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Lerner JL, Vishwanath N, Borrelli MR, Rao V, Crozier J, Woo AS. A Cost-Effective, Three-Dimensionally Printed Simulation Model Facilitates Learning of Bilobed and Banner Flaps for Mohs Nasal Reconstruction: A Pilot Study. Plast Reconstr Surg 2024; 154:358e-361e. [PMID: 37678816 DOI: 10.1097/prs.0000000000011037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
SUMMARY Flap design for Mohs reconstruction is a complex 3-dimensional process. Simulation offers trainees the chance to practice techniques safely before performing them in the operating room. To aid in teaching, the authors developed a high-fidelity, cost-effective model of the face using three-dimensional printing to simulate flap reconstruction after Mohs surgery. A model face was sculpted digitally to include skin, bone, and cartilage. Negative molds were printed and used to cast silicone, representing external skin. The cartilage and bone models were combined to create a single three-dimensionally printed base. Surgical residents practiced performing banner and bilobed flaps on the simulation model, and improvement was assessed using boards-style pretests and posttests assessing flap design on clinical photographs. Medical students were randomized to complete a similar practice session with the model or a reading on the topic, after which they completed the same assessment. Participants also completed a questionnaire about the model's didactic and monetary value. Residents showed significant improvement after use of the model (banner flap: P = 0.002, bilobed flap: P = 0.04). Medical students who used the model scored significantly higher than those assigned to train by reading ( P = 0.001). Subjective comfort with flap design and execution increased after practice with the model ( P = 0.001). The cost of materials for each model was $2.50; participants reported willingness to pay $24.36 (mean) for this tool. This accessible model was superior to traditional teaching materials for Mohs reconstruction, and aided the comfort and proficiency of trainees.
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Affiliation(s)
- Julia L Lerner
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
| | - Neel Vishwanath
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
| | - Mimi R Borrelli
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
| | - Vinay Rao
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
| | - Joseph Crozier
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
| | - Albert S Woo
- From the Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University
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Awad L, Abdi Z, Langridge BJ, Karoshi A, Butler PEM. A Comparison of Commercially Available Digital Microscopes for Their Use in Bench-Model Simulation of Microsurgery. J Reconstr Microsurg 2024. [PMID: 38991532 DOI: 10.1055/s-0044-1787980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Surgical education has seen a transition in the delivery of training, with increased use of online platforms to facilitate remote learning. Simulation training can increase access to education and reduce cost implications, while reducing patient risk. This study aims to compare commercially available digital microscopes, alongside a standard binocular surgical microscope, and determine whether they can be used as an alternative tool for remote microsurgery simulation. METHODS Data were collected for a total of four microscopes, including three commercially available digital microscopes, smartphone, and a binocular table microscope. Product characteristics were collated, and a subjective assessment was conducted using an 11-criteria questionnaire, graded with a 5-point scale. Results of digital microscopes were compared with the table binocular microscope.The Kruskal-Wallis test was used to compare the performance of digital microscopes to the standard binocular microscope RESULTS: The questionnaire was completed by 31 participants: two consultants, nine surgical registrars, fourteen junior trainees, and six medical students. Digital microscopes were found to be significantly more affordable and convenient for trainees; however, the cost of the smartphone was significant. Overall, the Pancellant Digital Microscope performed the poorest, with trainees commenting on its unsuitability for surgical practice; the Plugable USB Digital Microscope (PLDM) was rated overall most like the binocular table microscope. The Depth of field was shallow in all digital microscopes. CONCLUSION With the increasing role of remote learning and simulation training in surgical education, the PLDM can provide a cheaper, more accessible alternative for junior trainees, in their pursuit of microsurgical skill acquisition.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Zakee Abdi
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Benjamin J Langridge
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Akul Karoshi
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter E M Butler
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Fanizzi C, Carone G, Rocca A, Ayadi R, Petrenko V, Casali C, Rani M, Giachino M, Falsitta LV, Gambatesa E, Galbiati TF, Orena EF, Tramacere I, Riker NI, Mocca A, Schaller K, Meling TR, DiMeco F, Perin A. Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study. BRAIN & SPINE 2024; 4:102829. [PMID: 38812880 PMCID: PMC11134543 DOI: 10.1016/j.bas.2024.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
Introduction Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess. Research question The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance. Material and methods Seventy-two residents were randomized into the simulation group (SG) and control group (CG). The course spanned five days, commencing with assessment of technical skills in basic procedures within a wet-lab setting on day 1. Over the subsequent core days, the SG engaged in simulated procedures, while the CG carried out routine activities in an OR. On day 5, all residents' technical competencies were evaluated. Psychometric measures of all participants were subjected to analysis. Results The SG demonstrated superior performance (p < 0.0001) in the brain tumour removal compared to the CG. Positive learning curves were evident in the SG across the three days of simulator-based training for all tumour removal tasks (all p-values <0.05). No significant differences were noted in other tasks, and no meaningful correlations were observed between performance and any psychometric parameters. Discussion and conclusion A brief and intensive training regimen utilizing 3D virtual reality simulators enhances residents' microsurgical proficiency in brain tumour removal models. Simulators emerge as a viable tool to expedite the learning curve of in-training neurosurgeons.
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Affiliation(s)
- Claudia Fanizzi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Giovanni Carone
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandra Rocca
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Roberta Ayadi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Veronika Petrenko
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Martina Rani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Marta Giachino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Lydia Viviana Falsitta
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Enrico Gambatesa
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Tommaso Francesco Galbiati
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Eleonora Francesca Orena
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Irene Tramacere
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Nicole Irene Riker
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandro Mocca
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, Geneva, Switzerland
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, and SFITS, Geneva,
Switzerland
| | - Torstein Ragnar Meling
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Neurosurgery, The National Hospital of Denmark,
Rigshospitalet, Copenhagen, Denmark
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milano,
Milano, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School,
Baltimore, MD, USA
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Life Sciences, University of Trieste, Trieste,
Italy
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King A, Cairns S, Shepherd L, Barrett J, Inkster T. Advancing outbreak simulation training: a collaborative pilot study for dual-specialty medical trainees and infection prevention and control professionals. J Hosp Infect 2024; 147:68-76. [PMID: 38432585 DOI: 10.1016/j.jhin.2024.02.014] [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: 11/14/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND In response to identified gaps in infection prevention and control (IPC) training within Scotland, a Short Life Working Group initiated an innovative outbreak simulation training programme. AIM To enhance the knowledge and confidence of medical microbiology and infectious diseases trainees and IPC professionals in managing healthcare-associated infection (HAI) outbreaks, employing the National Infection Prevention and Control Manual guidelines. METHODS Participants completed prerequisite online training in epidemiology and surveillance before engaging in a meticulously crafted vancomycin-resistant enterococci outbreak simulation, which mirrored a real-life incident and adhered to the standards set by the Association for Simulated Practice in Healthcare. The programme incorporated Kolb's experiential learning cycle, fostering an authentic and engaging learning environment. A total of 41 individuals participated in the synchronous online training phase, with eight individuals involved in the pilot outbreak simulation. Evaluation of the training's efficacy followed Kirkpatrick's model, combining quantitative (five-point Likert scales) and qualitative (open-ended questions and participant reflections) data collection methods. FINDINGS Results demonstrated significant improvements in participants' knowledge, skills, and confidence in outbreak management. Feedback highlighted the realism and educational value of the simulation, with 100% agreement on its efficacy in enhancing outbreak management capabilities. CONCLUSION The success of this pilot study underscores the potential of simulation training in IPC and paves the way for broader implementation. It emphasizes the effectiveness of structured, experiential learning in equipping healthcare professionals with practical skills and confidence for managing complex HAI outbreaks, contributing to a more competent and prepared workforce.
