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Li W, Ma S, Zhou L, Konge L, Pan J, Hui J. The bibliometric analysis of extended reality in surgical training: Global and Chinese perspective. Heliyon 2024; 10:e27340. [PMID: 38495188 PMCID: PMC10943385 DOI: 10.1016/j.heliyon.2024.e27340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives The prospect of extended reality (XR) being integrated with surgical training curriculum has attracted scholars. However, there is a lack of bibliometric analysis to help them better understand this field. Our aim is to analyze relevant literature focusing on development trajectory and research directions since the 21st century to provide valuable insights. Methods Papers were retrieved from the Web of Science Core Collection. Microsoft Excel, VOSviewer, and CiteSpace were used for bibliometric analysis. Results Of the 3337 papers published worldwide, China contributed 204, ranking fifth. The world's enthusiasm for this field has been growing since 2000, whereas China has been gradually entering since 2001. Although China had a late start, its growth has accelerated since around 2016 due to the reform of the medical postgraduate education system and the rapid development of Chinese information technology, despite no research explosive period has been yet noted. International institutions, notably the University of Toronto, worked closely with others, while Chinese institutions lacked of international and domestic cooperation. Sixteen stable cooperation clusters of international scholars were formed, while the collaboration between Chinese scholars was not yet stable. XR has been primarily applied in orthopedic surgery, cataract surgery, laparoscopic training and intraoperative use in neurosurgery worldwide. Conclusions There is strong enthusiasm and cooperation in the international research on the XR-based surgical training. Chinese scholars are making steady progress and have great potential in this area. There has not been noted an explosive research phase yet in the Chinese pace. The research on several surgical specialties has been summarized at the very first time. AR will gradually to be more involved and take important role of the research.
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Affiliation(s)
- Wei Li
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zhou
- School of Postgraduate Education, Southern Medical University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- PENG CHENG Laboratory, Shenzhen, China
| | - Jialiang Hui
- Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou City, China
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Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons. JSES Int 2022; 7:178-185. [PMID: 36820421 PMCID: PMC9937840 DOI: 10.1016/j.jseint.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The purpose of this investigation was to assess surgical outcomes after distal biceps tendon (DBT) repair for upper-extremity surgeons at the beginning of their careers, immediately following fellowship training. We aimed to determine if procedure times, complication rates, and clinical outcomes differed during the learning curve period for these early-career surgeons. Methods All cases of DBT repairs performed by 2 fellowship-trained surgeons from the start of their careers were included. Demographic data as well as operative times, complication rates, and patient reported outcomes were retrospectively collected. A cumulative sum chart (CUSUM) analysis was performed for the learning curve for both operative times and complication rate. This analysis continuously compares performance of an outcome to a predefined target level. Results A total of 78 DBT repairs performed by the two surgeons were included. In the CUSUM analysis of operative time for surgeon 1 and 2, both demonstrated a learning curve until case 4. In CUSUM analysis for complication rates, neither surgeon 1 nor surgeon 2 performed significantly worse than the target value and learning curve ranged from 14 to 21 cases. Mean Disabilities of Arm, Shoulder, and Hand score (QuickDASH) (10.65 ± 5.81) and the pain visual analog scale scores (1.13 ± 2.04) were comparable to previously reported literature. Conclusions These data suggest that a learning curve between 4 and 20 cases exists with respect to operative times and complication rates for DBT repairs for fellowship-trained upper-extremity surgeons at the start of clinical practice. Early-career surgeons appear to have acceptable clinical results and complications relative to previously published series irrespective of their learning stage.
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Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes N. Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review. JMIR Serious Games 2022; 10:e29594. [PMID: 35416789 PMCID: PMC9047880 DOI: 10.2196/29594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 12/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. OBJECTIVE Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education. METHODS We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%). CONCLUSIONS RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tatiana Erlikh Fox
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Internal Medicine, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdegurg, Germany.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra Kemp
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, Australia
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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Sankaranarayanan G, Odlozil CA, Hasan SS, Shabbir R, Qi D, Turkseven M, De S, Funk G, Weddle RJ. Training on a virtual reality cricothyroidotomy simulator improves skills and transfers to a simulated procedure. Trauma Surg Acute Care Open 2022; 7:e000826. [PMID: 35340706 PMCID: PMC8889411 DOI: 10.1136/tsaco-2021-000826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The virtual airway skills trainer (VAST) is a virtual reality simulator for training in cricothyroidotomy (CCT). The goal of the study is to test the effectiveness of training and transfer of skills of the VAST-CCT. Methods Two groups, control (no training) and simulation (2 weeks of proficiency-based training), participated in this study. Subjects in the control condition did not receive any training on the task whereas those in the simulation received a proficiency-based training on the task during a period of 2 weeks. Two weeks post-training, both groups performed CCT on the TraumaMan to demonstrate the transfer of skills. Results A total of (n=20) subjects participated in the study. The simulation group performed better than the control group at both the post-test (p<0.001) and retention test (p<0.001) on the simulator. The cumulative sum analysis showed that all subjects in the simulation group reached proficiency with acceptable failure rate within the 2 weeks of training. On the transfer test, the simulation group performed better on skin cut (p<0.001), intubation (p<0.001) and total score (p<0.001) than the control group. Conclusions The VAST-CCT is effective in training and skills transfer for the CCT procedure. Level of evidence Not applicable. Simulator validation study.
