Learning Surgical Skills Through Video-Based Education: A Systematic Review

Examining the transition from print to electronic journals through the lens of sustainability

This paper presents a comparative analysis of the sustainability aspects between print and electronic journals. A narrative synthesis is presented under the three key areas of environmental impact, social impact, and impact on research practices. Over the past decades, the gradual transition from print to electronic media has facilitated greater global access to academic research, reshaped research methodologies through innovative tools and systems, and arguably, reduced the ecological footprint of academia.

Objective performance indicators during specific steps of robotic right colectomy can differentiate surgeon expertise

BACKGROUND

Current surgical assessment tools are subjective and nonscalable. Objective performance indicators, calculated from robotic systems data, provide automated data regarding surgeon movements and robotic arm kinematics. We identified objective performance indicators that significantly differed among expert and trainee surgeons during specific steps of robotic right colectomy.

METHODS

Endoscopic videos were annotated to delineate surgical steps during robotic right colectomies. Objective performance indicators were compared during mesenteric dissection, ascending colon mobilization, hepatic flexure mobilization, and bowel preparation for transection.

RESULTS

Twenty-five robotic right colectomy procedures (461 total surgical steps) performed by 2 experts and 8 trainees were analyzed. Experts exhibited faster camera acceleration and jerk during all steps, as well as faster dominant and nondominant arm acceleration and dominant arm jerk during all steps except distal bowel preparation. During mesenteric dissection, experts used faster camera and dominant arm velocity. During medial-to-lateral ascending colon mobilization, experts used less-dominant wrist yaw and pitch, faster nondominant arm velocity, shorter dominant arm path length, and shorter moving times for camera, dominant arm, and nondominant arm. During lateral-to-medial ascending colon mobilization, experts had faster dominant and nondominant arm velocity and third-arm acceleration. During hepatic flexure mobilization, experts exhibited more camera movements, greater velocity for camera, dominant and nondominant arms, and faster third-arm acceleration. During distal bowel preparation, experts used greater dominant wrist articulation, faster camera velocity, and longer nondominant arm path length. During proximal bowel preparation, experts demonstrated faster nondominant arm velocity.

CONCLUSION

Objective performance indicators can differentiate experts from trainees during distinct steps of robotic right colectomy. These automated, objective and scalable metrics can provide personalized feedback for trainees.

HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center

Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.

Innovation in surgical trauma care education: assessment of a Panamerican Trauma Society online surgical skills course hosted by the Spanish Surgical Association

PURPOSE

Incorporating surgical skills education in trauma care is essential for young surgeons and surgical trainees. This study describes an innovative e-learning course for teaching trauma care surgical skills in an international cooperative setting. Furthermore, it aims to offer valuable insights on enhancing e-learning practices.

METHODS

The Panamerican Trauma Society and the Spanish Surgical Association have joined forces to launch an online course focusing on advanced trauma care surgical skills. This report provides an in-depth examination of the project and scrutinizes participant feedback through a post-course survey. The survey thoroughly evaluates their satisfaction level, the usefulness of the course content, and their view on its clinical relevance.

RESULTS

Three hundred eighty-two surgeons from 16 countries completed an online course. Three hundred seventy-nine of them responded to the post-course survey. The mean age was 36, with 64% females and 36% males. The course consisted of 9.9 h of academic content, including 5 h of video lectures and 4.9 h of live discussions. Ninety-seven percent of the participants were practicing general and acute care surgeons, and only 2% were exclusively dedicated to trauma surgery. Sixty-one percent of participants highly valued real-time interaction with faculty, and 95% believed their trauma surgical skills would improve. Additionally, 93% of the participants were satisfied or very satisfied with the e-learning experience.

CONCLUSIONS

The use of video-based instructional materials has revolutionized surgical education. With online courses in trauma surgery, surgeons can now improve their skills and better prepare themselves to handle severe trauma cases. This innovative approach to surgical education has proven to be very effective and can potentially enhance patients' quality of care.

Adoption of routine surgical video recording: a nationwide freedom of information act request across England and Wales

Background

Surgical video contains data with significant potential to improve surgical outcome assessment, quality assurance, education, and research. Current utilisation of surgical video recording is unknown and related policies/governance structures are unclear.

