; 18:103-109. [PMID: 38381935 PMCID: PMC11034973 DOI: 10.5489/cuaj.8530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Hand/instrument motion-tracking in surgical simulation provides valuable data to improve psychomotor skills and can serve as a formative evaluation tool. Motion analysis has been well-studied in laparoscopic surgery; however, there are essentially no studies looking at motion-tracking for flexible ureteroscopy (fURS ), a common surgical procedure requiring hand dexterity and 3D spatial awareness. We aimed to design a synchronized motion-tracking and video capture system for fURS capable of collecting objective metrics for use in surgical skills training. METHODS Motion tracking of the ureteroscope was performed using a motion-tracking platform, inertial measurement units (IMUs), and an optical sensor. Position (x, y, z) and orientation (roll, pitch, yaw) of the ureteroscope handle, lever deflection, and translation of the scope insertion point were collected. Video capture of the operator's hands was collected with a Raspberry Pi camera. All peripherals were controlled on a Raspberry Pi 4 and synchronized to its system clock. RESULTS Our system demonstrated good accuracy in detecting translation of the ureteroscope in the x- and y-axes, and yaw, pitch and roll of the ureteroscope at discrete orientations of 0, ±30, ±60, and ±90 degrees. Unique to fURS, deflection of the lever was captured by the difference in IMU static accelerations with good accuracy. The optical sensor detected translation of the ureteroscope at the insertion point with good precision and an average error of 5.51%. CONCLUSIONS We successfully developed a motion-tracking and video-capture system capable of collecting motion-analysis parameters unique to fURS . Future studies will focus on establishing the construct validity of this tool.
Collapse
Affiliation(s)
- Jessica Trac
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonguk Lee
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kai-Ho Fok
- Division of Urology, Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Monica Farcas
- Division of Urology, Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
3
|
Rueda Esteban RJ, López-McCormick JS, Rodríguez-Bermeo AS, Andrade M, Hernández Restrepo JD, Targarona Soler EM. Face, Content, and Construct Validity Evaluation of Simulation Models in General Surgery Laparoscopic Training and Education: A Systematic Review. Surg Innov 2023; 30:251-260. [PMID: 36062557 DOI: 10.1177/15533506221123704] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laparoscopic technical surgical skills (LTS) are considered a fundamental competence for General Surgery residents. Several simulation tools (ST) have been explored to develop LTS. Although a plethora of systematic reviews evaluate the translation of LTS developed in simulation to real surgery, there is a lack of evidence that clarifies effectiveness of different validated ST in acquisition of LTS in surgical residents. The aim of this systematic review (SR) is to summarize published evidence on ST validation used for surgery education and training. METHODS A protocol was published in PROSPERO. A SR was carried out following PRISMA guidelines. Complete published articles in English or Spanish that validate either content or construct, plus another form of validation of ST to acquire LTS in general surgery were included. Articles that used only one validation or did not validate an ST were excluded. RESULTS 1052 publications were initially identified across all searched databases. Title review identified 204 studies eligible for full text screening. 10 studies were included for final review. Two studies assessed both face and content, 4 face and construct, and 4 face, content and construct validity. None of the studies presented comparable outcomes due to metrics variation and scores used for the validation strategies. CONCLUSIONS This study assessed validated laparoscopic simulation models, particularly in content and construct validity. Articles reported an increased use of simulation models in laparoscopic training with positive feedback from trainees, but few studies reported validation of training model. Validation strategies are not standardized, limiting comparability between them.
