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Chen Z, An J, Wu S, Cheng K, You J, Liu J, Jiang J, Yang D, Peng B, Wang X. Surgesture: a novel instrument based on surgical actions for objective skill assessment. Surg Endosc 2022; 36:6113-6121. [PMID: 35737138 DOI: 10.1007/s00464-022-09108-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Due to varied surgical skills and the lack of an efficient rating system, we developed Surgesture based on elementary functional surgical gestures performed by surgeons, which could serve as objective metrics to evaluate surgical performance in laparoscopic cholecystectomy (LC). METHODS We defined 14 LC basic Surgestures. Four surgeons annotated Surgestures among LC videos performed by experts and novices. The counts, durations, average action time, and dissection/exposure ratio (D/E ratio) of LC Surgestures were compared. The phase of mobilizing hepatocystic triangle (MHT) was extracted for skill assessment by three professors using a modified Global Operative Assessment of Laparoscopic Skills (mGOALS). RESULTS The novice operation time was significantly longer than the expert operation time (58.12 ± 19.23 min vs. 26.66 ± 8.00 min, P < 0.001), particularly during MHT phase. Novices had significantly more Surgestures than experts in both hands (P < 0.05). The left hand and inefficient Surgesture of novices were dramatically more than those of experts (P < 0.05). The experts demonstrated a significantly higher D/E ratio of duration than novices (0.79 ± 0.37 vs. 2.84 ± 1.98, P < 0.001). The counts and time pattern map of LC Surgestures during MHT demonstrated that novices tended to complete LC with more types of Surgestures and spent more time exposing the surgical scene. The performance metrics of LC Surgesture had significant but weak associations with each aspect of mGOALS. CONCLUSION The newly constructed Surgestures could serve as accessible and quantifiable metrics for demonstrating the operative pattern and distinguishing surgeons with various skills. The association between Surgestures and Global Rating Scale laid the foundation for establishing a bridge to automated objective surgical skill evaluation.
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Affiliation(s)
- Zixin Chen
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jingjing An
- Department of Operating Room, West China Hospital, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Shangdi Wu
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Ke Cheng
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaying You
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jie Liu
- ChengDu Withai Innovations Technology Company, Chengdu, China
| | - Jingwen Jiang
- West China Biomedical Big Data Center of West China Hospital, Chengdu, China
| | - Dewei Yang
- West China Biomedical Big Data Center of West China Hospital, Chengdu, China.,Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.
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Unal F, Atakul N, Turan H, Yaman Ruhi I. Evaluation of YouTube laparoscopic hysterectomy videos as educational materials during the COVID-19 era using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) and LAP-VEGaS video assessment tool. J OBSTET GYNAECOL 2021; 42:1325-1330. [PMID: 34704513 DOI: 10.1080/01443615.2021.1962823] [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] [Indexed: 10/20/2022]
Abstract
With increasing numbers of laparoscopic hysterectomies, surgical trainees are compelled to learn more about endoscopy. Owing to coronavirus disease-related social distancing requirements, online education has gained prominence. Here, we aimed to investigate the laparoscopic hysterectomy video quality on YouTube using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). YouTube was searched on June 7, 2020 using 'laparoscopic hysterectomy'. Three examiners evaluated videos using Global Operative Assessment of Laparoscopic Skills (GOALS). Subsequently, videos were assessed for their conformity to the LAP-VEGaS and LAP-VEGaS Video Assessment Tool. Interobserver reliability was estimated using intraclass coefficients and Cronbach's alpha. Cochran's Q test was used to determine correlations among quantitative data. The median GOALS score was 21.50. The observers' GOALS scores were significantly correlated. The results showed low conformity to the LAP-VEGaS. YouTube is the most used platform among trainees. The low YouTube video educational quality highlights the necessity for peer review, as trainees increasingly seek such resources during the pandemic.IMPACT STATEMENTWhat is already known on this subject? YouTube is the most commonly used online resource for educational material among surgical trainees. Online videos usually do not undergo a peer-review process. The LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) may be used to assess the educational quality of surgical videos.What do the results of this study add? To our knowledge, this is the first study on the quality of laparoscopic hysterectomy videos available on YouTube and the first study to evaluate YouTube laparoscopic surgery videos using the LAP-VEGaS Video Assessment Tool (VAT). Our study revealed the low educational quality of YouTube laparoscopic hysterectomy videos. The LAP-VEGaS VAT seems to be a valid and practical tool for assessing online laparoscopic hysterectomy videos.What are the implications of these findings for clinical practice and/or further research? Medical communities, especially tertiary care or academic centres, may upload educational peer-reviewed videos for trainees seeking this type of resource, especially during the coronavirus disease pandemic, as surgical education alternatives are limited.
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Affiliation(s)
- Fehmi Unal
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
| | - Nil Atakul
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
| | - Hasan Turan
- Department of Gynecologic Oncology, Cam Sakura City Hospital, Istanbul, Turkey
| | - Irem Yaman Ruhi
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
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Kalun P, Dunn K, Wagner N, Pulakunta T, Sonnadara R. Recent evidence on visual-spatial ability in surgical education: A scoping review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e111-e127. [PMID: 33349760 PMCID: PMC7749687 DOI: 10.36834/cmej.69051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. METHODS We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. RESULTS We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. CONCLUSIONS It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.