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Affiliation(s)
| | | | - Salman S Hasan
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Rehma Shabbir
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Di Qi
- Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Melih Turkseven
- Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Geoffrey Funk
- Baylor University Medical Center at Dallas, Dallas, Texas, USA
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Jiang H, Vimalesvaran S, Wang JK, Lim KB, Mogali SR, Car LT. Virtual Reality in Medical Students' Education: Scoping Review. JMIR MEDICAL EDUCATION 2022; 8:e34860. [PMID: 35107421 PMCID: PMC8851326 DOI: 10.2196/34860] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. OBJECTIVE The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. METHODS We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. CONCLUSIONS Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-046986.
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Affiliation(s)
- Haowen Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jeremy King Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Kee Boon Lim
- School of Biological Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | | | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Nemani A, Kamat A, Gao Y, Yucel M, Gee D, Cooper C, Schwaitzberg S, Intes X, Dutta A, De S. Functional brain connectivity related to surgical skill dexterity in physical and virtual simulation environments. NEUROPHOTONICS 2021; 8:015008. [PMID: 33681406 PMCID: PMC7927423 DOI: 10.1117/1.nph.8.1.015008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/11/2021] [Indexed: 05/15/2023]
Abstract
Significance: Surgical simulators, both virtual and physical, are increasingly used as training tools for teaching and assessing surgical technical skills. However, the metrics used for assessment in these simulation environments are often subjective and inconsistent. Aim: We propose functional activation metrics, derived from brain imaging measurements, to objectively assess the correspondence between brain activation with surgical motor skills for subjects with varying degrees of surgical skill. Approach: Cortical activation based on changes in the oxygenated hemoglobin (HbO) of 36 subjects was measured using functional near-infrared spectroscopy at the prefrontal cortex (PFC), primary motor cortex, and supplementary motor area (SMA) due to their association with motor skill learning. Inter-regional functional connectivity metrics, namely, wavelet coherence (WCO) and wavelet phase coherence were derived from HbO changes to correlate brain activity to surgical motor skill levels objectively. Results: One-way multivariate analysis of variance found a statistically significant difference in the inter-regional WCO metrics for physical simulator based on Wilk's Λ for expert versus novice, F ( 10,1 ) = 7495.5 , p < 0.01 . Partial eta squared effect size for the inter-regional WCO metrics was found to be highest between the central prefrontal cortex (CPFC) and SMA, CPFC-SMA ( η 2 = 0.257 ). Two-tailed Mann-Whitney U tests with a 95% confidence interval showed baseline equivalence and a statistically significant ( p < 0.001 ) difference in the CPFC-SMA WPCO metrics for the physical simulator training group ( 0.960 ± 0.045 ) versus the untrained control group ( 0.735 ± 0.177 ) following training for 10 consecutive days in addition to the pretest and posttest days. Conclusion: We show that brain functional connectivity WCO metric corresponds to surgical motor skills in the laparoscopic physical simulators. Functional connectivity between the CPFC and the SMA is lower for subjects that exhibit expert surgical motor skills than untrained subjects in laparoscopic physical simulators.
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Affiliation(s)
- Arun Nemani
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States
| | - Anil Kamat
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States
| | - Yuanyuan Gao
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States
| | - Meryem Yucel
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts, United States
| | - Denise Gee
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts, United States
| | - Clairice Cooper
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States
| | - Steven Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States
| | - Xavier Intes
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States
| | - Anirban Dutta
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, United States
| | - Suvranu De
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation, and Imaging in Medicine, Troy, New York, United States
- Address all correspondence to Suvranu De,
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Train AT, Hu J, Narvaez JRF, Towle-Miller LM, Wilding GE, Cavuoto L, Noyes K, Hoffman AB, Schwaitzberg SD. Teaching surgery novices and trainees advanced laparoscopic suturing: a trial and tribulations. Surg Endosc 2020; 35:5816-5826. [PMID: 33051759 DOI: 10.1007/s00464-020-08067-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The benefits of minimally invasive surgery are numerous; however, considerable variability exists in its application and there is a lack of standardized training for important advanced skills. Our goal was to determine whether participation in an advanced laparoscopic curriculum (ALC) results in improved laparoscopic suturing skills. METHODS AND PROCEDURES Study design was a prospective, randomized controlled trial. Surgery novices and trainees underwent baseline FLS training and were pre-tested on bench models. Participants were stratified by pre-test score and randomized to undergo either further FLS training (control group) or ALC training (intervention group). All were post-tested on the same bench model. Tests for differences between post-test scores of cohorts were performed using least squared means. Multivariable regression identified predictors of post-test score, and Wilcoxon rank sum test assessed for differences in confidence improvement in laparoscopic suturing ability between groups. RESULTS Between November 2018 and May 2019, 25 participants completed the study (16 females; 9 males). After adjustment for relevant variables, participants randomized to the ALC group had significantly higher post-test scores than those undergoing FLS training alone (mean score 90.50 versus 82.99, p = 0.001). The only demographic or other variables found to predict post-test score include level of training (p = 0.049) and reported years of video gaming (p = 0.034). There was no difference in confidence improvement between groups. CONCLUSIONS Training using the ALC as opposed to basic laparoscopic skills training only is associated with superior advanced laparoscopic suturing performance without affecting improvement in reported confidence levels. Performance on advanced laparoscopic suturing tasks may be predicted by lifetime cumulative video gaming history and year of training but does not appear to be associated with other factors previously studied in relation to basic laparoscopic skills, such as surgical career aspiration or musical ability.