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Affiliation(s)
- A King
- NHS Education for Scotland, Glasgow, UK
| | - S Cairns
- Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), Delta House, Glasgow, UK
| | | | - J Barrett
- Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), Delta House, Glasgow, UK
| | - T Inkster
- Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), Delta House, Glasgow, UK.
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Poljo A, Sortino R, Daume D, Probst P, Billeter AT, Müller-Stich BP, Klasen JM. Educational challenges and opportunities for the future generation of surgeons: a scoping review. Langenbecks Arch Surg 2024; 409:82. [PMID: 38433154 DOI: 10.1007/s00423-024-03270-7] [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: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature. METHODS Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms "surgeons/education," for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows. RESULTS The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training (n = 7), surgical culture and environment (n = 19), and mentoring (n = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents' burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees' needs, training challenges, and the qualities expected of both mentors and mentees were addressed. CONCLUSION At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.
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Affiliation(s)
- Adisa Poljo
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Rosita Sortino
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Diana Daume
- Department of Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, 8501, Frauenfeld, Switzerland
| | - Adrian T Billeter
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Beat P Müller-Stich
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Jennifer M Klasen
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland.
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Aichner J, Kaefer M, Zundel S, Jhala T, Szavay P. Surgical simulation of hypospadias repair - High-fidelity, reproducible and affordable animal tissue model. J Pediatr Urol 2024:S1477-5131(24)00090-1. [PMID: 38402079 DOI: 10.1016/j.jpurol.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Teaching methods in hypospadias repair are still traditional. Available simulators often lack authenticity in terms of haptic feedback and realistic tissue handling. OBJECTIVE Our aim was to develop a high-fidelity, easily reproducible, and affordable animal tissue model for the advanced surgical simulation of hypospadias repair with realistic haptic feedback and tissue handling. MATERIAL AND METHODS A regular-sized chicken leg and a lamb tenderloin are used to assess the feasibility of simulating hypospadias correction by using the example of a Snodgrass Tubularized Incised Plate-Repair. The model preparation is incorporated into the training process. RESULTS A detailed description of the high-fidelity model is provided. All steps of a hypospadias repair can be trained while providing realistic anatomy, adequate size, and multilayer tissue properties. Haptic conditions highly resemble human tissue properties. Fine tissue handling corresponds to intraoperative conditions. Limitations to this surgical model apply as in other animal tissue models. CONCLUSION We developed a high-fidelity, easily reproducible, and affordable hypospadias animal tissue model. Due to the multilayer animal tissue properties, this model provides realistic haptic feedback and thus an inexpensive and reproducible model for hypospadias simulation. External validation is mandatory prior to implementation into urological training.
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Affiliation(s)
- Jonathan Aichner
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Martin Kaefer
- Department of Surgery, Riley Children's Health, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA.
| | - Sabine Zundel
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Tobias Jhala
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Philipp Szavay
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
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Faisal H, Qamar F, Martinez S, Razmi S, Oviedo R, Masud F. Learning curve of ultrasound-guided surgeon-administered transversus abdominis plane (UGSA-TAP) block on a porcine model. Heliyon 2024; 10:e25006. [PMID: 38322832 PMCID: PMC10844114 DOI: 10.1016/j.heliyon.2024.e25006] [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: 10/03/2022] [Revised: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Background Surgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning. Methods We performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant. Results All simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83-1) confirmed the robustness of study evaluations. Conclusion The UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.
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Affiliation(s)
- H. Faisal
- Clinical Surgery at Weill Cornell Medical College, USA
- Clinical Surgery at Houston Methodist Academic Institute, USA
- Clinical Medicine at Texas A&M University, Houston Methodist Hospital, Houston, TX, USA
| | - F. Qamar
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - S. Martinez
- Clinical Surgery at Texas A&M College of Medicine, Surgery Residency Program Director/Interim Chief of the Division of Acute Care Surgery, Houston Methodist Hospital, USA
| | - S.E. Razmi
- Texas A&M College of Medicine EnMed, Houston, TX, USA
| | - R.J. Oviedo
- Surgery, Weill Cornell Medical College, Cornell University, Texas A&M University College of Medicine, USA
| | - F. Masud
- Anesthesiology at Houston Methodist Academic Institute, Medical Director, Center for Critical Care, USA
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Towning R, Rennie C, Ferguson M. Multidisciplinary Simulation Training for Surgical Tracheostomy in Patients Mechanically Ventilated Secondary to Severe Acute Respiratory Syndrome Coronavirus 2. EAR, NOSE & THROAT JOURNAL 2024; 103:NP89-NP97. [PMID: 34427150 DOI: 10.1177/01455613211042119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A proportion of patients with coronavirus disease (COVID) and severe respiratory manifestations of disease will require admission to intensive care for intubation and ventilation. When anticipating prolonged ventilation, the patient may proceed to surgical tracheostomy to afford safe respiratory wean. As surgical tracheostomy is an aerosol-generating procedure, it poses a high risk of viral transmission and ultimately may prompt anxiety and caution in participating staff members. We aimed to mitigate these risks by providing staff with appropriate training and experience, to improve their confidence as well as practical ability. METHODS We developed a multidisciplinary simulation training experience and checklist in order to optimize team performance during the high-stakes procedure. We evaluated staff confidence before and after the training with questionnaires. RESULTS Post-simulation, surgeons were more confident with donning the high level personal protective equipment, and nurses were more confident in performing their role. CONCLUSIONS Simulation allows the multidisciplinary team an opportunity to practice high-risk procedures and prompts the team to assess staff knowledge base, troubleshoot queries, and teach roles and responsibilities in a safe environment. In the context of COVID-19, simulation encourages staff sense of preparedness and protection for true participation during a high-risk procedure.
