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Chang SY, Chan KS, Oo AM. Can Computerized Simulation be Used to Assess Surgical Proficiency in Laparoscopic Colorectal Surgeries? A Systematic Review. Surg Innov 2024; 31:195-211. [PMID: 38373603 DOI: 10.1177/15533506241232791] [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: 02/21/2024]
Abstract
INTRODUCTION Computerized simulation (CS) of surgery in virtual reality (VR), augmented reality (AR) and mixed reality (MR) settings are used to teach foundational skills, but its applicability in advanced training is to be determined. This review aims to summarize the types of CS available for laparoscopic colorectal surgery (CRS) and its utility in assessment of proficiency. METHODS A systematic review of CS in laparoscopic CRS was done on PubMed, Embase, Scopus and Cochrane Library databases. RESULTS Eleven relevant observational studies were identified. The most common procedure simulated was laparoscopic colectomy. Assessment using performance metrics measured by the simulator such as path length moved by laparoscopic tools, procedure time and number of discrete movements had the most consistent differentiating ability between expert and non-expert cohorts. Surgeons fared similarly in proficiency scores in assessment with CS compared to assessment with traditional cadaveric or porcine models. CONCLUSION CS of laparoscopic CRS may be used in assessment of proficiency using performance metrics measuring economy of movement. CS may be a viable assessment tool in advanced surgical training, but further studies should assess utility of incorporating it as a formal assessment tool in training programs.
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Affiliation(s)
- Si Yuan Chang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- MOH Holdings Pte Ltd, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Aung Myint Oo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Paschold M, Kneist W, Soufiah E, Nissen A, Nikolay J, Seilheimer N, Watzka F, Zimniak L. Keep it simple: a crosshair on the screen during proctored laparoscopic surgeries. Langenbecks Arch Surg 2024; 409:69. [PMID: 38376630 DOI: 10.1007/s00423-024-03255-6] [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: 08/17/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Inside the operating room, experts use verbal instructions to guide surgical novices through laparoscopic procedures. In this study, we evaluated the use of a crosshair attached to the video monitor, as a hands-free pointing tool to simplify instructions during operation. METHODS Ten surgical novices performed two elective laparoscopic cholecystectomies within a week of each other, randomized such that one was performed with and the other without using the crosshair. Directly after operation, questionnaires were completed by the novices and the consultant surgeons. Measures including the comprehensibility of instructions, subjective feeling of safety during preparation, time delays due to different instruction options, and disruptive influence while instructors used the crosshair. Differences in operative performance were evaluated based on the global operative assessment of laparoscopic skills (GOALS) scores. RESULTS When the crosshair was used, surgical novices had a better understanding of which anatomical structure should be shown (p = 0.028). Operating time (p = 0.222) and feeling of confidence during preparation did not differ with versus without crosshair use (p = 0.081). All participants stated that the crosshair did not negatively affect the field of vision. In terms of the median GOALS score, the operative performance was improved when the crosshair was used compared with verbal instructions only (median 15, IQR (11; 21) vs. median 12, IQR (5; 19), p < 0.001). CONCLUSION The crosshair is a simple, inexpensive, and widely available method to improve communication between instructors and novices in everyday training.
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Affiliation(s)
- Markus Paschold
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany.
| | - Werner Kneist
- Department of General and Visceral Surgery, Klinikum Darmstadt, Grafenstraße 9, 64283, Darmstadt, Germany
| | - Edwar Soufiah
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
| | - Arnold Nissen
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
| | - Johannes Nikolay
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
| | - Natalie Seilheimer
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
| | - Felix Watzka
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
| | - Lennart Zimniak
- Department of General and Visceral Surgery, St. Marienwoerth Hospital, Muehlenstr. 39, 55543, Bad Kreuznach, Germany
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Liang JZ, Ng DKW, Raveendran V, Teo MYK, Quah ELY, Chua KZY, Lua JK, Owyong JLJ, Vijayan AV, Abdul Hamid NAB, Yeoh TT, Ong EK, Phua GLG, Mason S, Fong W, Lim C, Woong N, Ong SYK, Krishna LKR. The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review. PLoS One 2024; 19:e0296367. [PMID: 38181035 PMCID: PMC10769105 DOI: 10.1371/journal.pone.0296367] [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: 06/07/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024] Open
Abstract
Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.