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Affiliation(s)
- Arianne T Train
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Jinwei Hu
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - J Reinier F Narvaez
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Lorin M Towle-Miller
- Department of Biostatistics, University at Buffalo, State University of New York School of Public Health and Health Professions, Buffalo, NY, USA
| | - Gregory E Wilding
- Department of Biostatistics, University at Buffalo, State University of New York School of Public Health and Health Professions, Buffalo, NY, USA
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York School of Engineering and Applied Sciences, Buffalo, NY, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York School of Public Health and Health Professions, Buffalo, NY, USA
| | - Aaron B Hoffman
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Steven D Schwaitzberg
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Lyman WB, Passeri MJ, Murphy K, Siddiqui IA, Khan AS, Iannitti DA, Martinie JB, Baker EH, Vrochides D. An objective approach to evaluate novice robotic surgeons using a combination of kinematics and stepwise cumulative sum (CUSUM) analyses. Surg Endosc 2020; 35:2765-2772. [PMID: 32556751 DOI: 10.1007/s00464-020-07708-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current evaluation methods for robotic-assisted surgery (ARCS or GEARS) are limited to 5-point Likert scales which are inherently time-consuming and require a degree of subjective scoring. In this study, we demonstrate a method to break down complex robotic surgical procedures using a combination of an objective cumulative sum (CUSUM) analysis and kinematics data obtained from the da Vinci® Surgical System to evaluate the performance of novice robotic surgeons. METHODS Two HPB fellows performed 40 robotic-assisted hepaticojejunostomy reconstructions to model a portion of a Whipple procedure. Kinematics data from the da Vinci® system was recorded using the dV Logger® while CUSUM analyses were performed for each procedural step. Each kinematic variable was modeled using machine learning to reflect the fellows' learning curves for each task. Statistically significant kinematics variables were then combined into a single formula to create the operative robotic index (ORI). RESULTS The inflection points of our overall CUSUM analysis showed improvement in technical performance beginning at trial 16. The derived ORI model showed a strong fit to our observed kinematics data (R2 = 0.796) with an ability to distinguish between novice and intermediate robotic performance with 89.3% overall accuracy. CONCLUSIONS In this study, we demonstrate a novel approach to objectively break down novice performance on the da Vinci® Surgical System. We identified kinematics variables associated with improved overall technical performance to create an objective ORI. This approach to robotic operative evaluation demonstrates a valuable method to break down complex surgical procedures in an objective, stepwise fashion. Continued research into objective methods of evaluation for robotic surgery will be invaluable for future training and clinical implementation of the robotic platform.
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Affiliation(s)
- William B Lyman
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, MEB Suite 601, Charlotte, NC, 28203, USA.
| | - Michael J Passeri
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Keith Murphy
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Adeel S Khan
- Washington University School of Medicine, St. Louis, MO, USA
| | - David A Iannitti
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Erin H Baker
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Sankaranarayanan G, Odlozil CA, Wells KO, Leeds SG, Chauhan S, Fleshman JW, Jones DB, De S. Training with cognitive load improves performance under similar conditions in a real surgical task. Am J Surg 2020; 220:620-629. [PMID: 32107012 DOI: 10.1016/j.amjsurg.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/10/2019] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhancing cognitive load while performing a bimanual surgical task affects performance. Whether repeated training under this condition could benefit performance in an operating room was tested using a virtual reality simulator with cognitive load applied through two-digit math multiplication questions. METHOD 11 subjects were randomized to Control, VR and VR + CL groups. After a pre-test, VR and VR + CL groups repeated the peg transfer task 150 times over 15 sessions with cognitive load applied only for the last 100 trials. After training, all groups took a post-test and two weeks later the retention test with and without cognitive load and the transfer task on a pig intestine of 150 cm long under cognitive load. RESULTS AND CONCLUSION Mixed ANOVA analysis showed significant differences between the control and VR and VR + CL groups (p = 0.013, p = 0.009) but no differences between the VR + CL and the VR groups (p = 1.0). GOALS bimanual dexterity score on transfer test show that VR + CL group outperformed both Control and VR groups (p = 0.016, p = 0.03). Training under cognitive load benefitted performance on an actual surgical task under similar conditions.
