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Kale S, Vatkar A, Mishra R, Singh S, Saheta A, Shyam A. Live Surgery in Orthopedics: Balancing Educational Benefits and Ethical Challenges in the Modern Surgical Practice. J Orthop Case Rep 2024; 14:4-9. [PMID: 39381316 PMCID: PMC11458206 DOI: 10.13107/jocr.2024.v14.i10.4790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/14/2024] [Indexed: 10/10/2024] Open
Abstract
There is a saying that “a picture speaks more than a thousand words.” Similarly, an ongoing video streaming of live surgery can teach you much more than what books can teach. Live surgery in orthopedics offers a unique and dynamic educational experience, providing real-time insights into surgical techniques and decision-making processes. This method has been praised for its potential to enhance learning among residents and practicing surgeons by offering an unfiltered view of operative procedures. However, the integration of live surgery into educational frameworks is not without its challenges. Ethical concerns, patient safety, and the potential for increased stress on the performing surgeon are significant considerations that must be balanced against the educational benefits. Ethical challenges in orthopedic surgery often revolve around the introduction of new technology and maintaining patient safety and confidentiality during live broadcasts [1]. Furthermore, the effectiveness of live surgery as an educational tool must be carefully weighed against these ethical dilemmas and the associated risks [2]. As live surgical broadcasts become more prevalent, it is crucial to establish standardized guidelines to ensure patient safety and uphold ethical standards [3]. This editorial aims to explore the delicate balance between the educational benefits and the ethical challenges inherent in the practice of live surgery within the field of orthopedics.
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Affiliation(s)
- Sachin Kale
- Consultant Orthopaedic Surgeon, Apollo Hospital, Belapur, Navi Mumbai, Maharashtra, India
- Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India
| | - Arvind Vatkar
- Consultant Orthopaedic Spine Surgeon, Fortis Hiranandani Hospital, Vashi, Apollo Hospital, Belapur
- Assistant Professor at MGM Medical College, Navi Mumbai, Maharashtra, India
| | - Ronak Mishra
- Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India
| | - Shikhar Singh
- Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India
| | - Ayush Saheta
- Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Yong CW, Loy RCH, Wong RCW, Islam I. Optimizing each learning opportunity with intra-procedural recordings by enhancing self-reflection and feedback. J Dent Educ 2024. [PMID: 38877651 DOI: 10.1002/jdd.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/15/2024] [Accepted: 06/02/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Chee Weng Yong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | | | - Intekhab Islam
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Qu G, Zhang H, Qian R. The learning curve of a bronchus-first method in bi-port video-assisted thoracoscopic surgery for left upper lobe lung cancer. Updates Surg 2024:10.1007/s13304-024-01826-2. [PMID: 38575804 DOI: 10.1007/s13304-024-01826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
Video-assisted thoracic surgery (VATS) has been widely used in lung cancer treatment. However, VATS left upper lobectomy (LUL) is complex due to the intricate branching pattern of the left pulmonary artery (PA). Nevertheless, VATS right upper lobectomy can be simplified through a bronchus-first and simultaneous vessel stapling technique. In this study, the learning curve was obtained while ensuring favorable oncological outcomes using bronchus-first method for VATS LUL. First, retrospective data of 148 consecutive patients who underwent VATS LUL (bronchus-first method) for non-small cell lung cancer (NSCLC) from March 2018 to October 2020 were analyzed. The learning curve was then assessed via cumulative sum (CUSUM) analysis. Moreover, data at different stages of the learning curve, including operation time, blood loss, postoperative hospital stay, lymph node harvested, thoracotomy conversion, postoperative complications, endoscopic stapler consumptions, and 3 year overall survival, were recorded. The learning curve was best modeled as the equation: y = - 7.78 + 2.05x-2.23 × 10-2x2 + 6.43 × 10-5x3, with a good-to-fit test R2 = 0.97. The surgeon entered the proficient stage (59th case-148th case) after consecutive operations of 58 cases (learning stage, 1st case-58th case). Notably, more lymph nodes were harvested in the proficient stage than in the learning stage (17.69 ± 1.47 vs. 15.53 ± 1.43, P < 0.01). Compared with the learning stage, the proficient stage was associated with shorter operation time (114.28 ± 8.56 min vs. 126.81 ± 7.30 min, P < 0.01), fewer blood loss (44.22 ± 7.75 mL vs. 57.41 ± 22.98 mL, P < 0.01), shorter postoperative hospital stay (6.02 ± 0.99 d vs. 7.22 ± 1.34 d, P < 0.01), and fewer endoscopic stapler consumptions (5.89 ± 0.64 vs. 6.53 ± 0.50, P < 0.01). However, thoracotomy conversion (4/90 vs. 5/58, P = 0.32), postoperative complications (10/90 vs. 11/58, P = 0.23) and 3 year overall survival (62.2% vs. 50.8%, log-rank test, P = 0.11) showed no significant difference between the two stages. The surgeon with former single-direction VATS lobectomy experience can master bronchus-first VATS LUL after attending to 58 cases.
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Affiliation(s)
- Ge Qu
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Chest Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Heng Zhang
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Chest Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Rulin Qian
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Chest Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety. Surg Endosc 2024; 38:983-991. [PMID: 37973638 DOI: 10.1007/s00464-023-10528-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice. METHODS A multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes. RESULTS Of the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability. CONCLUSIONS A safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.
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Affiliation(s)
- Gina Adrales
- Division of Minimally Invasive Surgery, Minimally Invasive Surgical Training and Innovation Center (MISTIC), Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Monash University Department of Surgery & Lap Surgery, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center Bonn, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- Tamale Teaching Hospital, University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. Laparoscopic cholecystectomy critical view of safety (LC-CVS): a multi-national validation study of an objective, procedure-specific assessment using video-based assessment (VBA). Surg Endosc 2024; 38:922-930. [PMID: 37891369 DOI: 10.1007/s00464-023-10479-y] [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: 03/29/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A novel 6-item objective, procedure-specific assessment for laparoscopic cholecystectomy incorporating the critical view of safety (LC-CVS OPSA) was developed to support trainee formative and summative assessments. The LC-CVS OPSA included two retraction items (fundus and infundibulum retraction) and four CVS items (hepatocystic triangle visualization, gallbladder-liver separation, cystic artery identification, and cystic duct identification). The scoring rubric for retraction consisted of poor (frequently outside of defined range), adequate (minimally outside of defined range) and excellent (consistently inside defined range) and for CVS items were "poor-unsafe", "adequate-safe", or "excellent-safe". METHODS A multi-national consortium of 12 expert LC surgeons applied the OPSA-LC CVS to 35 unique LC videos and one duplicate video. Primary outcome measure was inter-rater reliability as measured by Gwet's AC2, a weighted measure that adjusts for scales with high probability of random agreement. Analysis of the inter-rater reliability was conducted on a collapsed dichotomous scoring rubric of "poor-unsafe" vs. "adequate/excellent-safe". RESULTS Inter-rater reliability was high for all six items ranging from 0.76 (hepatocystic triangle visualization) to 0.86 (cystic duct identification). Intra-rater reliability for the single duplicate video was substantially higher across the six items ranging from 0.91 to 1.00. CONCLUSIONS The novel 6-item OPSA LC CVS demonstrated high inter-rater reliability when tested with a multi-national consortium of LC expert surgeons. This brief instrument focused on safe surgical practice was designed to support the implementation of entrustable professional activities into busy surgical training programs. Instrument use coupled with video-based assessments creates novel datasets with the potential for artificial intelligence development including computer vision to drive assessment automation.