Methods

A nationwide Freedom of Information (FOI) request concerning surgical video recording, technology, consent, access, and governance was sent to all acute National Health Service (NHS) trusts/boards in England/Wales between 20th February and 20th March 2023.

Findings

140/144 (97.2%) trusts/boards in England/Wales responded to the FOI request. Surgical procedures were routinely recorded in 22 trusts/boards. The median estimate of consultant surgeons routinely recording their procedures was 20%. Surgical video was stored on internal systems (n = 27), third-party products (n = 29), and both (n = 9). 32/140 (22.9%) trusts/boards ask for consent to record procedures as part of routine care. Consent for recording included non-clinical purposes in 55/140 (39.3%) trusts/boards. Policies for surgeon/patient access to surgical video were available in 48/140 (34.3%) and 32/140 (22.9%) trusts/boards, respectively. Surgical video was used for non-clinical purposes in 64/140 (45.7%) trusts/boards. Governance policies covering surgical video recording, use, and/or storage were available from 59/140 (42.1%) trusts/boards.

Interpretation

There is significant heterogeneity in surgical video recording practices in England and Wales. A minority of trusts/boards routinely record surgical procedures, with large variation in recording/storage practices indicating scope for NHS-wide coordination. Revision of surgical video consent, accessibility, and governance policies should be prioritised by trusts/boards to protect key stakeholders. Increased availability of surgical video is essential for patients and surgeons to maximally benefit from the ongoing digital transformation of surgery.

Funding

KL is supported by an NIHR Academic Clinical Fellowship and acknowledges infrastructure support for this research from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

Perceived Impact of Coronavirus Disease 2019 on Surgical Training: A Brazilian Survey

INTRODUCTION

Recent studies revealed that coronavirus disease 2019 (COVID-19) negatively impacted residency programs worldwide, particularly procedure-based programs. However, most studies are from high-income countries, with scarce data from low- and middle-income countries. Pandemic effects on surgical training were likely worse in strictly apprenticeship models relying heavily on surgical volume as opposed to competency-based programs. Notably, training programs in Brazil and other low- and middle-income countries follow these strict apprenticeship style frameworks. In this study, we aimed to evaluate the trainees' perceptions of the impact of COVID-19 on their Brazilian surgical programs.

METHODS

A cross-sectional study was performed using an anonymous survey in Portuguese, distributed via social media platforms to surgical residents enrolled in Brazilian surgery programs. Data collection took place from August 2021 to May 2022. The survey contained 30 questions on the perception of the impact of COVID-19 on surgical training.

RESULTS

One-hundred sixty-two residents from 17 different surgical specialties and all five regions of Brazil responded to the survey. Of 162 residents, 145 (89%) believed the pandemic negatively impacted their surgical training. Furthermore, of 162 residents, 153 (94%) reported that elective surgical volume decreased during the pandemic and 91 (56%) were redeployed to assist with COVID-19 management. As a result, 102 of 162 (63%) residents believed their surgical skills were negatively impacted by COVID-19. Yet, 95 of 162 (59%) residents reported their residency programs did not offer resources to mitigate the pandemic's impact on training. Of 162 residents, 57 (35%) reported they did not feel on track for graduation, with no statistical difference between responses by year of residency (P = 0.083). Additionally, 124 of 162 (77%) residents reported that the pandemic negatively affected their mental health, most commonly related to stress at work, stress about transmitting COVID-19, and loss in surgical training.

CONCLUSIONS

Most of the surveyed Brazilian surgical residents felt the COVID-19 pandemic negatively impacted their training. This leads to believe that the detrimental impacts of the pandemic exposed preexisting weaknesses in the Brazilian surgical training model's dependence on a strict apprenticeship model. Our findings suggest a crucial need to redesign surgical education programs to make residency programs more prepared for changes in surgical volume, evolve the apprenticeship model to competency-based approaches, and unify surgical training standards in low- and middle-income countries.