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Affiliation(s)
| | - Coleman A Odlozil
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Katerina O Wells
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Steven G Leeds
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Sanket Chauhan
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - James W Fleshman
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | | | - Suvranu De
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
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Gao Y, Kruger U, Intes X, Schwaitzberg S, De S. A machine learning approach to predict surgical learning curves. Surgery 2019; 167:321-327. [PMID: 31753325 DOI: 10.1016/j.surg.2019.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Contemporary surgical training programs rely on the repetition of selected surgical motor tasks. Such methodology is inherently open ended with no control on the time taken to attain a set level of proficiency, given the trainees' intrinsic differences in initial skill levels and learning abilities. Hence, an efficient training program should aim at tailoring the surgical training protocols to each trainee. In this regard, a predictive model using information from the initial learning stage to predict learning curve characteristics should facilitate the whole surgical training process. METHODS This paper analyzes learning curve data to train a multivariate supervised machine learning model. One factor is extracted to define the trainees' learning ability. An unsupervised machine learning model is also utilized for trainee classification. When established, the model can predict robustly the learning curve characteristics based on the first few trials. RESULTS We show that the information present in the first 10 trials of surgical tasks can be utilized to predict the number of trials required to achieve proficiency (R2=0.72) and the final performance level (R2=0.89). Furthermore, only a single factor, learning index, is required to describe the learning process and to classify learners with unique learning characteristics. CONCLUSION Using machine learning models, we show, for the first time, that the first few trials contain sufficient information to predict learning curve characteristics and that a single factor can capture the complex learning behavior. Using such models holds the potential for personalization of training regimens, leading to greater efficiency and lower costs.
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Affiliation(s)
- Yuanyuan Gao
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY
| | - Uwe Kruger
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Xavier Intes
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Steven Schwaitzberg
- Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, NY; Department of Surgery, The State University of New York, Buffalo, NY; Buffalo General Hospital, NY
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY.
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Characterizing the learning curve of a virtual intracorporeal suturing simulator VBLaST-SS©. Surg Endosc 2019; 34:3135-3144. [PMID: 31482354 DOI: 10.1007/s00464-019-07081-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The virtual basic laparoscopic skill trainer suturing simulator (VBLaST-SS©) was developed to simulate the intracorporeal suturing task in the FLS program. The purpose of this study was to evaluate the training effectiveness and participants' learning curves on the VBLaST-SS© and to assess whether the skills were retained after 2 weeks without training. METHODS Fourteen medical students participated in the study. Participants were randomly assigned to two training groups (7 per group): VBLaST-SS© or FLS, based on the modality of training. Participants practiced on their assigned system for one session (30 min or up to ten repetitions) a day, 5 days a week for three consecutive weeks. Their baseline, post-test, and retention (after 2 weeks) performance were also analyzed. Participants' performance scores were calculated based on the original FLS scoring system. The cumulative summation (CUSUM) method was used to evaluate learning. Two-way mixed factorial ANOVA was used to compare the effects of group, time point (baseline, post-test, and retention), and their interaction on performance. RESULTS Six out of seven participants in each group reached the predefined proficiency level after 7 days of training. Participants' performance improved significantly (p < 0.001) after training within their assigned group. The CUSUM learning curve shows that one participant in each group achieved 5% failure rate by the end of the training period. Twelve out of fourteen participants' CUSUM curves showed a negative trend toward achieving the 5% failure rate after further training. CONCLUSION The VBLaST-SS© is effective in training laparoscopic suturing skill. Participants' performance of intracorporeal suturing was significantly improved after training on both systems and was retained after 2 weeks of no training.
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Nemani A, Kruger U, Cooper CA, Schwaitzberg SD, Intes X, De S. Objective assessment of surgical skill transfer using non-invasive brain imaging. Surg Endosc 2019; 33:2485-2494. [PMID: 30334166 PMCID: PMC10756643 DOI: 10.1007/s00464-018-6535-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical and virtual surgical simulators are increasingly being used in training technical surgical skills. However, metrics such as completion time or subjective performance checklists often show poor correlation to transfer of skills into clinical settings. We hypothesize that non-invasive brain imaging can objectively differentiate and classify surgical skill transfer, with higher accuracy than established metrics, for subjects based on motor skill levels. STUDY DESIGN 18 medical students at University at Buffalo were randomly assigned into control, physical surgical trainer, or virtual trainer groups. Training groups practiced a surgical technical task on respective simulators for 12 consecutive days. To measure skill transfer post-training, all subjects performed the technical task in an ex-vivo environment. Cortical activation was measured using functional near-infrared spectroscopy (fNIRS) in the prefrontal cortex, primary motor cortex, and supplementary motor area, due to their direct impact on motor skill learning. RESULTS Classification between simulator trained and untrained subjects based on traditional metrics is poor, where misclassification errors range from 20 to 41%. Conversely, fNIRS metrics can successfully classify physical or virtual trained subjects from untrained subjects with misclassification errors of 2.2% and 8.9%, respectively. More importantly, untrained subjects are successfully classified from physical or virtual simulator trained subjects with misclassification errors of 2.7% and 9.1%, respectively. CONCLUSION fNIRS metrics are significantly more accurate than current established metrics in classifying different levels of surgical motor skill transfer. Our approach brings robustness, objectivity, and accuracy in validating the effectiveness of future surgical trainers in translating surgical skills to clinically relevant environments.
