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Khan MTA, Patnaik R, Lee CS, Willson CM, Demario VK, Krell RW, Laverty RB. Systematic review of academic robotic surgery curricula. J Robot Surg 2022; 17:719-743. [DOI: 10.1007/s11701-022-01500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
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James J, Irace AL, A Drusin M, Kim AH, Gudis DA, Overdevest JB. Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training. Ann Otol Rhinol Laryngol 2022:34894221115753. [PMID: 35915918 DOI: 10.1177/00034894221115753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.
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Affiliation(s)
- Joel James
- City University of New York School of Medicine, New York, NY, USA
| | - Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Madeleine A Drusin
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ana H Kim
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Mendelsohn AH, Kim C, Song J, Singh A, Le T, Abiri A, Berke GS, Geoghegan R. Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System. Laryngoscope 2020; 130 Suppl 6:S1-S17. [PMID: 32865822 DOI: 10.1002/lary.29034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. METHODS Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). RESULTS Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor resection grading. Tumor resection scores was significantly (P = .02) improved with collision awareness system activated than trials without collision awareness. CONCLUSION In order to test our primary hypothesis, a novel TORS training platform was successfully developed that provides collision force measurements including frequency, severity, and duration of anatomic collisions. Additionally, the platform was modulated to provide real-time tactile feedback of the occurrence of out-of-field collisions. Utilizing this custom platform, our hypothesis that anatomic collisions during TORS diminishes surgical performance was supported. Additionally, our secondary hypothesis that subsequent reduction of anatomic collisions improves TORS proficiency was supported by the surgical trial. Dedicated investigation to characterize the effect size and clinical impact is required in order to translate this finding into training curriculums and into clinical utilization. LEVEL OF EVIDENCE II (Randomized trial) Laryngoscope, 130:S1-S17, 2020.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.,Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Christine Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jonathan Song
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Aadesh Singh
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tyler Le
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ahmad Abiri
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Rory Geoghegan
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
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Sramek M, Shi Y, Quintanilla E, Wu X, Ponukumati A, Pastel D, Halter R, Paydarfar J. Tumor phantom for training and research in transoral surgery. Laryngoscope Investig Otolaryngol 2020; 5:677-682. [PMID: 32864438 PMCID: PMC7444757 DOI: 10.1002/lio2.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE With the paradigm shift towards minimally invasive surgical techniques such as transoral laser microsurgery and transoral robotic surgery for resection of head and neck malignancies, there is a need to enhance the surgical training of these techniques as well as provide a platform for testing new approaches and technologies. The steeper learning curve associated with minimally invasive surgical techniques may be mitigated with the use of tumor phantoms (TP) placed in cadaver models. METHODS An injectable TP was developed using an agar-gelatin base, unsalted chicken stock, deionized water, food coloring for visual mimicry, and iohexol for radiographic mimicry. Four percentage glutaraldehyde was used as a cross-linking agent for solidification of the TP. The TP was then injected in various mucosal anatomic sites in four unfixed cadaver heads. Visual, radiographic, and tactile mimicry was assessed via endoscopy, CT scan, and tumor dissection and palpation, respectively. RESULTS Tumor phantom injection was successfully achieved in all four cadaver heads. Visually and tactilely, the TP demonstrated similar color change, induration, and firmness of a typical squamous cell carcinoma (SCCa). However, ulceration that is often seen with SCCa could not be replicated. CT mimicry was compared with nine patients with known SCCa. Tumor radiodensity in the nine patients was between 77 and 110 HU (mean 86.3 HU) whereas TP radiodensity was 59 and 127 HU (mean 93.7 HU), with no significant difference between groups (P = .21). CONCLUSION This inexpensive, easy to apply, and unique tumor phantom could be used both to train transoral techniques and as a tool to further investigate new approaches and technologies for transoral surgery. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Michael Sramek
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Yuan Shi
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | | | - Xiaotian Wu
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | | | - David Pastel
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Division of Neuroradiology, Department of RadiologyDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | - Ryan Halter
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | - Joseph Paydarfar
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
- Section of Otolaryngology, Department of SurgeryDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
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