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Affiliation(s)
- Rebecca Towning
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Catherine Rennie
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Mark Ferguson
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
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Gill P, Levin M, Farhood Z, Asaria J. Surgical Training Simulators for Rhinoplasty: A Systematic Review. Facial Plast Surg 2024; 40:86-92. [PMID: 37172948 DOI: 10.1055/a-2092-6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Rhinoplasty training currently follows an apprenticeship model that is largely observational. Trainees have limited experience in performing maneuvers of this complex surgery. Rhinoplasty simulators can address this issue by providing trainees with the opportunity to gain surgical simulator experience that could improve technical competences in the operating room. This review amalgamates the collective understanding of rhinoplasty simulators described to date. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, OVID Embase, OVID Medline, and Web of Science databases were all searched for original research on surgical simulators for rhinoplasty education and reviewed by independent reviewers. Articles underwent title and abstract screening, and then relevant articles underwent full-text review to extract simulator data. Seventeen studies, published between 1984 and 2021, were included for final analysis. Study participant numbers ranged from 4 to 24, and included staff surgeons, fellows, residents (postgraduate year 1-6), and medical students. Cadaveric surgical simulators comprised eight studies, of which three were with human cadavers, one study was a live animal simulator, two were virtual simulators, and six were three-dimensional (3D) models. Both animal and human-based simulators increased the confidence of trainees significantly. Significant improvement in various aspects of rhinoplasty knowledge occurred with implementation of a 3D-printed model in rhinoplasty education. Rhinoplasty simulators are limited by a lack of an automated method of evaluation and a large reliance on feedback from experienced rhinoplasty surgeons. Rhinoplasty simulators have the potential to provide trainees with the opportunity for hands-on training to improve skill and develop competencies without putting patients in harm's way. Current literature on rhinoplasty simulators largely focuses on simulator development, with few simulators being validated and assessed for utility. For wider implementation and acceptance, further refinement of simulators, validation, and assessment of outcomes is required.
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Affiliation(s)
- P Gill
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - M Levin
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Z Farhood
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- FACE Cosmetic Surgery, Toronto, Ontario, Canada
| | - J Asaria
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- FACE Cosmetic Surgery, Toronto, Ontario, Canada
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Hermans T, Snoeks JM, vom Dorp F, Wiesner C, Steiner T, von Rundstedt F. Validation of a 3D-printed robot-assisted partial nephrectomy training model. BJUI COMPASS 2024; 5:90-100. [PMID: 38179024 PMCID: PMC10764170 DOI: 10.1002/bco2.269] [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: 04/09/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives Most renal tumours can be treated with a partial nephrectomy, with robot-assisted partial nephrectomy becoming the new gold standard. This procedure is challenging to learn in a live setting, especially the enucleation and renorraphy phases. In this study, we attempted to evaluate face, content, and preliminary construct validity of a 3D-printed silicone renal tumour model in robotic training for robot-assisted partial nephrectomy. Materials and Methods We compared the operative results of three groups of surgeons with different experience levels (>20 partial nephrectomies, 1-20 partial nephrectomies and no experience at all) performing a robotic tumour excision of a newly developed silicone model with four embedded 3D-printed renal tumours. We evaluated the participants' performance using surgical margins, excision time, total preserved parenchyma, tumour injury and GEARS score (as assessed by two blinded experts) for construct validity. Postoperatively, the participants were asked to complete a survey to evaluate the usefulness, realism and difficulty of the model as a training and/or evaluation model. NASA-TLX scores were used to evaluate the operative workload. Results Thirty-six participants were recruited, each group consisting of 10-14 participants. The operative performance was significantly better in the expert group as compared to the beginner group. NASA-TLX scores proved the model to be of an acceptable difficulty level.Expert group survey results showed an average score of 6.3/10 on realism of the model, 8.2/10 on the usefulness as training model and 6.9/10 score on the usefulness as an evaluation tool. GEARS scores showed a non-significant tendency to improve between trials, emphasizing its potential as a training model. Conclusion Face and content validity of our 3D renal tumour model were demonstrated. The vast majority of participants found the model realistic and useful for training and for evaluation. To evaluate construct and predictive validity, we require further research, aiming to compare the results of 3D-model trained surgeons with those of untrained surgeons in real-life surgery.
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Affiliation(s)
- Thomas Hermans
- Department of UrologyHelios University Hospital Wuppertal, University of Witten/HerdeckeWuppertalGermany
| | - Joren M. Snoeks
- Community Ecology Lab, Department of BiologyVrije Universiteit Brussel (VUB)BrusselsBelgium
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11
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Zoia C, Mantovani G, Aldea C, Bartek J, Bauer M, Belo D, Drosos E, Kaprovoy S, Stengel F, Lepic M, Lippa L, Mohme M, Motov S, Schwake M, Spiriev T, Torregrossa F, Thomé C, Meling TR, Raffa G. Neurosurgical fellowship in Europe: It's time to cooperate - A call from the EANS Young Neurosurgeons' Committee. BRAIN & SPINE 2023; 4:102734. [PMID: 38510596 PMCID: PMC10951695 DOI: 10.1016/j.bas.2023.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Jiri Bartek
- Karolinska University Hospital, Stockholm, Sweden
| | - Marlies Bauer
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | | | | | - Laura Lippa
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Toma Spiriev
- Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | | | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Italy
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12
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Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In Situ Simulation and Clinical Outcomes in Infants Born Preterm. J Pediatr 2023; 263:113715. [PMID: 37659586 PMCID: PMC10841094 DOI: 10.1016/j.jpeds.2023.113715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
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Affiliation(s)
- Ritu Chitkara
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
| | - Mihoko Bennett
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Janine Bohnert
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Nicole Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Janene Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Jenny Quinn
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Kimber Padua
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Henry C Lee
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
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13
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Perin A, Gambatesa E, Rui CB, Carone G, Fanizzi C, Lombardo FM, Galbiati TF, Sgubin D, Silberberg H, Cappabianca P, Meling TR, DI Meco F. The "STARS" study: advanced preoperative rehearsal and intraoperative navigation in neurosurgical oncology. J Neurosurg Sci 2023; 67:671-678. [PMID: 35380197 DOI: 10.23736/s0390-5616.22.05516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neurosurgical 3D visualizers and simulators are innovative devices capable of defining a surgical strategy in advance and possibly making neurosurgery safer by rehearsing the phases of the operation beforehand. The aim of this study is to evaluate Surgical Theater™ (Surgical Theater LLC, Mayfield, OH, USA), a new 3D neurosurgical planning, simulation, and navigation system, and qualitatively assess its use in the operating room. METHODS Clinical data were collected from 30 patients harboring various types of brain tumors; Surgical Theater™ was used for the preoperative planning and intraoperative 3D navigation. Preoperative and postoperative questionnaires were completed by first and second operators to get qualitative feedback on the system's functionality. Furthermore, we measured and compared the impact of this technology on surgery duration. RESULTS Neurosurgeons were overall satisfied when using this rehearsal and navigation tool and found it efficient and easy to use; interestingly, residents considered this device more useful as compared to their more senior colleagues (with significantly higher scores, P<0.05), possibly because of their limited anatomical experience and spatial/surgical rehearsal ability. The length of the surgical procedure was not affected by this technology (P>0.05). CONCLUSIONS Surgical Theater™ system was found to be clinically useful in improving anatomical understanding, surgical planning, and intraoperative navigation, especially for younger and less experienced neurosurgeons.