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Affiliation(s)
- Jonathan Zhen Liang
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Donovan Kai Wei Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Mac Yu Kai Teo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Ting Ting Yeoh
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Assisi Hospice, Singapore, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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Feenstra TM, van der Storm SL, Barsom EZ, Bonjer JH, Nieveen van Dijkum EJ, Schijven MP. Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis. Surg Open Sci 2023; 16:100-110. [PMID: 37830074 PMCID: PMC10565595 DOI: 10.1016/j.sopen.2023.10.002] [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: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach. Methods Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical. Results The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills. Conclusion While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula. Key message This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
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Affiliation(s)
- Tim M. Feenstra
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Sebastiaan L. van der Storm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z. Barsom
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Jaap H. Bonjer
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Els J.M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
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Siu M, Debbink K, Duda A, Orthopoulos G, Romanelli J, Wu J, Seymour NE. Expert laparoscopist performance on virtual reality simulation tasks with and without haptic features. Surg Endosc 2023; 37:8748-8754. [PMID: 37563347 DOI: 10.1007/s00464-023-10321-5] [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: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback's effect on skill development. Our objective is to compare expert laparoscopists' skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces. METHODS Five expert laparoscopists performed seven skills tasks on two laparoscopic simulators, one with and one without haptic features. Tasks consisted of 2-handed instrument navigation, retraction and exposure, cutting, electrosurgery, and complicated object positioning. Laparoscopists alternated platforms at default difficulty settings. Metrics included time, economy of movement, completed task elements, and errors. Progressive change in performance for the final three iterations were determined by repeated measures ANOVA. Iteration quartile means were determined and compared using paired t-tests. RESULTS No change in performance was noted in the last three iterations for any metric. There were no significant differences between platforms on the final two quartiles for most metrics except avoidance of over-stretch error for retraction; and cutting task was significantly better with haptics on all iteration quartiles (p < 0.03). Economy of movement was significantly better with haptics for both hands for clip application (p < 0.01) and better for right hand on complex object positioning (p < 0.05). Accuracy was better with haptics for retraction and cutting (p < 0.05) and clip application (p < 0.05). CONCLUSION Results showed higher performance in accuracy, efficient instrument motion, and avoidance of excessive traction force on selected tasks performed on VR simulator with haptic feedback compared to those performed without haptics feedback. Laparoscopic surgeons interpreted machine-generated haptic cues appropriately and resulted in better performance with VR task requirements. However, our results do not demonstrate an advantage in skills acquisition, which requires additional study.
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Affiliation(s)
- Margaret Siu
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Kaitlin Debbink
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Amanda Duda
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - George Orthopoulos
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - John Romanelli
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Jacqueline Wu
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Neal E Seymour
- Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA.
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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Shi H, Lu P, Yu D, Wang J, Wang Z, Zhuang B, Shao C, Liu C, Liu B. The training of wrist arthroscopy. Front Med (Lausanne) 2022; 9:947459. [PMID: 36590938 PMCID: PMC9800421 DOI: 10.3389/fmed.2022.947459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.
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Affiliation(s)
- Haifei Shi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pan Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Pan Lu
| | - Dongdong Yu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiwen Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Zhenhua Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Baotang Zhuang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chao Shao
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chang Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China,*Correspondence: Bo Liu
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Ojala S, Sirola J, Nykopp T, Kröger H, Nuutinen H. The impact of teacher's presence on learning basic surgical tasks with virtual reality headset among medical students. MEDICAL EDUCATION ONLINE 2022; 27:2050345. [PMID: 35262467 PMCID: PMC8920371 DOI: 10.1080/10872981.2022.2050345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/26/2021] [Accepted: 03/03/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND The aim of this study was to investigate whether the presence of a teacher affects learning related outcomes in teaching basic surgical tasks with a Virtual Reality (VR) headset. METHODS 26 fourth-year medical studentsparticipated in a voluntary exercise. Students practiced basic surgical procedure exercises using the VR4HEALTHCARE application in VR with OCULUS Rift S glasses. 12 students performed the exercises under the guidance of a teacher and 14 without the teacher present. After the exercise, the groups filled out a feedback form. Statistical analysis was performed using IBM SPSS Statistics 25.0 software using the Mann-Whitney U test and multivariate analysis of variance. RESULTS The most important data collected related to whether the student learned something new and whether VR adds value to medical education. Ratings were based on a scale of 0-10 (0 = worst, 10 = best). When the teacher was present, on average, the students felt that they were learning something new and gave an average rating of 7.8 ± 1.8, and when the teacher was not present 5.3 ± 2.6 (p = 0.003). VR added value to teaching with a rating of 7.8 ± 1.7 when the teacher was present and 5.5 ± 3.0 when not present (p = 0.045). This study also analyzed specific use of VR for abscess incision, suturing and insertion of a suprapubic catheter. DISCUSSION When a teacher was present VR added value to teaching and the usefulness and usability of VR was experienced more positively. The student should also have adequate knowledge of the subject to be taught before VR training. CONCLUSIONS VR adds value to teaching, but VR exercises may not completely replace high-quality traditional teaching methods. Consequently, it is important to determine the differences between VR and traditional teaching methods and how to combine these methods in the future.
