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Araújo Silva D, Szutan LA, Zandonai AP. Assessment of the evolution of psychomotor skills in the robotic surgery simulation process. J Robot Surg 2024; 18:317. [PMID: 39123078 DOI: 10.1007/s11701-024-02069-4] [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: 07/07/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Robotic surgery is a rapidly expanding field, given the wide variety of new robotic platforms emerging. Looking at the training of surgeons in robotic surgery is of extreme necessity and urgency, considering the ongoing technological advancements. In this research, the performance during the virtual reality simulation phase of training for robotic surgery was analyzed. It was observed that, in addition to the lack of consensus among societies regarding the required simulation hours, there is no guidance on the best curriculum to be adopted. From the data in this study, it can be inferred that the more advanced skills have fewer proficient individuals, meaning that fewer surgeons in training have reached proficiency in all skill exercises. Even with differences in the number of exercises performed proficiently between groups that underwent varying amounts of simulation time, there is no statistically significant difference in the proportion between them.
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Affiliation(s)
- Danilo Araújo Silva
- Postgraduate, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Doutor Cesário Motta Junior Street, 61, São Paulo, São Paulo, 01221-020, Brazil.
| | - Luiz Arnaldo Szutan
- Digestive System Surgery, Hospital da Santa Casa de Misericórdia de São Paulo, Doutor Cesário Motta Junior Street, 112, São Paulo, São Paulo, 01221-020, Brazil
| | - Alexandra Paola Zandonai
- Postgraduate, Universidade de São Paulo (USP), Da Reitoria,374, São Paulo, São Paulo, 05508-220, Brazil
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2
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Katz D, Hyers B, Patten E, Sarte D, Loo M, Burnett GW. Relationship between demographic and social variables and performance in virtual reality among healthcare personnel: an observational study. BMC MEDICAL EDUCATION 2024; 24:227. [PMID: 38439056 PMCID: PMC10981290 DOI: 10.1186/s12909-024-05180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Virtual reality is emerging as an important component of medical education. Although the benefits of virtual reality are apparent, the optimal strategy to orient to or differentiate learners in the virtual space have not been delineated. The purpose of this study was to investigate the relationships between demographic variables, social variables, and self-perceived comfort with technology to performance on a standardized non-medical virtual reality experience. METHODS This observational study was performed at the International Meeting on Simulation in Healthcare in 2022. This conference includes medical and non-medical attendees. Participants provided demographic information and participated in a scored non-medical VR experience due to the heterogeneity of the sample. Participants then completed a System Usability Index and NASA Task Load Index form. Participants were dividedintolow scoring, medium scoring, and high scoring groups according to their final game score for further analysis. RESULTS 95 participants were included in final analysis. 55 (57.9%) of participants had prior virtual reality experience. Higher scores were associated with younger age (11.09, p < 0.001), identifying as male (11.09, p < 0.001), and a higher frequency of playing video games in the past (18.96, p < 0.001). The high score group was more likely to report comfort with virtual reality (6.29, p = 0.003) as well as comfort with new technology (4.61, p = 0.012). NASA Task Load Index scores trended down and System Usability Index scores trended up with increasing score. Being a nurse was a positive predictor of a higher score when compared to physicians in the multivariate analysis. CONCLUSION Performance during an immersive virtual reality experience was most closely related to age, gender, and frequency of playing video games. Self-perceived comfort with virtual reality was more predictive of score than prior virtual reality experience.
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Affiliation(s)
- Daniel Katz
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA
| | - Benjamin Hyers
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA
| | - Eric Patten
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Darren Sarte
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Mariano Loo
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA.
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3
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Wang E, Li J, Hong T, Xie Z, Ge Y, Zhou X, Zhang H. Effects of preoperative surgeon warm-up in video-assisted thoracoscopic surgery lobectomy. BMC Surg 2024; 24:11. [PMID: 38172798 PMCID: PMC10765877 DOI: 10.1186/s12893-023-02300-3] [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: 09/05/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In various surgical specialties, preoperative surgical warm-up has been demonstrated to affect a surgeon's performance and the perioperative outcomes for patients. However, the influence of warm-up activities on video-assisted thoracoscopic surgery lobectomy (VATSL) remains largely unexplored. This study aims to investigate the potential effects of preoperative surgical warm-up on VATSL. METHODS A cohort of 364 patients diagnosed with lung cancer through pathology and undergoing VATSL at the Thoracic Surgery Department of Xuzhou Medical University from January 2018 to September 2022 were included. Patients were categorized into two groups: the warm-up group, comprising 172 patients undergoing their first VATSL of the day, and the warm-up effect group, consisting of 192 patients undergoing their second VATSL on the same day. Propensity score matching was employed to compare operation times and postoperative complications between the two groups, resulting in 159 matched cases in each group. RESULTS There were no statistically significant differences in operation time (154.5 ± 54.9 vs. 147.2 ± 54.4 min, p = 0.239) and postoperative complications (including pulmonary infection, atelectasis, long-term pulmonary air leakage requiring incision suture in the operating room, and postoperative pleural effusion) (14:22 cases, p = 0.157) between the warm-up and warm-up effect groups. CONCLUSION The findings suggest that preoperative surgical warm-up does not significantly affect the perioperative outcomes of VATSL.
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Affiliation(s)
- Enjie Wang
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China
- Department of Thoracic Surgery, Dazhou Third People's Hospital, Dazhou, China
| | - Jun Li
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China
| | - Tao Hong
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China
| | - Zexin Xie
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China
| | - Yong Ge
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China
| | - Xiaotong Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China.
| | - Hao Zhang
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, China.
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, Jiangsu, 221003, China.
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Boal MWE, Anastasiou D, Tesfai F, Ghamrawi W, Mazomenos E, Curtis N, Collins JW, Sridhar A, Kelly J, Stoyanov D, Francis NK. Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. Br J Surg 2024; 111:znad331. [PMID: 37951600 PMCID: PMC10771126 DOI: 10.1093/bjs/znad331] [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: 07/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools for technical skills assessment, providing evaluation statuses to guide research and inform implementation into training curricula. METHODS A systematic literature search was conducted in accordance with the PRISMA guidelines. Ovid Embase/Medline, PubMed and Web of Science were searched. Inclusion criterion: robotic surgery technical skills tools. Exclusion criteria: non-technical, laparoscopy or open skills only. Manual tools and automated performance metrics (APMs) were analysed using Messick's concept of validity and the Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence and Recommendation (LoR). A bespoke tool analysed artificial intelligence (AI) studies. The Modified Downs-Black checklist was used to assess risk of bias. RESULTS Two hundred and forty-seven studies were analysed, identifying: 8 global rating scales, 26 procedure-/task-specific tools, 3 main error-based methods, 10 simulators, 28 studies analysing APMs and 53 AI studies. Global Evaluative Assessment of Robotic Skills and the da Vinci Skills Simulator were the most evaluated tools at LoR 1 (OCEBM). Three procedure-specific tools, 3 error-based methods and 1 non-simulator APMs reached LoR 2. AI models estimated outcomes (skill or clinical), demonstrating superior accuracy rates in the laboratory with 60 per cent of methods reporting accuracies over 90 per cent, compared to real surgery ranging from 67 to 100 per cent. CONCLUSIONS Manual and automated assessment tools for robotic surgery are not well validated and require further evaluation before use in accreditation processes.PROSPERO: registration ID CRD42022304901.