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Affiliation(s)
- Alessandro Perin
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy -
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy -
- Department of Life Sciences, University of Trieste, Trieste, Italy -
| | - Enrico Gambatesa
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Chiara B Rui
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Giovanni Carone
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Claudia Fanizzi
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Francesca M Lombardo
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Tommaso F Galbiati
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
| | - Donatella Sgubin
- Department of Neurosurgery, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
| | | | - Paolo Cappabianca
- Department of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Torstein R Meling
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- EANS Training Committee, Prague, Czech Republic
- Department of Neurosurgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Francesco DI Meco
- Department of Neurosurgery, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- Besta NeuroSim Center, I.R.C.C.S. Neurological Institute "Carlo Besta" Foundation, Milan, Italy
- EANS Training Committee, Prague, Czech Republic
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Johns Hopkins Medical School, Department of Neurological Surgery, Baltimore, MD, USA
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14
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Lading T, Kjaer D, Bendixen M, Petersen TI, Christensen TD, Katballe N. Safe and efficient 2-step implementation of totally minimally invasive esophagectomy. J Thorac Dis 2023; 15:5362-5370. [PMID: 37969264 PMCID: PMC10636444 DOI: 10.21037/jtd-23-462] [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: 03/22/2023] [Accepted: 08/04/2023] [Indexed: 11/17/2023]
Abstract
Background The clinical benefits of totally minimal invasive esophagectomy (TIME) compared to open esophagectomy are documented and include reduced morbidity like pulmonary infections, shorter hospital stay and an increase in short-term quality of life. However, transition to TIME can be associated with a learning curve associated increased morbidity. We report our implementation of TIME using a 2-step approach, where the thoracoscopic part was added to the laparoscopic part in carefully selected patients. The hypothesis was that the 2-step implementation provides a safe and efficient implementation without compromising the outcomes for the patients. The aim of this study was to evaluation the implementation of minimal invasive esophagectomy at Aarhus University Hospital, where a 2-step implementation strategy has been used. Methods In this retrospective observational cohort study a total of 369 patients with esophagus or gastroesophageal cancers underwent esophagectomy from September 1st, 2016 to July 31st, 2021 in a single high-volume tertiary institution. Totally minimally invasive Ivor Lewis esophagectomy was performed by experienced minimal invasive surgeons in 120 of the cases. The study presents the complication rates of the TIME patients in the implementation phase. Results Anastomotic leakage occurred in 7.5% of the cases and pneumonia occurred in 5.8% of the cases. The lymph node count reached 16 or more in 94.3% of the cases and R0-resection was performed in 98.3% of the cases. Textbook outcome for esophageal cancer surgery was achieved in 45.8% of the patients. Conclusions Hybrid minimal invasive esophagectomy can serve as a step towards totally minimally invasive esophagectomy. In our institution, major learning curve associated complications was avoided and a high level of cancer control was achieved by a 2-step implementation strategy in carefully selected patients.
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Affiliation(s)
- Troels Lading
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Kjaer
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Katballe
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Brian R, Oh D, Ifuku KA, Sarin A, O'Sullivan P, Chern H. Experience matters for robotic assistance: an analysis of case data. J Robot Surg 2023; 17:2421-2426. [PMID: 37450105 PMCID: PMC10492713 DOI: 10.1007/s11701-023-01677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Many robotic procedures require active participation by assistants. Most prior work on assistants' effect on outcomes has been limited in procedural focus and scope, with studies reporting differing results. Knowing how assistant experience affects operating room time could inform operating room case scheduling and provide an impetus for additional assistant training. As such, this retrospective cohort study aimed to determine the association between assistant experience and operating room time for 2291 robotic-assisted operations performed from 2016 to 2022 at our institution. Linear regression showed a significant association between the presence of a junior resident and increased case length differential with an increase of 26.9 min (p = 0.01). There were no significant associations between the presence of a senior resident (p = 0.52), presence of a fellow (p = 0.20), or presence of a physician assistant (p = 0.43) and case length differential. The finding of increased operating room time in the presence of a junior resident during robotic cases supports consideration of the adoption of formal assistant training programs for residents to improve efficiency.
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Affiliation(s)
- Riley Brian
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Daniel Oh
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
- Intuitive Surgical, Sunnyvale, CA, USA
| | - Kelli Ann Ifuku
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hueylan Chern
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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16
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Fazlollahi AM, Yilmaz R, Winkler-Schwartz A, Mirchi N, Ledwos N, Bakhaidar M, Alsayegh A, Del Maestro RF. AI in Surgical Curriculum Design and Unintended Outcomes for Technical Competencies in Simulation Training. JAMA Netw Open 2023; 6:e2334658. [PMID: 37725373 PMCID: PMC10509729 DOI: 10.1001/jamanetworkopen.2023.34658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023] Open
Abstract
Importance To better elucidate the role of artificial intelligence (AI) in surgical skills training requires investigations in the potential existence of a hidden curriculum. Objective To assess the pedagogical value of AI-selected technical competencies and their extended effects in surgical simulation training. Design, Setting, and Participants This cohort study was a follow-up of a randomized clinical trial conducted at the Neurosurgical Simulation and Artificial Intelligence Learning Centre at the Montreal Neurological Institute, McGill University, Montreal, Canada. Surgical performance metrics of medical students exposed to an AI-enhanced training curriculum were compared with a control group of participants who received no feedback and with expert benchmarks. Cross-sectional data were collected from January to April 2021 from medical students and from March 2015 to May 2016 from experts. This follow-up secondary analysis was conducted from June to September 2022. Participants included medical students (undergraduate year 0-2) in the intervention cohorts and neurosurgeons to establish expertise benchmarks. Exposure Performance assessment and personalized feedback by an intelligent tutor on 4 AI-selected learning objectives during simulation training. Main Outcomes and Measures Outcomes of interest were unintended performance outcomes, measured by significant within-participant difference from baseline in 270 performance metrics in the intervention cohort that was not observed in the control cohort. Results A total of 46 medical students (median [range] age, 22 [18-27] years; 27 [59%] women) and 14 surgeons (median [range] age, 45 [35-59] years; 14 [100%] men) were included in this study, and no participant was lost to follow-up. Feedback on 4 AI-selected technical competencies was associated with additional performance change in 32 metrics over the entire procedure and 20 metrics during tumor removal that was not observed in the control group. Participants exposed to the AI-enhanced curriculum demonstrated significant improvement in safety metrics, such as reducing the rate of healthy tissue removal (mean difference, -7.05 × 10-5 [95% CI, -1.09 × 10-4 to -3.14 × 10-5] mm3 per 20 ms; P < .001) and maintaining a focused bimanual control of the operative field (mean difference in maximum instrument divergence, -4.99 [95% CI, -8.48 to -1.49] mm, P = .006) compared with the control group. However, negative unintended effects were also observed. These included a significantly lower velocity and acceleration in the dominant hand (velocity: mean difference, -0.13 [95% CI, -0.17 to -0.09] mm per 20 ms; P < .001; acceleration: mean difference, -2.25 × 10-2 [95% CI, -3.20 × 10-2 to -1.31 × 10-2] mm per 20 ms2; P < .001) and a significant reduction in the rate of tumor removal (mean difference, -4.85 × 10-5 [95% CI, -7.22 × 10-5 to -2.48 × 10-5] mm3 per 20 ms; P < .001) compared with control. These unintended outcomes diverged students' movement and efficiency performance metrics away from the expertise benchmarks. Conclusions and Relevance In this cohort study of medical students, an AI-enhanced curriculum for bimanual surgical skills resulted in unintended changes that improved performance in safety but negatively affected some efficiency metrics. Incorporating AI in course design requires ongoing assessment to maintain transparency and foster evidence-based learning objectives.