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Affiliation(s)
- Sofianna Ojala
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Timo Nykopp
- Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Heikki Kröger
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Henrik Nuutinen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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Wilson CA, Davidson J, Chahine S, Chan EP, Stringer L, Quantz MA, Saklofske DH, Wang PZT. What is Transferred and How Much is Retained? A Simulation Study of Complex Surgical Skills. J Surg Res 2022; 280:411-420. [PMID: 36041341 DOI: 10.1016/j.jss.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/29/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Studies indicate that learning surgical skills on low-fidelity models is equally beneficial to learning on high-fidelity models in terms of skills retention and transfer. However, it is unclear how low-fidelity simulation training impacts retention and transfer in novice learners, particularly on complex surgical tasks that incorporate multiple challenging skills. This study explores the capacity of complete novices to learn and transfer complex surgical skills from a low-fidelity model to a high-fidelity simulation after a delay. METHODS Task-naïve medical and nonmedical undergraduate students (n = 62) participated in a three-phase prospective double-arm randomized (2:1) experimental study. Participants completed two skills training sessions (end-to-side anastomosis) on a low-fidelity bench model. After a 4-week delay, participants completed the task again either using the low-fidelity model or a high-fidelity model (cadaver) and were assessed using a validated checklist. RESULTS There was a significant time × fidelity group interaction (P = 0.004). Simple effects analysis indicated the high-fidelity group (Mdiff = 4.18, P < 0.001) performed significantly worse (P = 0.003) in phase 3 relative to phase 2 compared to the low-fidelity group (Mdiff = 0.75, P = 0.39). Post hoc logistic regression analysis indicated that radial suturing technique and economy of motion skills were less likely to be completed correctly for those in the high-fidelity group. CONCLUSIONS These findings suggest that for novice populations, relying on low-fidelity simulation training as a source of teaching complex skills may not provide a reliable transfer to high-fidelity models and in turn clinical settings.
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Affiliation(s)
- Claire A Wilson
- Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Saad Chahine
- Faculty of Education, Queen's University, Kingston, Ontario, Canada
| | | | - Leandra Stringer
- Department of Surgery, Western University, London, Ontario, Canada
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Jeffries S, Watt A, Harutyunyan R, Cyr S, Denis R, Hemmerling TM. The Development of a Novel Bariatric Laparoscopic Simulator. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:633-636. [PMID: 36085639 DOI: 10.1109/embc48229.2022.9871246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bariatric surgery presents a specific challenge in surgical education; simulators need to take into account the specific technical difficulties related to the patient population but also to various types of surgery. We interviewed several leaders in the fields of bariatric and general surgery with experience in laparoscopic surgery and developed a bariatric-specific laparoscopic simulator. This novel simulator was constructed using a variety of silicone-based materials and 3D printing techniques to be reusable and adjustable for a variety of procedures, with no essential components being disposed of following each use. Expert surgeons (n=4) with knowledge on bariatric procedures were recruited and asked to perform a simple simulated laparoscopic procedure. Following testing, participants were asked to complete a survey and rate the simulator based on its physical attributes, global realism, usefulness in improving surgical skills, and overall surgical experience. Face and content validation outcomes based on the questionnaire evaluations completed by expert surgeons showed very good results, with an overall mean score of 4.3 out of 5 (86%). These preliminary results highlight the potential for the simulator's application as a tool to improve bariatric surgical education and patient outcomes.
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Xu J, Zhou Z, Chen K, Ding Y, Hua Y, Ren M, Shen Y. How to minimize the impact of COVID-19 on laparoendoscopic single-site surgery training? ANZ J Surg 2022; 92:2102-2108. [PMID: 35594058 PMCID: PMC9347803 DOI: 10.1111/ans.17819] [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: 09/21/2021] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
Background Because of special technical challenges, laparoendoscopic single‐site surgery (LESS) has been introduced into surgical practice, with surgeons required to have adequate training. The COVID‐19 pandemic has significantly affected every aspect of healthcare systems, including LESS training, which must be modified to minimize the impact of the COVID‐19 pandemic. Methods A 3‐session training programme was designed in 2020 during the epidemic, which was modified in 2019 before the pandemic. Session 1 was an online study on LESS knowledge. Session 2 involved the trainees' self‐directed simulator‐training. Task performance was evaluated using the fundamentals of laparoscopic surgery (FLS) scoring. Session 3 was practical training, including trainers' live surgical video demonstrations and trainees' surgical video feedback after training. Video feedback performance was evaluated using the modified global rating scale (GRS). Furthermore, trainees completed a general self‐efficacy (GSE) instrument. Forty‐two gynaecology trainees were allocated into two groups: novices (n = 32) and experts (n = 10). Results Compared with pre‐training, FLS scores improved in peg transfer (P < 0.001 and P = 0.01) and pattern cutting (P = 0.02 and P < 0.001) for novices and experts, respectively. Participants (81% versus 67%) provided first and second video feedback, respectively. Compared to the first feedback, the GRS scores of both groups improved significantly in the second feedback. All trainees showed an increase in GSE after training (P < 0.001). Conclusion The modified LESS training programme is a practical and effective option that allows trainees to continue training during the epidemic.