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Affiliation(s)
- Matthew W E Boal
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
| | - Dimitrios Anastasiou
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Freweini Tesfai
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
| | - Walaa Ghamrawi
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
| | - Evangelos Mazomenos
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Nathan Curtis
- Department of General Surgey, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional Surgical Sciences (WEISS), University College London (UCL), London, UK
- Computer Science, UCL, London, UK
| | - Nader K Francis
- The Griffin Institute, Northwick Park & St Marks’ Hospital, London, UK
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, UCL, London, UK
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, Somerset, UK
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [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: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Patocka C, Pandya A, Brennan E, Lacroix L, Anderson I, Ganshorn H, Hall AK. The Impact of Just-in-Time Simulation Training for Healthcare Professionals on Learning and Performance Outcomes: A Systematic Review. Simul Healthc 2024; 19:S32-S40. [PMID: 38240616 DOI: 10.1097/sih.0000000000000764] [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: 01/23/2024]
Abstract
ABSTRACT Although just-in-time training (JIT) is increasingly used in simulation-based health professions education, its impact on learning, performance, and patient outcomes remains uncertain. The aim of this study was to determine whether JIT simulation training leads to improved learning and performance outcomes. We included randomized or nonrandomized interventional studies assessing the impact of JIT simulation training (training conducted in temporal or spatial proximity to performance) on learning outcomes among health professionals (trainees or practitioners). Of 4077 citations screened, 28 studies were eligible for inclusion. Just-in-time training simulation training has been evaluated for a variety of medical, resuscitation, and surgical procedures. Most JIT simulation training occurred immediately before procedures and lasted between 5 and 30 minutes. Despite the very low certainty of evidence, this systematic review suggests JIT simulation training can improve learning and performance outcomes, in particular time to complete skills. There remains limited data on better patient outcomes and collateral educational effects.
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Affiliation(s)
- Catherine Patocka
- From the Department of Emergency Medicine (C.P., A.P.), University of Calgary Cumming School of Medicine, Calgary, Canada; Department of Emergency Medicine (E.B.), Queen's University, Kingston, Canada ; Department of Emergency Medicine (L.L., A.K.H.), University of Ottawa, Ottawa, Canada; Department of Pediatric Emergency Medicine (I.A.), Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH; Royal College of Physicians and Surgeons of Canada (A.K.H.), Ottawa, Canada ; Libraries and Cultural Resources (H.G.), University of Calgary, Calgary, Canada
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7
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Chen CCG, Malpani A, Waldram MM, Romanczyk C, Tanner EJ, Fader AN, Scheib SA, Hager GD, Vedula SS. Effect of pre-operative warm-up on trainee intraoperative performance during robot-assisted hysterectomy: a randomized controlled trial. Int Urogynecol J 2023; 34:2751-2758. [PMID: 37449987 DOI: 10.1007/s00192-023-05595-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to study the effect of immediate pre-operative warm-up using virtual reality simulation on intraoperative robot-assisted laparoscopic hysterectomy (RALH) performance by gynecology trainees (residents and fellows). METHODS We randomized the first, non-emergent RALH of the day that involved trainees warming up or not warming up. For cases assigned to warm-up, trainees performed a set of exercises on the da Vinci Skills Simulator immediately before the procedure. The supervising attending surgeon, who was not informed whether or not the trainee was assigned to warm-up, assessed the trainee's performance using the Objective Structured Assessment for Technical Skill (OSATS) and the Global Evaluative Assessment of Robotic Skills (GEARS) immediately after each surgery. RESULTS We randomized 66 cases and analyzed 58 cases (30 warm-up, 28 no warm-up), which involved 21 trainees. Attending surgeons rated trainees similarly irrespective of warm-up randomization with mean (SD) OSATS composite scores of 22.6 (4.3; warm-up) vs 21.8 (3.4; no warm-up) and mean GEARS composite scores of 19.2 (3.8; warm-up) vs 18.8 (3.1; no warm-up). The difference in composite scores between warm-up and no warm-up was 0.34 (95% CI: -1.44, 2.13), and 0.34 (95% CI: -1.22, 1.90) for OSATS and GEARS respectively. Also, we did not observe any significant differences in each of the component/subscale scores within OSATS and GEARS between cases assigned to warm-up and no warm-up. CONCLUSION Performing a brief virtual reality-based warm-up before RALH did not significantly improve the intraoperative performance of the trainees.
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Affiliation(s)
- Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.
| | - Anand Malpani
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Edward J Tanner
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Amanda N Fader
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Stacey A Scheib
- Department of Gynecology and Obstetrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Gregory D Hager
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - S Swaroop Vedula
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
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Chen Z, Zheng YX, Hubert J, Jiang L, Yang K, Wang X. Exploring the use of driving simulation to improve robotic surgery simulator training: an observational case-control study. J Robot Surg 2023; 17:2177-2185. [PMID: 37269493 DOI: 10.1007/s11701-023-01641-8] [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: 05/08/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
The correlation between driving skills and the ability to perform robotic surgery have not yet been discussed. Therefore, this study aimed to investigate the impact of driving skills on learning robotic surgery using a driving simulator and a robotic simulator. Sixty robot- and simulator-naïve participants were recruited: 30 with a driver's license and 30 without a driver's license. All participants completed a test on the driving simulator and learned four tasks using a robotic surgical simulator (dV-Trainer). On the driving simulator, the lap time in the driver's license group (D-Group) was significantly lower than that in the non-driver's license group (ND-Group) [217.93 ± 42.79 s vs. 271.24 ± 46.63 s, P < 0.001]. The average number of tires off track in the D-Group was lower than that in the ND-Group (0.13 ± 0.35 vs. 0.57 ± 0.63, P = 0.002). The baseline score of the D-Group on the robotic simulator was higher than that of the ND-Group (467.53 ± 107.62 vs. 385.53 ± 136.30, P = 0.022). In the Pick-and-Place-Clutching, Peg-Board-2, and Thread-the-Rings-1 tasks, the learning curve of the D-Group was steeper than that of the ND-Group. However, no significant difference was observed in the Match-Board-2 task. According to the lap time ranking, participants in the top tertile had a steeper learning curve than those in the bottom tertile, especially for the Pick-and-Place-Clutching and Peg-Board-2 tasks (P < 0.05). Significant differences were also found in the baseline and final stages of the Thread-the-Rings-1 task and in the initial stage of the Match-Board-2 task (P < 0.05). Students with a driver's license or better performance in racing games had more success in learning robotic surgery. Driving simulators may promote robotic surgery training.
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Affiliation(s)
- Ziyan Chen
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yu Xuan Zheng
- University of Electronic Science and Technology of China, Chengdu, China
| | - Jacques Hubert
- Department of Urology, CHU Nancy, Nancy, France
- IADI/Inserm U947, Lorraine University, Nancy, France
| | - Lingxiao Jiang
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Kun Yang
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
| | - XingHuan Wang
- Department of Urology, ZhongNan Hospital, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
- Medicine-Remote Mapping Associated Laboratory, Wuhan University, No. 169 Donghu Road, Wuhan, 430071, Hubei, China.
