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Hikage M, Kosaka W, Kosaka A, Matsuura T, Horii S, Kawamura K, Yamada M, Hashimoto M, Ito Y, Kusuda K, Shibuya S, Goukon Y. Feasibility of initiating robotic surgery during the early stages of gastrointestinal surgery education. Langenbecks Arch Surg 2024; 409:236. [PMID: 39088125 DOI: 10.1007/s00423-024-03432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/27/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Minimally invasive surgery for gastrointestinal cancers is rapidly advancing; therefore, surgical education must be changed. This study aimed to examine the feasibility of early initiation of robotic surgery education for surgical residents. METHODS The ability of staff physicians and residents to handle robotic surgical instruments was assessed using the da Vinci® skills simulator (DVSS). The short-term outcomes of 32 patients with colon cancer who underwent robot-assisted colectomy (RAC) by staff physicians and residents, supervised by a dual console system, between August 2022 and March 2024 were compared. RESULTS The performances of four basic exercises were assessed after implementation of the DVSS. Residents required less time to complete these exercises and achieved a higher overall score than staff physicians. There were no significant differences in the short-term outcomes, operative time, blood loss, incidence of postoperative complications, and length of the postoperative hospital stay of the two surgeon groups. CONCLUSION Based on the evaluation involving the DVSS and RAC results, it appears feasible to begin robotic surgery training at an early stage of surgical education using a dual console system.
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Affiliation(s)
- Makoto Hikage
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan.
| | - Wataru Kosaka
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Atsumi Kosaka
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Taeko Matsuura
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Shinichiro Horii
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Keiichiro Kawamura
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Masato Yamada
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Munetaka Hashimoto
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Yasushi Ito
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Kazuyuki Kusuda
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Shunsuke Shibuya
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
| | - Yuji Goukon
- Division of Surgery, Iwate Prefectural Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu-shi, Iwate, 023-0864, Japan
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Neri A, Coduri M, Penza V, Santangelo A, Oliveri A, Turco E, Pizzirani M, Trinceri E, Soriero D, Boero F, Ricci S, Mattos LS. A novel affordable user interface for robotic surgery training: design, development and usability study. Front Digit Health 2024; 6:1428534. [PMID: 39139587 PMCID: PMC11319275 DOI: 10.3389/fdgth.2024.1428534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The use of robotic systems in the surgical domain has become groundbreaking for patients and surgeons in the last decades. While the annual number of robotic surgical procedures continues to increase rapidly, it is essential to provide the surgeon with innovative training courses along with the standard specialization path. To this end, simulators play a fundamental role. Currently, the high cost of the leading VR simulators limits their accessibility to educational institutions. The challenge lies in balancing high-fidelity simulation with cost-effectiveness; however, few cost-effective options exist for robotic surgery training. Methods This paper proposes the design, development and user-centered usability study of an affordable user interface to control a surgical robot simulator. It consists of a cart equipped with two haptic interfaces, a VR visor and two pedals. The simulations were created using Unity, which offers versatility for expanding the simulator to more complex scenes. An intuitive teleoperation control of the simulated robotic instruments is achieved through a high-level control strategy. Results and Discussion Its affordability and resemblance to real surgeon consoles make it ideal for implementing robotic surgery training programs in medical schools, enhancing accessibility to a broader audience. This is demonstrated by the results of an usability study involving expert surgeons who use surgical robots regularly, expert surgeons without robotic surgery experience, and a control group. The results of the study, which was based on a traditional Peg-board exercise and Camera Control task, demonstrate the simulator's high usability and intuitive control across diverse user groups, including those with limited experience. This offers evidence that this affordable system is a promising solution for expanding robotic surgery training.
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Affiliation(s)
- Alberto Neri
- Biomedical Robotics Lab, Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Computer Science, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genova, Italy
| | - Mara Coduri
- Department of Computer Science, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genova, Italy
- Simulation and Advanced Education Center, University of Genova, Genova, Italy
| | - Veronica Penza
- Biomedical Robotics Lab, Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Andrea Santangelo
- Biomedical Robotics Lab, Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Alessandra Oliveri
- Department of Computer Science, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genova, Italy
| | - Enrico Turco
- Humanoid and Human Centred Mechatronics (HHCM), Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Information Engineering and Mathematics, University of Siena, Siena, Italy
| | | | | | - Domenico Soriero
- Unit of Surgical Oncology, IRCCS Policlinico San Martino, Genoa, Italy
| | | | - Serena Ricci
- Department of Computer Science, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genova, Italy
- Simulation and Advanced Education Center, University of Genova, Genova, Italy
| | - Leonardo S. Mattos
- Biomedical Robotics Lab, Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Takayasu K, Yoshida K, Matsuzaki T, Mishima T, Kinoshita H. Development and evaluation of vesicourethral anastomosis bench-top model for measurement of traction force on urethra in robotic surgery. Surg Endosc 2024:10.1007/s00464-024-11080-7. [PMID: 39046496 DOI: 10.1007/s00464-024-11080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE In vesicourethral anastomosis (VUA), which is part of robot-assisted radical prostatectomy, surgeons must proceed carefully to avoid urethral damage. We developed and evaluated a VUA bench-top model that can measure the traction force on the urethra during robotic surgery. MATERIALS AND METHODS The VUA model included the urethra, bladder, pelvic bones, and a small force sensor that was capable of measuring the traction force on the urethra. Eight skilled and eight novice urologists performed a VUA task in robotic surgery. The skilled surgeons assessed the model's realism and usefulness as a training tool using a 5-point Likert scale. The evaluation items [task time, maximum force, force volume, and length of time that specific excessive forces were applied to the urethra (2, 3, 4, and ≥ 5 N)] were compared between the skilled and novice surgeons using the Mann-Whitney U test. Measurements were conducted in four directions with respect to the maximum force on the urethra: 11-1, 2-4, 5-7, and 8-10 o'clock. RESULTS The quality of the model was scored 3.7 to 4.9 points for all 16 items in 4 domains except for "Usefulness compared with animal models." There were differences in the task time and almost all force parameters between the skilled and novice surgeons. CONCLUSION We developed a relatively high-quality VUA bench-top model that measures traction force on the urethra, and we have revealed differences in the forces of action on the urethra in two groups of surgeons with different skill levels.