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Affiliation(s)
- Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhihao Zhou
- Department of Emergency, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kai Chen
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Howard University Hospital, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Yue Ding
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, China
| | - Yue Hua
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, China
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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12
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Tudor Car L, Poon S, Kyaw BM, Cook DA, Ward V, Atun R, Majeed A, Johnston J, van der Kleij RMJJ, Molokhia M, V Wangenheim F, Lupton M, Chavannes N, Ajuebor O, Prober CG, Car J. Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda. J Med Internet Res 2022; 24:e31977. [PMID: 35297767 PMCID: PMC8972116 DOI: 10.2196/31977] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. OBJECTIVE This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. METHODS We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. RESULTS We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). CONCLUSIONS We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Selina Poon
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - David A Cook
- Office of Applied Scholarship and Education Science, School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victoria Ward
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, MA, United States
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Johnston
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Mariam Molokhia
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Florian V Wangenheim
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Lupton
- Faculty of Medicine, Imperial College London, London, United Kingdom.,The Chelsea and Westminster Hospital, Chelsea, London, United Kingdom
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Onyema Ajuebor
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Charles G Prober
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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13
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Kantamaneni K, Jalla K, Renzu M, Jena R, Kannan A, Jain R, Muralidharan S, Yanamala VL, Zubair Z, Dominic JL, Win M, Tara A, Ruo SW, Alfonso M. Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review. Cureus 2021; 13:e17239. [PMID: 34540465 PMCID: PMC8447854 DOI: 10.7759/cureus.17239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
Latest advancements in science lead to drastic improvements in patient health care. Techniques and technology evolved in surgery over the years have resulted in the improvement of patient outcomes by leaps and bounds. Open surgeries previously done for procedures like appendectomy and cholecystectomy evolved into laparoscopic minimally invasive procedures. Such procedures pose few challenges to the surgeons, like lack of tissue feedback and fulcrum effect of the abdominal wall. But training surgeons for such an advanced skill is still following conventional methods. These procedures can be effectively trained using Virtual Reality (VR), which can simulate operations outside the operating room (OR). To maximize the outcomes of VR training, knowledge on various strategies affecting the skills acquisition and retention in VR training is essential. This review collected information from PubMed, EMBASE, Cochrane Library (CENTRAL) databases. Data from the previous ten years are included in the review. This included documents, clinical trials, meta-analysis, randomized controlled trials, reviews, systematic reviews, letters to editors, and grey literature. After an advanced Medical Subject Headings (MeSH) search, we got 59,532 results, and after the application of filters, 189 results showed up. Out of these, studies that were not exclusively relevant to the use of VR in laparoscopic surgery were manually excluded, and a total of 35 articles were included in the study. VR is found to be an excellent training modality with promising outcomes. It helps the surgeons perform the surgery accurately at a faster pace and improves confidence and multitasking ability in OR. Instructor feedback from mentors and deliberate practice of trainees, and early introduction of haptics in VR resulted in the most effective outcomes of the VR training. Box trainers are also compared with VR trainers as they are the cheaper modalities of training. However, this area needs more research to conclude if box trainers can act as a cheaper alternative to VR training providing similar outcomes.
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Affiliation(s)
- Ketan Kantamaneni
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, IND
| | - Krishi Jalla
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mahvish Renzu
- Internal medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rahul Jena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amudhan Kannan
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ruchi Jain
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Suchitra Muralidharan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijaya Lakshmi Yanamala
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zainab Zubair
- Dermatology, California Institute of Behavioural Neurosciences & Psychology, Fairfield, USA
| | - Jerry Lorren Dominic
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Stony Brook Medicine/Southampton Hospital, New York, USA.,General Surgery and Orthopaedic Surgery, Cornerstone Regional Hospital/South Texas Health System, Edinburg, Texas, USA.,General Surgery, Vinayaka Mission's Kirupananda Variyar Medical College, Salem, IND
| | - Myat Win
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Sheila W Ruo
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Michael Alfonso
- School of Medicine, Universidad del Rosario, Bogota, COL.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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14
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Consorti F, Panzera G. Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:422-427. [PMID: 35515747 PMCID: PMC8936611 DOI: 10.1136/bmjstel-2020-000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022]
Abstract
Background Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results. Objectives The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes. Study selection We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model. Findings We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (−0.19, 95% CI −0.44 to 0.06) and for time (−0.14, 95% CI −0.54 to 0.27). Conclusion Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.