Free-Viewpoint Video in Open Surgery: Development of Surgical Arena 360

OBJECTIVE

We aimed to apply the free-viewpoint video technology developed and introduced mainly for sports spectators to an open surgical video recording system.

DESIGN

Prospective feasibility study.

SETTING

University of Tsukuba Hospital, Ibaraki, Japan.

PARTICIPANTS

Patients who underwent open pancreaticoduodenectomy for pancreatic cancer between December 2022 and March 2023 were included. The gastrojejunal anastomosis was the subject of the recording.

RESULTS

Four surgeries were recorded with Surgical Arena 360, which is the free-viewpoint video system that we developed. The feasibility of performing a series of surgical procedures without interrupting the surgeon's line of sight or manipulation was demonstrated in all cases.

CONCLUSIONS

Our study revealed that Surgical Arena 360, an open surgical video recording system developed by applying free-viewpoint video technology, can provide new insights into surgical support and clinical knowledge to surgeons by enabling secure capture of the open surgical field from multiple angles.

Comparison of Educational and Academic Quality of Laparoscopic Distal Pancreatectomy Videos on WebSurg® and YouTube® Platforms

BACKGROUND

The aim of this study was to compare the educational and academic quality of laparoscopic distal pancreatectomy (LDP) videos on YouTube® and WebSurg® platforms.

MATERIAL AND METHODS

YouTube and WebSurg platforms were searched with the keyword "laparoscopic distal pancreatectomy". According to the exclusion criteria, 12 videos were found on WebSurg. To ensure a 1:1 ratio, the first 12 videos that met the criteria on YouTube were also analyzed. Journal of American Medical Association (JAMA) benchmark criteria were used to evaluate the reliability of the videos. The non-educational quality of the videos was calculated using the Global Quality Score (GQS), the educational and academic quality of videos was calculated using Laparoscopic Distal Pancreatectomy-specific score (LDP-SS) and Laparoscopic Surgery Video Educational Guidelines scoring system (LAP-VEGaS).

RESULTS

The mean JAMA score was 1.58 on YouTube and 2.83 on WebSurg (P < .001). The median GQS was 2 on YouTube and 5 on WebSurg (P < .001). The median LAP-VEGaS score was 8 on YouTube and 14.5 on WebSurg (P < .001). The median LDP-SS score was 6 on YouTube and 9.5 on WebSurg (P = .001). According to the LAP-VEGaS, eleven (91.7%) of the WebSurg videos had a high score of 11 or more (P = .04). According to Spearman correlation analysis, there was a statistically significant positive correlation between LDP-SS and JAMA, GQS and LAP-VEGaS (r: .589, P = .002; r: .648, P = .001; r: .848, P < .001 respectively).

CONCLUSIONS

The WebSurg is superior to the YouTube in terms of educational and academic value, quality, accuracy, reliability and usability in scientific meetings for LDP videos.

A novel high accuracy model for automatic surgical workflow recognition using artificial intelligence in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

INTRODUCTION

Artificial intelligence and computer vision are revolutionizing the way we perceive video analysis in minimally invasive surgery. This emerging technology has increasingly been leveraged successfully for video segmentation, documentation, education, and formative assessment. New, sophisticated platforms allow pre-determined segments chosen by surgeons to be automatically presented without the need to review entire videos. This study aimed to validate and demonstrate the accuracy of the first reported AI-based computer vision algorithm that automatically recognizes surgical steps in videos of totally extraperitoneal (TEP) inguinal hernia repair.

METHODS

Videos of TEP procedures were manually labeled by a team of annotators trained to identify and label surgical workflow according to six major steps. For bilateral hernias, an additional change of focus step was also included. The videos were then used to train a computer vision AI algorithm. Performance accuracy was assessed in comparison to the manual annotations.

RESULTS

A total of 619 full-length TEP videos were analyzed: 371 were used to train the model, 93 for internal validation, and the remaining 155 as a test set to evaluate algorithm accuracy. The overall accuracy for the complete procedure was 88.8%. Per-step accuracy reached the highest value for the hernia sac reduction step (94.3%) and the lowest for the preperitoneal dissection step (72.2%).

