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Gray KE, Premkumar A, Mahrer MG, Eastes JG, Gulati S, Kupanoff KM, Mankin JA, Wu P, Czarkowski BR, Bogert JN, Weinberg JA, Soe-Lin H. Unleashing surgical skills: Ultra-high fidelity trauma thoracotomy training on knowledge donor platform. Am J Surg 2024; 238:115899. [PMID: 39243501 DOI: 10.1016/j.amjsurg.2024.115899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/18/2024] [Accepted: 08/12/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 ± 1.7), followed by Live Patient only (4.3 ± 2.5), and KD only (2.6 ± 1.3). The mean confidence rating for residents with neither training opportunity was 1.4 ± 1.0. CONCLUSIONS The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.
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Affiliation(s)
- Kayla E Gray
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Agnes Premkumar
- Department of Surgery, Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Mikaela G Mahrer
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Joel G Eastes
- Department of Surgery, Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Snigdha Gulati
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Kristina M Kupanoff
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - James A Mankin
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Peter Wu
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Brian R Czarkowski
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - James N Bogert
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Jordan A Weinberg
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Hahn Soe-Lin
- Department of Trauma Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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Swain CS, Cohen HML, Stannard A, Faulconer ER, Pallister I. Bringing damage control surgery simulation to life: developing a novel surgical anatomy model within immersive military trauma surgery simulation. BMJ Mil Health 2024; 170:141-145. [PMID: 35772794 DOI: 10.1136/bmjmilitary-2022-002124] [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: 03/21/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
Haemorrhage from junctional injuries remains the most common cause of battlefield death. Changes to surgical training have meant acquiring and maintaining trauma surgical skills is becoming more difficult for military surgeons. The multidisciplinary Military Operational Specialist Team Training (MOSTT) course is designed to bridge the gap between civilian practice and the deployed environment, as part of predeployment trauma training. It involves immersive team simulation and uses cadaveric dissection for surgical skills practice.A novel surgical anatomy model, featuring junctional haemorrhage surgical task trainers of the groin and shoulder, was designed using reconstructed CT and MRI images obtained from a human volunteer. The model is designed to look and feel as realistic as possible, with the added dimension of pulsatile 'blood' flow from a simulation gunshot injury.This surgical anatomy model has been trialled, as part of the MOSTT course, by 90 surgeons and perioperative practitioners, with feedback analysis used for iterative model development. Feedback demonstrated that, alongside more traditional cadaveric dissection, this surgical anatomy model adds value to current predeployment training delivered within the immersive simulation of the MOSTT course. Research by the authors about the effects of this model on surgical ability and performance is ongoing. However, there is clear potential for this model to be used in other environments, including on exercises and as part of consolidation training while deployed.
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Affiliation(s)
- C S Swain
- Institute of Naval Medicine, Gosport, UK
| | | | - A Stannard
- Vascular Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - I Pallister
- Trauma & Orthopaedic Surgery, Cardiff and Vale University Health Board, Cardiff, UK
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Patel A, Orakwue CW, Olek D, Guzman JCA, Lim K, Pino R, Teh BS, Butler B, Satkunasivam R, Farach A. A feasibility study of utilizing a cadaveric training model for novel robotic bladder cancer brachytherapy techniques. Brachytherapy 2023; 22:195-198. [PMID: 36424254 DOI: 10.1016/j.brachy.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/26/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE The current standard of care for muscle-invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy with lymph node dissection. Although this treatment provides therapeutic benefit, it is associated with notable morbidity. Bladder sparing techniques, such as concurrent chemo-radiation, are less invasive and prioritize organ preservation in individuals with invasive bladder cancer and offer comparable disease control. High-dose-rate brachytherapy is an emerging paradigm in the management of muscle-invasive bladder cancer. During high-dose-rate brachytherapy, radioactive sources are introduced to the area of the primary tumor through specialized catheters. The specific placement of brachytherapy catheters results in heightened effectiveness of the radiation treatment with less radiation damage to surrounding structures. For bladder-sparing therapies such as brachytherapy to rival radical cystectomy, these techniques need to be refined further by radiation oncologists. PROCEDURE One such modality for developing and practicing these techniques is the use of cadaveric models in innovation-focused clinical training facilities, which provide a simulated sterile surgical environment without the concern for extending intraoperative time. FINDINGS AND CONCLUSIONS The objective of this technical note is to demonstrate how clinical training facilities such as the Houston Methodist Institute for Technology, Innovation & Education are ideal for the development, testing, and training of novel brachytherapy techniques using cadaveric models. By utilizing a network of similarly innovative training centers, research and development of brachytherapy techniques can be expedited, and novel bladder-sparing treatment methods can be implemented as the standard of care for bladder cancer.