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Affiliation(s)
- Fabrizio Consorti
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| | - Gianmarco Panzera
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
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15
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Yang J, Hu M, Shi X, Zhao D, Yu L. Deformation modeling based on mechanical properties of liver tissue for virtuanormal vectors of trianglesl surgical simulation. Int J Comput Assist Radiol Surg 2021; 16:253-267. [PMID: 33409837 DOI: 10.1007/s11548-020-02297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE In this paper, a method for rapidly constructing a virtual surgical simulation system is proposed. A deformation model based on the mechanical properties of the liver and a rapid collision detection between the surgical micro-instruments and the liver tissue are included in this method. The purpose of this work is to improve the accuracy and real time of particle model deformation interaction in virtual surgery system. METHODS Firstly, a finite element model is established based on the constitutive model parameters of liver tissue. According to the simulation results, a mathematical model of node displacement is established. Secondly, the virtual liver is established based on the fast model reconstruction method, and the virtual manipulator is controlled by Geomagic Touch manipulator. Based on the hybrid bounding box, a rapid collision detection process between the instrument and liver is realized and the proposed deformation method is used to simulate the deformation of liver tissue. RESULTS The simulation and experiment results show that the proposed deformation model can achieve high deformation interaction accuracy. The collision detection algorithm based on the hybrid bounding boxes can realize the collision between the liver and the instrument, and the established virtual surgical simulation system can simulate the liver tissue deformation in the case of small loading displacement. CONCLUSIONS The effectiveness of the collision detection algorithm and deformation model was verified by an established virtual surgery simulation system. The proposed rapid construction method of virtual surgical simulation is feasible.
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Affiliation(s)
- Jing Yang
- Faculty of Mechanical Engineering and Automation, Zhejiang Sci-Tech University, Hangzhou, Zhejiang Province, China
| | - Ming Hu
- Faculty of Mechanical Engineering and Automation, Zhejiang Sci-Tech University, Hangzhou, Zhejiang Province, China.
| | - Xinge Shi
- Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Deming Zhao
- Faculty of Mechanical Engineering and Automation, Zhejiang Sci-Tech University, Hangzhou, Zhejiang Province, China
| | - Lingtao Yu
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, Heilongjiang Province, China
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16
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Jin C, Dai L, Wang T. The application of virtual reality in the training of laparoscopic surgery: A systematic review and meta-analysis. Int J Surg 2020; 87:105859. [PMID: 33307244 DOI: 10.1016/j.ijsu.2020.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality becomes popular in laparoscopic surgery especially in the training process. An assessment on the learning curve of virtual reality compared to other methods of training or no training needed to be carried out. MATERIALS AND METHODS A systematic literature search between 2000 and 2020 was performed through PubMed, Cochrane library's Central, Embase, Clinicaltrials.gov, and Web of Science. All randomized controlled studies included kept the consistency of participants at the baseline and set the same time or repetitions of training. This systematic review and meta-analysis was under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the methodological quality of systematic reviews(AMSTAR). RESULTS Twenty-three randomized controlled studies and five non-randomized concurrent controlled studies were included among 2692 searched studies. Virtual reality was recommended to be applied among no experience medical students or novice surgeons in the laparoscopic training. It had steeper learning curve compared to no training and traditional trainers. While there was no significant difference between virtual reality and box training or video training in the aspect of learning curve. Moreover, it seemed effective to improve the initial stage of learning curve in actual surgery. CONCLUSION Virtual reality was not the first choice to be applied into laparoscopic training and it had its applicable surgeons or medical students. The superiority of virtual reality in the skill transfer from training room into operating room needed to be confirmed and complemented with further analyses. More importantly, the cost-effectiveness of virtual reality in the training process and patient safety were badly in need of discussion.
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Affiliation(s)
- Chi Jin
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, , China; Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, China
| | - Liuyan Dai
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, , China
| | - Tong Wang
- Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, China.
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17
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Preoperative tracheal resection and reconstruction simulations with patient-specific three-dimensional models. Gen Thorac Cardiovasc Surg 2020; 69:593-596. [PMID: 33123845 DOI: 10.1007/s11748-020-01531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Three-dimensional (3D) printers are increasingly being used for a variety of applications. In the surgical field, patient-specific organ models are increasingly being used as preoperative simulators for complicated surgeries. In this study, we describe the use of patient-specific 3D models for tracheal resection. We performed preoperative simulations for two patients diagnosed with tracheal ganglioneuroma and adenoid cystic carcinoma; the mimic operations suggested the necessity of a short cuff intubation tube across the surgical field, indicating the recommended amount of dissection around the trachea and bilateral hilum prior to tracheal reconstruction. The postoperative courses were free from any anastomotic or pulmonary complications. We described the availability of preoperative simulations for complicated tracheal resection and reconstruction using patient-specific 3D printed models. Mimic operations using the 3D printed models allowed accurate preparation and confidence in selection of the optimal surgical strategy.