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9
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Harji D, Houston F, Burke J, Griffiths B, Tilney H, Miskovic D, Evans C, Khan J, Soomro N, Bach SP. The current status of robotic colorectal surgery training programmes. J Robot Surg 2023; 17:251-263. [PMID: 35657506 DOI: 10.1007/s11701-022-01421-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
Robotic-assisted colorectal surgery (RACS) is steadily increasing in popularity with an annual growth in the number of colorectal procedures undertaken robotically. Further upscaling of RACS requires structured and standardised robotic training to safeguard high-quality clinical outcomes. The aims of this systematic review were to assess the structure and assessment metrics of currently established RACS training programmes. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was performed. Searches were performed of the Ovid Medline, Embase and Web of Science databases between 2000 and 27th November 2021 to identify studies reporting on training curricula in RACS. Core components of training programmes and their relevant outcome assessment metrics were extracted. Thirteen studies were identified, with all training programmes designed for the da Vinci platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Common elements of multimodal programmes included theoretical knowledge (76.9%), case observation (53.8%), simulation (100%) and proctored training (76.9%). Robotic skills acquisition was assessed primarily during the simulation phase (n = 4, 30.1%) and proctoring phase (n = 10, 76.9%). Performance metrics, consisting of time or assessment scores for VR simulation were only mandated in four (30.1%) studies. Objective assessment following proctored training was variably reported and employed a range of assessment metrics, including direct feedback (n = 3, 23.1%) or video feedback (n = 8, 61.5%). Five (38.4%) training programmes used the Global Assessment Score (GAS) forms. There is a broad consensus on the core multimodal components across current RACS training programmes; however, validated objective assessment is limited and needs to be appropriately standardised to ensure reproducible progression criteria and competency-based metrics are produced to robustly assess progression and competence.
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Affiliation(s)
- Deena Harji
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England.
| | | | - Joshua Burke
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Ben Griffiths
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Henry Tilney
- Department of Colorectal Surgery, Frimley Health NHS Foundation Trust, Frimley, Surrey, England
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Danilo Miskovic
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Naeem Soomro
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon P Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
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10
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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11
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Validity of a Patient-Specific Percutaneous Nephrolithotomy (PCNL) Simulated Surgical Rehearsal Platform: Impact on Patient and Surgical Outcomes. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2022.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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12
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Joosten M, Hillemans V, van Capelleveen M, Bökkerink GMJ, Verhoeven D, de Blaauw I, Verhoeven BH, Botden SMBI. The effect of continuous at-home training of minimally invasive surgical skills on skill retention. Surg Endosc 2022; 36:8307-8315. [PMID: 35604482 PMCID: PMC9125971 DOI: 10.1007/s00464-022-09277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Skill deterioration of minimally invasive surgical (MIS) skills may be prevented by continuous training. The aim of this study is to evaluate whether unsupervised continuous at-home training of MIS skills results in better skill retention compared to no training. METHODS Medical doctors followed a two-week interval training for two MIS tasks (precise peg transfer and interrupted suture with knot tying), ending with a baseline test. They were randomly assigned to the no-practice group or continuous-practice group. The latter practiced unsupervised at home every two weeks during the study period. Skill retention was measured after three and six months on both tasks by the total time needed, distance traveled by instruments and LS-CAT score (8 best possible score and > 40 worst score). RESULTS A total of 38 participants were included. No significant differences in performance were found at pre-test or baseline. At six months the no-practice group needed more time for the suturing task (309 s vs. 196 s at baseline, p = 0.010) and the LS-CAT score was significantly worse (30 vs. 20 at baseline, p < 0.0001). The continuous-practice group performed the suturing task significantly better than the no-practice group at both three and six months (17 vs. 25, p < 0.001 and 17 vs. 30, p < 0.001) and faster as well (p = 0.034 and p = 0.001). CONCLUSION This study shows a skill decay after only a few months of non-use and shows better skill retention after continuous unsupervised at-home practice of MIS skills. This indicates an added value of regular at-home practice of surgical skills.
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Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands.
| | - Vera Hillemans
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands
| | - Marije van Capelleveen
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands
| | - Guus M J Bökkerink
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Daan Verhoeven
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands
| | - Bas H Verhoeven
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10 route 618, Nijmegen, 6500HB, The Netherlands
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13
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Storm DW, Lockwood GM, Bonnett MA, Cooper BJ, Harris LM, Cooper CS. The Impact of Perioperative and Operative Variables on Early Postoperative Complications Following Primary Hypospadias Repair. Urology 2022; 170:184-188. [PMID: 35970358 DOI: 10.1016/j.urology.2022.08.002] [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: 04/21/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate possible risk factors for complications following primary hypospadias repair relative to factors associated with timing of hypospadias repair in terms of case order, morning or afternoon scheduling, perioperative delays, and surgeon's daily work schedule as well as individual operative techniques. METHODS We retrospectively reviewed charts of 422 boys undergoing primary hypospadias repair with a sutured urethroplasty by one of three surgeons over a 10-year period and the surgeon's daily schedule. RESULTS The median age and IQR of the patients at time of operation was 0.79 (0.57) years, and median follow-up was 259 (664) days. A significant increase in the rate of any complication was noted with morning versus afternoon cases for the group overall with morning cases having a hazard 2.3 times higher than afternoon cases (p=0.012). Additionally, there was a significant increase in hazard of complication with increasing difference in time between actual procedure duration versus scheduled duration, with hazard of complication increasing 5% for each increase of 15 minutes of surgical time (p=.043). CONCLUSIONS A variety of previously identified potential risk factors for hypospadias complications were identified. Our analysis also demonstrated variability in level of risk of different factors between surgeons, reinforcing the utility of surgeons monitoring their own results in response to changes in technique. Novel potential risk factors for some surgeons identified in our study included an increased risk of complications when the hypospadias was done in the morning rather than the afternoon and when the procedure lasted longer than scheduled.