Collapse
Affiliation(s)
- Roberto J Rueda Esteban
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Surgery Department, Universidad Autonoma de Barcelona Doctorate School, Barcelona, Spain
| | | | | | - Mateo Andrade
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Juan D Hernández Restrepo
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- General Surgery, Fundacion Santa Fe de Bogotá, Bogota, Colombia
| | - Eduardo M Targarona Soler
- Surgery Department, Universidad Autonoma de Barcelona Doctorate School, Barcelona, Spain
- Surgery Department, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| |
Collapse
|
4
|
Wang P, Zhang S, Liu Z, Huang Y, Huang J, Huang X, Chen J, Fang B, Peng D. Smart laparoscopic grasper integrated with fiber Bragg grating based tactile sensor for real-time force feedback. JOURNAL OF BIOPHOTONICS 2022; 15:e202100331. [PMID: 35020276 DOI: 10.1002/jbio.202100331] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Minimally invasive surgery, such as laparoscopic surgery, has developed rapidly due to its small wound, less bleeding and quick recovery. However, a lack of force feedback, which leads to tissue damage, is still unsolved. Many sensors have been used to offer force feedback but still limited by their large size, low security and high complexity. Based on the advantages of small size, high sensitivity and immunity to electromagnetic interferences, we propose a tactile sensor integrated with fiber Bragg gratings (FBGs) at the tip of laparoscopic grasper to offer real-time force feedback in the laparoscopic surgery. The tactile sensor shows a force sensitivity of 0.076 nm/N with a repeatable accuracy of 0.118 N. A bench test is conducted in a laparoscopic training box to verify its feasibility. Test results illustrate that gripping force exerted on the laparoscopic grasper in terms of peak and standard deviation values reduce significantly for the novice subjects with force feedback compared to those without force feedback. The proposed sensor integrated at the tip of the laparoscopic grasper demonstrates a better control of the gripping force among the novice surgeons and indicates that the smart grasper can help surgeons achieve precise gripping force to reduce unnecessary tissue trauma.
Collapse
Affiliation(s)
- Pingping Wang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shengqi Zhang
- Guangdong Provincial Key Laboratory of Optoelectronic Information Processing Chips and Systems, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, China
| | - Zhengyong Liu
- Guangdong Provincial Key Laboratory of Optoelectronic Information Processing Chips and Systems, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, China
- Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Yuxin Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuemei Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Chen
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bimei Fang
- Department of Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dongxian Peng
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
5
|
Hardon SF, van Gastel LA, Horeman T, Daams F. Assessment of technical skills based on learning curve analyses in laparoscopic surgery training. Surgery 2021; 170:831-840. [PMID: 34090675 DOI: 10.1016/j.surg.2021.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Objective force- and motion-based assessment is currently lacking in laparoscopic skills curricula. This study aimed to evaluate the added value of parameter-based assessment and feedback during training. METHODS Laparoscopy-naïve surgical residents that took part in a 3-week skills training curriculum were included. A box trainer equipped with the ForceSense system was used for assessment of tissue manipulation- (MaxForce) and instrument-handling skills (Path length and Time). Learning curves were established using linear regression tests. Pre- and post-course comparisons indicated the overall progression and were compared to predefined proficiency levels. A post-course survey was carried out to assess face validity. RESULTS In total, 4,268 trials, executed by 24 residents, were successfully assessed. Median (interquartile range) MaxForce outcomes improved from 2.7 Newton (interquartile range 1.9-3.8) to 1.8 Newton (interquartile range 1.2-2.4) between pre- and post-course assessment (P ≤ .009). Instrument Path length improved from 7,102.2 mm (interquartile range 5,255.2-9,025.9) to 3,545.3 mm (interquartile range 2,842.9-4,563.2) (P ≤.001). Time to execute the task improved from 159.8 seconds (interquartile range 119.8-219.0) to 60.7 seconds (interquartile range 46.0-79.5) (P ≤ .001). The learning curves revealed during what training phase the proficiency benchmarks were reached for each trainee. In the survey outcomes, trainees indicated that this curriculum should be part of a surgical residency program (mean visual analog scale score of 9.2 ± 0.9 standard deviation). CONCLUSION Force-, motion-, and time-parameters can be objectively measured during basic laparoscopic skills curricula and do indicate progression of skills over time. The ForceSense parameters enable curricula to be designed for specific proficiency-based training goals and offer the possibility for objective classification of the levels of expertise.
Collapse
Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Leonie A van Gastel
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, the Netherlands. https://twitter.com/freekdaams
| |
Collapse
|
6
|
Menekse Dalveren GG, Cagiltay NE. Distinguishing Intermediate and Novice Surgeons by Eye Movements. Front Psychol 2020; 11:542752. [PMID: 33013592 PMCID: PMC7511664 DOI: 10.3389/fpsyg.2020.542752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
Surgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.