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18
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Impact of the COVID-19 Pandemic on Student and Resident Teaching and Training in Surgical Oncology. J Clin Med 2020; 9:jcm9113431. [PMID: 33114552 PMCID: PMC7692303 DOI: 10.3390/jcm9113431] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has tremendously changed private and professional interactions and behaviors worldwide. The effects of this pandemic and the actions taken have changed our healthcare systems, which consequently has affected medical education and surgical training. In the face of constant disruptions of surgical education and training during this pandemic outbreak, structured and innovative concepts and adapted educational curricula are important to ensure a high quality of medical treatment. While efforts were undertaken to prevent viral spreading, it is important to analyze and assess the effects of this crisis on medical education, surgical training and teaching at large and certainly in the field of surgical oncology. Against this background, in this paper we introduce practical and creative recommendations for the continuity of students’ and residents’ medical and surgical training and teaching. This includes virtual educational curricula, skills development classes, video-based feedback and simulation in the specialty field of surgical oncology. In conclusion, the effects of COVID 19 on Surgical Training and Teaching, certainly in the field of Surgical Oncology, are challenging.
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19
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Abstract
Resources are available for remote laparoscopic and basic surgical training, including core skills, psychomotor, visual–spatial, and cognitive, to improve gaps in surgical training during the coronavirus disease 2019 (COVID-19) pandemic. The coronavirus disease 2019 (COVID-19) pandemic has created a unique educational circumstance in which medical students, residents, and fellows find themselves with a gap in their surgical training. We reviewed the literature, and nine categories of resources were identified that may benefit trainees in preventing skill decay: laparoscopic box trainers, virtual reality trainers, homemade simulation models, video games, online surgical simulations, webinars, surgical videos, smartphone applications, and hobbies including mental imagery. We report data regarding effectiveness, limitations, skills incorporated, cost, accessibility, and feasibility. Although the cost and accessibility of these resources vary, they all may be considered in the design of remote surgical training curricula during this unprecedented time of the COVID-19 pandemic.
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20
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Templin R, Tabriz N, Hoffmann M, Uslar VN, Lück T, Schenk A, Malaka R, Zachmann G, Kluge A, Weyhe D. Case Report: Virtual and Interactive 3D Vascular Reconstruction Before Planned Pancreatic Head Resection and Complex Vascular Anatomy: A Bench-To-Bedside Transfer of New Visualization Techniques in Pancreatic Surgery. Front Surg 2020; 7:38. [PMID: 32626723 PMCID: PMC7314924 DOI: 10.3389/fsurg.2020.00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Bühler's anastomosis (or Bühler's arcade) is an embryonic relic and represents an arterio-arterial connection between the superior mesenteric artery and the celiac trunk. It can be found as a variety in 1–2% of patients. Case Presentation: We present a case of a patient with metatastatic squamous cell carcinoma of the lung. The patient was in stable disease for 4 years under palliative therapy (most recently second-line therapy with Nevolumab). In 2019, a locally advanced adenocarcinoma of the papilla vateri was diagnosed, additionally. The patient also underwent right hemicolectomy and patch plasty of the celiac trunk and superior mesenteric artery due to colonic ischemia and arteriosclerotic disease with 50–70% stenosis of the superior mesenteric artery several years ago. Due to a complex vascular prehistory, the standardized preoperative imaging was supplemented by two independent vascular reconstructions (a CT angiogram and a reconstruction based on the CT) for the planning of a pylorus-preserving pancreatic head resection and reconstruction according to Traverso-Longmire. In addition, a 3D print was produced. Both, the reconstruction based on the CT scan and the 3D print were created for off-label use as a part of a research project (VIVATOP: Versatile Immersive Virtual and Augmented Tangible OP). Discussion: In the standardized CT scan and in the clinical CT-angiography, there were no obvious surgically relevant anatomical variations. A Bühler anastomosis was detected in a digital, virtual and interactive 3D-reconstruction. In addition, in the 3D print of the abdominal site the anastomosis was seen as well. Intraoperatively, the presence of Bühler's anastomosis was confirmed. This information had a significant impact on the intraoperative approach. Retrospectively, the vessel variant could be surmised in the axial projection of the CT scan, if one knew what to look for. Conclusion: For the conduction of a safe surgical procedure, it is imperative that rare anatomical variations are known preoperatively. Increasing digitalization in surgical and perioperative preparation holds great potential for better planning and improved patient safety. Research and cooperation projects such as the VIVATOP project are instrumental for the development of new visualization techniques, which are able to enhance the understanding of complex anatomical relations.