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Affiliation(s)
- Ali M. Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rolando F. Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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Khilnani TK, Kesselman A, D'Angelo D, RoyChoudhury A, Lamparello NA. Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency. Acad Radiol 2023; 30:2067-2078. [PMID: 36849334 DOI: 10.1016/j.acra.2023.01.036] [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: 08/19/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/27/2023]
Abstract
RATIONALE AND OBJECTIVES Endovascular simulation is a validated training method, allowing residents to improve technical skills with interventional equipment in a risk-free environment. The purpose of this study was to assess the utility and efficacy of supplementing the IR/DR Integrated Residency training program with a dedicated 2-year endovascular simulation curriculum. MATERIALS AND METHODS Trainees participated in a 2-year curriculum that included the completion of 8 modules using a high-fidelity endovascular simulator (Mentice AB, Gothenberg, Sweden). Procedural modules included IVC filter placement, transarterial chemoembolization, trauma embolization, uterine artery embolization, prostate artery embolization, and peripheral arterial disease interventions. Each quarter, two trainees were filmed while completing an assigned module. Sessions led by IR faculty were held with film footage review and didactics on the assigned topic. Pre- and postcase surveys were collected to evaluate trainee comfort and confidence and assess the validity of the simulation. At the conclusion of the 2-year period, a postcurriculum survey was sent to all trainees to determine how residents viewed the utility of the simulation sessions. RESULTS Eight residents participated in the pre- and postcase surveys. The simulation curriculum significantly increased trainee confidence for these 8 residents. A separate postcurriculum survey was completed by all 16 IR/DR residents. All 16 residents felt that simulation was a helpful addition to their education. A total of 87.5% of all residents felt that the sessions improved their confidence in the IR procedure room. A total of 75% of all residents believe that the simulation curriculum should be incorporated into the IR residency program. CONCLUSION Adoption of a 2-year simulation curriculum can be considered for existing IR/DR training programs with access to high-fidelity endovascular simulators using the described approach.
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Affiliation(s)
- Tyler K Khilnani
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, 525 E 68th Street, New York City, NY 10021
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, 525 E 68th Street, New York City, NY 10021
| | - Nicole A Lamparello
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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18
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Cardoso SA, Suyambu J, Iqbal J, Cortes Jaimes DC, Amin A, Sikto JT, Valderrama M, Aulakh SS, Ramana V, Shaukat B, Patel T. Exploring the Role of Simulation Training in Improving Surgical Skills Among Residents: A Narrative Review. Cureus 2023; 15:e44654. [PMID: 37799263 PMCID: PMC10549779 DOI: 10.7759/cureus.44654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
The role of simulation in medical education is crucial to the development of surgeons' skills. Surgical simulation can be used to improve surgical skills in a secure and risk-free environment. Animal models, simulated patients, virtual reality, and mannequins are some types of surgical simulation. As a result, feedback encourages students to reflect on their strengths and weaknesses, enabling them to focus on improvement. Healthcare simulation is a strong educational instrument, and the main goal of this is to give the students an opportunity to do a practical application of what they have learned through theory. Before taking it to the patients, they will already have certain tools they have previously acquired during the practice. This makes it easier for students to identify the knowledge gaps that they must fill to improve patient outcomes. Moreover, simulation brings a wonderful opportunity for students to acquire skills, gain confidence, and experience success before working with real patients, especially when their clinical exposure is limited. The use of simulation to teach technical skills to surgical trainees has become more prevalent. The cost of setting up a simulation lab ranges from $100,000 to $300,000. There are several ways to evaluate the effectiveness of simulation-based surgical training. Repetitive surgical simulation training can improve speed and fluidity in general surgical skills in comparison to conventional training. Few previous studies compared learners who received structured simulation training to a group of trainees who did not receive any simulation training in single-center randomized control research. Significantly faster and less time-consuming skill proficiency was noticeable in simulated trainees. Despite being anxious in the operating room for the first time, simulated trainees completed the surgery on time, demonstrating the effectiveness of surgical simulation training. Traditional surgical training involves senior-surgeon supervision in the operating room. In simulation-based training, the trainees have full control over clinical scenarios and settings; however, guidance and assessment are also crucial. Simulators allow users to practice tasks under conditions resembling real-life scenarios. Simulators can be compared with traditional surgical training methods for different reasons. For example, intraoperative bleeding may occasionally show up not only visibly on the screen but also by shaking the trocars erratically. Without haptics, training on virtual simulators can cause one's pulling and pushing forces, which are frequently greater than what the tissue needs, to be distorted. A good method of simulation training is using virtual reality simulators with haptics and simulated patients. The availability of these facilities is limited, though, and a typical session might include an exercise involving stacking sugar cubes and box trainers. The degree of expertise or competency is one area that needs clarification as medical education transitions to a competency-based paradigm. The article aims to provide an overview of simulation, methods of simulation training, and the key role and importance of surgical simulation in improving skills in surgical residents.