Collapse
Affiliation(s)
- Gonca Gokce Menekse Dalveren
- Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway.,Department of Information Systems Engineering, Atılım University, Ankara, Turkey
| | | |
Collapse
|
7
|
Motion analysis for better understanding of psychomotor skills in laparoscopy: objective assessment-based simulation training using animal organs. Surg Endosc 2020; 35:4399-4416. [PMID: 32909201 PMCID: PMC8263434 DOI: 10.1007/s00464-020-07940-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022]
Abstract
Background Our aim was to characterize the motions of multiple laparoscopic surgical instruments among participants with different levels of surgical experience in a series of wet-lab training drills, in which participants need to perform a range of surgical procedures including grasping tissue, tissue traction and dissection, applying a Hem-o-lok clip, and suturing/knotting, and digitize the level of surgical competency. Methods Participants performed tissue dissection around the aorta, dividing encountered vessels after applying a Hem-o-lok (Task 1), and renal parenchymal closure (Task 2: suturing, Task 3: suturing and knot-tying), using swine cadaveric organs placed in a box trainer under a motion capture (Mocap) system. Motion-related metrics were compared according to participants’ level of surgical experience (experts: 50 ≤ laparoscopic surgeries, intermediates: 10–49, novices: 0–9), using the Kruskal–Wallis test, and significant metrics were subjected to principal component analysis (PCA). Results A total of 15 experts, 12 intermediates, and 18 novices participated in the training. In Task 1, a shorter path length and faster velocity/acceleration/jerk were observed using both scissors and a Hem-o-lok applier in the experts, and Hem-o-lok-related metrics markedly contributed to the 1st principal component on PCA analysis, followed by scissors-related metrics. Higher-level skills including a shorter path length and faster velocity were observed in both hands of the experts also in tasks 2 and 3. Sub-analysis showed that, in experts with 100 ≤ cases, scissors moved more frequently in the “close zone (0 ≤ to < 2.0 cm from aorta)” than those with 50–99 cases. Conclusion Our novel Mocap system recognized significant differences in several metrics in multiple instruments according to the level of surgical experience. “Applying a Hem-o-lok clip on a pedicle” strongly reflected the level of surgical experience, and zone-metrics may be a promising tool to assess surgical expertise. Our next challenge is to give completely objective feedback to trainees on-site in the wet-lab. Electronic supplementary material The online version of this article (10.1007/s00464-020-07940-7) contains supplementary material, which is available to authorized users.
Collapse
|
8
|
Farcas MA, Azzie G. Performance assessment - The knowledge, skills and attitudes of surgical performance. Semin Pediatr Surg 2020; 29:150903. [PMID: 32423592 DOI: 10.1016/j.sempedsurg.2020.150903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pediatric surgical education has traditionally focused on the hard cognitive and psychomotor (technical) skills. While more and more attention is being paid to softer skills such as communication, collaboration, leadership, health advocacy, professionalism and scholarship, the bulk of curricula remain focused on the hard skills. An intricate part of education is the assessment of performance. This article reviews the current literature on the assessment of cognitive and psychomotor skills, focusing particularly on the assessment of technical skills in the realm of simulation.
Collapse
Affiliation(s)
- Monica A Farcas
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, St. Michael's Hospital, Toronto, Canada; Ki Ka Shing Knowledge Institute, Toronto, Canada; Institute for Biomedical Engineering, Science and Technology, Toronto, Canada.