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Affiliation(s)
- Gina Adrales
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Department of Surgery & LapSurgery, Monash University, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- University for Development Studies-School of Medicine and Health Sciences, Tamale Teaching Hospital, Tamales, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Nourrit V, Lamour JB, Abiven B, Fracasso B, de Bougrenet de la Tocnaye JL. Head-Mounted Miniature Motorized Camera and Laser Pointer Driven by Eye Movements. SENSORS (BASEL, SWITZERLAND) 2023; 23:3503. [PMID: 37050563 PMCID: PMC10098879 DOI: 10.3390/s23073503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
Recording a video scene as seen by an observer, materializing where is focused his visual attention and allowing an external person to point at a given object in this scene, could be beneficial for various applications such as medical education or remote training. Such a versatile device, although tested at the experimental laboratory demonstrator stage, has never been integrated in a compact and portable way in a real environment. In this context, we built a low-cost, light-weight, head-mounted device integrating a miniature camera and a laser pointer that can be remotely controlled or servo-controlled by an eye tracker. Two motorizations were implemented and tested (pan/tilt and Rilsey-prisms-based). The video was both recorded locally and transmitted wirelessly. Risley prisms allowed finer remote control of camera or laser pointer orientation (0.1° vs. 0.35°), but data processing and Wi-Fi transmission incur significant latency (~0.5 s) limiting the servo-controlling by eye movements. The laser beam was spatially shaped by a Diffractive Optical Element to facilitate object illumination or recognition. With this first proof-of-concept prototype, the data stream needs to be optimized to make full use of the eye tracker, but this versatile device can find various applications in education, healthcare or research.
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Affiliation(s)
- Vincent Nourrit
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
| | | | - Bernard Abiven
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
| | - Bruno Fracasso
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
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Song Z, Yuan Y, Cheng C, Luo Q, Cheng X. The learning curve on uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos. Front Oncol 2023; 13:1085634. [PMID: 37152033 PMCID: PMC10161897 DOI: 10.3389/fonc.2023.1085634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesVideo-assisted thoracoscopic lobectomy has become the preferred surgical approach in experienced centers, and uniportal approaches are becoming increasingly used. But the uniportal approach is still not widely applied presumably due to the learning difficulties of this complex procedure. The use of surgical videos may be helpful to accelerate the learning of this new techniques as in other fields. In this study, we aimed to analyze the learning curve of uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos.Methods114 patients with early-stage lung cancer who underwent uniportal video-assisted thoracoscopic lobectomy performed from 2020 to 2021 were reviewed in this study. We recorded the operation video for each patient and reviewed all the videos after surgery. The learning curves were assessed using cumulative sum analysis and the collected data of perioperative outcomes were assessed.ResultsThe CUMSUM curve showed its inflection points were around case 38 and 53. It was less compared with previous studies, which about 57–140 cases are needed to attain the proficient phase. The perioperative outcomes were similar in each phase, which included intraoperative blood loss (79.00 ± 26.70 vs 70.67 ± 26.64 vs 70.56 ± 27.23, p=0.0119), the length of hospital stay (3.60 ± 1.52 days vs. 3.23 ± 0.90 days vs. 3.06 ± 0.88 days, p=0.053), the rate of prolonged air leak and conversion to open thoracotomy. There was also no significant difference in the numbers and station of lymph node dissection among the three phases.ConclusionsUniportal video-assisted thoracoscopic lobectomy is a safe and reliable approach. Recording and reviewing the operation video could help the surgeon to improve deficiencies and refine the procedure.
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Perumalla C, Kearse L, Peven M, Laufer S, Goll C, Wise B, Yang S, Pugh C. AI-Based Video Segmentation: Procedural Steps or Basic Maneuvers? J Surg Res 2023; 283:500-506. [PMID: 36436286 PMCID: PMC10368211 DOI: 10.1016/j.jss.2022.10.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Video-based review of surgical procedures has proven to be useful in training by enabling efficiency in the qualitative assessment of surgical skill and intraoperative decision-making. Current video segmentation protocols focus largely on procedural steps. Although some operations are more complex than others, many of the steps in any given procedure involve an intricate choreography of basic maneuvers such as suturing, knot tying, and cutting. The use of these maneuvers at certain procedural steps can convey information that aids in the assessment of the complexity of the procedure, surgical preference, and skill. Our study aims to develop and evaluate an algorithm to identify these maneuvers. METHODS A standard deep learning architecture was used to differentiate between suture throws, knot ties, and suture cutting on a data set comprised of videos from practicing clinicians (N = 52) who participated in a simulated enterotomy repair. Perception of the added value to traditional artificial intelligence segmentation was explored by qualitatively examining the utility of identifying maneuvers in a subset of steps for an open colon resection. RESULTS An accuracy of 84% was reached in differentiating maneuvers. The precision in detecting the basic maneuvers was 87.9%, 60%, and 90.9% for suture throws, knot ties, and suture cutting, respectively. The qualitative concept mapping confirmed realistic scenarios that could benefit from basic maneuver identification. CONCLUSIONS Basic maneuvers can indicate error management activity or safety measures and allow for the assessment of skill. Our deep learning algorithm identified basic maneuvers with reasonable accuracy. Such models can aid in artificial intelligence-assisted video review by providing additional information that can complement traditional video segmentation protocols.