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Affiliation(s)
- Arun Nemani
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Uwe Kruger
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Clairice A Cooper
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14228, USA
| | - Steven D Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14228, USA
| | - Xavier Intes
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Suvranu De
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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Arikatla V, Horvath S, Fu Y, Cavuoto L, De S, Schwaitzberg S, Enquobahrie A. Development and face validation of a virtual camera navigation task trainer. Surg Endosc 2018; 33:1927-1937. [PMID: 30324462 DOI: 10.1007/s00464-018-6476-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/02/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The fundamentals of laparoscopic surgery (FLS) trainer box, which is now established as a standard for evaluating minimally invasive surgical skills, consists of five tasks: peg transfer, pattern cutting, ligation, intra- and extracorporeal suturing. Virtual simulators of these tasks have been developed and validated as part of the Virtual Basic Laparoscopic Skill Trainer (VBLaST) (Arikatla et al. in Int J Med Robot Comput Assist Surg 10:344-355, 2014; Zhang et al. in Surg Endosc 27(10):3603-3615, 2013; Sankaranarayanan et al. in J Laparoendosc Adv Surg Tech 20(2):153-157, 2010; Qi et al. J Biomed Inform 75:48-62, 2017). The virtual task trainers have many advantages including automatic real-time objective scoring, reduced costs, and eliminating human proctors. In this paper, we extend VBLaST by adding two camera navigation system tasks: (a) pattern matching and (b) path tracing. METHODS A comprehensive camera navigation simulator with two virtual tasks, simplified and cheaper hardware interface (compared to the prior version of VBLaST), graphical user interface, and automated metrics has been designed and developed. Face validity of the system is tested with medical students and residents from the University at Buffalo's medical school. RESULTS The subjects rated the simulator highly in all aspects including its usefulness in training to center the target and to teach sizing skills. The quality and usefulness of the force feedback scored the lowest at 2.62.
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Affiliation(s)
- Venkata Arikatla
- Medical Computing Team, Kitware Inc., 101 E Weaver Street, Suite G4, Carrboro, NC, 27510, USA.
| | - Sam Horvath
- Medical Computing Team, Kitware Inc., 101 E Weaver Street, Suite G4, Carrboro, NC, 27510, USA
| | - Yaoyu Fu
- School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lora Cavuoto
- School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, RPI, Troy, NY, USA
| | | | - Andinet Enquobahrie
- Medical Computing Team, Kitware Inc., 101 E Weaver Street, Suite G4, Carrboro, NC, 27510, USA
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Nemani A, Yücel MA, Kruger U, Gee DW, Cooper C, Schwaitzberg SD, De S, Intes X. Assessing bimanual motor skills with optical neuroimaging. SCIENCE ADVANCES 2018; 4:eaat3807. [PMID: 30306130 PMCID: PMC6170034 DOI: 10.1126/sciadv.aat3807] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/29/2018] [Indexed: 05/12/2023]
Abstract
Measuring motor skill proficiency is critical for the certification of highly skilled individuals in numerous fields. However, conventional measures use subjective metrics that often cannot distinguish between expertise levels. We present an advanced optical neuroimaging methodology that can objectively and successfully classify subjects with different expertise levels associated with bimanual motor dexterity. The methodology was tested by assessing laparoscopic surgery skills within the framework of the fundamentals of a laparoscopic surgery program, which is a prerequisite for certification in general surgery. We demonstrate that optical-based metrics outperformed current metrics for surgical certification in classifying subjects with varying surgical expertise. Moreover, we report that optical neuroimaging allows for the successful classification of subjects during the acquisition of these skills.
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Affiliation(s)
- Arun Nemani
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Meryem A. Yücel
- Department of Radiology, Harvard Medical School, Cambridge, MA 02138, USA
| | - Uwe Kruger
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Denise W. Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Clairice Cooper
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14260, USA
| | - Steven D. Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14260, USA
| | - Suvranu De
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
- Corresponding author. (S.D.); (X.I.)
| | - Xavier Intes
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
- Corresponding author. (S.D.); (X.I.)