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Affiliation(s)
- Ashmi Patel
- Texas A&M College of Medicine, Houston Methodist Hospital, Houston, TX
| | | | - Devin Olek
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | | | - Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | | | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
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Development of a post-mortem human specimen flow model for advanced bleeding control training. Injury 2023; 54:214-222. [PMID: 35948510 DOI: 10.1016/j.injury.2022.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prompt and effective hemorrhage control is paramount to improve survival in patients with catastrophic bleeding. In the ever-expanding field of bleeding control techniques, there is a need for a realistic training model to practice these life-saving skills. This study aimed to create a realistic perfused post-mortem human specimen (PMHS) flow model that is suitable for training various bleeding control techniques. MATERIALS AND METHODS This laboratory study was conducted in the SkillsLab & Simulation Center of Erasmus MC, University Medical Center Rotterdam, the Netherlands. One fresh frozen and five AnubiFiX® embalmed PMHS were used for the development of the model. Subsequent improvements in the exact preparation and design of the flow model were made based on model performance and challenges that occurred during this study and are described. RESULTS Circulating arteriovenous flow with hypertonic saline was established throughout the entire body via inflow and outflow cannulas in the carotid artery and jugular vein of embalmed PMHS. We observed full circulation and major hemorrhage could be mimicked. Effective bleeding control was achieved by placing a resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter in the model. Regional perfusion significantly reduced the development of tissue edema. CONCLUSION Our perfused PMHS model with circulating arterial and venous flow appears to be a feasible method for the training of multiple bleeding control techniques. Regional arteriovenous flow successfully reduces tissue edema and increases the durability of the model. Further research should focus on reducing edema and enhancing the durability of the model.
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Durongphan A, Suksantilap S, Panrong N, Aungsusiripong A, Wiriya A, Pisittrakoonporn S, Pichaisak W, Pamornpol B. Latex-injected, non-decapitated, saturated salt method-embalmed cadaver technique development and application as a head and neck surgery training model. PLoS One 2022; 17:e0262415. [PMID: 35051207 PMCID: PMC8775333 DOI: 10.1371/journal.pone.0262415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022] Open
Abstract
Published cerebrovascular injection techniques have mostly used decapitated, fresh cadavers or heads embalmed with 10% formaldehyde. There have been no reports using vascular-injected cadavers for head and neck surgical training models or using vascular injections in saturated salt method-embalmed cadavers. Thus, we performed vascular labeling of five saturated salt method-embalmed cadavers without decapitation. Latex mixed with red ink was injected into the common carotid artery via a 3D-printed vascular adapter. The injection force was provided by a peristaltic pump. Thyroidectomy, submandibular gland excision, neck dissection, parotidectomy, and mandibulotomy were performed on both sides of each cadaver (n = 10). The consistency of the cadavers was softer than fresh ones. Subcutaneous tissues were well preserved, and muscles were moist and elastic. Five physicians graded the resemblance of the heads and necks of the latex-injected, saturated salt method-embalmed, non-decapitated of five cadavers compared to living humans using a Likert scale from 0 (no resemblance) to 5 (maximum resemblance). Fifty-two percent of the head and neck region resemblance scale ratings were four or five. Although the cadavers were practical for head and neck surgical simulations, the brain parenchyma was only partially preserved and unsuitable for use. The most distal arterial branches reached by the injected latex were measured. The external caliber of the smallest vessels reached were lacrimal arteries (mean caliber ± SD, 0.04 ± 0.04 mm; 95% CI [0, 0.09]). There were no significant differences in the mean caliber of the smallest vessels reached between the left- and right-sided arterial branches (all p < 0.05).
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Affiliation(s)
- Anuch Durongphan
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail: (AD); (BP)
| | - Songsak Suksantilap
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nutthanun Panrong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aimpat Aungsusiripong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apipat Wiriya
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Witchate Pichaisak
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjaporn Pamornpol
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail: (AD); (BP)
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Murr AT, Lumley CJ, Feins RH, Hackman TG. Evaluation of a 3D-Printed Transoral Robotic Surgery Simulator Utilizing Artificial Tissue. Laryngoscope 2021; 132:1588-1593. [PMID: 34882806 PMCID: PMC9177903 DOI: 10.1002/lary.29981] [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: 06/15/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) poses challenges for operators in training, with limited robot access on a platform requiring distinct surgical skills. Few simulators exist, and current virtual reality training modules exclude head and neck simulations. This study evaluates the construct validity for a novel low-cost TORS simulator. STUDY DESIGN Single institution prospective observational study. METHODS Using 3D-printed oral cavity structures and replaceable artificial tissue components, a modular TORS simulator was constructed for short-duration hands-on simulations with the da Vinci SI robot. Sixteen surgeons of differing robotic skill levels, no experience (novice), prior experience, and formal robot training, participated in simulated tonsil and tongue base tumor resections. Video recordings of each participant were graded by a blinded robotically trained surgeon using a 35-point Global Evaluative Assessment of Robotic Surgery (GEARS) criterion adapted for the TORS simulator. RESULTS Operators reporting formal robotic training or prior robot experience achieved significantly higher mean total GEARS scores compared to novice operators (32 vs. 20.5; P < .001). Overall, mean total GEARS scores correlated with reported experience level; novice operators scored 54% of total points at 19 (4.5), operators with prior experience scored 82.3% of total points at 28.8 (2.6), and robotically trained operators scored 97.1% of total points at 34 (1.7). CONCLUSION With a GEARS criterion, our simulator successfully differentiated novice from experienced and robotically trained operators of the da Vinci SI robot during simulated tonsillectomy and base of tongue resections. These findings support the construct validity of this prototype simulator and offer a foundation for further testing of predictive validity. LEVEL OF EVIDENCE 2 Laryngoscope, 2021.
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Affiliation(s)
- Alexander T Murr
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Catherine J Lumley
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Richard H Feins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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