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Affiliation(s)
- Douglas W Storm
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Gina M Lockwood
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Megan A Bonnett
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Benjamin J Cooper
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Logan M Harris
- Department of Biostatistics, University of Iowa, Iowa City, IA
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14
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Khimani K, Koshevarova V, Mathew AA, Gupta AK, Schmitz-Brown M, Gupta PK. Video Game Warm-Up May Suggest Improvement in Ophthalmic Surgical Simulator Performance in Surgically Naïve Students. Clin Ophthalmol 2022; 16:2561-2568. [PMID: 35978609 PMCID: PMC9377345 DOI: 10.2147/opth.s369697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Karima Khimani
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Alfred A Mathew
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Akshaya K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Mary Schmitz-Brown
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Praveena K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Correspondence: Praveena K Gupta, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555-1108, USA, Tel +409 747 5823, Fax +1 409 747 5824, Email
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15
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Feeley AA, Feeley IH, Merghani K, Sheehan E. Use of procedure specific preoperative warm-up during surgical priming improves operative outcomes: A systematic review. Am J Surg 2022; 224:1126-1134. [DOI: 10.1016/j.amjsurg.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
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16
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Ghazi A, Melnyk R, Farooq S, Bell A, Holler T, Saba P, Joseph J. Validity of a patient-specific percutaneous nephrolithotomy (PCNL) simulated surgical rehearsal platform: impact on patient and surgical outcomes. World J Urol 2022; 40:627-637. [PMID: 34165633 PMCID: PMC9796494 DOI: 10.1007/s00345-021-03766-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Simulators provide a safe method for improving surgical skills without the associated patient risks. Advances in rapid prototyping technology have permitted the reconstruction of patient imaging into patient-specific surgical simulations that require advanced expertise, potentially continuing the learning curve. OBJECTIVES To evaluate the impact of preoperative high-fidelity patient-specific percutaneous nephrolithotomy hydrogel simulations on surgical and patient outcomes. MATERIALS AND METHODS Between 2016 and 2017, a fellowship-trained endourologist performed 20 consecutive percutaneous nephrolithotomy procedures at an academic referral center. For the first ten patients, only standard review of patient imaging was completed. For the next ten patients, patient imaging was utilized to fabricate patient-specific models including pelvicalyceal system, kidney, stone, and relevant adjacent structures from hydrogel. The models were tested to confirm anatomic accuracy and material properties similar to live tissue. Full procedural rehearsals were completed 24-48 h before the real case. Surgical metrics and patient outcomes from both groups (rehearsal vs. standard) were compared. RESULTS Significant improvements in mean fluoroscopy time, percutaneous needle access attempts, complications, and additional procedures were significantly lower in the rehearsal group (184.8 vs. 365.7 s, p < 0.001; 1.9 vs. 3.6 attempts, p < 0.001; 1 vs. 5, p < 0.001; and 1 vs. 5, p < 0.001, respectively). There were no differences in stone free rates, mean patient age, body mass index, or stone size between the two groups. CONCLUSION This study demonstrates that patient-specific procedural rehearsal is effective reducing the experience curve for a complex endourological procedure, resulting in improved surgical performance and patient outcomes.
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Affiliation(s)
- Ahmed Ghazi
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA,Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Rachel Melnyk
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Shamroz Farooq
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Adrian Bell
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Tyler Holler
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Patrick Saba
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Jean Joseph
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Kehily E, Mazzone E, Coffey N, Allen F, Gallagher A, Roberts A. Proficiency Based Progression (PBP) training- the future model for dental operative skills training?: A systematic review and meta-analysis of existing literature. J Dent 2021; 116:103906. [PMID: 34838846 DOI: 10.1016/j.jdent.2021.103906] [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: 09/27/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of Proficiency-Based Progression (PBP) operative training using validated performance metrics, by comparing this to standard, conventional training methods. DATA This systematic review was conducted in accordance with the guidelines of the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA). Study quality was assessed using the MERSQI tool and the Cochrane Risk of Bias tool. Results were pooled using biased corrected standardized mean difference and ratio-of-means (ROM). Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. In quantitative synthesis testing for procedural errors, a pooled meta-analysis on 87 trainees was conducted using random-effects models. In a ROM analysis, PBP was estimated to reduce the mean rate of errors by 62%, when compared to standard training (ROM 0.38, 95% CI: 0.25; 0.58; p < 0.001) Sources: The electronic databases of PubMed, Embase, Web of Science, MEDLINE and Cochrane library's CENTRAL were searched from inception to 8/11/2021. Filters activated were Randomized Controlled trials, clinical trial. STUDY SELECTION 13 studies were included for review with 11 included in the quantitative synthesis from 174 potentially relevant publications identified by the search strategy. Main inclusion criteria were studies comparing standard surgical/operative training with proficiency-based simulation training using validated metrics based on expert performance. CONCLUSIONS Our meta-analysis found that PBP training improved trainees' performances, by decreasing procedural errors. There is sufficient evidence to explore PBP training for use in dental skills training. PBP training was estimated to reduce the mean rate of operative errors by 62%, when compared to standard training. Given that there is a direct correlation between operative skill and patient outcomes, these data suggest that there is sufficient evidence to explore PBP training for use in dental skills training.
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Affiliation(s)
- Elaine Kehily
- Cork University Dental School & Hospital, University College Cork, Ireland.
| | - Elio Mazzone
- Division of Oncology, Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan 20132, MI, Italy
| | - Niamh Coffey
- Cork University Dental School & Hospital, University College Cork, Ireland
| | - Finbarr Allen
- Faculty of Dentistry, National University of Singapore, Singapore; National University Centre for Oral Health, Singapore, Singapore
| | - Anthony Gallagher
- Faculty of Medicine, KU Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Northern Ireland; ORSI Academy, Belgium
| | - Anthony Roberts
- Cork University Dental School & Hospital, University College Cork, Ireland
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18
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Rosser JB, Nitsche L, Yee G, Alam H. The evolution of surgical virtual education and telementoring: One surgeon's journey. J Surg Oncol 2021; 124:162-173. [PMID: 34245579 DOI: 10.1002/jso.26563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/12/2022]
Abstract
The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation.
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Affiliation(s)
- James Butch Rosser
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Lindsay Nitsche
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Gabrielle Yee
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Harris Alam
- University of Central Florida, Orlando, Florida, USA
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Thornblade LW, Fong Y. Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods. J Laparoendosc Adv Surg Tech A 2021; 31:556-560. [PMID: 33835885 DOI: 10.1089/lap.2021.0082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
While robotic surgery has grown in popularity and scope over the past decade, there is a persistent need for simulation-based training as surgeons adapt from the working at the bedside to the immersive and multisensory tasks at the console. From dry laboratory to virtual reality (VR) environments, simulation can be used to train surgeons in basic tasks, complex operative steps, and coordination of whole operations with members of the entire operating room (OR) staff. By integrating simulation into mentored training programs, surgeons can reduce the number of cases required to master a complex operation. Future VR based simulation will become essential to the adaptation of the surgical workforce to new technologies and adoption of emerging robotic platforms. Ultimately, robotic simulation will set standards for credentialing of new surgeons.
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Affiliation(s)
- Lucas W Thornblade
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
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20
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Bielsa VF. Virtual reality simulation in plastic surgery training. Literature review. J Plast Reconstr Aesthet Surg 2021; 74:2372-2378. [PMID: 33972199 DOI: 10.1016/j.bjps.2021.03.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 11/07/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Major changes have occurred in the medical environment leading to an evolution from the traditional residency programmes to competency-based ones. Virtual reality (VR) represents a promising simulation resource for surgical training. Several types of VR simulators can be considered, depending on the level of immersion they offer. The goal of the article is to review the progress of VR simulation in plastic surgery (PS) training. A systematic search of the literature was performed on PUBMED/MEDLINE with the following key words: (Simulation OR Virtual Reality) AND (Education OR Training) AND Plastic Surgery from January 1998 to September 2019. A total of 244 results were found, and 80 of them were selected for abstract review. Sixty-four articles were selected for complete reading. Several attempts have been made to create VR simulators and most of them are non-immersive or partially immersive. The main conclusions of them are summarized. VR simulation has been proven to have a role in PS training, offering many advantages. Furthermore, VR simulation can be used for safety training, team interaction and decision-making education. Validation is a key point for acceptance of simulators. Further efforts are required to include simulation in PS curricula.
