Using Automated Continuous Instrument Tracking to Benchmark Simulated Laparoscopic Performance and Personalize Training

Objective assessment for open surgical suturing training by finger tracking can discriminate novices from experts

It is difficult, time consuming and expensive to assess manual skills in open surgery. The aim of this study is to investigate the construct validity of a low-cost, easily accessible tracking technique for basic open suturing tasks. Medical master students, surgical residents, and surgeons at the Radboud University Medical Center were recruited between September 2020 until September 2021. The participants were divided, according to experience, in a novice group (≤10 sutures performed) and an expert group (>50 sutures performed). For objective tracking, a tablet with SurgTrac software was used, which tracked a blue and a red tag placed on respectively their left and right index finger. The participants executed four basic tasks on a suturing model: 1) knot tying by hand, 2) transcutaneous suturing with an instrument knot, 3) 'Donati' (vertical mattress suture) with an instrument knot and 4) continuous intracutaneous suturing without a knot. In total 76 participants were included: 57 novices and 19 experts. All four tasks showed significant differences between the novice group and expert group for the parameters time (p<0.001), distance (p<0.001 for Task 1, 2 and 3 and p=0.034 for Task 4) and smoothness (p<0.001). Additionally, Task 3 showed a significant difference for the parameter handedness (p=0.006) and Task 4 for speed (p=0.033). Tracking index finger movements using SurgTrac software on a tablet while executing basic open suturing skills on a simulator shows excellent construct validity for time, distance and motion smoothness in all four suturing tasks.

Application of a highly simulated and adaptable training system in the laparoscopic training course for surgical residents: Experience from a high-volume teaching hospital in China

Objective

To explore the effectiveness, feasibility, and training effect of a highly simulated and adaptable laparoscopic training system in the advanced integrated two-stage laparoscopic simulation training course for surgical residents.

Methods

This study prospectively took the surgical residents who received the advanced integrated two-stage laparoscopic simulation training course in our hospital from December 2019 to December 2021 as the research objects. In the stage one course, the trainees are randomly distributed into the dry simulation system group and Darwin laparoscopic training system group. The subjective assessment results of the trainees from the two groups are collected by questionnaires, and the simulation assessment results of the two groups are evaluated in a unified, objective, and standardized assessment form. The pre-course and post-course questionnaires were used to evaluate the feasibility and effectiveness of the Darwin system in the stage two course.

Results

A total of 62 trainees completed the stage one and stage two courses. In the stage one course, the trainees were randomly distributed into the dry simulation trainer group (N = 19) and the Darwin group (N = 43). The results of the subjective assessment questionnaire showed that compared with the dry simulator group, the students in the Darwin group had higher subjective scores (P < 0.05). The objective assessment results for the 3 modules of "One Track Transfer", "One Tunnel Pass" and "High and Low Pillars" in the Darwin group were significantly better than those in the dry simulator group (P < 0.05). The trainees who received the stage two course completed the questionnaires before and after the course. The results showed that compared with pre-course evaluation, "basic theoretical knowledge of laparoscopy", "basic skills of laparoscopy", "laparoscopic suture technique" and "camera-holding technique" were significantly improved after training (P < 0.05).

Conclusion

The highly simulated and adaptable laparoscopic training system is effective and feasible in the advanced integrated two-stage laparoscopic simulation training course for surgical residents.

Feasibility of tracking in open surgical simulation

The aim of this study was to develop an adequate tracking method for open surgical training, using tracking of the instrument or hand motions.

An open surgical training model and the SurgTrac application were used to track four separate suturing tasks. These tasks were performed with colour markings of either instruments or fingers, to find the most promising setting for reliable tracking.

Four experiments were used to find the optimal settings for the tracking system. Tracking of instruments was not usable for knot tying by hand. Tracking of fingers seemed to be a more promising method. Tagging the fingers with a coloured balloon-tube, seemed to be a more promising method (1.2–3.0% right hand vs. 9.2–17.9% left hand off-screen) than covering the nails with coloured tape (1.5–3.5% right hand vs. 25.5–55.4% left hand off-screen). However, analysis of the videos showed that redness of the hand was seen as red tagging as well. To prevent misinterpreting of the red tag by redness of the hand, white surgical gloves were worn underneath in the last experiment. The off-screen percentage of the right side decreased from 1.0 to 1.2 without gloves to 0.8 with gloves and the off-screen percentage of the left side decreased from 16.9–17.9 to 6.6–7.2, with an adequate tracking mark on the video images.

This study shows that tagging of the index fingers with a red (right) and blue (left) balloon-tube while wearing surgical gloves is a feasible method for tracking movements during basic open suturing tasks.

The Impact of Novel Nontechnical Stressors (Visual and Auditory) on Simulated Laparoscopic Task Performance Among Surgeons and Students

Background: Surgical training emphasizes technical competence. Growing evidence indicates that nontechnical skills are also significant in determining performance. Critically, surgeons should be aware how performance is affected by pressure or distraction. We assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We hypothesized that the stressors would worsen performance, and that stress-induced diminution in performance would be inversely related to surgical experience. Methods: Twenty participants (10 surgeons and 10 medical students) completed a peg-threading task using a laparoscopic simulator: three times under control conditions, next with a visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance), and then with an auditory distraction overlay (operating theater environment noise). Task completion time and instrument tracking metrics (instrument tip distance traveled and instrument smoothness) were measured. Results: Under control conditions, surgeons completed the task significantly faster, with greater economy of movement, and improved instrument smoothness-compared with students. When exposed to distracting stimuli, the groups behaved differently. Surgeons completed the task more slowly, instrument movements became less smooth (significantly so under audio distraction conditions), but total distance traveled by instruments was unchanged. By contrast, student performance was not impaired and, in some ways, improved. Conclusion: The impact of visual and auditory distraction on surgical performance can be modeled in a laparoscopic simulation environment. The effect of distraction varies according to expertise. This environment may be an effective setting within which to learn to mitigate stress-induced diminution in performance.