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Affiliation(s)
- Portia Kalun
- Department of Surgery, McMaster University, Ontario, Canada
| | - Krista Dunn
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Natalie Wagner
- Department of Surgery, McMaster University, Ontario, Canada
- Office of Professional Development & Educational Scholarship, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Ranil Sonnadara
- Department of Surgery, McMaster University, Ontario, Canada
- Department of Surgery, University of Toronto, Ontario, Canada
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Postema RR, van Gastel LA, Hardon SF, Bonjer HJ, Horeman T. Haptic exploration improves performance of a laparoscopic training task. Surg Endosc 2020; 35:4175-4182. [PMID: 32875419 PMCID: PMC8263408 DOI: 10.1007/s00464-020-07898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopy has reduced tactile and visual feedback compared to open surgery. There is increasing evidence that visual and haptic information converge to form a more robust mental representation of an object. We investigated whether tactile exploration of an object prior to executing a laparoscopic action on it improves performance. METHODS A prospective cohort study with 20 medical students randomized in two different groups was conducted. A silicone ileocecal model, on which a laparoscopic action had to be performed, was used inside an outside a ForceSense box trainer. During the pre-test, students either did a combined manual and visual exploration or only visual exploration of the caecum model. To track performance during the trials of the study we used force, motion and time parameters as representatives of technical skills development. The final trial data were used for statistical comparison between groups. RESULTS All included time and motion parameters did not show any clear differences between groups. However, the force parameters Mean force non-zero (p = 004), Maximal force (p = 0.01) Maximal impulse (p = 0.02), Force volume (p = 0.02) and SD force (p = 0.01) showed significant lower values in favour of the tactile exploration group for the final trials. CONCLUSIONS By adding haptic sensation to the existing visual information during training of laparoscopic tasks on life-like models, tissue manipulation skills improve during training.
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Affiliation(s)
- Roelf R Postema
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628CD, Delft, The Netherlands.
| | - Leonie A van Gastel
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Sem F Hardon
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628CD, Delft, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Tim Horeman
- Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628CD, Delft, The Netherlands
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Bobel MC, Kemp SE, Wagner WA, Ramaswamy A, Chipman JG. Undergraduate, Nonmedical Students can Pass the FLS Manual Skills Exam With Minimal Practice. JOURNAL OF SURGICAL EDUCATION 2020; 77:485-490. [PMID: 31882238 DOI: 10.1016/j.jsurg.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The primary objective of this study is to investigate whether undergraduate, nonmedical students could pass the FLS Manual Skills Exam with minimal practice. The secondary objective is to examine ACGME case log data from graduating chief residents over the past 18 years to examine how laparoscopic experience has evolved over that time period. DESIGN Undergraduate, nonmedical students received training and unlimited practice time before being tested on each task of the FLS Manual Skills Exam. Each task was timed and scored using the MISTELS system. ACGME case log data from graduating chief residents over the past 18 years was obtained. SETTING The setting is SimPortal, the simulation center associated with the University of Minnesota Medical School. PARTICIPANTS The participants are 25 undergraduate, nonmedical students from the University of Minnesota. Participants were recruited on campus. RESULTS Twenty-three out of 25 (92%) undergraduate, nonmedical students successfully completed one attempt for each task of the FLS Manual Skills Exam and 21 out of 25 (84%) completed both attempts. The average total practice time was 39 minutes. Over the past 18 years, the average number of laparoscopic cases completed by a graduating chief increased from 142 to 275 cases (93% increase). Additionally, the average number of cases of the top 5 most common laparoscopic operations increased from 25% to over 400%. CONCLUSIONS Undergraduate, nonmedical students can pass the FLS Manual Skills Exam with minimal practice. Additionally, general surgery residents and medical students continue to gain more laparoscopic experience throughout medical training as laparoscopic surgery is utilized for more operations. The FLS Manual Skills Exam should be re-examined to determine its utility as a high-stakes exam.
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Affiliation(s)
- Matthew C Bobel
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota.
| | - Sarah E Kemp
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota
| | - Wyatt A Wagner
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota
| | - Archana Ramaswamy
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota; Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Jeffrey G Chipman
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota
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Viewer discretion advised: is YouTube a friend or foe in surgical education? Surg Endosc 2017; 32:1724-1728. [DOI: 10.1007/s00464-017-5853-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/22/2017] [Indexed: 12/18/2022]
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Trudeau MO, Carrillo B, Nasr A, Gerstle JT, Azzie G. Educational Role for an Advanced Suturing Task in the Pediatric Laparoscopic Surgery Simulator. J Laparoendosc Adv Surg Tech A 2017; 27:441-446. [DOI: 10.1089/lap.2016.0516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maeve O'Neill Trudeau
- Department of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Ahmed Nasr
- Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Justin T. Gerstle
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
| | - Georges Azzie
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada
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