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Affiliation(s)
- Calvin Perumalla
- Stanford School of Medicine, Department of Surgery, Stanford, California.
| | - LaDonna Kearse
- Stanford School of Medicine, Department of Surgery, Stanford, California
| | - Michael Peven
- John Hopkins University, Department of Computer Science, Baltimore, Maryland
| | - Shlomi Laufer
- Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
| | - Cassidi Goll
- Stanford School of Medicine, Department of Surgery, Stanford, California
| | - Brett Wise
- Stanford School of Medicine, Department of Surgery, Stanford, California
| | - Su Yang
- Stanford School of Medicine, Department of Surgery, Stanford, California
| | - Carla Pugh
- Stanford School of Medicine, Department of Surgery, Stanford, California
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Information and Guidance on the Adoption of Surgical Innovation and Technology in Urogynecology. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:318-326. [PMID: 36808927 DOI: 10.1097/spv.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT The development of new technology and techniques (NTT) is an integral component of contemporary medicine. In surgery, rapidly advancing technology offers opportunities to innovate and study new approaches to help improve the quality and effectiveness of therapies. The American Urogynecologic Society is committed to the responsible implementation and use of NTT prior to the broad application of clinical care for patients, which includes not just new devices but application of new procedures. The aim of this document is to present a framework by which AUGS and its members can address future NTT development. Core areas of patient advocacy, industry partnerships, postmarket surveillance, and credentialing were identified to provide both a perspective and pathway for responsible use of NTT.
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11
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Zanello M, Dibué M, Cornips E, Roux A, McGonigal A, Pallud J, Carron R. Training and teaching of vagus nerve stimulation surgery: Worldwide survey and future perspectives. Neurochirurgie 2023; 69:101420. [PMID: 36775121 DOI: 10.1016/j.neuchi.2023.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/12/2022] [Accepted: 02/05/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Vagus nerve stimulation (VNS) therapy has been used for more than two decades to treat drug resistant epilepsy and depression and most recently received FDA approval for stroke rehabilitation. Expanding indications will renew the interest in the technique and increase the number of surgeons to be trained. The aim of this study was to survey surgeons with substantial expertise on optimal teaching and training approaches. METHODS Anonymous forms comprising 16 questions were sent by e-mail to surgeons with substantial expertise. Statistical analyses were used to compare the answers of the most experienced surgeons (>5 years) with the less experienced ones (<5 years). RESULTS Fully-completed forms were collected from 57 experts from 20 countries. The placement of the helical coils was deemed to be the most difficult step by 36 (63.2%) experts, and the use of optical magnification during this step was deemed necessary by 39 (68.4%) experts. Vocal cord palsy should be largely avoidable with proper surgical technique according to 44 (77.2%) experts. The teaching tool considered the most useful was mentoring (38, 66.7%). The future of VNS surgery teaching was deemed to be in anatomical workshops (29, 50.9%) and surgical simulation (26, 45.6%). Overall, answers did not vary significantly according to experience. CONCLUSIONS VNS surgery should be mastered by actively participating in dedicated practical training courses and by individual mentoring during actual surgery, which is still the best way to learn. This study highlights the need for a formal training course and possible specific accreditation.
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Affiliation(s)
- M Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
| | - M Dibué
- Department of Neurosurgery, Friedrich-Schiller University, Jena, Germany; Medical Affairs Neuromodulation International, LivaNova PLC, London, United Kingdom
| | - E Cornips
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - A Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - A McGonigal
- Aix Marseille Univ, AP-HM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Epileptology Department, Marseille, France
| | - J Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - R Carron
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France; Aix Marseille Univ, AP-HM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
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Filicori F, Bitner DP, Fuchs HF, Anvari M, Sankaranaraynan G, Bloom MB, Hashimoto DA, Madani A, Mascagni P, Schlachta CM, Talamini M, Meireles OR. SAGES video acquisition framework-analysis of available OR recording technologies by the SAGES AI task force. Surg Endosc 2023:10.1007/s00464-022-09825-3. [PMID: 36729231 DOI: 10.1007/s00464-022-09825-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical video recording provides the opportunity to acquire intraoperative data that can subsequently be used for a variety of quality improvement, research, and educational applications. Various recording devices are available for standard operating room camera systems. Some allow for collateral data acquisition including activities of the OR staff, kinematic measurements (motion of surgical instruments), and recording of the endoscopic video streams. Additional analysis through computer vision (CV), which allows software to understand and perform predictive tasks on images, can allow for automatic phase segmentation, instrument tracking, and derivative performance-geared metrics. With this survey, we summarize available surgical video acquisition technologies and associated performance analysis platforms. METHODS In an effort promoted by the SAGES Artificial Intelligence Task Force, we surveyed the available video recording technology companies. Of thirteen companies approached, nine were interviewed, each over an hour-long video conference. A standard set of 17 questions was administered. Questions spanned from data acquisition capacity, quality, and synchronization of video with other data, availability of analytic tools, privacy, and access. RESULTS Most platforms (89%) store video in full-HD (1080p) resolution at a frame rate of 30 fps. Most (67%) of available platforms store data in a Cloud-based databank as opposed to institutional hard drives. CV powered analysis is featured in some platforms: phase segmentation in 44% platforms, out of body blurring or tool tracking in 33%, and suture time in 11%. Kinematic data are provided by 22% and perfusion imaging in one device. CONCLUSION Video acquisition platforms on the market allow for in depth performance analysis through manual and automated review. Most of these devices will be integrated in upcoming robotic surgical platforms. Platform analytic supplementation, including CV, may allow for more refined performance analysis to surgeons and trainees. Most current AI features are related to phase segmentation, instrument tracking, and video blurring.
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Affiliation(s)
- Filippo Filicori
- Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel P Bitner
- Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Hans F Fuchs
- Department of Surgery, Division of Surgical Robotics and Artificial Intelligence, University of Cologne, Cologne, Germany
| | - Mehran Anvari
- Center for Surgical Invention and Innovation, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ganesh Sankaranaraynan
- Artificial Intelligence and Medical Simulation (AIMS) Lab, Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Matthew B Bloom
- Minimally Invasive Surgery Laboratory, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel A Hashimoto
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amin Madani
- Surgical Artificial Intelligence Research Academy, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Pietro Mascagni
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Christopher M Schlachta
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London Health Sciences Centre, London, ON, Canada
| | - Mark Talamini
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ozanan R Meireles
- Surgical Artificial Intelligence and Innovation Laboratory (SAIIL), Department of General Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 339, Boston, MA, 02139, USA.