CONCLUSIONS

These results indicate that the novel AI model was able to provide fully automated video analysis with a high accuracy level. High-accuracy models leveraging AI to enable automation of surgical video analysis allow us to identify and monitor surgical performance, providing mathematical metrics that can be stored, evaluated, and compared. As such, the proposed model is capable of enabling data-driven insights to improve surgical quality and demonstrate best practices in TEP procedures.

From Videogames to Teaching - Different Camera Perspectives in an Interactive Synchronous Online Tutorial

The global COVID-19 pandemic has required clinical skills training to be transferred to an online format. An interactive synchronous online tutorial with different camera perspectives was developed. In a survey, 79% of the students preferred the first-person perspective, which allowed students to view the abdominal examination through the examiner's eyes.

Evaluation of an Instructional Video and Simulation Model for Teaching Slit Lamp Examination to Medical Students

Purpose  This article assesses the efficacy of an instructional video and model eye simulation for teaching slit lamp exam to medical students as compared to traditional preceptor teaching. Methods  First through 4th year students from the University of California, San Francisco School of Medicine were recruited via email to participate in the study. Students were randomized into two groups. The experimental "model eye" group watched an instructional video on slit lamp exam, spent 10 minutes practicing on the model eye, then practiced for 25 minutes with a student partner. The control "preceptor teaching" group received 25 minutes of in-person preceptor teaching on slit lamp exam, then spent 25 minutes practicing with a student partner. Students were objectively assessed by a blinded grader who scored their examination skills with a 31-item checklist. Qualtrics surveys that measured student perceptions were distributed before and after the intervention. Results  Seventeen medical students participated in the study. Students in the model eye group achieved higher mean objective assessment scores than students in the preceptor teaching group on skills relating to slit lamp set up (1.75, standard deviation [SD] = 0.50 and 1.50, SD = 0.80 out of 2 points, p  = 0.03) and on the total score (1.69, SD = 0.6 and 1.48, SD = 0.8 out of 2 points, p  < 0.01). Both groups reported a significant increase in their understanding of what a slit lamp is used for ( p  < 0.01) and in their confidence using a slit lamp ( p  < 0.01). All students felt their skills improved with the workshop, 94% found the workshop to be useful, and 88% enjoyed the workshop, with no intergroup differences on these metrics. Conclusion  An instructional video combined with a simulation model is as effective as traditional preceptor teaching of the slit lamp exam. Such a teaching module may be considered as an adjunct to traditional methods.

Reliability of Ahmed glaucoma valve surgical videos for educational purposes

PURPOSE

The use of video-based social media platforms is increasing among trainee residents, fellows, and practicing ophthalmologists. In this study, we objectively evaluate the quality of Ahmed glaucoma valve (AGV) implantation videos on open access, video-based internet platforms.

DESIGN

Internet-based cross-sectional study.

PARTICIPANTS

Not applicable.

METHODS

In this cross-sectional study, 23 websites publishing medical surgery training video content were queried using the keyword "Ahmed glaucoma valve implantation".

MAIN OUTCOME MEASURES

The descriptive statistics of video parameters were noted, and the videos were assessed using established scoring systems-Sandvik, Health on the Net Foundation Code of Conduct (HON code), mDISCERN, and Global Quality Score (GQS) scores. Video Quality Score (VQS) was determined based on the 14 steps per the AGV implantation rubric.

RESULTS

One hundred and nineteen videos were evaluated, and 35 were excluded. The total quality of all 84 videos according to their Sandvik, HON Code, GQS, DISCERN, and VQS scores was 11.79 ± 1.70 (excellent quality), 6.86 ± 0.75 (excellent quality), 3.97 ± 0.93 (good quality), 3.26 ± 0.66 (fair quality) and 11.45 ± 2.67 (good quality), respectively. No significant correlation was found between the descriptive parameters and video quality score. However, no significant correlation was found between the descriptive parameters and video quality score.

CONCLUSIONS

The objective analysis showed that the video quality ranged from good to excellent. AGV implantation videos were sparse on exclusive ophthalmology surgical video portals. Therefore, more peer-reviewed videos following standardized rubric are needed on open-access surgical video platforms.