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Affiliation(s)
- V Fuertes Bielsa
- Plastic Surgery Department University Hospital Miguel Servet Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
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21
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Kelly JD, Kowalewski TM, Brand T, French A, Nash M, Meryman L, Heller N, Organ N, George E, Smith R, Sorensen MD, Comstock B, Lendvay TS. Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial. J Surg Res 2021; 264:107-116. [PMID: 33799119 DOI: 10.1016/j.jss.2021.01.037] [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: 08/10/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
TRIAL DESIGN This was a randomized controlled trial. BACKGROUND Intraoperative errors correlate with surgeon skill and skill declines with intervals of inactivity. The goals of this research were to identify the optimal virtual reality (VR) warm-up curriculum to prime a surgeon's technical skill and validate benefit in the operating room. MATERIALS AND METHODS Surgeons were randomized to receive six trial sessions of a designated set of VR modules on the da Vinci Skills Simulator to identify optimal VR warm-up curricula to prime technical skill. After performing their curricula, warm-up effect was assessed based on performance on a criterion task. The optimal warm-up curriculum was chosen from the group with the best task time and video review-based technical skill. Robot-assisted surgery-experienced surgeons were then recruited to either receive or not receive warm-up before surgery. Skill in the first 15 min of surgery was assessed by blinded surgeon and crowdworker review as well as tool motion metrics. The intervention was performing VR warm-up before human robot-assisted surgery. Warm-up effect was measured using objective performance metrics and video review using the Global Evaluative Assessment of Robotic Skills tool. Linear mixed effects models with a random intercept for each surgeon and nonparametric modified Friedman tests were used for analysis. RESULTS The group performing only a Running Suture task on the simulator was on average 31.3 s faster than groups performing other simulation tasks and had the highest Global Evaluative Assessment of Robotic Skills scores from 41 surgeons who participated. This was chosen as the optimal curriculum. Thereafter, 34 surgeons completed 347 surgeries with corresponding video and tool motion data. No statistically significant differences in skill were observed with the warm-up intervention. CONCLUSIONS We conclude that a robotic VR warm-up before performing the early stages of surgery does not impact the technical skill of the surgeon.
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Affiliation(s)
- Jason D Kelly
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota.
| | - Timothy M Kowalewski
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota
| | - Tim Brand
- University of Washington, Department of Urology, Seattle, Washington
| | - Anna French
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota
| | - Michael Nash
- University of Washington, Department of Urology, Seattle, Washington
| | - Lois Meryman
- University of Washington, Department of Urology, Seattle, Washington
| | - Nicholas Heller
- University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota
| | - Nancy Organ
- University of Washington, Department of Urology, Seattle, Washington
| | - Evalyn George
- Madigan Army Medical Center, Henry M. Jackson Foundation, Tacoma, Washington
| | - Roger Smith
- Florida Hospital Nicholson Center, Orlando, Florida
| | - Mathew D Sorensen
- University of Washington, Department of Urology, Seattle, Washington
| | - Bryan Comstock
- University of Washington, Department of Urology, Seattle, Washington
| | - Thomas S Lendvay
- University of Washington, Department of Urology, Seattle, Washington
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22
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Gupta A, Lawendy B, Goldenberg MG, Grober E, Lee JY, Perlis N. Can video games enhance surgical skills acquisition for medical students? A systematic review. Surgery 2021; 169:821-829. [PMID: 33419578 DOI: 10.1016/j.surg.2020.11.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To systematically assess literature examining the impact of being a gamer or participating in video-game-based training on surgical skills acquisition amongst medical students. BACKGROUND Video games and surgical procedures share similar skills such as visuospatial abilities and hand-eye coordination; therefore, video games can be a valuable tool for surgical training amongst medical students. However, comprehensive, up-to-date systematic reviews are necessary to confirm. METHODS A systematic literature search of PubMed, MEDLINE, and EMBASE was performed in April 2020 with no limits set on the date of publication. Observational and randomized controlled studies were included. Quality and bias were assessed using the Newcastle-Ottawa Scale for nonrandomized studies and the Grading of Recommendations Assessment, Development and Evaluation system for randomized studies. RESULTS A total of 575 participants from 16 studies were included. The most common surgical skills tested were laparoscopy (n = 283, from 8 studies) and robotic surgery (n = 199, from 5 studies). A history of gaming and video-game-based training were associated with improved metrics in robotic surgery and laparoscopy, respectively. Neither was beneficial in arthroscopy or bronchoscopy. Studies using the Wii U and Underground reported significant improvement in overall laparoscopic performance. CONCLUSION Video games demonstrate potential as adjunctive training in surgical skill education, with a history of gaming and video-game-based training being beneficial in robotic surgery and laparoscopy, respectively. Methodological heterogeneity amongst included studies limit the ability to make conclusive decisions; thus, future studies with long-term follow-up, larger sample sizes, outcomes stratified by video-game characteristics, and up-to-date technology are necessary.
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Affiliation(s)
- Arnav Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bishoy Lawendy
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mitchell G Goldenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sprott Department of Surgery, Division of Urology, University Health Network, Toronto, ON, Canada
| | - Ethan Grober
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Surgery, Division of Urology, Sinai Health System, Toronto, ON, Canada
| | - Jason Y Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sprott Department of Surgery, Division of Urology, University Health Network, Toronto, ON, Canada
| | - Nathan Perlis
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sprott Department of Surgery, Division of Urology, University Health Network, Toronto, ON, Canada.
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Mendelsohn AH, Kim C, Song J, Singh A, Le T, Abiri A, Berke GS, Geoghegan R. Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System. Laryngoscope 2020; 130 Suppl 6:S1-S17. [PMID: 32865822 DOI: 10.1002/lary.29034] [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: 05/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. METHODS Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). RESULTS Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor resection grading. Tumor resection scores was significantly (P = .02) improved with collision awareness system activated than trials without collision awareness. CONCLUSION In order to test our primary hypothesis, a novel TORS training platform was successfully developed that provides collision force measurements including frequency, severity, and duration of anatomic collisions. Additionally, the platform was modulated to provide real-time tactile feedback of the occurrence of out-of-field collisions. Utilizing this custom platform, our hypothesis that anatomic collisions during TORS diminishes surgical performance was supported. Additionally, our secondary hypothesis that subsequent reduction of anatomic collisions improves TORS proficiency was supported by the surgical trial. Dedicated investigation to characterize the effect size and clinical impact is required in order to translate this finding into training curriculums and into clinical utilization. LEVEL OF EVIDENCE II (Randomized trial) Laryngoscope, 130:S1-S17, 2020.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.,Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Christine Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jonathan Song
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Aadesh Singh
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tyler Le
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ahmad Abiri
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Rory Geoghegan
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
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Dickinson KJ, Gronseth SL. Application of Universal Design for Learning (UDL) Principles to Surgical Education During the COVID-19 Pandemic. JOURNAL OF SURGICAL EDUCATION 2020; 77:1008-1012. [PMID: 32576451 PMCID: PMC7274614 DOI: 10.1016/j.jsurg.2020.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/02/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic in 2020, we have faced unprecedented challenges in the delivery of surgical education. At the time of writing, changes to the structure and nature of the surgical workforce are occurring rapidly, even daily. Surgical educators are utilizing remote learning solutions, including flipped classroom approaches, online educational materials, telemedicine, and simulations, to continue education for surgical residents despite cancelations of face-to-face instruction. Our objective is to delineate an interdisciplinary strategy, utilizing the principles of Universal Design for Learning (UDL), by which we can optimize learning during this pandemic. DESIGN This perspective describes the UDL framework which can be used to situate solutions to issues with delivery of surgical education during this pandemic within the broader view of strategic inclusive instructional design to meet diverse learning needs.. CONCLUSION The principles of UDL can inform curricular and pedagogical changes in surgical education that may be employed during a time of social distancing, isolation, and quarantine. UDL involves planning flexibility into curricular design from the outset, recognizing that learners are varied in their learning preferences and capabilities, motivational characteristics, and environmental constraints. Viewing the design of remote learning opportunities through the UDL lens aims to remove barriers to learning during this pandemic by targeting three areas: expansion of the means that information is communicated, ways that learners are supported and motivated, and approaches to assessing learning through available distance learning technologies.