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Affiliation(s)
- Robert Templin
- University Hospital for Visceral Surgery, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Navid Tabriz
- University Hospital for Visceral Surgery, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Martin Hoffmann
- University Hospital for Visceral Surgery, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Verena Nicole Uslar
- University Hospital for Visceral Surgery, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Andrea Schenk
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Rainer Malaka
- Digital Media Lab, University of Bremen, Bremen, Germany
| | - Gabriel Zachmann
- Computer Graphics and Virtual Reality, University of Bremen, Bremen, Germany
| | - Alexander Kluge
- Department of Diagnostic and Interventional Radiology, Pius-Hospital, Oldenburg, Germany
| | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius-Hospital, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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21
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Berg H, Steinsbekk A. Is individual practice in an immersive and interactive virtual reality application non-inferior to practicing with traditional equipment in learning systematic clinical observation? A randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:123. [PMID: 32326948 PMCID: PMC7181571 DOI: 10.1186/s12909-020-02030-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/01/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND The aim was to investigate if individual self-practice of the ABCDE approach (Airways, Breathing, Circulation, Disability, Exposure) in an immersive and interactive virtual reality (VR) application gave non-inferior learning outcome compared to using traditional equipment (TP) in first year medical and nursing students. METHODS A non-inferior parallel group randomized controlled trial. The study was linked to a regular teaching program conducted in August and September 2019. All students participated in a 15-min ABCDE introduction session, before they self-practiced the ABCDE approach for 20 min in either a fully immersive and interactive VR application using hand controllers with some haptic feedback (Individual VR) or with blood pressure gauge, ear-thermometer and oximeter (Individual TP). The primary outcome was the number of students who documented all the eight predefined observations in the ABCDE approach in the correct order in a practical test on an advanced simulator manikin with a time limit of 5 min, done immediately after the self-practice. The predefined one-sided non-inferiority limit was 13% points. RESULTS Of all eligible students, 84% participated in the study and randomly allocated to VR (n = 149) or TP (n = 140). The primary outcome showed non-inferiority of the VR application with 24.8% in individual VR doing all observations in correct order compared to 27.1% TP (absolute difference 2.3% points, one sided 95% CI 2.3 to 10.8). The secondary outcomes were similar between the groups, but more students in VR reported liking the way they practiced (absolute difference 46% points, 95% CI 36.5 to 56.6) and that it was a good way to learn (36.9% points, 95% CI 26.8 to 47). VR also scored high on the System Usability Scale (mean difference 6.4% points, 95% CI 2.8-10.1). CONCLUSIONS Individual self-practicing the ABCDE approach in VR was non-inferior to individual self-practicing with traditional equipment.
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Affiliation(s)
- Helen Berg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway
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22
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Abstract
PURPOSE OF REVIEW To review the cardiac surgical simulation experience with a focus on data supporting its use. RECENT FINDINGS Simulators have been used to improve trainee performance across multiple surgical domains. Few cardiac surgery residency programs have incorporated the use of simulation individually and Boot Camp programs in the United States and Canada have also introduced surgical simulation early in cardiac surgical training. Simulation curricula have some common elements: component tasks, deliberate practice, progressive operative responsibility, and coaching by an experienced surgeon. Cardiac surgical simulators can range from inexpensive, low-fidelity models for the practice of isolated skills to high-fidelity, operating room-scenarios. Multiple small studies have consistently demonstrated that the use of simulation improves qualitative and quantitative performance measures as well as overall resident confidence in clinical settings. To our knowledge, no study has demonstrated that use of simulation has led to improved quantitative performance measures in the operating room or patient outcomes. The barriers to wider use of surgical simulators include perceived lack of time and resources, the need for sustained practice and the lack of high-quality data to demonstrate clinical benefit. SUMMARY Incorporation of cardiac surgery simulation has been slow in most residency programs. There is consistent data demonstrating that simulation improves resident performance measures of simulation-based tasks but whether this will lead to improved patient outcomes remains an open question.
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Oussi N, Enochsson L, Henningsohn L, Castegren M, Georgiou E, Kjellin A. Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor. J Surg Res 2020; 250:1-11. [PMID: 32014696 DOI: 10.1016/j.jss.2019.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Training using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents' laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students. MATERIALS AND METHODS Sixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer-virtual reality (MIST-VR) simulator, finalizing a questionnaire. RESULTS More Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students' performance in the MIST-simulator. No such correlations were found in the LapMentor group. CONCLUSIONS Results indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students' performance in the MIST-VR simulator, with some gender-specific differences.