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Varela E, Castelli I, Szwarcfiter V, Turner L, Gaete MI, Belmar F, Cortés M, Jiménez G, Corvetto M, Varas J. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1708. [PMID: 36542006 PMCID: PMC9767423 DOI: 10.1590/0102-672020220002e1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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Affiliation(s)
- Eduardo Varela
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Ignacio Castelli
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Vania Szwarcfiter
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Lawrence Turner
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - María Inés Gaete
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Francisca Belmar
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Matías Cortés
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Gerónimo Jiménez
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Marcia Corvetto
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Julián Varas
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
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14
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Srinivasa K, Moir F, Goodyear-Smith F. The Role of Online Videos in Teaching Procedural Skills in Postgraduate Medical Education: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1295-1307. [PMID: 35725724 DOI: 10.1016/j.jsurg.2022.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/27/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this scoping review was to outline the extent of available literature including the prevalence of video quality appraisal tools, characterize how online videos were used, and identify the gaps in the literature with implications for future research. DESIGN The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR). Six databases were searched: (1) MEDLINE (Ovid), (2) EMBASE, (3) Cochrane, (4) ERIC, (5) CINAHL PLUS, and (6) Google Scholar for Medical Subject Headings terms online videos, postgraduate health education, and health professional/s. RESULTS A total of 6948 articles were identified, of which 78 were included in the review. The articles included were primarily either experimental or observational studies, with most being from North America. Twelve concepts were identified: (1) procedural skills teaching; (2) video assessment; (3) validation of an assessment tool; (4) video feedback; (5) coaching; (6) broadcasting; (7) learner characteristics; (8) video characteristics; (9) video quality; (10) a quality assessment tool; (11) platforms and video library; and (12) health information governance. CONCLUSIONS While there is a diverse and growing body of literature on this area, information is lacking about the quality appraisal of online videos.
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Affiliation(s)
- Komal Srinivasa
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand.
| | - Fiona Moir
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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15
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Vadhera AS, Lee JS, Veloso IL, Singh H, Trasolini NA, Kunze KN, Gursoy S, Geeslin AG, Verma NN, Chahla J. Technique Articles Are More Effective at Increasing Social Media Attention in Comparison With Original Research Articles: An Altmetrics-Based Analysis. Arthrosc Sports Med Rehabil 2022; 4:e989-e995. [PMID: 35747624 PMCID: PMC9210375 DOI: 10.1016/j.asmr.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare social media attention and citation rates between technique articles and matched original research articles (ORAs) regarding surgical procedures. Methods All technique articles published from August 2019 through July 2020 in the free, electronic versions of Arthroscopy Techniques and JBJS Essential Surgical Techniques were matched by topic to articles in the “Original Research” sections of Arthroscopy, Sports Medicine, and Rehabilitation and JBJS Open Access in a 4:1 ratio within this time frame. The primary outcome was the Altmetric Attention Score (AAS). Secondary outcomes included citations, bibliometrics, and social media metrics. Independent t tests were used to compare primary and secondary outcomes between technique articles and ORAs. A multivariate linear regression analysis was performed to determine the association between article type and social media attention while controlling for confounding bibliometric characteristics. Results A total of 285 matched research articles (n = 57, 20.0%) and technique articles (n = 228, 80.0%) were included. The mean AAS among all technique articles was 3.63 ± 10.08 (range, 0-96) whereas the mean AAS among all ORAs was 1.30 ± 3.98 (range, 0-25), representing a statistically significant difference (P = .016). The mean citation rate among all technique articles was not significantly different from that among ORAs (P = .73). Multivariate linear regression analysis showed a statistically significant positive association between AAS and article type, with an additional mean increase in the AAS of 2.91 (95% confidence interval, 0.04-5.77; P = .047) for every technique article compared with an ORA. Furthermore, a significant positive relation was noted between the article origin and the AAS, with an increase in the AAS of 3.00 (95% confidence interval, 0.82-5.17; P = .007) for every article published in North America compared with an article originating from another continent. Conclusions Technique articles resulted in significantly greater AASs and social media attention in comparison with open-access ORAs on similar topics. Publications that described technical procedures in a technique journal and studies from North America were positively associated with greater AASs and greater numbers of citations received by articles. Clinical Relevance An improved understanding of how much attention is given to technique articles versus matched ORAs by social media may influence the methods authors and journals use for distributing content. The present study suggests that one option to increase the amount of social media attention received for a particular study may be to utilize an accompanying surgical technique video or illustrations as these are easily shareable on social media and offer rapid dissemination of knowledge, similar to that of an infographic. However, physicians who view multimedia within technique articles should be encouraged to review the accompanying articles and the supporting original research as a primary source before making changes in their clinical practice.
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021. [PMID: 34059480 DOI: 10.1016/j.jsurg.2021.1905.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery. OBJECTIVE This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field. DESIGN A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy. RESULTS 134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%). CONCLUSION The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.
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Affiliation(s)
- Layne N Raborn
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Columbus, Ohio.
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17
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1948-1964. [PMID: 34059480 PMCID: PMC8894132 DOI: 10.1016/j.jsurg.2021.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery. OBJECTIVE This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field. DESIGN A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy. RESULTS 134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%). CONCLUSION The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.
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Affiliation(s)
- Layne N Raborn
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Columbus, Ohio.
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18
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Leong JMC, Lam WL, Tan SZ, Ng CY. Changing face of medical education during a pandemic: tragedy or opportunity? Postgrad Med J 2021; 98:492-498. [PMID: 34193542 DOI: 10.1136/postgradmedj-2021-140330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/05/2021] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has changed forever the way we do certain things. Although the race for a cure and vaccine has taken centre stage, traditional face-to-face medical education has slowly metamorphosised in the background to a virtual world with innumerable webinars, virtual tutorials and lectures in the World Wide Web. Despite this seemingly 'perfect' solution, there remains a hidden cost. Educators are forced to learn new skills to engage students as well as manipulate the electronic platform. Impact on learning for students, both undergraduate and postgraduate from a lack of social interactions, remains unknown. In this article, the authors share their experiences from different specialities about the pros and cons of virtual learning and teaching. Suggestions and practical tips are offered to enhance the learning experience. More emphasis may need to be placed on the creation of learning communities rather than lecture-based curricula. Hybrid curricula or conferences may become the future norm. As we slowly move out of lockdown into a changed world and new ways of doing things, lessons learnt can be harnessed for future hybrid models that can combine the best of technology and physical teaching to reduce worldwide inequalities.
