10 research outputs found

    Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

    Full text link
    Purpose: Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator. Methods: Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results: In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions: Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program

    Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

    Get PDF
    Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

    Simulação em Laparoscopia

    Get PDF
    INTRODUÇÃO Atualmente a laparoscopia é uma via de abordagem alternativa na realização de muitas cirurgias com benefícios comprovados em situações selecionadas. Para a realização desta técnica os cirurgiões precisam de desenvolver habilidades psicomotoras laparoscópicas (LPS - Laparoscopic Psycomotor Skills), que não se adquirem com a cirurgia clássica por laparotomia, que têm um longa curva de aprendizagem e cujo treino deve ser feito antes da cirurgia no doente. Os modelos de treino mais usados são simuladores: caixas de treino e realidade virtual, que permitem o treino seguro e controlado. O treino em simuladores continua a ser objeto de pesquisas na tentativa de fornecer provas da sua aplicação no treino cirúrgico, da sua validação e do seu uso na otimização de habilidades cirúrgicas. MATERIAL E MÉTODOS Procedeu-se à revisão bibliográfica sobre modelos de aprendizagem laparoscópica e fez-se um estudo observacional e transversal com aplicação do modelo LASTT® aos médicos, internos e estagiários do Departamento de Obstetrícia e Ginecologia do CHTV. A recolha dos dados foi feita através de um questionário adaptado da Sociedade Europeia de Endoscopia Ginecológica (ESGE) e do registo dos tempos e objetivos cumpridos nos exercícios do LASTT® do centro de simulação do CHTV. Procedeu-se à análise estatística usando a ferramenta SPSS®. RESULTADOS No estudo participaram 2 médicos especialistas (10%), 13 internos complementares (100%), 3 alunos estagiários (8%) e 11 alunos da UBI (85%). Verificou-se que para os exercícios 2 e 3 nas categorias cirurgião e ajudante, os grupos com exposição limitada e importante à laparoscopia (G2) demonstram melhor desempenho que o grupo com nenhuma ou muito pouca exposição (G1). As mulheres têm piores resultados, sem significância estatística. A prévia exposição aos simuladores Caixa e Animais e o curso prévio de introdução a laparoscopia também são fatores de melhor desempenho, sendo estatisticamente significativo nos exercícios 2 e 3; a prévia exposição ao simulador realidade virtual e o certificado LASTT® melhoram o desempenho, porém não são estatisticamente significativos. A exposição a videojogos e a instrumentos musicais não se demonstra relevante. A repetição melhorou o desempenho, sendo estatisticamente significativo nos exercícios 1 e 2. CONCLUSÃO Pode-se concluir que este modelo aplicado a um pequeno grupo tem validade construtiva para diferenciar participantes com e sem exposição laparoscópica e que a repetição em participantes sem experiência em laparoscopia melhora o desempenho. Assim, este modelo pode ser usado como ferramenta de teste e treino das LPS.INTRODUCTION Today, laparoscopy is an alternative pathway of approach for carrying out many surgeries with proven benefits in selected situations. To perform this technique the surgeons need to develop laparoscopic psychomotor skills (LPS), which are not acquired with classical laparotomy surgery, that have a long learning curve and whose training should be done before surgery. The training models most commonly used are simulators: box trainer and virtual reality, which allow safe and controlled training. The training simulators continue to be subject of research in an attempt to provide evidence of its application in surgical training, its validation and its use in optimizing surgical skills. MATERIAL E METHODS We carried out the literature review on models of learning laparoscopy and made an observational and cross-sectional study with application of LASTT Model® to physicians, trainees and medical students of the Department of Obstetrics and Gynaecology of CHTV. Data collection was done with a questionnaire adapted from the European Society of Gynecological Endoscopy (ESGE) and recording of times and completed objectives of the exercise LASTT® from the simulation center of CHTV. The statistical analysis was made by using the SPSS® tool. RESULTS The participants were 2 consultants (10%), 13 trainees (100%), 3 medical students (8%) and 11 medical students from UBI (85%). It was found that for exercises 2 and 3 in the surgeon and assistant categories, the groups with limited and important exposure to laparoscopy (G2) show better performance than the group with no or very little exposure (G1). Women have worse outcomes, with no statistical significance. Prior exposure to simulators Box and Animals and the prior introductory course in laparoscopy are also better performance factors, being statistically significant for exercises 2 and 3; previous exposure to virtual reality simulator and LASTT® certificate improves performance, but are not statistically significant. Exposure to videogames and musical instruments does not appear relevant. The repetition improved performance, being statistically significant for exercises 1 and 2. CONCLUSION It can be concluded that this model applied to a small group has construct validity to differentiate participants with and without laparoscopic exposure and that repetition in participants without experience in laparoscopy improves performance. Thus, this model can be used as training and test tool of LPS

    Objektív sebészet – robotok és szimulátorok használata a sebészeti képességek felmérésére

    Get PDF
    A laparoscopos sebészet sikerességére alapozva a robotsebészet az egyik legmeghatározóbb irányzattá vált a nyugati ellátásban, elsősorban a hasi beavatkozások tekintetében. Míg a kézi laparoscopos eljárások elsajátítása hosszú és fáradsá- gos feladat, a da Vinci típusú robotizált alkalmazások számos intuitív vezérlési és ergonómiai funkciót kínálnak. Mindkét esetben alapvető fontosságú, hogy a sebészek valós technikai képességeivel, készségeivel tisztában legyünk. A robotizált sebészeti eszközök használata radikálisan új mérési módszereket tesz lehetővé a műtéti folyamatok számos paraméterét tekintve, amely alapján új tananyagok és vizsgáztatási módszerek kerültek kidolgozásra. Ezek forradalmasíthatják a laparoscopos sebészet oktatását, hiszen objektív kritériumrendszer bevezetését teszik lehetővé. A robotos környezetben és szimulátorokon alkalmazott alapvető metrikákat és módszereket viszi végig ez a cikk, részletesen kitérve az egyes módszerek validáltságára és hasznosságára. Az elkövetkező pár évben várhatóan ezek fogják meghatározni a modern laparoscopos sebészeti képzések összetételét

