Homemade laparoscopic simulator

Assessing the educational value of laparoscopic radical nephrectomy videos on YouTube®: A comparative analysis of short versus long videos

INTRODUCTION

To evaluate the quality of laparoscopic radical nephrectomy videos and determine the extent to which they are informative and educational for healthcare professionals.

PATIENTS AND METHODS

We used the YouTube ® search engine to search for the term 'laparoscopic radical nephrectomy' with time filters of 4-20 min (Group 1) and >20 min (Group 2) and then sorted the results uploaded chronologically before January 2023. One hundred videos were analysed for each group. The reliability of the videos was assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and DISCERN questionnaire scores (DISCERN). Educational quality was assessed using the Global Quality Score (GQS) and a 20-item objective scoring system (OSS) for laparoscopic nephrectomy. The popularity of the videos was evaluated using the video power index (VPI).

RESULTS

The mean video duration was 8.9 ± 4.3 min in Group 1 and 52.02 ± 31.09 min in Group 2 ( P < 0.001). The mean JAMA (2.49 ± 0.61) and OSS scores (60 ± 12.3) were higher in Group 2 than in Group 1, while no significant difference was observed in the mean GQS (2.53 ± 0.7, 2.39 ± 0.88, respectively) between the groups ( P < 0.001, P = 0.039, P = 0.131, respectively).

CONCLUSION

While the standardisation of surgical videos published on YouTube ® and the establishment of auditing mechanisms do not seem plausible, high total OSS, periprocedural OSS, and VPI scores, and high OSS, JAMAS, GQS and DISCERN scores in long videos indicate that such videos offer a greater contribution to education.

A 3D-Printed, High-Fidelity Pelvis Training Model: Cookbook Instructions and First Experience

Background: Since laparoscopic surgery became the gold standard for colorectal procedures, specific skills are required to achieve good outcomes. The best way to acquire basic and advanced skills and reach the learning curve plateau is by using dedicated simulators: box-trainers, video-trainers and virtual reality simulators. Laparoscopic skills training outside the operating room is cost-beneficial, faster and safer, and does not harm the patient. When compared to box-trainers, virtual reality simulators and cadaver models have no additional benefits. Several laparoscopic trainers available on the market as well as homemade box and video-trainers, most of them using plastic boxes and standard webcams, were described in the literature. The majority of them involve training on a flat surface without any anatomical environment. In addition to their demonstrated benefits, box-trainers which add anatomic details can improve the training quality and skills development of surgeons. Methods: We created a 3D-printed anatomic pelvi-trainer which offers a real-size narrow pelvic space environment for training. The model was created starting with a CT-scan performed on a female pelvis from the Anatomy Museum (Cluj-Napoca University of Medicine and Pharmacy, Romania), using Invesalius 3 software (Centro de Tecnologia da informação Renato Archer CTI, InVesalius open-source software, Campinas, Brazil) for segmentation, Fusion 360 with Netfabb software (Autodesk software company, Fusion 360 with Netfabb, San Francisco, CA, USA) for 3D modeling and a FDM technology 3D printer (Stratasys 3D printing company, Fortus 380mc 3D printer, Minneapolis, MN, USA). In addition, a metal mold for casting silicone valves was made for camera and endoscopic instruments ports. The trainer was tested and compared using a laparoscopic camera, a standard full HD webcam and "V-Box" (INTECH-Innovative Training Technologies, Milano, Italia), a dedicated hard paper box. The pelvi-trainer was tested by 33 surgeons with different qualifications and expertise. Results: We made a complete box-trainer with a versatile 3D-printed pelvi-trainer inside, designed for a wide range of basic and advanced laparoscopic skills training in the narrow pelvic space. We assessed the feedback of 33 surgeons regarding their experience using the anatomic 3D-printed pelvi-trainer for laparoscopic surgery training in the narrow pelvic space. Each surgeon tested the pelvi-trainer in three different setups: using a laparoscopic camera, using a webcam connected to a laptop and a "V-BOX" hard paper box. In the experiments that were performed, each participant completed a questionnaire regarding his/her experience using the pelvi-trainer. The results were positive, validating the device as a valid tool for training. Conclusions: We validated the anatomic pelvi-trainer designed by our team as a valuable alternative for basic and advanced laparoscopic surgery training outside the operating room for pelvic organs procedures, proving that it supports a much faster learning curve for colorectal procedures without harming the patients.

Low-cost laparoscopic simulator - viable way of enabling access to basic laparoscopic training for medical students?

BACKGROUND

Commercial laparoscopic simulators are costly and with limited accessibility. For this reason, medical students very often do not have an easy access to laparoscopic training important for their practical skills development.

PATIENTS AND METHODS

Using materials available at a standard hardware store we managed to construct a laparoscopic training box with four eye-hand coordination modules that could substitute commercial solutions. In this work we provide a detailed instructions on creating such a training box. Moreover, to evaluate the functionality of our simulator we conducted a survey of students who were provided training using commercial box trainer and our homemade box trainer.

RESULTS

Students considered our homemade laparoscopic training box to be of comparable quality to the commercial solution. All of the surveyed students considered training using a low cost laparoscopic training box to be a positive experience.

CONCLUSIONS

Our homemade low cost laparoscopic simulator is relatively easy to construct and was deemed noninferior to the commercial laparoscopic simulator by surveyed students. Such type of laparoscopic simulators could enhance access to laparoscopic training for medical students.

Construct Validity and Experience of Using a Low-cost Arthroscopic Shoulder Surgery Simulator

Objective  To validate the low-cost model for arthroscopy training and analyze the acceptance and usefulness of the developed simulator in medical teaching and training. Method  Ten medical students, ten third-year orthopedic residents, and ten shoulder surgeons performed predetermined tasks on a shoulder simulator twice. The parameters used were time to complete the tasks, number of looks at the hands, GOALS score (Global Operative Assessment of Laparoscopic Skills) and comparison between groups and within groups. An adapted Likert scale was applied addressing the individuals' impressions about the simulator and its applicability. Results  In the intergroup comparison, the shoulder surgeons had better scores and times than the other groups. When the tasks were repeated, the group of surgeons had a 59% improvement in time (p < 0.05), as did the group of medical students. In the GOALS score, shoulder surgeons had consistently better scores than the other groups. And when we evaluated the evolution from the first to the second test, the group of surgeons and the group of academics had a statistically significant improvement (p < 0.05). In terms of lookdowns, there was a decrease in all groups. There was consensus that the simulator is useful in training. Conclusion  The simulator developed allowed the differentiation between individuals with different levels of training in arthroscopic surgery. It was accepted by 100% of the participants as a useful tool in arthroscopic shoulder surgical training.

Innovations in Urologic Surgical Training

PURPOSE OF REVIEW

This review aims to summarize innovations in urologic surgical training in the past 5 years.

RECENT FINDINGS

Many assessment tools have been developed to objectively evaluate surgical skills and provide structured feedback to urologic trainees. A variety of simulation modalities (i.e., virtual/augmented reality, dry-lab, animal, and cadaver) have been utilized to facilitate the acquisition of surgical skills outside the high-stakes operating room environment. Three-dimensional printing has been used to create high-fidelity, immersive dry-lab models at a reasonable cost. Non-technical skills such as teamwork and decision-making have gained more attention. Structured surgical video review has been shown to improve surgical skills not only for trainees but also for qualified surgeons. Research and development in urologic surgical training has been active in the past 5 years. Despite these advances, there is still an unfulfilled need for a standardized surgical training program covering both technical and non-technical skills.