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Linsk AM, Monden KR, Sankaranarayanan G, Ahn W, Jones DB, De S, Schwaitzberg SD, Cao CGL. Validation of the VBLaST pattern cutting task: a learning curve study. Surg Endosc 2017; 32:1990-2002. [PMID: 29052071 DOI: 10.1007/s00464-017-5895-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/16/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mastery of laparoscopic skills is essential in surgical practice and requires considerable time and effort to achieve. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC©) is a virtual simulator that was developed as a computerized version of the pattern cutting (PC) task in the Fundamentals of Laparoscopic Surgery (FLS) system. To establish convergent validity for the VBLaST-PC©, we assessed trainees' learning curves using the cumulative summation (CUSUM) method and compared them with those on the FLS. METHODS Twenty-four medical students were randomly assigned to an FLS training group, a VBLaST training group, or a control group. Fifteen training sessions, 30 min in duration per session per day, were conducted over 3 weeks. All subjects completed pretest, posttest, and retention test (2 weeks after posttest) on both the FLS and VBLaST© simulators. Performance data, including time, error, FLS score, learning rate, learning plateau, and CUSUM score, were analyzed. RESULTS The learning curve for all trained subjects demonstrated increasing performance and a performance plateau. CUSUM analyses showed that five of the seven subjects reached the intermediate proficiency level but none reached the expert proficiency level after 150 practice trials. Performance was significantly improved after simulation training, but only in the assigned simulator. No significant decay of skills after 2 weeks of disuse was observed. Control subjects did not show any learning on the FLS simulator, but improved continually in the VBLaST simulator. CONCLUSIONS Although VBLaST©- and FLS-trained subjects demonstrated similar learning rates and plateaus, the majority of subjects required more than 150 trials to achieve proficiency. Trained subjects demonstrated improved performance in only the assigned simulator, indicating specificity of training. The virtual simulator may provide better opportunities for learning, especially with limited training exposure.
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Affiliation(s)
- Ali M Linsk
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Woojin Ahn
- Rensselaer Polytechnic Institute, Troy, NY, USA
| | | | - Suvranu De
- Rensselaer Polytechnic Institute, Troy, NY, USA
| | | | - Caroline G L Cao
- Wright State University, 207 Russ Engineering Center, 3640 Colonel Glenn Hwy, Dayton, OH, 45435, USA.
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Nemani A, Ahn W, Cooper C, Schwaitzberg S, De S. Convergent validation and transfer of learning studies of a virtual reality-based pattern cutting simulator. Surg Endosc 2017; 32:1265-1272. [PMID: 28812196 DOI: 10.1007/s00464-017-5802-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Research has clearly shown the benefits of surgical simulators to train laparoscopic motor skills required for positive patient outcomes. We have developed the Virtual Basic Laparoscopic Skill Trainer (VBLaST) that simulates tasks from the Fundamentals of Laparoscopic Surgery (FLS) curriculum. This study aims to show convergent validity of the VBLaST pattern cutting module via the CUSUM method to quantify learning curves along with motor skill transfer from simulation environments to ex vivo tissue samples. METHODS 18 medical students at the University at Buffalo, with no prior laparoscopic surgical skills, were placed into the control, FLS training, or VBLaST training groups. Each training group performed pattern cutting trials for 12 consecutive days on their respective simulation trainers. Following a 2-week break period, the trained students performed three pattern cutting trials on each simulation platform to measure skill retention. All subjects then performed one pattern cutting task on ex vivo cadaveric peritoneal tissue. FLS and VBLaST pattern cutting scores, CUSUM scores, and transfer task completion times were reported. RESULTS Results indicate that the FLS and VBLaST trained groups have significantly higher task performance scores than the control group in both the VBLaST and FLS environments (p < 0.05). Learning curve results indicate that three out of seven FLS training subjects and four out of six VBLaST training subjects achieved the "senior" performance level. Furthermore, both the FLS and VBLaST trained groups had significantly lower transfer task completion times on ex vivo peritoneal tissue models (p < 0.05). CONCLUSION We characterized task performance scores for trained VBLaST and FLS subjects via CUSUM analysis of the learning curves and showed evidence that both groups have significant improvements in surgical motor skill. Furthermore, we showed that learned surgical skills in the FLS and VBLaST environments transfer not only to the different simulation environments, but also to ex vivo tissue models.