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Affiliation(s)
- Swizel Ann Cardoso
- Major Trauma Services, University Hospital Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Jenisha Suyambu
- Medical Education, Jonalta School of Medicine, University of Perpetual Help System Dalta, Laspinas City, PHL
| | | | - Diana Carolina Cortes Jaimes
- Epidemiology, Universidad Autónoma de Bucaramanga, Bucaramanga, COL
- Medicine, Pontificia Universidad Javeriana, Bogotá, COL
| | - Aamir Amin
- Cardiothoracic Surgery, Guy's and St Thomas National Health Service (NHS) Foundation Trust, London, GBR
| | - Jarin Tasnim Sikto
- College of Medicine, Jahurul Islam Medical College and Hospital, Kishoreganj, BGD
| | | | | | - Venkata Ramana
- Orthopedics, All India Institute of Medical Sciences, Mangalagiri, IND
| | | | - Tirath Patel
- College of Medicine, American University of Antigua, St. John, ATG
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Zoia C, Mantovani G, Müther M, Suero Molina E, Scerrati A, De Bonis P, Cornelius J, Roche P, Tatagiba M, Jouanneau E, Manet R, Schroeder H, Cavallo L, Kasper E, Meling T, Mazzatenta D, Daniel R, Messerer M, Visocchi M, Froelich S, Bruneau M, Spena G. Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section. BRAIN & SPINE 2023; 3:102669. [PMID: 37720459 PMCID: PMC10500473 DOI: 10.1016/j.bas.2023.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery. Research question Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection. Material and methods A PRISMA based literature search was performed to select the most relevant papers on the topic. Results Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery. Discussion and conclusion This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
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Affiliation(s)
- C. Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - G. Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - M. Müther
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - E. Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - A. Scerrati
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - P. De Bonis
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - J.F. Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - P.H. Roche
- Department of Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - M. Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - E. Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - R. Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - H.W.S. Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Germany
| | - L.M. Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Policlinico Federico II University Hospital, Italy
| | - E.M. Kasper
- Department of Neurosurgery, Steward Medical Group, Brighton, USA
| | - T.R. Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D. Mazzatenta
- Department of Neurosurgery, Neurological Sciences Institut IRCCS, Bologna, Italy
| | - R.T. Daniel
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Messerer
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Visocchi
- Department of Neurosurgery, Institute of Neurosurgery Catholic University of Rome, Italy
| | - S. Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M. Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G. Spena
- Neurosurgery Unit, IRCSS San Matteo Hospital, Pavia, Italy
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Beaulieu-Jones BR, de Geus SWL, Rasic G, Woods AP, Papageorge MV, Sachs TE. A propensity score matching analysis: Impact of senior resident versus fellow participation on outcomes of complex surgical oncology. Surg Oncol 2023; 48:101925. [PMID: 36913848 PMCID: PMC10200751 DOI: 10.1016/j.suronc.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/12/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Teaching hospitals that train both general surgery residents and fellows in complex general surgical oncology have become more common. This study investigates whether participation of a senior resident versus a fellow has an impact on outcomes of patients undergoing complex cancer surgery. METHODS Patients who underwent esophagectomy, gastrectomy, hepatectomy, or pancreatectomy between 2007 and 2012 with assistance from a senior resident (post-graduate years 4-5) or a fellow (post-graduate years 6-8) were identified from the ACS NSQIP. Based on age, sex, body mass index, ASA classification, diagnosis of diabetes mellitus, and smoking status, propensity-scores were created for odds of undergoing the operation assisted by a fellow. Patients were matched 1:1 based on propensity score. Postoperative outcomes including risk of major complication were compared after matching. RESULTS In total, 6934 esophagectomies, 13,152 gastrectomies, 4927 hepatectomies, and 8040 pancreatectomies were performed with assistance of a senior resident or fellow. After matching, overall rates of major complications were equivalent across all four anatomic locations between cases performed with the participation of a senior resident versus a surgical fellow: esophagectomy (37.0%% vs 31.6%, p = 0.10), gastrectomy (22.6% vs 22.3%, p = 0.93), hepatectomy (15.8% v 16.0%, p = 0.91), and pancreatectomy (23.9% vs 25.2%, p = 0.48). Operative time was shorter for gastrectomy (212 vs. 232 min; p = 0.004) involving a resident compared to a fellow, but comparable for esophagectomy (330 vs. 336 min; p = 0.41), hepatectomy (217 vs. 219 min; p = 0.85), and pancreatectomy (320 vs. 330 min; p = 0.43). CONCLUSIONS Senior resident participation in complex cancer operations does not appear to negatively impact operative time or postoperative outcomes. Future research is needed to further assess this domain of surgical practice and education, particularly with regard to case selection and operative complexity.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | | | - Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Alison P Woods
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Wong K, Gorthey S, Arrighi-Allisan AE, Fan CJ, Barber SR, Schwam ZG, Wanna GB, Cosetti MK. Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study. Otol Neurotol 2023; 44:346-352. [PMID: 36805421 DOI: 10.1097/mao.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development. STUDY DESIGN Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer. SETTING Two academic teaching hospitals. SUBJECTS Otolaryngology residents. MAIN OUTCOME MEASURES Trial completion times; rate of improvement over time. RESULTS Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = -16.7, p = 0.005) and sinus endoscopy (B = -23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience ( p < 0.001). CONCLUSIONS Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
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Affiliation(s)
| | - Scott Gorthey
- Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Samuel R Barber
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ
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Rahimi AM, Hardon SF, Scholten SR, Bonjer HJ, Daams F. Objective measurement of retention of laparoscopic skills: a prospective cohort study. Int J Surg 2023; 109:723-728. [PMID: 37010141 PMCID: PMC10389389 DOI: 10.1097/js9.0000000000000272] [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: 11/17/2022] [Accepted: 01/30/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION There has been an overall growth of 462% in laparoscopic procedures performed by surgical residents between 2000 and 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. METHODS First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after, and 4 months after completing the basic laparoscopy course. Force, motion, and time were the measured variables. RESULTS A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force ( P= 0.004), motion ( P ≤0.001), and time ( P ≤0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force ( P ≤0.001), motion ( P= 0.005), and time ( P ≤0.001).Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force ( P= 0.046), max impulse ( P= 0.12), and time ( P= 0.002). For the ZigZag loop, skill decay was observed for force ( P= 0.021), motion ( P= 0.015), and time ( P ≤0.001) parameters. CONCLUSION Acquired laparoscopic technical skills decreased 4 months after the basic laparoscopy course. Compared to baseline performance, participants showed significant improvement, however deterioration was observed compared to postcourse measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.
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Affiliation(s)
- A. Masie Rahimi
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Amsterdam Skills Centre for Health Sciences
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sem F. Hardon
- Department of Surgery, Amsterdam UMC – VU University Medical Center
| | | | - H. Jaap Bonjer
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Amsterdam Skills Centre for Health Sciences
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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23
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Seely KD, Hansen M, Paluri SN, Rasmussen K, Carter S, Nigh A. Surgical simulation in osteopathic medical schools. J Osteopath Med 2023:jom-2023-0024. [PMID: 36998107 DOI: 10.1515/jom-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Kevin D Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, USA
| | - Maxwell Hansen
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Sarin N Paluri
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Kodee Rasmussen
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, USA
| | - Susan Carter
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, USA
| | - Andrew Nigh
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, USA
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24
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Rahimi AM, Hardon SF, Uluç E, Bonjer HJ, Daams F. Prediction of laparoscopic skills: objective learning curve analysis. Surg Endosc 2023; 37:282-289. [PMID: 35927349 PMCID: PMC9839814 DOI: 10.1007/s00464-022-09473-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Prediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box. METHODS Surgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency. RESULTS A total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses. CONCLUSION The learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.