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Josef Lindegger D, Alnafisse N, Thomsen ASS, Logeswaran A, Saleh GM. The future of virtual reality in cataract surgical training. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1781619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Nouf Alnafisse
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ann Sofia Skou Thomsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Centre for HR, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | | | - George M. Saleh
- Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, the Department of Education, The UCL Institute of Ophthalmology, London, UK
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Souza-Junior VDD, Mendes IAC, Tori R, Marques LP, Mashuda FKK, Hirano LAF, Godoy SD. VIDA-Nursing v1.0: immersive virtual reality in vacuum blood collection among adults. Rev Lat Am Enfermagem 2020; 28:e3263. [PMID: 32491118 PMCID: PMC7266633 DOI: 10.1590/1518-8345.3685.3263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/23/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0. METHOD methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects. RESULTS the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions. CONCLUSION the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.
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Affiliation(s)
- Valtuir Duarte De Souza-Junior
- PAHO/WHO Collaborating Centre for Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Isabel Amélia Costa Mendes
- PAHO/WHO Collaborating Centre for Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Romero Tori
- Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leonardo Prates Marques
- PAHO/WHO Collaborating Centre for Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Simone De Godoy
- PAHO/WHO Collaborating Centre for Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Canalichio KL, Berrondo C, Lendvay TS. Simulation Training in Urology: State of the Art and Future Directions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:391-396. [PMID: 32581620 PMCID: PMC7276194 DOI: 10.2147/amep.s198941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/10/2020] [Indexed: 05/08/2023]
Abstract
There has been a major shift from the old paradigm of 'see one, do one, teach one' in medical training due in large part to resident work-hour restrictions and required oversight in the operating room. In response to this, advancements in technology have allowed for the introduction of more objective measures to assess the skill competency and proficiency of surgical trainees. Patient safety and trainee well-being are important drivers for this new model, and so surgical training programs are adopting simulation into their curriculum. Urology is uniquely positioned at the forefront of new emerging technologies in surgery, because of the field's commitment to safe and efficient minimally invasive surgery and endourological procedures. Due to these technically challenging procedures, urological training must incorporate these educational technologies to allow for objective skills assessment, skills transfer, and ultimately providing optimal patient care with the production of proficient and competent urological trainees.
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Affiliation(s)
- Katie Lynn Canalichio
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
- Correspondence: Katie Lynn Canalichio Pediatric Urology, Seattle Children’s Hospital, OA.9.220 PO Box 5371, Seattle, WA98145-5005, USATel +1 206 987 6913Fax +1 206 987 3155 Email
| | - Claudia Berrondo
- Pediatric Urology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thomas S Lendvay
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
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Cost, training and simulation models for robotic-assisted surgery in pediatric urology. World J Urol 2019; 38:1875-1882. [PMID: 31209563 DOI: 10.1007/s00345-019-02822-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/21/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Laparoscopic procedures in pediatric urology have been shown to be safe and effective over the last number of years. Coupled with this is the technological trend to provide minimally invasive options for even the most complex pediatric patients. Whilst robotic platforms continue to try to demonstrate superior patient outcomes in adults with mixed results, the utilization of robotic platforms for pediatric urology is increasing. METHODS A review of the current literature was undertaken to assess the evidence for training models and cost-effectiveness of robotic-assisted pediatric urology. CONCLUSIONS A growing body of evidence in this field has demonstrated that robotic platforms are safe and effective in children and can provide additional reconstructive benefits due to motion scaling, magnification, stereoscopic views, instrument dexterity and tremor reduction. The main drawbacks remain the financial implications associated with this platform through purchase, maintenance, and disposable costs. This review addresses some of the addresses issues pertaining to cost, training and simulation for robotic-assisted surgery in pediatric urology.
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A Pilot Study on Oocyte Retrieval Simulator: A New Tool for Training? J Med Syst 2019; 43:202. [PMID: 31129724 DOI: 10.1007/s10916-019-1340-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
This prospective study was aimed at assessing the usefulness of a box simulator in oocyte pick-up and at establishing whether it could be an appropriate training tool for egg retrieval. Forty-four clinicians, divided in two groups on the grounds of the previous experience (Novices and Experts), participated to two training sessions with a pick-up simulator. Data concerning the mean number of follicles correctly aspired (%OK med), the average time needed to correctly aspirate one follicle (t foll med) and the ratio between the two afore-mentioned parameters (%OK med/t foll med) were collected. At the end of the two sessions all participants completed a questionnaire aimed at assessing the performance of the simulator in terms of realism and acceptability for use. A significant improvement in efficiency (mean number of follicles correctly aspired, 82% versus 75%), speed (mean time needed to aspirate one follicle, 21 versus 28 s) and accuracy (mean percentage of follicles correctly aspirated in one minute, 2.53% versus 1.86%) was noted in the total sample. The performance accuracy was significantly increased in both groups (2.34% versus 1.83% for Novices and 2.50% versus 2.06%, for Experts). Speed was significantly improved in the Novices' group. Simulator-based training has been shown to be effective and useful and it should be considered in training programs.
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Rapoport LM, Bezrukov EA, Tsarichenko DG, Martirosyan GA, Sukhanov RB, Krupinov GE, Slusarenco RI, Morozov AO, Avakyan SK, Sargsyan NA. [Methods for training of robot-assisted radical prostatectomy]. Khirurgiia (Mosk) 2019:89-94. [PMID: 30789615 DOI: 10.17116/hirurgia201901189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.
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Affiliation(s)
- L M Rapoport
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Bezrukov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D G Tsarichenko
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G A Martirosyan
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R B Sukhanov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G E Krupinov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R I Slusarenco
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - A O Morozov
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S K Avakyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N A Sargsyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Performance Assessment. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Weitman E, Saleh M, Marescaux J, Martin TR, Ballantyne GH. Reprints of: Robotic colorectal surgery: Evolution and future. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hovgaard LH, Andersen SAW, Konge L, Dalsgaard T, Larsen CR. Validity evidence for procedural competency in virtual reality robotic simulation, establishing a credible pass/fail standard for the vaginal cuff closure procedure. Surg Endosc 2018; 32:4200-4208. [PMID: 29603003 DOI: 10.1007/s00464-018-6165-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of robotic surgery for minimally invasive procedures has increased considerably over the last decade. Robotic surgery has potential advantages compared to laparoscopic surgery but also requires new skills. Using virtual reality (VR) simulation to facilitate the acquisition of these new skills could potentially benefit training of robotic surgical skills and also be a crucial step in developing a robotic surgical training curriculum. The study's objective was to establish validity evidence for a simulation-based test for procedural competency for the vaginal cuff closure procedure that can be used in a future simulation-based, mastery learning training curriculum. METHODS Eleven novice gynaecological surgeons without prior robotic experience and 11 experienced gynaecological robotic surgeons (> 30 robotic procedures) were recruited. After familiarization with the VR simulator, participants completed the module 'Guided Vaginal Cuff Closure' six times. Validity evidence was investigated for 18 preselected simulator metrics. The internal consistency was assessed using Cronbach's alpha and a composite score was calculated based on metrics with significant discriminative ability between the two groups. Finally, a pass/fail standard was established using the contrasting groups' method. RESULTS The experienced surgeons significantly outperformed the novice surgeons on 6 of the 18 metrics. The internal consistency was 0.58 (Cronbach's alpha). The experienced surgeons' mean composite score for all six repetitions were significantly better than the novice surgeons' (76.1 vs. 63.0, respectively, p < 0.001). A pass/fail standard of 75/100 was established. Four novice surgeons passed this standard (false positives) and three experienced surgeons failed (false negatives). CONCLUSION Our study has gathered validity evidence for a simulation-based test for procedural robotic surgical competency in the vaginal cuff closure procedure and established a credible pass/fail standard for future proficiency-based training.
