Learning curve patterns generated by a training method for laparoscopic small bowel anastomosis

Application of three-dimensional printing in plastic surgery: a bibliometric analysis

Recent years have seen the publication of numerous papers on the application of three-dimensional (3D) printing in plastic surgery. Despite this growing interest, a comprehensive bibliometric analysis of the field has yet to be conducted. To address this gap, we undertook a bibliometric study to map out the knowledge structure and identify research hotspots related to 3D printing in plastic surgery. We analyzed publications from 1995 to 2024, found in the Web of Science Core Collection (WoSCC), utilizing tools such as VOSviewer, CiteSpace, and the R package "bibliometrix". Our analysis included 1,057 documents contributed by 5,545 authors from 1,620 organizations across 71 regions, and these were published in 400 journals. We observed a steady growth in annual publications, with Europe, Asia, North America, and Oceania leading in research output. Notably, Shanghai Jiao Tong University emerged as a primary research institution in this domain. The Journal of Craniofacial Surgery and Journal of Oral and Maxillofacial Surgery have made significant contributions to the field, with Thieringer, Florian M being the most prolific and frequently cited author. Key areas of focus include medical education and surgical procedures, with "3D printing", "virtual surgical planning" and "reconstructive/orthognathic surgery" highlighted as future research hotspots. Our study provides a detailed bibliometric analysis, revealing the evolution and progress of 3D printing technologies in plastic surgery. As these technologies continue to advance, their impact on clinical practice and patient lives is expected to be profound.

Insight into the history and trends of surgical simulation training in education: a bibliometric analysis

BACKGROUND

Surgical simulation training enables surgeons to acquire clinical experience or skills from the operating room to the simulation environment. Historically, it has changed with advances in science and technology. Moreover, no previous study has analyzed this field from the bibliometric analysis dimension. The study aimed to review changes in surgical simulation training worldwide using bibliometric software.

MATERIALS AND METHODS

Two searches were performed on the core collection database, Web of Science, regarding data from 1991 to the end of 2020 using three topic words (surgery, training, and simulation). From 1 January 2000, to 15 May 2022, the keyword 'robotic' was added for the hotspot exploration. The data were chiefly analyzed by publication date, country, author(s), and keywords using bibliometric software.

RESULTS

A total of 5285 articles were initially analyzed, from which it was clear that laparoscopic skill, three-dimensional printing, and virtual reality were the main focuses during those study periods. Subsequently, 348 publications on robotic surgery training were identified.

CONCLUSION

This study systematically summarizes the current status in the field of surgical simulation training and provides insights into the research focuses and future hotspot in a global context.

A mechanically validated open-source silicone model for the training of gastric perforation sewing

BACKGROUND

Gastrointestinal perforation is commonly seen in emergency departments. The perforation of the stomach is an emergency situation that requires immediate surgical treatment. The necessary surgical skills require regular practical training. Owing to patient`s safety, in vivo training opportunities in medicine are restricted. Animal tissue especially porcine tissue, is commonly used for surgical training. Due to its limiting factors, artificial training models are often to be preferred. Many artificial models are on the market but to our knowledge, none that mimic the haptic- and sewing properties of a stomach wall at the same time. In this study, an open source silicone model of a gastric perforation for training of gastric sewing was developed that attempts to provide realistic haptic- and sewing behaviour.

METHODS

To simulate the layered structure of the human stomach, different silicone materials were used to produce three different model layups. The production process was kept as simple as possible to make it easily reproducible. A needle penetration setup as well as a systematic haptic evaluation were developed to compare these silicone models to a real porcine stomach in order to identify the most realistic model.

RESULTS

A silicone model consisting of three layers was identified as being the most promising and was tested by clinical surgeons.

CONCLUSIONS

The presented model simulates the sewing characteristics of a human stomach wall, is easily reproducible at low-costs and can be used for practicing gastric suturing techniques.

TRIAL REGISTRATIONS

Not applicable.

Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score

INTRODUCTION

The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS).

MATERIALS AND METHODS

The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8).

RESULTS

The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807-0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923-0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale.

CONCLUSION

With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.

Development, manufacture and initial assessment of validity of a 3-dimensional-printed bowel anastomosis simulation training model

Background

It is critical that junior residents be given opportunities to practise bowel anastomosis before performing the procedure in patients. Three-dimensional (3D) printing is an affordable way to provide realistic, reusable intestinal simulators. The aim of this study was to test the face and content validity of a 3D-printed simulator for bowel anastomosis.