| | - Georges Azzie
- Department of Surgery, University of Toronto, Toronto, Canada; Department of Pediatric Surgery, Hopitaux Pédiatriques de Nice CHU-Lenval, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
9
|
Hardon SF, van Kasteren RJ, Dankelman J, Bonjer HJ, Tuynman JB, Horeman T. The value of force and torque measurements in transanal total mesorectal excision (TaTME). Tech Coloproctol 2019; 23:843-852. [PMID: 31432333 PMCID: PMC6791959 DOI: 10.1007/s10151-019-02057-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/31/2019] [Indexed: 12/16/2022]
Abstract
Background Transanal total mesorectal excision (TaTME) is associated with a relatively long learning curve. Force, motion, and time parameters are increasingly used for objective assessment of skills to enhance laparoscopic training efficacy. The aim of this study was to identify relevant metrics for accurate skill assessment in more complex transanal purse-string suturing. Methods A box trainer was designed for TaTME and equipped with two custom made multi-DOF force/torque sensors. These sensors measured the applied forces in the axial direction of the instruments (Fz), instrument load orientation expressed in torque (Mx and My) on the entrance port, and the full tissue interaction force (Fft) at the intestine fixation point. In a construct validity study, novices for TaTME performed a purse-string suture to investigate which parameters can be used best to identify meaningful events during tissue manipulation and instrument handling. Results Significant differences exist between pre- and post-training assessment for the mean axial force at the entrance port Fz (p = 0.01), mean torque in the entrance port Mx (p = 0.03) and mean force on the intestine during suturing Fft (p = 0.05). Furthermore, force levels during suturing exceed safety threshold values, potentially leading to dangerous complications such as rupture of the rectum. Conclusions Forces and torque measured at the entrance port, and the tissue interaction force signatures provide detailed insight into instrument handling, instrument loading, and tissue handling during purse-string suturing in a TaTME training setup. This newly developed training setup for single-port laparoscopy that enables objective feedback has the potential to enhance surgical training in TaTME.
Collapse
Affiliation(s)
- S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - R J van Kasteren
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - H J Bonjer
- Department of Surgery, Amsterdam UMC-VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC-VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| |
Collapse
|
10
|
Force-based learning curve tracking in fundamental laparoscopic skills training. Surg Endosc 2018; 32:3609-3621. [PMID: 29423553 PMCID: PMC6061061 DOI: 10.1007/s00464-018-6090-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/01/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND Within minimally invasive surgery (MIS), structural implementation of courses and structured assessment of skills are challenged by availability of trainers, time, and money. We aimed to establish and validate an objective measurement tool for preclinical skills acquisition in a basic laparoscopic at-home training program. METHODS A mobile laparoscopic simulator was equipped with a state-of-the-art force, motion, and time tracking system (ForceSense, MediShield B.V., Delft, the Netherlands). These performance parameters respectively representing tissue manipulation and instrument handling were continuously tracked during every trial. Proficiency levels were set by clinical experts for six different training tasks. Resident's acquisition and development of fundamental skills were evaluated by comparing pre- and post-course assessment measurements and OSATS forms. A questionnaire was distributed to determine face and content validity. RESULTS Out of 1842 captured attempts by novices, 1594 successful trials were evaluated. A decrease in maximum exerted absolute force was shown in comparison of four training tasks (p ≤ 0.023). Three of the six comparisons also showed lower mean forces during tissue manipulation (p ≤ 0.024). Lower instrument handling outcomes (i.e., time and motion parameters) were observed in five tasks (resp. (p ≤ 0.019) and (p ≤ 0.025)). Simultaneously, all OSATS scores increased (p ≤ 0.028). Proficiency levels for all tasks can be reached in 2 weeks of at home training. CONCLUSIONS Monitoring force, motion, and time parameters during training showed to be effective in determining acquisition and development of basic laparoscopic tissue manipulation and instrument handling skills. Therefore, we were able to gain insight into the amount of training needed to reach certain levels of competence. Skills improved after sufficient amount of training at home. Questionnaire outcomes indicated that skills and self-confidence improved and that this training should therefore be part of the regular residency training program.