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Affiliation(s)
- Lisette Hvid Hovgaard
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Steven Arild Wuyts Andersen
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Lars Konge
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
| | - Torur Dalsgaard
- Endometriosis Team and Robotic Surgery Section, Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Christian Rifbjerg Larsen
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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The role of simulation and warm-up in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 29:212-217. [PMID: 28520585 DOI: 10.1097/gco.0000000000000368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to update the reader on the current literature and recent studies evaluating the role of simulation and warm-up as part of surgical education and training, and maintenance of surgical skills. RECENT FINDINGS Laparoscopic and hysteroscopic simulation may improve psychomotor skills, particularly for early-stage learners. However, data are mixed as to whether simulation education is directly transferable to surgical skill. Data are insufficient to determine if simulation can improve clinical outcomes. Similarly, performance of surgical warm-up exercises can improve performance of novice and expert surgeons in a simulated environment, but the extent to which this is transferable to intraoperative performance is unknown. Surgical coaching, however, can facilitate improvements in performance that are directly reflected in operative outcomes. SUMMARY Simulation-based curricula may be a useful adjunct to residency training, whereas warm-up and surgical coaching may allow for maintenance of skill throughout a surgeon's career. These experiences may represent a strategy for maintaining quality and value in a lower volume surgical setting.
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Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 2018; 122:501-519. [PMID: 29603869 DOI: 10.1111/bju.14219] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. MATERIALS AND METHODS A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. RESULTS Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. CONCLUSION There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present.
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Affiliation(s)
| | - Jason Y Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anthony Costello
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
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Towards standardized robotic surgery in gastrointestinal oncology. Langenbecks Arch Surg 2017; 402:1003-1014. [DOI: 10.1007/s00423-017-1623-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/10/2017] [Indexed: 02/07/2023]
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Abstract
PURPOSE OF REVIEW There has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks was conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon. RECENT FINDINGS A structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of basic robotic skills in the dry and wet lab setting along with achievement of individual and team-based non-technical skills, modular console training under supervision, and finally independent practice. Robotic surgical training must be based on demonstration of proficiency and safety in executing basic robotic skills and procedural tasks prior to independent practice.
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Affiliation(s)
- Ashwin N. Sridhar
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Tim P. Briggs
- Department of Urology, University College London Hospital NHS Trust, London, UK
| | - John D. Kelly
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Senthil Nathan
- Department of Urology, University College London Hospital NHS Trust, London, UK
- Division of Surgery and Cancer, University College London, London, UK
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Moglia A, Perrone V, Ferrari V, Morelli L, Boggi U, Ferrari M, Mosca F, Cuschieri A. Influence of videogames and musical instruments on performances at a simulator for robotic surgery. MINIM INVASIV THER 2016; 26:129-134. [PMID: 27981866 DOI: 10.1080/13645706.2016.1267018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS). MATERIALS AND METHODS A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS. RESULTS Subjects from group 3 achieved the best performances on overall score: 527.09 ± 130.54 vs. 493.73 ± 108.88 (group 2), 472.72 ± 85.31 (group 1), and 403.13 ± 99.83 (group 4). Statistically significant differences (p < .05) between group 3 and group 4 were found for overall score (p = .009) and for time of completion (p = .044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98 ± 122.71 vs. 470.25 ± 92.31), but without statistically significant difference (p = .646). CONCLUSIONS The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.
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Affiliation(s)
- Andrea Moglia
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy
| | - Vittorio Perrone
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Vincenzo Ferrari
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,d Information Engineering Department , University of Pisa , Pisa , Italy
| | - Luca Morelli
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Ugo Boggi
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Mauro Ferrari
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,b Cisanello Teaching Hospital of Pisa , Pisa , Italy
| | - Franco Mosca
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,b Cisanello Teaching Hospital of Pisa , Pisa , Italy
| | - Alfred Cuschieri
- e Scuola Superiore Sant'Anna of Pisa , Pisa , Italy.,f Institute for Medical Science and Technology, University of Dundee , Dundee , UK
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A systematic examination of preoperative surgery warm-up routines. Surg Endosc 2016; 31:2202-2214. [PMID: 27633438 DOI: 10.1007/s00464-016-5218-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented? METHODS In order to address these issues, we adopted a two-pronged approach: (1) we conducted a systematic review of the literature to identify existing studies utilising preoperative simulation techniques; (2) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised cross-over trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation. RESULTS Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. While the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies. CONCLUSIONS There is an urgent need for a more rigorous approach to the development of "warm-up" routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance.
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Finnesgard EJ, Aho JM, Pandian TK, Farley DR. Effect of Rehearsal Modality on Knowledge Retention in Surgical Trainees: A Pilot Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:831-835. [PMID: 27142721 DOI: 10.1016/j.jsurg.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/02/2016] [Accepted: 04/04/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The operating room is an exciting learning environment. With growing curriculum limitations and increasing complexity of care, existing education opportunities need to be optimized. Rehearsal has benefits for surgeon performance in the operating room, but its role for enhancing operative learning remains unclear. This pilot study aimed to differentiate the effects of physical rehearsal (PR) and cognitive rehearsal (CR) modalities on surgical trainee technical knowledge retention. DESIGN Participants took part in a 2-day (sequential Fridays), instructed operative workshop performing midline laparotomy, splenectomy, left nephrectomy, and hand-sewn, side-to-side small bowel anastomosis (SBA). Participants were randomized to 10 minutes of either a (PR; n = 5) or (CR; n = 5) activity each day before operating. PR consisted of practicing SBA on a felt bowel model. CR entailed viewing narrated operative footage detailing the steps of SBA. Participants' technical knowledge of all procedures was assessed at 1 and 12 weeks postworkshop using a 31-question test. SETTING Animal operative suites at an academic medical center. PARTICIPANTS A total of 10 general surgery postgraduate year 1 interns participated in the workshop; all completed the study. Participants had similar levels of operative exposure at the time of study participation. RESULTS At 1-week postworkshop, mean assessment scores for CR were higher than PR (Mean ± Standard Deviation) (CR = 24.7 ± 1.6 vs. PR = 21.8 ± 1.7, p = 0.02). After 12 weeks, there was no difference in mean scores (CR = 23.3 ± 2 vs. PR = 21.7 ± 1.8, p = 0.22). Knowledge decay for the 12-week period was similar between groups (CR = -1.4 ± 1.6 vs. PR = -0.1 ± 2.4, p = 0.36). Study participants performed better on SBA-related questions than unrelated questions (laparotomy, splenectomy, and nephrectomy) at 1-week (related = 81.5% ± 11.3 vs. unrelated = 71.9% ± 6.6, p = 0.03) and 12 weeks (related = 81% ± 13.1 vs. unrelated = 68.6% ± 8.8, p = 0.02). CONCLUSION This pilot data suggests the modality of the rehearsal activity may not significantly effect surgical learners' technical knowledge retention. Participants did score higher on questions related to the rehearsal topic, indicating a potential supplementary role for rehearsal activities.