Methods

The bowel anastomosis simulator was designed and assembled with the use of desktop 3D printers and silicone solutions. The production cost ranges from $2.67 to $131, depending on which aspects of the model one prefers to include. We incorporated input from a general surgeon regarding design modifications to improve the realism of the model. Nine experts in general surgery (6 staff surgeons and 3 senior residents) were asked to perform an anastomosis with the model and then complete 2 surveys regarding face and content validity. Items were rated on a 5-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).

Results

The overall average score for product quality was 3.58, indicating good face validity. The average score for realism (e.g., flexibility and texture of the model) was 3.77. The simulator was rated as being useful for training, with an overall average score of 3.98. In general, the participants agreed that the simulator would be a valuable addition to current simulation-based medical education (average score 4.11). They commented that the model would be improved by adding extra layers to simulate mucosa.

Conclusion

Experts found the 3D-printed bowel anastomosis simulator to be an appropriate tool for the education of surgical residents, based on the model’s texture, appearance and ability to undergo an anastomosis. This model provides an affordable way for surgical residents to learn bowel anastomosis. Future research will focus on proving educational efficacy, effectiveness and transfer that can be adapted for laparoscopic anastomosis training, hand-sewing and stapling procedures.

Sleep Deprivation Adversely Impacts Resident Performance for Simulated Arthroscopy

Purpose

The purpose of the study was to assess the performance of residents in orthopaedics before and after a 24-hour shift on a shoulder arthroscopy simulator. The primary study endpoint was an overall performance score (OPS) generated by the simulator.

Methods

A prospective, comparative study of 120 simulator trials by 10 resident junior surgeons was performed in our university hospital’s simulation center between May and November 2018. To avoid memorization bias, all participants performed the same exercise 10 times on a VirtaMed ArthroS simulator prior to the study. Each resident’s performance (the OPS, the operating time, the proportion of procedures with iatrogenic lesions, the camera path length and the hook path length) in two different simulated arthroscopy exercise tasks was assessed once before and once after a 24-hour shift. This sequence was performed three times during the semester, and the change over time in performance was also evaluated.

Results

The OPS was significantly lower after the night shift (P = 0.035 for the first exercise, and P = 0.025 for the second).

Conclusion

In a group of previously trained resident junior surgeons, overall performance with an arthroscopy simulator was significantly worse after a 24-hour shift. The study of secondary parameters of the OPS and the subgroup analysis based on the sleep time and Epworth score vary depending on the type of exercise performed arthroscopically. However, the use of a simulator after a night shift did not prevent the trainee from improving his/her level of performance over time.

Level of Evidence

II, a prospective, comparative study

Anesthesia Simulation Boot Camp-a Decade of Experience Enhancing Self-efficacy in First-year Residents

BACKGROUND

Novice anesthesiology residents must acquire new technical, cognitive, and behavioral skills as they transition into the high-stakes perioperative environment. Simulation-based education improves procedural skill and behavior, and it permits deliberate practice with feedback; exposure to uncommon, high-consequence events; assessment; reproducibility; and zero risk to patients. We introduced a 5-day, high-fidelity Simulation Boot Camp (SBC) in 2006 for first-year clinical anesthesia residents (CA-1s) and report over a decade of experience assessing its impact on self-efficacy, value, feasibility, and sustainability.

METHODS

All CA-1s in our residency program participated in the SBC as part of orientation. Participants completed 2 individual high-fidelity simulations per day, each with a private debriefing session from an attending anesthesiologist in our simulation center. We measured their self-reported confidence, which we report as self-efficacy (SE), the belief in one's own ability to successfully execute a skill or behavior necessary for a desired outcome, for 25 basic anesthesia skills before and after course completion. Participants also completed a postcourse evaluation.

RESULTS

Of the 281 CA-1s who participated in the course from 2006 to 2016, we collected data on 267 (95%). SE improved over the course of SBC for all 25 individual skills (P < .001) and remained stable over the decade-long period of study. Univariate analysis revealed a strong association between increased SE and male sex (P < .001), video gaming experience (P < .001), and completion of a prior residency (P = .018). Males were also more likely to report video gaming experience (P < .001). Multivariable analysis revealed that although women had lower SE than did men, they had a greater increase in SE attributed to participation in SBC (P = .041). Participants strongly agreed SBC was a realistic and nonjudgmental learning tool, built confidence, and should be mandatory. Most comments were positive, reflecting overall satisfaction with SBC.

CONCLUSIONS

SBC increases SE, is feasible, valuable to participants, and sustainable with remarkably consistency over the study period.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia

OBJECTIVE

An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated.

MATERIAL AND METHOD

Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed.

RESULTS

Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues.

CONCLUSIONS

A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.