Collapse
|
11
|
Trudeau MO, Carrillo B, Nasr A, Gerstle JT, Azzie G. Educational Role for an Advanced Suturing Task in the Pediatric Laparoscopic Surgery Simulator. J Laparoendosc Adv Surg Tech A 2017; 27:441-446. [DOI: 10.1089/lap.2016.0516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maeve O'Neill Trudeau
- Department of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Ahmed Nasr
- Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Justin T. Gerstle
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
| | - Georges Azzie
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Analysis of motion in laparoscopy: the deconstruction of an intra-corporeal suturing task. Surg Endosc 2016; 31:3130-3139. [DOI: 10.1007/s00464-016-5337-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
|
14
|
Sánchez R, Rodríguez O, Rosciano J, Vegas L, Bond V, Rojas A, Sanchez-Ismayel A. Robotic surgery training: construct validity of Global Evaluative Assessment of Robotic Skills (GEARS). J Robot Surg 2016; 10:227-31. [PMID: 27039189 DOI: 10.1007/s11701-016-0572-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/06/2016] [Indexed: 12/14/2022]
Abstract
The objective of this study is to determine the ability of the GEARS scale (Global Evaluative Assessment of Robotic Skills) to differentiate individuals with different levels of experience in robotic surgery, as a fundamental validation. This is a cross-sectional study that included three groups of individuals with different levels of experience in robotic surgery (expert, intermediate, novice) their performance were assessed by GEARS applied by two reviewers. The difference between groups was determined by Mann-Whitney test and the consistency between the reviewers was studied by Kendall W coefficient. The agreement between the reviewers of the scale GEARS was 0.96. The score was 29.8 ± 0.4 to experts, 24 ± 2.8 to intermediates and 16 ± 3 to novices, with a statistically significant difference between all of them (p < 0.05). All parameters from the scale allow discriminating between different levels of experience, with exception of the depth perception item. We conclude that the scale GEARS was able to differentiate between individuals with different levels of experience in robotic surgery and, therefore, is a validated and useful tool to evaluate surgeons in training.
Collapse
Affiliation(s)
- Renata Sánchez
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela.,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| | - Omaira Rodríguez
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela. .,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela.
| | - José Rosciano
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Liumariel Vegas
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Verónica Bond
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Aram Rojas
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Alexis Sanchez-Ismayel
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela.,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| |
Collapse
|
15
|
Gonzalez-Neira EM, Jimenez-Mendoza CP, Suarez DR, Rugeles-Quintero S. Objective evaluation of surgical competency for minimally invasive surgery with a collection of simple tests. Colomb Med (Cali) 2016; 47:45-50. [PMID: 27226664 PMCID: PMC4867516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aims at determining if a collection of 16 motor tests on a physical simulator can objectively discriminate and evaluate practitioners' competency level, i.e. novice, resident, and expert. METHODS An experimental design with three study groups (novice, resident, and expert) was developed to test the evaluation power of each of the 16 simple tests. An ANOVA and a Student Newman-Keuls (SNK) test were used to analyze results of each test to determine which of them can discriminate participants' competency level. RESULTS Four of the 16 tests used discriminated all of the three competency levels and 15 discriminated at least two of the three groups (α= 0.05). Moreover, other two tests differentiate beginners' level from intermediate, and other seven tests differentiate intermediate level from expert. CONCLUSION The competency level of a practitioner of minimally invasive surgery can be evaluated by a specific collection of basic tests in a physical surgical simulator. Reduction of the number of tests needed to discriminate the competency level of surgeons can be the aim of future research.