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Affiliation(s)
- A. Masie Rahimi
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD Amsterdam, The Netherlands
| | - Sem F. Hardon
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
| | - Ezgi Uluç
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
| | - H. Jaap Bonjer
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
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Varela E, Castelli I, Szwarcfiter V, Turner L, Gaete MI, Belmar F, Cortés M, Jiménez G, Corvetto M, Varas J. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1708. [PMID: 36542006 PMCID: PMC9767423 DOI: 10.1590/0102-672020220002e1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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Affiliation(s)
- Eduardo Varela
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Ignacio Castelli
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Vania Szwarcfiter
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Lawrence Turner
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - María Inés Gaete
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Francisca Belmar
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Matías Cortés
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Gerónimo Jiménez
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Marcia Corvetto
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Julián Varas
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
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Broggi M, Zattra CM, Falco J. Commentary: Transsulcal, Transchoroidal Approach for Resection of Posterior Clinoid Meningioma With Virtual Reality Demonstration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e287-e288. [PMID: 36103322 DOI: 10.1227/ons.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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27
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Cutting Simulation in Unity 3D Using Position Based Dynamics with Various Refinement Levels. ELECTRONICS 2022. [DOI: 10.3390/electronics11142139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Augmented and Virtual Reality-based surgical simulations have become some of the fastest-developing areas, due to the recent technological advances and changes, in surgical education. Cutting simulation is a crucial part of the virtual surgery simulation in which an incision operation is performed. It is a complex process that includes three main tasks: soft body simulation, collision detection and handling, and topological deformation of the soft body. In this paper, considering the content developer’s convenience, the deformable object simulation, using position-based dynamics (PBD), was applied in the Unity 3D environment. The proposed algorithm for fast collision detection and handling between the cutting tool and the deformable object uses a sweep surface. In case of incision, the algorithm updates the mesh topology by deleting intersected triangles, re-triangulation, and refinement. In the refinement part, the boundary edges threshold was used to match the resolution of new triangles to the existing mesh triangles. Additionally, current research is focused on triangle surface meshes, which help to reduce the computational costs of the topology modifications. It was found that the algorithm can successfully handle arbitrary cuts, keeping the framerate within interactive and, in some cases, in the real-time.
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Gibson JAG, Gorse SH, Pallister I, Cubitt JJ. Surgical simulation training for escharotomy: a novel course, improving candidate’s confidence in a time critical procedure. Burns 2022; 49:783-787. [PMID: 35654704 DOI: 10.1016/j.burns.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circumferential deep burns on the limb lead to a constrictive, tourniquet-like effect causing critical limb ischaemia. The treatment, escharotomy, is a time-critical procedure that sometimes is required before the patient arrives at a burn centre. At present, no practical method of teaching this procedure is incorporated into formal educational courses. METHODS The feasibility of a comprehensive education package to teach upper limb escharotomy was assessed in a group of plastic and general surgery trainees in Wales. Small group workshops focused on the clinical presentation of patients requiring escharotomy. Participants then executed this on a custom-made high-fidelity simulation upper limb model. The articulated limb has subcutaneous silicone fat which bulges upon decompression and a finger-tip which turns pink indicating satisfactory reperfusion. A before and after five-point Likert scale was used to evaluate changes in participants' self-assessed confidence in the surgical management of escharotomy. Statistical significance between scores was assessed using the Wilcoxon signed-rank test. RESULTS A total of 34 participants took part. Following completion of the course, general surgery trainees' confidence in executing the procedure increased from a median score of 1.00 "not confident at all" (IQR 1.00-2.00) to 4.00 "fairly confident" (IQR 4.00-5.00, p < 0.01). Plastic surgery trainees' confidence increased from a median score of was 3.00 "somewhat confident" (IQR 1.75-4.00) to 4.00 "fairly confident" (IQR 3.00-4.25, p < 0.01). DISCUSSION We developed a comprehensive simulator course that has been demonstrated to improve candidate's confidence in performing escharotomy. The next stage in the course development is to confirm the results in a larger cohort. By developing this simulator course we aim to improve emergency burn care education in the UK and globally.
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Affiliation(s)
- John A G Gibson
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom.
| | - Sarah Hemington Gorse
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
| | - Ian Pallister
- Department of Trauma & Orthopaedic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
| | - Jonathan J Cubitt
- The Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
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Chen CL, Jen-Huei Yeh V, Yeh YT. A novel homemade simulator for training and assessing competency of totally implantable venous access port implantation via venous cutdown. J Chin Med Assoc 2022; 85:259-262. [PMID: 34974508 DOI: 10.1097/jcma.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Total implantable venous access port (TIVAP) by cephalic vein cutdown (CVCD) is one of the first procedures surgery residents can be performed independently under supervision. There is currently a lack of affordable simulators for teaching and assessing TIVAP competency to improve patient safety. A panel of 10 experts divided the TIVAP by CVCD procedure into 9 steps. A homemade, low-cost ($3 USD) simulator was then designed for practicing standardized procedural steps in the context of a simulation-based mastery learning course. Residents were given a simulator for at-home practice and completed a survey evaluating the simulator and their learning experience. Twenty-eight first-year surgery residents participated in the course and completed the survey. They were highly satisfied with the simulator (mean score = 8.7 of 10) and generally agreed with its anatomical appearance and functional fidelity. They also appreciated the educational value of using this simulator to learn and practice basic techniques and procedural steps. Our novel, homemade simulator of CVCD TIVAP implantation is a cost-effective way of achieving procedural competence of a basic operation for inexperienced surgery residents. We envision the same principle can be applied to other procedures to enhance resident education.
