Ergonomics of the Operative Field in Paediatric Minimal Access Surgery

Imperial Users onl

Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer

With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high-fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform

Evaluation of Three Sources of Validity Evidence for a Laparoscopic Duodenal Atresia Repair Simulator

Purpose: Laparoscopic duodenal atresia (DA) repair is a relatively uncommon pediatric operation requiring advanced minimally invasive skills. Currently, there are no commercial simulators available that address surgeons' needs for refining skills associated with this procedure. The purposes of this study were (1) to create an anatomically correct, size-relevant model and (2) to evaluate the content validity of the simulator. Materials and Methods: Radiologic images were used to create an abdominal domain consistent with a full-term infant. Fetal bovine tissue was used to complete the simulator. Following Institutional Review Board exempt determination, 18 participants performed the simulated laparoscopic DA repair. Participants completed a self-report, six-domain, 24-item instrument consisting of 4-point rating scales (from 1=not realistic to 4=highly realistic). Validity evidence relevant to test content and response processes was evaluated using the many-facet Rasch model, and evidence of internal structure (inter-item consistency) was estimated using Cronbach's alpha. Results: The highest observed averages were for ?Value as a training and testing tool? (both observed averages=3.9), whereas the lowest ratings were ?Palpation of liver? (observed average=3.3) and ?Realism of skin? (observed average=3.2). The Global opinion rating was 3.2, indicating the simulator can be considered for use as is, but could be improved slightly. Inter-item consistency was high (α=0.89). Conclusions: We have successfully created a size-appropriate laparoscopic DA simulator. Participants agreed that the simulator was relevant and valuable as a learning/testing tool. Prior to implementing this simulator as a training tool, minor improvements should be made, with subsequent evaluation of additional validation evidence.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140148/1/lap.2014.0358.pd

Training for MIS in pediatric urology: Proposition of a structured training curriculum

Abstract In Europe there are a lot of training centers for minimally invasive surgery (MIS) but a standardized MIS training program in pediatric urology doesn't exist at the moment. We performed a literature review with the last goals to propose a structured training curriculum in MIS urology for pediatric surgeons. Pediatric urologists have to obtain a valid MIS training curriculum completing the following 4 steps: (I) Theoretical part (theoretical courses, masterclass) to acquire theoretical knowledge; (II) experimental training (simulation on pelvic trainer, virtual reality simulators, animal models, 3-D ex-vivo models) to acquire basic laparoscopic skills; (III) stages in European centers of reference for pediatric MIS urology to learn all surgery aspects; (IV) personal operative experience. At the end of the training period, the trainee would be expected to perform several MIS urological procedures independently, under supervision of an expert tutor. At the end of the training program, each center will analyze the candidate training booklet and release for each applicant a certification after an exam. We think that this MIS training program in pediatric urology may assure an integrated acquisition of basic and advanced laparoscopic skills during residency training in pediatric urology. Each European country should adopt this program so as to secure a standardized technical qualification in MIS urology for all future pediatric urologists

Pre-clinical Training for New Notes Procedures: From Ex-vivo Models to Virtual Reality Simulators

Natural orifice transluminal endoscopic surgery (NOTES) is a newer field of endoscopic surgery that allows for scarless treatment of pathologic entities, using novel transluminal approaches. There has been a shift of focus from a clinical and research standpoint from the development and dissemination of "first-generation" NOTES procedures to "new NOTES" procedures that traverse the mucosa of luminal structures, yet do not stray far into the peritoneal cavity. It has been a challenge to find appropriate and effective ways to train gastroenterologists and surgeons in these novel approaches. We review the importance of simulation in training and discuss available simulation options

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented

Simulation-based training in the paediatric surgery population: A review of current trends and future direction

In recent years, simulation-based training in surgery has emerged as a viable accompaniment to traditional teaching methods. Multiple studies have highlighted the benefits of simulation-based training in both learning and teaching aspects of surgical training, with a particular emphasis on the honing of technical skills. However, multiple issues still exist in widespread implementation of simulation-based training, especially in the developing countries. Furthermore, the existing literature needs to be expanded upon in both quantity and quality domains to ensure a more evidence-based transition to simulation-based training in surgery. The current review article was planned to take a look at the existing literature on the current state of simulation-based training in paediatric surgery, its potential to revolutionise paediatric surgical training, and to propose solutions to the issues that are delaying wider implementation

Modernizing Biomedical Training: Replacing Live Animal Laboratories with Human Simulation

This chapter reviews the global trend towards a modernization of biomedical education in favor of simulation-based training methods, which studies confirm improve student learning and transference of applied skills to clinical practice, reduce laboratory costs, and spare animals from harmful procedures

Three-Dimensional Minimally Invasive Surgery Enhances Surgeon’s Performances, Reducing Operative Time and Errors. Comparative Study in a Pediatric Surgery Setting.

Assumptions Advanced MIS procedures in neonates & infants <5 kg are a very demanding field because of: • very small anatomical structures • limited operative spaces (5-7 cm3) Postulate 3D laparoscopy improves operative time & precision in small spaces Advantages in 3D laparoscopy are mostly described in adults for better depth perception, more precise visualization of anatomical structures, as well as for complex manoeuvres such as suturing. In the pediatric field these data are lacking. In collaboration with Neuromed (Neuromed Spa, Torino) and Storz (Karl Storz, Tuttlingen, Germany) we tested 3D 4mm scopes specific for pediatric laparoscopy with a 3D HD camera, with the possibility to shift from 3D to 2D. In vitro setting – 1 With Visionsense III Stereoscopic Endoscopy System (Neuromed Spa), FDA and CE approved for pediatric surgery, we performed a comparative study between surgical skills achievements in subjects without any surgical experience, using 2D and a 3D laparoscopic equipment. 3 skills were evaluated in 2D and 3D modalities. 20 pediatrics residents without any previous laparoscopic experience were randomly divided in two groups and evaluated doing object transfer and basic surgical manoeuvres in a laparoscopic simulator validated for pediatric surgery. Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities. Time and error rates (missed attempts, dropped objects, and failure to complete the task) were recorded. In vitro setting – 2 Experimental project comparing 2D vs 3D laparoscopic camera in a set-up standardized and validated for Pediatric Surgeons. With Storz TipCam 4mm, we performed a comparative study between surgical skills achievements in experienced pediatric surgeons. Four skills were evaluated in 2D and 3D modalities. 10 pediatric surgeons with more than 50 MIS procedures were randomly divided in two groups and evaluated doing 3 training modules (“threading”, “suturing”, “tension suturing” and “intestinal anastomosis”) in a laparoscopic simulator (iSIM2 – iSurgicals, Chorley, UK). Switching the type of vision from 2D to 3D we evaluated bimanual dexterity, efficiency, tissue handling in both modalities. Time and error rates (missed attempts and failure to complete the task) were recorded. Inconveniences related to the 3D vision were also recorded. Surgical Application Using Visionsense III Stereoscopic Endoscopy System and Storz TipCam 4mm we performed 40 laparoscopic/thoracoscopic procedures in children and neonates hospitalized at the Regina Margherita Children’s Hospital. Operative time and intra- or post-operative complications were recorded