Collapse
Affiliation(s)
- Eliana Maria Gonzalez-Neira
- Departamento de Ingeniería Industrial, Facultad de Ingeniería, Pontifica Universidad Javeriana, Bogotá, Colombia
| | | | - Daniel R Suarez
- Departamento de Ingeniería Industrial, Facultad de Ingeniería, Pontifica Universidad Javeriana, Bogotá, Colombia
| | - Saul Rugeles-Quintero
- Departamento de Cirugía, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| |
Collapse
|
16
|
Kassahun Y, Yu B, Tibebu AT, Stoyanov D, Giannarou S, Metzen JH, Vander Poorten E. Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions. Int J Comput Assist Radiol Surg 2015; 11:553-68. [PMID: 26450107 DOI: 10.1007/s11548-015-1305-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/21/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Advances in technology and computing play an increasingly important role in the evolution of modern surgical techniques and paradigms. This article reviews the current role of machine learning (ML) techniques in the context of surgery with a focus on surgical robotics (SR). Also, we provide a perspective on the future possibilities for enhancing the effectiveness of procedures by integrating ML in the operating room. METHODS The review is focused on ML techniques directly applied to surgery, surgical robotics, surgical training and assessment. The widespread use of ML methods in diagnosis and medical image computing is beyond the scope of the review. Searches were performed on PubMed and IEEE Explore using combinations of keywords: ML, surgery, robotics, surgical and medical robotics, skill learning, skill analysis and learning to perceive. RESULTS Studies making use of ML methods in the context of surgery are increasingly being reported. In particular, there is an increasing interest in using ML for developing tools to understand and model surgical skill and competence or to extract surgical workflow. Many researchers begin to integrate this understanding into the control of recent surgical robots and devices. CONCLUSION ML is an expanding field. It is popular as it allows efficient processing of vast amounts of data for interpreting and real-time decision making. Already widely used in imaging and diagnosis, it is believed that ML will also play an important role in surgery and interventional treatments. In particular, ML could become a game changer into the conception of cognitive surgical robots. Such robots endowed with cognitive skills would assist the surgical team also on a cognitive level, such as possibly lowering the mental load of the team. For example, ML could help extracting surgical skill, learned through demonstration by human experts, and could transfer this to robotic skills. Such intelligent surgical assistance would significantly surpass the state of the art in surgical robotics. Current devices possess no intelligence whatsoever and are merely advanced and expensive instruments.
Collapse
Affiliation(s)
- Yohannes Kassahun
- Robotics Innovation Center, German Research Center for Artificial Intelligence, Robert-Hooke-Str. 1, 28359, Bremen, Germany.
| | - Bingbin Yu
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Abraham Temesgen Tibebu
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Danail Stoyanov
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Jan Hendrik Metzen
- Faculty 3 - Mathematics and Computer Science, University of Bremen, Robert-Hooke-Str. 1, 28359, Bremen, Germany
| | - Emmanuel Vander Poorten
- Department of Mechanical Engineering, University of Leuven, Celestijnenlaan 300B, 3001, Heverlee, Belgium
| |
Collapse
|
17
|
Fuchs Weizman N, Manoucheri E, Vitonis AF, Hicks GJ, Einarsson JI, Cohen SL. Design and validation of a novel assessment tool for laparoscopic suturing of the vaginal cuff during hysterectomy. JOURNAL OF SURGICAL EDUCATION 2015; 72:212-219. [PMID: 25439178 DOI: 10.1016/j.jsurg.2014.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/15/2014] [Accepted: 08/31/2014] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to design and validate a new assessment tool for laparoscopic vaginal cuff suturing in a box trainer. DESIGN A primary grading tool was constructed including a novel checklist component and a previously validated global rating scale. A four-step validation process was then undertaken. Face validity was determined by a survey of a panel of experts in the field of minimally invasive gynecologic surgery. Content validity was assessed via analysis of consistency and variability of the experts' ratings, and items were removed or rephrased according to the experts' comments. PARTICIPANTS Overall, five novices and five expert laparoscopic surgeons were videotaped performing suture closure of a latex vaginal cuff model in a box trainer. The videotapes were reviewed by two raters. Discriminate validity, along with interrater and intrarater reliabilities, was assessed by analysis of the video ratings. SETTING The Simulation, Training, Research, and Technology Utilization System center at Brigham and Women's Hospital, a tertiary medical center in Boston, MA. RESULTS The final assessment tool is presented. CONCLUSION We have validated an assessment tool for vaginal cuff suturing in a box trainer.