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Affiliation(s)
| | - Wee Leon Lam
- Plastic Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Shi Zhuan Tan
- Opthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Chye Yew Ng
- Orthopaedics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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19
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Evaluating the Effect of Surgical Skill on Outcomes for Laparoscopic Sleeve Gastrectomy: A Video-based Study. Ann Surg 2021; 273:766-771. [PMID: 31188214 DOI: 10.1097/sla.0000000000003385] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies have demonstrated a correlation between surgical skill and complication rates after laparoscopic Roux-en-Y gastric bypass. However, the impact of surgical skill on a similar but less technically challenging procedure such as sleeve gastrectomy (SG) is unknown. METHODS Practicing bariatric surgeons (n = 25) participating in a statewide quality improvement collaborative submitted an unedited deidentified video of a representative laparoscopic SG. Videos were obtained between 2015 and 2016 and were rated by bariatric surgeons in a blinded fashion using a validated instrument that assesses surgical skill. Overall scores were based on a 5-point Likert scale with 5 representing a "master surgeon" and 1 representing a "surgeon-in-training." Risk-adjusted 30-day complication rates, 1-year weight loss among cases performed during the study period, and operative technique were compared between surgeons rated in the top and bottom quartiles according to skill. RESULTS Surgeon ratings for skill varied between 2.73 and 4.60. Ratings for skill did not correlate with overall 30-day risk-adjusted complication rates (Pearson correlation coefficient, 0.213, P = 0.303). However, surgeons with higher skill ratings had lower rates of specific surgical complications, including postoperative obstruction (0.13% vs 0.3%, P = 0.017), hemorrhage (0.85% vs 1.27%, P = 0.005), and reoperation (0.24% vs 0.92%, P < 0.0001). Surgeons ranked in the top quartile for skill had faster operating times for SG (59.0 vs 82.1 min, P < 0.0001) and higher annual case volumes for both SG and any bariatric procedure (224.3 cases/yr vs 73.4 cases/yr, P = 0.009 and 244.9 cases/yr and 93.9 cases/yr, P = 0.009) when compared with surgeons in the bottom quartile. When comparing operative technique, top rated surgeons were noted to have a higher likelihood of using buttressing (83.3% vs 0%, P = 0.0041) and intraoperative endoscopy (83.3% vs 0%, P = 0.0041). CONCLUSIONS Peer ratings for surgical skill varied for laparoscopic sleeve gastrectomy but did not have a significant impact on overall complication rates. Top rated surgeons had lower rates of obstruction, hemorrhage, and reoperation; however, severe morbidity remained extremely low among all surgeons.
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20
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Cristofari H, Jung MK, Niclauss N, Toso C, Kloetzer L. Teaching and learning robotic surgery at the dual console: a video-based qualitative analysis. J Robot Surg 2021; 16:169-178. [PMID: 33723791 PMCID: PMC8863707 DOI: 10.1007/s11701-021-01224-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
Robotic-assisted surgery (RAS) involves training processes and challenges that differ from open or laparoscopic surgery, particularly regarding the possibilities of observation and embodied guidance. The video recording and the dual-console system creates a potential opportunity for participation. Our research, conducted within the department of visceral surgery of a big Swiss, public, academic hospital, uses a methodology based on the co-analysis of video recordings with surgeons in self-confrontation interviews, to investigate the teaching activity of the lead surgeon supervising a surgeon in training at the dual console. Three short sequences have been selected for the paper. Our analysis highlights the skills-in-construction of the surgeon in training regarding communication with the operating team, fluency of working with three hands, and awareness of the whole operating site. It also shows the divergent necessities of enabling verbalization for professional training, while ensuring a quiet and efficient environment for medical performance. To balance these requirements, we argue that dedicated briefing and debriefing sessions may be particularly effective; we also suggest that the self-confrontation video technique may be valuable to support the verbalization on both the mentor’s and the trainee’s side during such debriefing, and to enhance the mentor’s reflexivity regarding didactic choices.
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Affiliation(s)
- Hélène Cristofari
- Institute of Psychology and Education, University of Neuchâtel, Neuchâtel, Switzerland
| | - Minoa Karin Jung
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nadja Niclauss
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laure Kloetzer
- Institute of Psychology and Education, University of Neuchâtel, Neuchâtel, Switzerland.
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21
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Mazer L, Varban O, Montgomery JR, Awad MM, Schulman A. Video is better: why aren't we using it? A mixed-methods study of the barriers to routine procedural video recording and case review. Surg Endosc 2021; 36:1090-1097. [PMID: 33616730 DOI: 10.1007/s00464-021-08375-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Video-based case review for minimally invasive surgery is immensely valuable for education and quality improvement. Video review can improve technical performance, shorten the learning curve, disseminate new procedures, and improve learner satisfaction. Despite these advantages, it is underutilized in many institutions. So far, research has focused on the benefits of video, and there is relatively little information on barriers to routine utilization. METHODS A 36-question survey was developed on video-based case review and distributed to the SAGES email list. The survey included closed and open-ended questions. Numeric responses and Likert scales were compared with t-test; open-ended responses were reviewed qualitatively through rapid thematic analysis to identify themes and sub-themes. RESULTS 642 people responded to the survey for a response rate of 11%. 584 (91%) thought video would improve the quality of educational conferences. 435 qualitative responses on the value of video were analyzed, and benefits included (1) improved understanding, (2) increased objectivity, (3) better teaching, and (4) better audience engagement. Qualitative comments regarding specific barriers to recording and editing case video identified challenges at all stages of the process, from (1) the decision to record a case, (2) starting the recording in the OR, (3) transferring and storing files, and (4) editing the file. Each step had its own specific challenges. CONCLUSION Minimally invasive surgeons want to increase their utilization of video-based case review, but there are multiple practical challenges to overcome. Understanding these barriers is essential in order to increase use of video for education and quality improvement.