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Affiliation(s)
- Arun Nemani
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Woojin Ahn
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Clairice Cooper
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Steven Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Suvranu De
- Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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Kilkenny J, Santarossa A, Mrotz V, Walker M, Monaghan D, Singh A. Investigating laparoscopic psychomotor skills in veterinarians and veterinary technicians. Vet Surg 2017; 46:433-440. [PMID: 28158937 DOI: 10.1111/vsu.12626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the influence of age, year of graduation, and video game experience on baseline laparoscopic psychomotor skills. STUDY DESIGN Cross-sectional. SAMPLE POPULATION Licensed veterinarians (n = 38) and registered veterinary technicians (VTs) (n = 49). METHODS A laparoscopic box trainer was set up at the 2016 Ontario Veterinary Medical Association (OVMA) and the 2016 Ontario Association of Veterinary Technicians (OAVT) conferences held in Toronto, Ontario, Canada. Participants volunteered to perform a single repetition of a peg transfer (PT) exercise. Participants were given a short demonstration of the PT task prior to testing. A Spearman's rank correlation (rs ) was used to identify associations between baseline psychomotor skills and self-reported surgical and non-surgical experiences collected via survey. Mann-Whitney U tests were used to compare PT scores in veterinarians and VTs. A P-value of < .05 was considered significant. RESULTS The mean age of participants was 36 years (range 21-67) and the majority were female (83%). In veterinarians, PT scores were highest in the most recent graduates (P = .01, rs = 0.42), and PT scores increased with self-reported VG experience (P = .02, rs = 0.38). PT scores correlated inversely with age (P = .02, rs = -0.37). No associations were observed in VTs (P > .05). Veterinary technicians that frequently used chopsticks scored higher than those without chopstick experience (P = .04). CONCLUSIONS Age and year of graduation correlated inversely, while self-reported VG experience correlated positively with laparoscopic psychomotor skills of veterinarians, when assessed on a simulator. The use of chopsticks may contribute to the acquisition of psychomotor skills in VTs.
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Affiliation(s)
- Jessica Kilkenny
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Amanda Santarossa
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Victoria Mrotz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Meagan Walker
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Dominique Monaghan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Hagelsteen K, Sevonius D, Bergenfelz A, Ekelund M. Simball Box for Laparoscopic Training With Advanced 4D Motion Analysis of Skills. Surg Innov 2016; 23:309-16. [DOI: 10.1177/1553350616628678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background. Laparoscopic skills training and evaluation outside the operating room is important for all surgeons learning new skills. To study feasibility, a video box trainer tracking 4-dimensional (4D) metrics was evaluated as a laparoscopic training tool. Method. Simball Box is a video box trainer with authentic surgical instruments and camera with video recording, equipped with 4D motion analysis registered through trocars using machine vision technology. Residents attending a 3-day laparoscopy course were evaluated performing a laparoscopic surgical knot at start, middle, and end. Metrics were obtained. Feedback data were presented in reference to expert/tutorial performance. Results. Ten right-handed residents were included. Median time (range) to finish the task was 359 (253-418), 129 (95-166), and 95 (52-156) seconds; 655%, 236%, and 174% of tutorial performance, with significance pre-/midcourse ( P < .0001), pre-/postcourse ( P < .0001), and mid-/postcourse ( P = .0050). Combined median total instrument motion decreased pre-/midcourse from 1208 (845-1751) to 522 cm (411-810 cm); P = .042 to 405 cm (246-864 cm) postcourse; pre-/postcourse P < .0001; 673%, 291%, 225% of tutorial performance. Total angular distance in radians (range) was 150 (87-251), 65 (42-116), and 50 (33-136) with significance pre-/midcourse ( P = .022) and pre-/postcourse ( P = .0002). Right-handed average speed (cm/s) increased: 1.94 (1.11-2.27) pre-, 2.39 (1.56-2.83) mid-, 2.60 (1.67-3.19) postcourse with significance pre-/midcourse ( P = .022) and pre-/postcourse ( P = .002). Average acceleration (mm/s2) and motion smoothness (µm/s3) failed to show any difference. Conclusion. For laparoscopic training and as a promising evaluation device, Simball Box obtained metrics mirroring progression well.
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Affiliation(s)
| | - Dan Sevonius
- Skåne University Hospital, Sweden
- Lund University, Lund, Sweden
| | | | - Mikael Ekelund
- Skåne University Hospital, Sweden
- Lund University, Lund, Sweden
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Awtrey C, Chellali A, Schwaitzberg S, De S, Jones D, Cao C. Validation of the VBLaST: A Virtual Peg Transfer Task in Gynecologic Surgeons. J Minim Invasive Gynecol 2015. [PMID: 26216094 DOI: 10.1016/j.jmig.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To validate the Virtual Basic Laparoscopic Skill Trainer (VBLaST-PT; the peg transfer task) for concurrent validity based on its ability to differentiate between novice, intermediate, and expert groups of gynecologists, and the gynecologists' subjective preference between the physical Fundamentals of Laparoscopic Surgery (FLS) system and the virtual reality system. DESIGN Prospective study (Canadian Task Force II-2). SETTING Academic medical center. PARTICIPANTS Obstetrics and gynecology residents (n = 18) and attending gynecologists (n = 9). INTERVENTIONS Twenty-seven subjects were divided into 3 groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). All subjects performed 10 trials of the peg transfer on each simulator. Assessment of laparoscopic performance was based on FLS scoring, whereas a questionnaire was used for subjective evaluation. MEASUREMENTS AND MAIN RESULTS The performance scores in the 2 simulators were nearly identical. Experts performed better than intermediates and novices in both the FLS trainer and the VBLAST, and intermediates performed better than novices in both simulators. The results also show a significant learning effect on both trainers for all subgroups; however, the greatest learning effect was in the novice group for both trainers. Subjectively, 74% participants preferred the FLS over the VBLaST for training laparoscopic surgical skills. CONCLUSION This study demonstrates that the peg transfer task was reproduced well in the VBLaST in gynecologic surgeons and trainees. The VBLaST has the potential to be a valuable tool in laparoscopic training for gynecologic surgeons.