Collapse
Affiliation(s)
- Noga Fuchs Weizman
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elmira Manoucheri
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gloria J Hicks
- Simulation, Training, Research, and Technology Utilization System (STRATUS) Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
18
|
Trudeau MO, Nasr A, Carrillo B, Gerstle JT, Azzie G. Construct validity and educational role for motion analysis in a laparoscopic trainer. Surg Endosc 2014; 29:2491-5. [DOI: 10.1007/s00464-014-3988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/15/2014] [Indexed: 12/31/2022]
|
19
|
Partridge RW, Hughes MA, Brennan PM, Hennessey IA. Accessible Laparoscopic Instrument Tracking (“InsTrac”): Construct Validity in a Take-Home Box Simulator. J Laparoendosc Adv Surg Tech A 2014; 24:578-83. [DOI: 10.1089/lap.2014.0015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mark A. Hughes
- Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Paul M. Brennan
- Western General Hospital, Edinburgh, Scotland, United Kingdom
| | | |
Collapse
|
20
|
Nasr A, Carrillo B, Gerstle JT, Azzie G. Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills. J Pediatr Surg 2014; 49:791-4. [PMID: 24851772 DOI: 10.1016/j.jpedsurg.2014.02.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Construct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS). METHODS Participants were asked to perform a standardized intracorporeal suturing task. They were classified as novices, intermediates, and experts. Motion in the four degrees of freedom available during traditional MAS (PITCH, YAW, ROLL and SURGE) was assessed using range, velocity, and acceleration. RESULTS Analysis of motion allowed discrimination between the 75 participants according to level of expertise. The most discriminating motion parameter was the acceleration in performing the ROLL (pronation/supination) with values of 30±27 for novices, 15±5 for intermediates, and 3.7±3 for experts (p<0.001). CONCLUSIONS Tracking and analyzing the motion of instruments within the PLS simulator allow discrimination between novices, intermediates, and experts, thus establishing construct validity. Further development may establish motion analysis as a useful "real time" modality to teach and assess MAS skills.
Collapse
Affiliation(s)
- Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Brian Carrillo
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Ted Gerstle
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Georges Azzie
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
21
|
Yang T, Yin QS. Letter to the editor: Simulator for spine pathologies. J Neurosurg Pediatr 2013; 12:414. [PMID: 23931765 DOI: 10.3171/2013.6.peds13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tao Yang
- Southern Medical University, Guangzhou, Guangdong, China
| | | |
Collapse
|
22
|
Akdemir A, Ergenoğlu AM, Yeniel AÖ, Sendağ F. Conventional box model training improves laparoscopic skills during salpingectomy on LapSim: a randomized trial. J Turk Ger Gynecol Assoc 2013; 14:157-62. [PMID: 24592096 DOI: 10.5152/jtgga.2013.55563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/25/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Box model trainers have been used for many years to facilitate the improvement of laparoscopic skills. However, there are limited data available on box trainers and their impact on skill acquisition, assessed by virtual reality systems. MATERIAL AND METHODS Twenty-two Postgraduate Year 1 gynecology residents with no laparoscopic experience were randomly divided into one group that received structured box model training and a control group. All residents performed a salpingectomy on LapSim before and after the training. Performances before and after the training were assessed using LapSim and were recorded using objective parameters, registered by a computer system (time, damage, and economy of motion scores). RESULTS There were initially no differences between the two groups. The box trainer group showed significantly greater improvement in time (p=0.01) and economy of motion scores (p=0.001) compared with the control group post-training. CONCLUSION The present study confirmed the positive effect of low cost box model training on laparoscopic skill acquisition as assessed using LapSim. Novice surgeons should obtain practice on box trainers and teaching centers should make efforts to establish training laboratories.