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Affiliation(s)
- Laura Mazer
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Oliver Varban
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - John R Montgomery
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Michael M Awad
- Department of Surgery, Division of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, USA
| | - Allison Schulman
- Department of Gastroenterology, Division of Interventional Gastroenterology, University of Michigan, Ann Arbor, USA
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22
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Varban OA, Thumma JR, Carlin AM, Finks JF, Ghaferi AA, Dimick JB. Peer Assessment of Operative Videos with Sleeve Gastrectomy to Determine Optimal Operative Technique. J Am Coll Surg 2020; 231:470-477. [DOI: 10.1016/j.jamcollsurg.2020.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
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23
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Manabe T, Takasaki M, Ide T, Kitahara K, Sato S, Yunotani S, Hirohashi Y, Iyama A, Taniguchi M, Ogata T, Shimizu S, Noshiro H. Regional education on endoscopic surgery using a teleconference system with high-quality video via the internet: Saga surgical videoconferences. BMC MEDICAL EDUCATION 2020; 20:329. [PMID: 32972399 PMCID: PMC7513322 DOI: 10.1186/s12909-020-02215-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Effective education about endoscopic surgery (ES) is greatly needed for unskilled surgeons, especially at low-volume institutions, to maintain the safety of patients. We have tried to establish the remote educational system using videoconference system through the internet for education about ES to surgeons belonging to affiliate institutions. The aim of this manuscript was to report the potential to establish a comfortable remote educational system and to debate its advantages. METHODS We established a local remote educational conference system by combining the use of a general web conferencing system and a synchronized remote video playback system with annotation function through a high-speed internet. RESULTS During 2014-2019, we conducted 14 videoconferences to review and improve surgeons' skills in performing ES at affiliated institutions. At these conferences, while an uncut video of ES that had been performed at one of the affiliated institutions was shown, the surgical procedure was discussed frankly, and expert surgeons advised improvements. The annotation system is useful for easy, prompt recognition among the audience regarding anatomical structures and procedures that are difficult to explain verbally. CONCLUSIONS This system is of low initial cost and offers easy participation and high-quality videos. It would therefore be a useful tool for regional ES education.
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Affiliation(s)
- Tatsuya Manabe
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Mitsuhiro Takasaki
- Saga University Organization for General Education, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga, 849-8571, Japan
| | - Seiji Sato
- Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga, 849-8571, Japan
| | - Seiji Yunotani
- Department of Surgery, Japanese Red Cross Karatsu Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Yoshimi Hirohashi
- Department of Surgery, Takagi Hospital, 141-11 Sakemi, Okawa, Fukuoka, 831-0016, Japan
| | - Akihiro Iyama
- Department of Surgery, Oda Hospital, 4306 Takatsuhara, Kashima, Saga, 849-1311, Japan
| | - Masahiko Taniguchi
- Department of Surgery, Saint Mary Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Toshiro Ogata
- Department of Surgery, Saint Mary Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Shuji Shimizu
- International Medical Department, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Prebay ZJ, Peabody JO, Miller DC, Ghani KR. Video review for measuring and improving skill in urological surgery. Nat Rev Urol 2020; 16:261-267. [PMID: 30622365 DOI: 10.1038/s41585-018-0138-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Interest is growing within the urological surgery community for objective assessments of technical skill. Surgical video review relies on the use of objective assessment tools to evaluate both global and procedure-specific skill. These evaluations provide structured feedback to surgeons with the aim of improving technique, which has been associated with patient outcomes. Currently, skill assessments can be performed by using expert peer-review, crowdsourcing or computer-based methods. Given the relationship between skill and patient outcomes, surgeons might be required in the future to provide empirical evidence of their technical skill for certification, employment, credentialing and quality improvement. Interventions such as coaching and skills workshops incorporating video review might help surgeons improve their skill, with the ultimate goal of improving patient outcomes.
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Affiliation(s)
- Zachary J Prebay
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James O Peabody
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Schirmer CM, Griessenauer CJ, Dalal SS, Weiner G, Goren O. Commentary: Double-Barrel Extracranial-Intracranial Bypass and Trapping of Dolichoectatic Middle Cerebral Artery Aneurysms: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 17:E16-E17. [PMID: 30418625 DOI: 10.1093/ons/opy318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Clemens M Schirmer
- Department of Neurosurgery and Neu-roscience Institute, Geisinger, Danville, Pennsylvania
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neu-roscience Institute, Geisinger, Danville, Pennsylvania.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Gregory Weiner
- Department of Neurosurgery and Neu-roscience Institute, Geisinger, Danville, Pennsylvania
| | - Oded Goren
- Department of Neurosurgery and Neu-roscience Institute, Geisinger, Danville, Pennsylvania
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Townsend JM, Beck EC, Gehrke SH, Berkland CJ, Detamore MS. Flow Behavior Prior to Crosslinking: The Need for Precursor Rheology for Placement of Hydrogels in Medical Applications and for 3D Bioprinting. Prog Polym Sci 2019; 91:126-140. [PMID: 31571701 PMCID: PMC6768569 DOI: 10.1016/j.progpolymsci.2019.01.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hydrogels - water swollen cross-linked networks - have demonstrated considerable promise in tissue engineering and regenerative medicine applications. However, ambiguity over which rheological properties are needed to characterize these gels before crosslinking still exists. Most hydrogel research focuses on the performance of the hydrogel construct after implantation, but for clinical practice, and for related applications such as bioinks for 3D bioprinting, the behavior of the pre-gelled state is also critical. Therefore, the goal of this review is to emphasize the need for better rheological characterization of hydrogel precursor formulations, and standardized testing for surgical placement or 3D bioprinting. In particular, we consider engineering paste or putty precursor solutions (i.e., suspensions with a yield stress), and distinguish between these differences to ease the path to clinical translation. The connection between rheology and surgical application as well as how the use of paste and putty nomenclature can help to qualitatively identify material properties are explained. Quantitative rheological properties for defining materials as either pastes or putties are proposed to enable easier adoption to current methods. Specifically, the three-parameter Herschel-Bulkley model is proposed as a suitable model to correlate experimental data and provide a basis for meaningful comparison between different materials. This model combines a yield stress, the critical parameter distinguishing solutions from pastes (100-2000 Pa) and from putties (>2000 Pa), with power law fluid behavior once the yield stress is exceeded. Overall, successful implementation of paste or putty handling properties to the hydrogel precursor may minimize the surgeon-technology learning time and ultimately ease incorporation into current practice. Furthermore, improved understanding and reporting of rheological properties will lead to better theoretical explanations of how materials affect rheological performances, to better predict and design the next generation of biomaterials.