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Affiliation(s)
- Kenta Takayasu
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
| | - Kenji Yoshida
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Tomoaki Matsuzaki
- Department of Urology and Andrology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Takao Mishima
- Department of Urology and Andrology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
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Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
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Abstract
The new tools for transmission of knowledge and skills (simulation, surgery broadcast, virtual reality, augmented reality…) offer novel opportunities for training through mentoring. The peer network is widened; the dissemination of knowledge is accelerated. The new ways of teaching bring benefit to each aspect of the surgical profession: clinical reasoning, performance of technical procedures, stress management, communication and management of severe or exceptional adverse events. Previously, confined to surgical teams, mentoring has been extended to simulation centers, which are becoming virtual hospitals, and it has been prolonged on the Internet via social networks. In the sphere of digital mentoring, objectives are henceforth more structured, skills assessment is more standardized, phases of apprenticeship are redefined, and individualized training contracts are formalized.
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Affiliation(s)
- N Berte
- Service de chirurgie viscérale infantile, CHRU de Nancy, hôpital Brabois enfants, allée du Morvan, 54500 Vandoeuvre-Lès-Nancy, France; École de Chirurgie de Nancy-Lorraine, Campus Santé, 9, avenue de la Forêt-de-Haye BP 20199, 54505 Vandœuvre-Lès-Nancy cedex, France; Hôpital Virtuel de Lorraine, Campus Santé, 9, avenue de la Fôret-de-Haye, 54500 Vandœuvre-les-Nancy, France.
| | - C Perrenot
- Service de chirurgie générale et urgences, CHRU de Nancy, hôpital Brabois enfants, allée du Morvan, 54500 Vandoeuvre-Lès-Nancy, France; École de Chirurgie de Nancy-Lorraine, Campus Santé, 9, avenue de la Forêt-de-Haye BP 20199, 54505 Vandœuvre-Lès-Nancy cedex, France; Hôpital Virtuel de Lorraine, Campus Santé, 9, avenue de la Fôret-de-Haye, 54500 Vandœuvre-les-Nancy, France
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Alshuaibi M, Perrenot C, Hubert J, Perez M. Concurrent, face, content, and construct validity of the RobotiX Mentor simulator for robotic basic skills. Int J Med Robot 2020; 16:e2100. [PMID: 32112491 DOI: 10.1002/rcs.2100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess several criteria, such as concurrent, face, content, and construct validity of the RobotiX Mentor (RXM) simulator for basic robotic skills and to compare virtual and actual dry lab dome. METHODS A prospective study was conducted from December 2017 to May 2018 using RXM and a da Vinci Si robot. 37 subjects, divided into three groups according to their initial surgical training (expert, intermediate, and novice), were evaluated in terms of six representative exercises of basic robotic specific skills as recommended by the fundamentals of robotic surgery. RESULTS There was a correlation between the automatic data from the RXM and the subjective evaluation with the robot. The face and content validity, which were evaluated by the experts, were generally considered high (71.5% and 62.5%, respectively). Three levels (analysis of variance [ANOVA]; P = .01) and two levels (P = .001) of experience were clearly identified by the simulator. CONCLUSION Our study proves the concurrent validity and confirms the face, content, and construct validity of the RXM.