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Affiliation(s)
- Ninos Oussi
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
| | - Lars Enochsson
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Lars Henningsohn
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Urology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Markus Castegren
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Sweden
| | - Evangelos Georgiou
- Medical Physics Laboratory and Simulation Center, Medical School, University of Athens, Athens, Greece
| | - Ann Kjellin
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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Lesch H, Johnson E, Peters J, Cendán JC. VR Simulation Leads to Enhanced Procedural Confidence for Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2020; 77:213-218. [PMID: 31466895 PMCID: PMC8041454 DOI: 10.1016/j.jsurg.2019.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 08/04/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Active learning techniques result in greater knowledge acquisition compared to passive methods. For medical students with limited hands-on operative experiences, virtual reality platforms represent active learning and may enhance procedural training. We hypothesize that virtual reality simulators like Toolkit for Illustration of Procedures in Surgery (TIPS) are a more effective modality in teaching laparoscopic surgical techniques to medical students when compared to passive learning tools like videos. DESIGN In this crossover study, participants were randomly assigned to perform either a TIPS laparoscopic appendectomy followed by video of a laparoscopic cholecystectomy, or video of a laparoscopic appendectomy followed by TIPS laparoscopic cholecystectomy. A knowledge assessment followed each intervention. A postsurvey was used to gather feedback and subjective impressions of the learning experience. SETTING University of Central Florida College of Medicine. PARTICIPANTS Second, third, and fourth-year medical students (n = 37). RESULTS Validation of the content assessments revealed strong internal consistency (Cronbach's α = 0.73). A 2-tailed Fisher's exact test revealed that the video had greater ease of use (p = 0.032), but TIPS had greater utility as a learning tool (p < 0.001) and instilled greater confidence in the ability to reproduce procedural steps (p < 0.001). A 2-tailed t test of the average content quiz scores revealed no significant difference in percentage correct between groups on the laparoscopic appendectomy quiz (p = 0.772), but a difference favoring video learning on the laparoscopic cholecystectomy quiz (p = 0.042) CONCLUSIONS: Video and TIPS both enhanced different aspects of student learning; however, the active TIPS platform produced greater confidence in the ability to reproduce the steps of the procedure and had greater utility as a learning strategy. Videos are simple to use and can serve a complementary role in curriculum design.
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Affiliation(s)
- Heather Lesch
- University of Central Florida College of Medicine, Orlando, Florida
| | - Evan Johnson
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jörg Peters
- University of Florida College of Engineering, Gainesville, Florida
| | - Juan C Cendán
- University of Central Florida College of Medicine, Orlando, Florida.
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Assessing practical laparoscopic training in certified Training Centers of the Gynecological Endoscopy Working Group (AGE) of the German Society of Gynecology and Obstetrics (DGGG). Arch Gynecol Obstet 2019; 300:957-966. [PMID: 31435777 PMCID: PMC6759625 DOI: 10.1007/s00404-019-05263-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
Purpose This study was performed to assess the practical laparoscopic training in Gynecological Endoscopy Working Group (AGE) certified Training Centers (TC) and evaluate the possible implementation for a manual dexterity skills-training within the Minimal Invasive Surgery (MIC) certification process. Material and methods An online questionnaire was developed and the link provided for the heads of the AGE TC. The questionnaire comprised topics on TC organization, practical training performance and perspectives for future training and demographic data. Results Response rate was 78.9% (15/19) of AGE TC. Grasping for the basic and suturing exercises for the advanced curricula, respectively, are thought to be of highest value (each 1.0 ± 0, on a scale from 1 = very valuable to 6 = not at all valuable). Most valuable parameter in assessing training was thought to be pressure/tension with 1.80 ± 1.08 The most valuable training capacity was considered for box training under supervision (1.27 ± 0.59) and feed-back box training with direct evaluation of various surgical skills (1.40 ± 0.63). Supervised box training was also thought to have the most positive influence on surgical performance (1.33 ± 0.49). The majority of respondents (86.7%) were qualified with the highest MIC certification and additional 66.7% were sub-specialized Gynecological Oncologists. Conclusion The AGE certified TC offer a structured curriculum with emphasis on practical training. The results of this questionnaire and the additional respondents comments on value and future perspectives/changes of practical training support the concept and the implementation of a skills-training to the AGE MIC concept.
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Bojanic C, To K. Letter to the editor on the article “Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis”. Int J Surg 2019; 67:87-88. [DOI: 10.1016/j.ijsu.2019.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/01/2022]
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Guedes HG, Ferreira ZMCC, Leão LRS, Montero EFS, Otoch JP, Artifon ELA. Reply letter to: Letter to the editor on the article "Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis". Int J Surg 2019; 67:89-90. [PMID: 31125661 DOI: 10.1016/j.ijsu.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H G Guedes
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil.
| | - Z M C C Ferreira
- Potiguar University, Senador Salgado Filho Avenue, number 1610, Lagoa Nova, Natal, RN, 59056-000, Brazil
| | - L R S Leão
- Hospital Israelita Albert Einstein, Albert Einstein Avenue, number 627/701, Morumbi, São Paulo, SP, 05652-900, Brazil
| | - E F S Montero
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
| | - J P Otoch
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
| | - E L A Artifon
- General Surgery Department, University of Sao Paulo School of Medicine, Carvalho Aguiar Street, number 255, São Paulo, SP, 05422-090, Brazil
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