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Affiliation(s)
- Chia-Lin Chen
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | - Yi-Ting Yeh
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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30
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Fazlollahi AM, Bakhaidar M, Alsayegh A, Yilmaz R, Winkler-Schwartz A, Mirchi N, Langleben I, Ledwos N, Sabbagh AJ, Bajunaid K, Harley JM, Del Maestro RF. Effect of Artificial Intelligence Tutoring vs Expert Instruction on Learning Simulated Surgical Skills Among Medical Students: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2149008. [PMID: 35191972 PMCID: PMC8864513 DOI: 10.1001/jamanetworkopen.2021.49008] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE To better understand the emerging role of artificial intelligence (AI) in surgical training, efficacy of AI tutoring systems, such as the Virtual Operative Assistant (VOA), must be tested and compared with conventional approaches. OBJECTIVE To determine how VOA and remote expert instruction compare in learners' skill acquisition, affective, and cognitive outcomes during surgical simulation training. DESIGN, SETTING, AND PARTICIPANTS This instructor-blinded randomized clinical trial included medical students (undergraduate years 0-2) from 4 institutions in Canada during a single simulation training at McGill Neurosurgical Simulation and Artificial Intelligence Learning Centre, Montreal, Canada. Cross-sectional data were collected from January to April 2021. Analysis was conducted based on intention-to-treat. Data were analyzed from April to June 2021. INTERVENTIONS The interventions included 5 feedback sessions, 5 minutes each, during a single 75-minute training, including 5 practice sessions followed by 1 realistic virtual reality brain tumor resection. The 3 intervention arms included 2 treatment groups, AI audiovisual metric-based feedback (VOA group) and synchronous verbal scripted debriefing and instruction from a remote expert (instructor group), and a control group that received no feedback. MAIN OUTCOMES AND MEASURES The coprimary outcomes were change in procedural performance, quantified as Expertise Score by a validated assessment algorithm (Intelligent Continuous Expertise Monitoring System [ICEMS]; range, -1.00 to 1.00) for each practice resection, and learning and retention, measured from performance in realistic resections by ICEMS and blinded Objective Structured Assessment of Technical Skills (OSATS; range 1-7). Secondary outcomes included strength of emotions before, during, and after the intervention and cognitive load after intervention, measured in self-reports. RESULTS A total of 70 medical students (41 [59%] women and 29 [41%] men; mean [SD] age, 21.8 [2.3] years) from 4 institutions were randomized, including 23 students in the VOA group, 24 students in the instructor group, and 23 students in the control group. All participants were included in the final analysis. ICEMS assessed 350 practice resections, and ICEMS and OSATS evaluated 70 realistic resections. VOA significantly improved practice Expertise Scores by 0.66 (95% CI, 0.55 to 0.77) points compared with the instructor group and by 0.65 (95% CI, 0.54 to 0.77) points compared with the control group (P < .001). Realistic Expertise Scores were significantly higher for the VOA group compared with instructor (mean difference, 0.53 [95% CI, 0.40 to 0.67] points; P < .001) and control (mean difference. 0.49 [95% CI, 0.34 to 0.61] points; P < .001) groups. Mean global OSATS ratings were not statistically significant among the VOA (4.63 [95% CI, 4.06 to 5.20] points), instructor (4.40 [95% CI, 3.88-4.91] points), and control (3.86 [95% CI, 3.44 to 4.27] points) groups. However, on the OSATS subscores, VOA significantly enhanced the mean OSATS overall subscore compared with the control group (mean difference, 1.04 [95% CI, 0.13 to 1.96] points; P = .02), whereas expert instruction significantly improved OSATS subscores for instrument handling vs control (mean difference, 1.18 [95% CI, 0.22 to 2.14]; P = .01). No significant differences in cognitive load, positive activating, and negative emotions were found. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, VOA feedback demonstrated superior performance outcome and skill transfer, with equivalent OSATS ratings and cognitive and emotional responses compared with remote expert instruction, indicating advantages for its use in simulation training. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04700384.
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Affiliation(s)
- Ali M. Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Ian Langleben
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Abdulrahman J. Sabbagh
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Bajunaid
- Department of Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Jason M. Harley
- Department of Surgery, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Institute for Health Sciences Education, McGill University, Montreal, Canada
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada
| | - Rolando F. Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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31
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Perin A, Gambatesa E, Galbiati TF, Fanizzi C, Carone G, Rui CB, Ayadi R, Saladino A, Mattei L, Legninda Sop FY, Caggiano C, Prada FU, Acerbi F, Ferroli P, Meling TR, DiMeco F. The "STARS-CASCADE" Study: Virtual Reality Simulation as a New Training Approach in Vascular Neurosurgery. World Neurosurg 2021; 154:e130-e146. [PMID: 34284158 DOI: 10.1016/j.wneu.2021.06.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery. METHODS We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed. RESULTS There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P < 0.005). CONCLUSIONS Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.
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Affiliation(s)
- Alessandro Perin
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Department of Life Sciences, University of Trieste, Trieste, Italy.
| | - Enrico Gambatesa
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Tommaso Francesco Galbiati
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Claudia Fanizzi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Giovanni Carone
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Chiara Benedetta Rui
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Roberta Ayadi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Francois Yves Legninda Sop
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Chiara Caggiano
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Francesco Ugo Prada
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Torstein Ragnar Meling
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; EANS Training Committee, Sint Martens Latem, Belgium; Neurosurgery Department, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico Nazionale "C. Besta", Milan, Italy; EANS Training Committee, Sint Martens Latem, Belgium; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA
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32
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Egashira Y, Enomoto Y, Nakayama N, Fujimura M, Kikkawa Y, Aihara M, Sorimachi T, Mizunari T, Iwama T. Real-world treatment results for ruptured blood-blister aneurysm of the internal carotid artery: analysis of a Japanese nationwide multicenter study. Neurosurg Rev 2021; 44:3539-3546. [PMID: 33851266 DOI: 10.1007/s10143-021-01542-0] [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: 03/02/2021] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Ruptured blood-blister aneurysm (BBA) of the internal carotid artery (ICA) remains a challenging lesion, even in the age of modern neurosurgery and endovascular treatment. This retrospective multicenter study aimed to investigate the real-world treatment choice and treatment results. We included 182 ruptured BBAs of the ICA treated at 51 neurosurgical centers in Japan between 2013 and 2017. The baseline patient characteristics, radiological features of the aneurysm, treatment modality, details of treatment, complications of treatment, and treatment results were retrospectively collected. The treatment strategy was divided into deconstructive and reconstructive procedures. Primary clinical outcomes were evaluated using the modified Rankin scale (mRS) at final follow-up. Direct surgery was performed in 144 (79%) cases, and the remaining 38 (21%) cases received endovascular treatment. The majority of treatment selections were deconstructive and reconstructive procedures in the direct surgery group and endovascular treatment group, respectively. Overall, favorable clinical outcomes (mRS 0 to 2) were achieved in 66% of cases, and the mortality rate was 15% at the final follow-up (mean 23 months). There was no significant difference in clinical outcome between direct and endovascular treatment groups. Our large nationwide study compared the real-world treatment options for ruptured BBAs and their results. Our findings may offer beneficial information for treatment decision and for future studies investigating ruptured BBAs.
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Affiliation(s)
- Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan.
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takayuki Mizunari
- Department of Neurosurgery, Nippon Medical School, Chiba Hokuso Hospital, Inba, Chiba, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan
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