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Affiliation(s)
- Muaath Alshuaibi
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,Department of Urology, Hospital University, Ha'il, Saudi Arabia
| | - Cyril Perrenot
- School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Jacques Hubert
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U1254, Nancy University, Vandœuvre-lès-Nancy, France
| | - Manuela Perez
- Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U947, Nancy University, Vandœuvre-lès-Nancy, France
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Abdelaal AE, Sakr M, Avinash A, Mohammed SK, Bajwa AK, Sahni M, Hor S, Fels S, Salcudean SE. Play Me Back: A Unified Training Platform for Robotic and Laparoscopic Surgery. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2018.2890209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Skinner A, Diller D, Kumar R, Cannon-Bowers J, Smith R, Tanaka A, Julian D, Perez R. Development and application of a multi-modal task analysis to support intelligent tutoring of complex skills. INTERNATIONAL JOURNAL OF STEM EDUCATION 2018; 5:14. [PMID: 30631704 PMCID: PMC6310465 DOI: 10.1186/s40594-018-0108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/20/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND Contemporary work in the design and development of intelligent training systems employs task analysis (TA) methods for gathering knowledge that is subsequently encoded into task models. These task models form the basis of intelligent interpretation of student performance within education and training systems. Also referred to as expert models, they represent the optimal way(s) of performing a training task. Within Intelligent Tutoring Systems (ITSs), real-time comparison of trainee task performance against the task model drives automated assessment and interactive support (such as immediate feedback) functionality. However, previous task analysis (TA) methods, including various forms of cognitive task analysis (CTA), may not be sufficient to support identification of the detailed design specifications required for the development of an ITS for a complex training task incorporating multiple underlying skill components, as well as multi-modal information presentation, assessment, and feedback modalities. Our current work seeks to develop an ITS for training Robotic Assisted Laparoscopic Surgery (RALS), a complex task domain that requires a coordinated utilization of integrated cognitive, psychomotor, and perceptual skills. RESULTS In this paper, we describe a methodological extension to CTA, referred to as multi-modal task analysis (MMTA) that elicits and captures the nuances of integrated and isolated cognitive, psychomotor, and perceptual skill modalities as they apply to training and performing complex operational tasks. In the current case, we illustrate the application of the MMTA method described here to RALS training tasks. The products of the analysis are quantitatively summarized, and observations from a preliminary qualitative validation are reported. CONCLUSIONS We find that iterative use of the described MMTA method leads to sufficiently complete and robust task models to support encoding of cognitive, psychomotor, and perceptual skills requisite to training and performance of complex skills within ITS task models.
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Affiliation(s)
| | | | | | | | - Roger Smith
- Florida Hospital Nicholson Center, Celebration, USA
| | | | | | - Ray Perez
- Office of Naval Research, Arlington, USA
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Julian D, Tanaka A, Mattingly P, Truong M, Perez M, Smith R. A comparative analysis and guide to virtual reality robotic surgical simulators. Int J Med Robot 2017; 14. [DOI: 10.1002/rcs.1874] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Alyssa Tanaka
- Florida Hospital Nicholson Center; Celebration, Florida USA
| | | | | | | | - Roger Smith
- Florida Hospital Nicholson Center; Celebration, Florida USA
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Face, content, construct, and concurrent validity of a novel robotic surgery patient-side simulator: the Xperience™ Team Trainer. Surg Endosc 2015; 30:3334-44. [DOI: 10.1007/s00464-015-4607-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/29/2015] [Indexed: 12/27/2022]
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Robotic surgery simulation validity and usability comparative analysis. Surg Endosc 2015; 30:3720-9. [DOI: 10.1007/s00464-015-4667-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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Bric JD, Lumbard DC, Frelich MJ, Gould JC. Current state of virtual reality simulation in robotic surgery training: a review. Surg Endosc 2015; 30:2169-78. [PMID: 26304107 DOI: 10.1007/s00464-015-4517-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/06/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Worldwide, the annual number of robotic surgical procedures continues to increase. Robotic surgical skills are unique from those used in either open or laparoscopic surgery. The acquisition of a basic robotic surgical skill set may be best accomplished in the simulation laboratory. We sought to review the current literature pertaining to the use of virtual reality (VR) simulation in the acquisition of robotic surgical skills on the da Vinci Surgical System. MATERIALS AND METHODS A PubMed search was conducted between December 2014 and January 2015 utilizing the following keywords: virtual reality, robotic surgery, da Vinci, da Vinci skills simulator, SimSurgery Educational Platform, Mimic dV-Trainer, and Robotic Surgery Simulator. Articles were included if they were published between 2007 and 2015, utilized VR simulation for the da Vinci Surgical System, and utilized a commercially available VR platform. RESULTS The initial search criteria returned 227 published articles. After all inclusion and exclusion criteria were applied, a total of 47 peer-reviewed manuscripts were included in the final review. CONCLUSIONS There are many benefits to utilizing VR simulation for robotic skills acquisition. Four commercially available simulators have been demonstrated to be capable of assessing robotic skill. Three of the four simulators demonstrate the ability of a VR training curriculum to improve basic robotic skills, with proficiency-based training being the most effective training style. The skills obtained on a VR training curriculum are comparable with those obtained on dry laboratory simulation. The future of VR simulation includes utilization in assessment for re-credentialing purposes, advanced procedural-based training, and as a warm-up tool prior to surgery.
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Affiliation(s)
- Justin D Bric
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Derek C Lumbard
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Matthew J Frelich
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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