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Affiliation(s)
| | | | - T K Pandian
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Weitman E, Saleh M, Marescaux J, Martin TR, Ballantyne GH. Robotic colorectal surgery: Evolution and future. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Yang K, Perez M, Hossu G, Hubert N, Perrenot C, Hubert J. “Alarm-corrected” ergonomic armrest use could improve learning curves of novices on robotic simulator. Surg Endosc 2016; 31:100-106. [DOI: 10.1007/s00464-016-4934-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/09/2016] [Indexed: 11/24/2022]
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44
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Les outils d’apprentissage en chirurgie robotique. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Phé V, Cattarino S, Parra J, Bitker MO, Ambrogi V, Vaessen C, Rouprêt M. Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Véronique Phé
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Susanna Cattarino
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Jérôme Parra
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Marc-Olivier Bitker
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Vanina Ambrogi
- Pitié-Salpêtrière Academic Hospital, Department of Statistics, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Christophe Vaessen
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Morgan Rouprêt
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School; Paris 6 University; Paris France
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Whittaker G, Aydin A, Raison N, Kum F, Challacombe B, Khan MS, Dasgupta P, Ahmed K. Validation of the RobotiX Mentor Robotic Surgery Simulator. J Endourol 2016; 30:338-46. [DOI: 10.1089/end.2015.0620] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- George Whittaker
- School of Medical Education, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Francesca Kum
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Muhammed Shamim Khan
- MRC Centre for Transplantation, King's College London, London, United Kingdom
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, United Kingdom
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, United Kingdom
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Samuelson ST, Burnett G, Sim AJ, Hofer I, Weinberg AD, Goldberg A, Chang TS, DeMaria S. Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation? Br J Anaesth 2016; 116:398-404. [PMID: 26821699 DOI: 10.1093/bja/aev436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents. METHODS Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents. RESULTS Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (SD 3.2) s vs. 57 (SD 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (SD 1.7) s vs. 31 (SD 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (SD 1.2) vs. 37.6 (SD 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (SD 1.1) vs. 42.8 (SD 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance. CONCLUSIONS Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
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Affiliation(s)
| | | | - A J Sim
- Department of Anesthesiology
| | - I Hofer
- Department of Anesthesiology, UCLA David Geffen School of Medicine, 757 Westwood Plaza #3325, Los Angeles, CA 90024, USA
| | - A D Weinberg
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, and
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Lucereau B, Thaveau F, Lejay A, Roussin M, Georg Y, Heim F, Lee JT, Chakfe N. Learning Curve of Robotic-Assisted Anastomosis: Shorter than the Laparoscopic Technique? An Educational Study. Ann Vasc Surg 2016; 33:39-44. [PMID: 26806248 DOI: 10.1016/j.avsg.2015.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Achieving aortic anastomosis in laparoscopic surgery remains a technical challenge. The Da Vinci robot could theoretically counteract this issue by minimizing the technical challenge. The aim of this study was to compare the learning curves of performing vascular anastomoses by trainees without any experience using purely laparoscopic versus robotic-assisted techniques. METHODS Surgery residents were randomly included in the laparoscopic group (group A, n = 3) and the robotic group (group B, n = 3). They performed 10 end-to-end anastomoses on 18-mm-diameter tubular expanded polytetrafluoroethylene grafts. The parameters recorded were duration to complete the anastomosis and an indirect sealing quality evaluation (ISQE) defined as the following ratio: number of stitches with a distance of less than 4 mm/total number of stitches. RESULTS The mean duration to perform the anastomosis decreased from 2340 s (±64) for the first anastomosis to 651 s (±248) for the last in group A (P < 0.05) and from 1989 s (±556) to 801 s (±120) in group B (P < 0.05). The mean ISQE increased from 74% (±18) for the first anastomosis to 98% (±3) for the last in group A (P < 0.05) and decreased from 100% to 98% (±2) in group B (nonsignificant). The mean duration to perform the first anastomosis was lower in group B than in group A (P < 0.05). The mean duration to perform the last anastomosis was not significantly different between the groups. Sealing tended to be better in group B for the first anastomosis compared with group A. CONCLUSIONS Minimally invasive laparoscopic technique training demonstrates a learning curve to perform vascular anastomoses. The robotic-assisted technique tended to improve suturing skills and should be considered as a valuable tool to reduce the technical learning curve.
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Affiliation(s)
- Benoit Lucereau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mathieu Roussin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Frédéric Heim
- Laboratoire de Physique et Mécanique des Textiles, Université de Haute-Alsace, Mulhouse, France
| | - Jason T Lee
- Department of Vascular Surgery, Stanford University Medical Center, Stanford, CA
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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Song PH, Ko YH. The Surgical Skill of a Novice Trainee Manifests in Time-Consuming Exercises of a Virtual Simulator Rather Than a Quick-Finishing Counterpart: A Concurrent Validity Study Using an Urethrovesical Anastomosis Model. JOURNAL OF SURGICAL EDUCATION 2016; 73:166-172. [PMID: 26403727 DOI: 10.1016/j.jsurg.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/03/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The purpose of this study is to determine an optimal training curriculum using a robotic virtual simulator (RVS) that enables unexperienced trainees to perform a complex task in a hands-on setting. PATIENTS AND METHODS This study was conducted in 2 phases. In the RVS phase, 43 participants sequentially completed 12 exercises consistent with all primary exercises in the EndoWrist manipulation and advanced needle-driving category, until the overall score reached more than 80% by repeated practice. In the hands-on phase using a robotic surgical system, 10 randomly selected trainees performed 8 sutures once, simulating urethrovesical anastomosis, and the console time was recorded. RESULTS The median total time and total attempts for the RVS phase was 195.2 minutes and 54 times, respectively. The trainees were divided by median total time, and times to accomplish each RVS exercise were then compared between the early- and the late-completion groups; among 12 exercises trained, 6 exercises (prolonged course) requiring significantly more time in the late-completion group were identified. The prolonged course occupied 88.18% of the total time and 77.61% of the total attempts. For participants the in hands-on phase, a multiple linear regression model showed that the time to accomplish the prolonged course was a single independent predictor of the console time (R(2) = 0.524, B = 0.05; p = 0.018). CONCLUSION After establishment of a high standard cutoff score, the time spent for the prolonged course showed a significant association with console time in hands-on training simulating urethrovesical anastomosis, implying educational efficacy of training involving time-consuming exercise in performance of a complex task.
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Affiliation(s)
- Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
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50
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Robotic surgery simulation validity and usability comparative analysis. Surg Endosc 2015; 30:3720-9. [DOI: 10.1007/s00464-015-4667-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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