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Affiliation(s)
- Jakob M. Townsend
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Emily C. Beck
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Stevin H. Gehrke
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA
| | - Cory J. Berkland
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66045, USA
| | - Michael S. Detamore
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
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Green JL, Suresh V, Bittar P, Ledbetter L, Mithani SK, Allori A. The Utilization of Video Technology in Surgical Education: A Systematic Review. J Surg Res 2018; 235:171-180. [PMID: 30691792 DOI: 10.1016/j.jss.2018.09.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/05/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of surgical video has great potential to enhance surgical education, but there exists limited information about how to effectively use surgical videos. We performed a systematic review of video technology in surgical training and provided evidence-based recommendations for its effective use. MATERIALS AND METHODS A systematic review of literature on surgical video in residency education was conducted. All articles meeting inclusion criteria were evaluated for technical characteristics pertaining to video usage. Included studies were critically appraised using a quality-scoring system. Recommendations were provided for the effective implementation of video in surgical education based on associations with improved training outcomes. RESULTS Twenty articles met inclusion criteria. In these studies, the source of video acquisition was primarily laparoscopy (40.0% of papers), and the main perspective of video was endoscopy (45.0%). Features of videos included supplementation with other educational tools (55.0%), schematic diagrams or images (50.0%), audio (40.0%), and narration (25.0%). Videos were primarily viewed preoperatively (60.0%) or postoperatively (50.0%). The intended viewer for videos was usually residents (70.0%) but also included attendings/faculty (30.0%). When compared with a nonvideo training group, video training was associated with improved resident knowledge (100%), improved operative performance (81.3%), and greater participant satisfaction (100%). CONCLUSIONS Based on this review, we recommend that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilize audio in video. For video review, we recommend that residents review video preoperatively and postoperatively for learning and that attendings review video postoperatively for assessment.
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Affiliation(s)
- Jason L Green
- Duke University School of Medicine, Durham, North Carolina.
| | - Visakha Suresh
- Duke University School of Medicine, Durham, North Carolina
| | - Peter Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina
| | - Suhail K Mithani
- Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Allori
- Pediatric Plastic & Craniofacial Surgery, Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Jaffe TA, Hasday SJ, Knol M, Pradarelli J, Pavuluri Quamme SR, Greenberg CC, Dimick JB. Strategies for New Skill Acquisition by Practicing Surgeons. JOURNAL OF SURGICAL EDUCATION 2018; 75:928-934. [PMID: 28974428 DOI: 10.1016/j.jsurg.2017.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/27/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To understand how practicing surgeons utilize available training methods, which methods are perceived as effective, and important barriers to using more effective methods. DESIGN Online survey designed to characterize surgeon utilization and perception of available training methods. SETTING Two large Midwestern academic health centers. PARTICIPANTS 150 faculty surgeons. METHODS Nominal values were compared using a McNemar's Test and Likert-like values were compared using a paired t-test (IBM SPSS Statistics v. 21.0; New York, NY). RESULTS Survey response rate was 81% (122/150). 98% of surgeons reported learning a new procedure or technology after formal training. Many surgeons reported scrubbing in expert cases (78%) and self-directed study (66%), while few surgeons (6%) completed a mini-fellowship. The modalities used most commonly were scrubbing in expert cases (34%) and self-directed study (27%). Few surgeons (7%) believed self-directed study would be most effective, whereas 31% and 16% believed operating under supervision and mini-fellowships would be most effective, respectively. Surgeons believed more effective methods "would require too much time" or they had "confidence in their ability to implement safely." CONCLUSIONS Practicing surgeons use a variety of training methods when learning new procedures and technologies, and there is disconnect between commonly used training methods and those deemed most effective. Confidence in surgeon's ability was cited as a reason for this discrepancy; and surgeons found time associated with more effective methods to be prohibitive.
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Affiliation(s)
- Todd A Jaffe
- The University of Michigan Medical School, Ann Arbor, Michigan.
| | - Steven J Hasday
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Meghan Knol
- The University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason Pradarelli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sudha R Pavuluri Quamme
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Caprice C Greenberg
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Justin B Dimick
- The University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, The University of Michigan, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Wagner JP, Cochran AL, Jones C, Gusani NJ, Varghese TK, Attai DJ. Professional Use of Social Media Among Surgeons: Results of a Multi-Institutional Study. JOURNAL OF SURGICAL EDUCATION 2018; 75:804-810. [PMID: 28964746 DOI: 10.1016/j.jsurg.2017.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/20/2017] [Accepted: 09/11/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Among surgeons, professional use of social media (SM) is varied, and attitudes are ambiguous. We sought to characterize surgeons' professional use and perceptions of SM. DESIGN Surgical faculty and trainees received institutional review board-approved e-mail surveys assessing SM usage and attitudes. Regression analyses identified predictors of SM attitudes and preference for professional contact. SETTING Surveys were administered to surgical faculty, fellows, and residents at 4 academic medical centers between January and April 2016. PARTICIPANTS Of 1037 surgeons, clinical fellows, and residents e-mailed, 208 (20%) responded, including 132 faculty and 76 trainees. RESULTS Among 208 respondents, 46 (22%) indicated they preferred some form of SM as their preferred networking and communication modality. A total of 145 (70%) indicated they believe SM benefits professional development. The position of clinical resident predicted preference to maintain professional contact via SM (p = 0.03). Age <55 predicted positive attitude (p = 0.02) and rank of associate professor predicted negative attitude toward SM (p = 0.03). Lack of time as well as personal and patient privacy concerns were cited most commonly as reasons for not using SM. CONCLUSIONS Most of surgeons responding to our survey used some form of SM for professional purposes. Perceived barriers include lack of value, time constraints, and personal and patient privacy concerns. Generational differences in surgeon attitudes suggest usage of SM among surgeons will expand over time.
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Affiliation(s)
- Justin P Wagner
- Department of Pediatric Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Christian Jones
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Niraj J Gusani
- Department of Surgery, Program for Liver, Pancreas, and Foregut Tumors, Penn State College of Medicine, Hershey, Pennsylvania
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, UCLA Health Burbank Breast Care, Burbank, California.
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Improving the feasibility and utility of OpTrust-A tool assessing intraoperative entrustment. Am J Surg 2017; 216:13-18. [PMID: 29128100 DOI: 10.1016/j.amjsurg.2017.10.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/08/2017] [Accepted: 10/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative assessments. METHODS Entrustment assessment scores for video-based and 1-h (short-course) observations were compared to previously validated intraoperative assessment scores. Faculty and residents were surveyed for their perceptions related to operative observation. RESULTS There was a strong association between entrustment scores when comparing in-person to video-based observations (R2 = 0.76-0.84, p < 0.01) as well as short-course to full-duration observations (R2 = 0.65-0.76, p < 0.01). The majority of faculty and residents (>97%) felt observation did not negatively impact operative experience. CONCLUSIONS Assessment of entrustment behaviors using short-course video review provides a feasible approach to intraoperative assessment. This latest application of OpTrust allows for the tool to be incorporated into surgical training programs across a variety of environments.