Collapse
Affiliation(s)
- Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University Medical Faculty, İzmir, Turkey
| | - Ahmet Mete Ergenoğlu
- Department of Obstetrics and Gynecology, Ege University Medical Faculty, İzmir, Turkey
| | - Ahmet Özgür Yeniel
- Department of Obstetrics and Gynecology, Ege University Medical Faculty, İzmir, Turkey
| | - Fatih Sendağ
- Department of Obstetrics and Gynecology, Ege University Medical Faculty, İzmir, Turkey
| |
Collapse
|
23
|
Mattei TA, Frank C, Bailey J, Lesle E, Macuk A, Lesniak M, Patel A, Morris MJ, Nair K, Lin JJ. Design of a synthetic simulator for pediatric lumbar spine pathologies. J Neurosurg Pediatr 2013; 12:192-201. [PMID: 23705840 DOI: 10.3171/2013.4.peds12540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Simulation has become an important tool in neurosurgical education as part of the complex process of improving residents' technical expertise while preserving patient safety. Although different simulators have already been designed for a variety of neurosurgical procedures, spine simulators are still in their infancy and, at present, there is no available simulator for lumbar spine pathologies in pediatric neurosurgery. In this paper the authors describe the peculiarities and challenges involved in developing a synthetic simulator for pediatric lumbar spine pathologies, including tethered spinal cord syndrome and open neural tube defects. METHODS The Department of Neurosurgery of the University of Illinois at Peoria, in a joint program with the Mechanical Engineering Department of Bradley University, designed and developed a general synthetic model for simulating pediatric neurosurgical interventions on the lumbar spine. The model was designed to be composed of several sequential layers, so that each layer might closely mimic the tensile properties of the natural tissues under simulation. Additionally, a system for pressure monitoring was developed to enable precise measurements of the degree of manipulation of the spinal cord. RESULTS The designed prototype successfully simulated several scenarios commonly found in pediatric neurosurgery, such as tethered spinal cord, retethered spinal cord, and fatty terminal filum, as well as meningocele, myelomeningocele, and lipomyelomeningocele. Additionally, the formulated grading system was able to account for several variables involved in the qualitative evaluation of the technical performance during the training sessions and, in association with an expert qualitative analysis of the recorded sessions, proved to be a useful feedback tool for the trainees. CONCLUSIONS Designing and building a synthetic simulator for pediatric lumbar spine pathologies poses a wide variety of unique challenges. According to the authors' experience, a modular system composed of separable layers that can be independently replaced significantly enhances the applicability of such a model, enabling its individualization to distinctive but interrelated pathologies. Moreover, the design of a system for pressure monitoring (as well as a general score that may be able to account for the overall technical quality of the trainee's performance) may further enhance the educational applications of a simulator of this kind so that it can be further incorporated into the neurosurgical residency curriculum for training and evaluation purposes.
Collapse
Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, University of Illinois College of Medicine, Illinois Neurological Institute, Peoria, Illinois 61637, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Kakucs T, Lukovich P, Dobó N, Benkő P, Harsányi L. [Measuring residents' and specialists' laparoscopic technique with the MENTOR® training box]. Magy Seb 2013; 66:55-61. [PMID: 23591609 DOI: 10.1556/maseb.66.2013.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Operating room is not the ideal place to acquire laparoscopic skills since patients can be put at risk and it is also relatively expensive. Using training boxes seems to be a more appropriate way of teaching and learning the technique, but there is little data about measuring the technique of experienced specialists and comparing their results with residents. METHODS At the 1st Department of Surgery, Semmelweis University we tested 30 residents and 25 specialists in general surgery and urology on MENTOR® training box. Before training, all participants completed a questionnaire on professional experience, previous usage of training boxes, virtual simulators, and video games, and whether they played a musical instrument earlier. Subjects were asked to complete in a defined time limit 3 of the Fundamentals of Laparoscopic Surgery tasks (which is required for American surgical residents for surgical board examination), and 3 tasks decided by us. Linear regression analysis (ANOVA table) was used to evaluate the data. RESULTS 16% of the specialists and 6.66% of the residents completed all tasks within time limit. Statistically significant correlation (p < 0.05) was demonstrated between the number of previous laparoscopic surgeries and task completion time, while there were no significant correlations between other factors, which may influence laparoscopic technique and task completion time. CONCLUSIONS Training boxes are suitable for developing eye-hand coordination and bimanuality, as well as for learning instrument handling. Nonetheless, residents acquire most of their laparoscopic surgical skills on patients in Hungary, yet. For this reason there is a need for organized training opportunities.
Collapse
Affiliation(s)
- Tímea Kakucs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. sz. Sebészeti Klinika 1082 Budapest
| | | | | | | | | |
Collapse
|
25
|
Learning curve on the TrEndo laparoscopic simulator compared to an expert level. Surg Endosc 2013; 27:2934-9. [DOI: 10.1007/s00464-013-2859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/28/2013] [Indexed: 12/17/2022]
|