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Affiliation(s)
- Christopher Awtrey
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Amine Chellali
- Department of Computer Engineering, IBISC Laboratory, University of Evry, Evry, France; Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Steven Schwaitzberg
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, New York
| | - Daniel Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Caroline Cao
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, Ohio
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Hu Y, Goodrich RN, Le IA, Brooks KD, Sawyer RG, Smith PW, Schroen AT, Rasmussen SK. Vessel ligation training via an adaptive simulation curriculum. J Surg Res 2015; 196:17-22. [PMID: 25796112 DOI: 10.1016/j.jss.2015.01.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND A cost-effective model for open vessel ligation is currently lacking. We hypothesized that a novel, inexpensive vessel ligation simulator can efficiently impart transferrable surgical skills to novice trainees. MATERIALS AND METHODS VesselBox was designed to simulate vessel ligation using surgical gloves as surrogate vessels. Fourth-year medical students performed ligations using VesselBox and were evaluated by surgical faculty using the Objective Structured Assessments of Technical Skills global rating scale and a task-specific checklist. Subsequently, each student was trained using VesselBox in an adaptive practice session guided by cumulative sum. Posttesting was performed on fresh human cadavers by evaluators blinded to pretest results. RESULTS Sixteen students completed the study. VesselBox practice sessions averaged 21.8 min per participant (interquartile range 19.5-27.7). Blinded posttests demonstrated increased proficiency, as measured by both Objective Structured Assessments of Technical Skills (3.23 versus 2.29, P < 0.001) and checklist metrics (7.33 versus 4.83, P < 0.001). Median speed improved from 128.2 s to 97.5 s per vessel ligated (P = 0.001). After this adaptive training protocol, practice volume was not associated with posttest performance. CONCLUSIONS VesselBox is a cost-effective, low-fidelity vessel ligation model suitable for graduating medical students and junior residents. Cumulative sum can facilitate an adaptive, individualized curriculum for simulation training.
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Affiliation(s)
- Yinin Hu
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robyn N Goodrich
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ivy A Le
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kendall D Brooks
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert G Sawyer
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Philip W Smith
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Anneke T Schroen
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sara K Rasmussen
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
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Chellali A, Ahn W, Sankaranarayanan G, Flinn JT, Schwaitzberg SD, Jones DB, De S, Cao CGL. Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers. Surg Endosc 2014; 29:815-21. [PMID: 25159626 DOI: 10.1007/s00464-014-3764-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/18/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers. METHODS Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1-4). They were asked to perform the PC or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared. RESULTS There were no significant differences between the FLS and VBLaST© scores for either the PC or the ligating loop task. Experts' scores were significantly higher than the scores for novices on both trainers. CONCLUSION This study showed that the subjects' performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Although concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.
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Affiliation(s)
- A Chellali
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA,
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Validation of the VBLaST peg transfer task: a first step toward an alternate training standard. Surg Endosc 2014; 28:2856-62. [PMID: 24771197 DOI: 10.1007/s00464-014-3538-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/10/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND The FLS trainer lacks objective and automated assessments of laparoscopic performance and requires a large supply of relatively expensive consumables. Virtual reality simulation has a great potential as a training and assessment tool of laparoscopic skills and can overcome some limitations of the FLS trainer. This study was carried out to assess the value of our Virtual Basic Laparoscopic Surgical Trainer (VBLaST(©)) in the peg transfer task compared to the FLS trainer and its ability to differentiate performance between novice, intermediate, and expert groups. METHODS Thirty subjects were divided into three groups: novices (PGY1-2, n = 10), intermediates (PGY3-4, n = 10), and experts (PGY5, surgical fellows and attendings, n = 10). All subjects performed ten trials of the peg transfer task on each simulator. Assessment of laparoscopic performance was based on FLS scoring while a questionnaire was used for subjective evaluation. RESULTS The performance scores in the two simulators were correlated, though subjects performed significantly better in the FLS trainer. Experts performed better than novices only on the FLS trainer while no significant differences were observed between the other groups. Moreover, a significant learning effect was found on both trainers, with a greater improvement of performance on the VBLaST(©). Finally, 82.6% of the subjects preferred the FLS over the VBLaST(©) for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the user interface for the VBLaST(©). CONCLUSION This study demonstrated that the VBLaST(©) reproduced faithfully some aspects of the FLS peg transfer task (such as color, size, and shape of the peg board, etc.) while other aspects require additional development. Future improvement of the user interface and haptic feedback will enhance the value of the system as an alternative to the FLS as the standard training tool for laparoscopic surgery skills.
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