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Safety considerations in learning new procedures: a survey of surgeons. J Surg Res 2017; 218:361-366. [PMID: 28985875 DOI: 10.1016/j.jss.2017.06.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND There exists a tension between surgical innovation and safety. The learning curve associated with the introduction of new procedures/technologies has been associated with preventable patient harm. Surgeon's perceptions regarding the safety of methods for learning new procedures/technologies are largely uncharacterized. MATERIALS AND METHODS A survey was designed to evaluate surgeons' perceptions related to learning new procedures/technologies. This included clinical vignettes across two domains: (1) experience with an operation (e.g., colectomy) and (2) experience with a technology (e.g., laparoscopy). This study also focuses on a surgeon's perceptions of existing credentialing/privileging requirements. Participants were faculty surgeons (n = 150) at two large Midwestern academic health centers. RESULTS Survey response rate was 77% (116/150). 69% of respondents believed the processes of credentialing/privileging is "far too relaxed" or "too relaxed" for ensuring patient safety. Surgeons most commonly indicated a mini-fellowship is required to learn a new laparoscopic procedure. However, that requirement differed based on a surgeon's prior experience with laparoscopy. For example, to learn laparoscopic colectomy, 35% of respondents felt a surgeon with limited laparoscopic experience should complete a mini-fellowship, whereas 3% felt this was necessary if the surgeon had extensive laparoscopic experience. In the latter scenario, most respondents felt a surgeon should scrub in cases performed by an expert (38%) or perform cases under a proctor's supervision (33%) when learning laparoscopic colectomy. CONCLUSIONS Many surgeons believe existing hospital credentialing/privileging practices may be too relaxed. Moreover, surgeons believe the "one-size-fits-all" approach for training practicing surgeons may not protect patients from unsafe introduction of new procedures/technologies.
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Varban OA, Niemann A, Stricklen A, Ross R, Ghaferi AA, Finks JF, Dimick JB. Far from Standardized: Using Surgical Videos to Identify Variation in Technique for Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 27:761-767. [PMID: 28686537 DOI: 10.1089/lap.2017.0184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Video assessment is an emerging tool for understanding variation in surgical technique. METHODS Representative videos of laparoscopic sleeve gastrectomy (LSG) were voluntarily submitted by 20 surgeons who participated in a statewide quality improvement collaborative. The amount of time required to complete the salient steps of the operation was measured and variations in the tasks performed during each step were captured. RESULTS Twenty-two videos of LSG were submitted and 11 videos included concurrent hiatal hernia repair. Data obtained from video analysis identified variation in time to complete each step of the procedure: prestapling dissection of stomach (5-25 minutes), gastric stapling (8-20 minutes), and management of the staple line (1-25 minutes). Time required to perform a hiatal hernia repair also varied (1-26 minutes), as did the type of repair: 55% were performed with a posterior cruropexy, 27% were performed with an anterior cruropexy, and 18% were performed with both. Ten different permutations of staple heights and buttressing material were used during division of the stomach with a gastric stapler. Management of the staple line included use of buttressing (64%), fibrin sealant (36%), oversewing (9%), surgical clips (18%), imbrication of the staple line (36%), and omentoplasty (55%). CONCLUSIONS LSG technique is not uniform. Video analysis identified variation in (1) time to complete each step of the procedure, (2) hiatal hernia repair technique, (3) stapling technique, and (4) post-transection staple line management. Future efforts linking video analysis with clinical outcomes can provide objective evidence to support best practices.
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Affiliation(s)
- Oliver A Varban
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan
| | - Adam Niemann
- 2 Department of Surgery, University of Michigan Medical School , Ann Arbor, Michigan
| | - Amanda Stricklen
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Rachel Ross
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Amir A Ghaferi
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Jonathan F Finks
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan
| | - Justin B Dimick
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan.,3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
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Lee JH, Tanaka E, Woo Y, Ali G, Son T, Kim HI, Hyung WJ. Advanced real-time multi-display educational system (ARMES): An innovative real-time audiovisual mentoring tool for complex robotic surgery. J Surg Oncol 2017. [DOI: 10.1002/jso.24722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Joong Ho Lee
- Department of Surgery; National Health Insurance Service Ilsan Hospital; Goyang Republic of Korea
| | - Eiji Tanaka
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Department of Surgery; Kobe City Medical Center West Hospital; Kobe Japan
| | - Yanghee Woo
- Department of Surgery; City of Hope National Medical Center; Duarte California
| | - Güner Ali
- Department of General Surgery, Karadeniz Technical University College of Medicine; Farabi Hospital; Trabzon Turkey
| | - Taeil Son
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
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35
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Using Video Analysis to Understand and Improve Technical Quality in Bariatric Surgery. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Bassani GA, Lonati C, Brambilla D, Rapido F, Valenza F, Gatti S. Ex Vivo Lung Perfusion in the Rat: Detailed Procedure and Videos. PLoS One 2016; 11:e0167898. [PMID: 27936178 PMCID: PMC5148015 DOI: 10.1371/journal.pone.0167898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/22/2016] [Indexed: 12/22/2022] Open
Abstract
Ex vivo lung perfusion (EVLP) is a promising procedure for evaluation, reconditioning, and treatment of marginal lungs before transplantation. Small animal models can contribute to improve clinical development of this technique and represent a substantial platform for bio-molecular investigations. However, to accomplish this purpose, EVLP models must sustain a prolonged reperfusion without pharmacological interventions. Currently available protocols only partly satisfy this need. The aim of the present research was accomplishment and optimization of a reproducible model for a protracted rat EVLP in the absence of anti-inflammatory treatment. A 180 min, uninjured and untreated perfusion was achieved through a stepwise implementation of the protocol. Flow rate, temperature, and tidal volume were gradually increased during the initial reperfusion phase to reduce hemodynamic and oxidative stress. Low flow rate combined with open atrium and protective ventilation strategy were applied to prevent lung damage. The videos enclosed show management of the most critical technical steps. The stability and reproducibility of the present procedure were confirmed by lung function evaluation and edema assessment. The meticulous description of the protocol provided in this paper can enable other laboratories to reproduce it effortlessly, supporting research in the EVLP field.
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Affiliation(s)
- Giulia Alessandra Bassani
- Center for Surgical Research, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Center for Preclinical Investigation, Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Caterina Lonati
- Center for Surgical Research, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Center for Preclinical Investigation, Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Brambilla
- Center for Surgical Research, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Rapido
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Franco Valenza
- Center for Preclinical Investigation, Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Gatti
- Center for Surgical Research, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
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