    A Novel Haptic Simulator for Evaluating and Training Salient Force-Based Skills for Laparoscopic Surgery

    Get PDF
    Laparoscopic surgery has evolved from an \u27alternative\u27 surgical technique to currently being considered as a mainstream surgical technique. However, learning this complex technique holds unique challenges to novice surgeons due to their \u27distance\u27 from the surgical site. One of the main challenges in acquiring laparoscopic skills is the acquisition of force-based or haptic skills. The neglect of popular training methods (e.g., the Fundamentals of Laparoscopic Surgery, i.e. FLS, curriculum) in addressing this aspect of skills training has led many medical skills professionals to research new, efficient methods for haptic skills training. The overarching goal of this research was to demonstrate that a set of simple, simulator-based haptic exercises can be developed and used to train users for skilled application of forces with surgical tools. A set of salient or core haptic skills that underlie proficient laparoscopic surgery were identified, based on published time-motion studies. Low-cost, computer-based haptic training simulators were prototyped to simulate each of the identified salient haptic skills. All simulators were tested for construct validity by comparing surgeons\u27 performance on the simulators with the performance of novices with no previous laparoscopic experience. An integrated, \u27core haptic skills\u27 simulator capable of rendering the three validated haptic skills was built. To examine the efficacy of this novel salient haptic skills training simulator, novice participants were tested for training improvements in a detailed study. Results from the study demonstrated that simulator training enabled users to significantly improve force application for all three haptic tasks. Research outcomes from this project could greatly influence surgical skills simulator design, resulting in more efficient training

    Validación de un dispositivo electrónico para el aprendizaje y evaluación de técnicas endoquirúrgicas

    Get PDF
    Los abordajes quirúrgicos de mínima invasión poseen ventajas ampliamente contrastadas para pacientes y también para cirujanos. Como inconveniente, especialmente en laparoscopia, su dominio exige un específico programa de aprendizaje y evaluación en simuladores. El objetivo principal del trabajo fue poder disponer de de un nuevo elemento de simulación híbrida, LapPlate®, para la evaluación objetivo-numérica de habilidades laparoscópicas básicas en los programas de formación del Centro de Cirugía de Mínima Invasión de Cáceres (CCMIJU). Sesentaiocho asistentes participaron en el estudio, separados en tres grupos: Grupo noveles -GN-(n=34); grupo intermedio -GI- (n=13); grupo de expertos -GE-, (n=21). La validación subjetiva de LapPlate®, en términos globales, fue muy positiva por parte de los usuarios y de los expertos. Todas las respuestas estaban cercanas a la nota máxima y sólo una de ellas fue intermedia. Asimismo ninguna de las mismas fue de carácter negativo. En cuanto a la validación constructiva, ésta ha quedado demostrada en cuanto que los registros de los tres grupos se corresponden con el nivel de experiencia previo (GN<GI<GE). La curva de aprendizaje también se ha comprobado para los tres grupos, es decir, gradualmente ha habido una mejora en los registros. Sólo hubo una variación en cuanto a lo esperado ya que los registros del grupo intermedio en uno de los ejercicios fueron similares a los del grupo básico. En conclusión, a falta de realizar la validación concurrente del mismo, creemos que LapPlate® podría comenzar a ser incluido en el programa integral de formación del CCMIJU.Minimally invasive surgical approaches possess largely contrasted advantages for patients and also for surgeons. Disadvantages, especially in laparoscopy, include to accomplish a specific program of learning and assessment in simulators. The main objective of this work was to have a new element for laparoscopic hybrid simulation, LapPlate®, aimed to the objective-numerical evaluation of laparoscopic skills in the basic training programs of the “Jesús Usón” Minimally Invasive Surgery Centre (JUMISC), Cáceres. Sixty eight attendants participated in the study, divided in three groups: Novices group -GN- (n= 34); Intermediate group -GI- (n= 13); Expert group -GE- (n= 21). Subjective validation was globally rated as very positive by the users and experts. All of the answers were close to the highest rank and only one of them was intermediate. None of them was rated as negative. Constructive validation was demonstrated that the scores of the three groups were in accordance to the level of prior experience (GN<GI<GE).The learning curves were also proven for the three groups, i.e. There were gradually an improvement in scores of both tasks. There was only one unexpected variation because of the median times of GI in one of the tasks were similar to GN. In conclusion, although concurrent validation is still remaining, we believe that LapPlate® could already be included in the comprehensive training program of the JUMISC.Junta de Extremadura, Consejería de Economía, Comercio e Innovación

    Motor learning induced neuroplasticity in minimally invasive surgery

    Get PDF
    Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

    Validation and determination of the influence of a virtual simulator on the acquisition of ultrasound skills and comparison of learning curves of those using simulation- supported training with a conventional training approach

    Get PDF
    Delivery of ultrasound training remains a challenge. This thesis presents a series of projects that investigated a new approach in acquiring transvaginal ultrasound skills (TVS) in obstetrics and gynaecology using a novel virtual reality simulator (ScanTrainer®, Medaphor plc, Cardiff, Wales). Aims and objectives:(1) To evaluate the validity and reliability of the simulator,(2)to assess the learning curves of trainees’ competence in performing TVS, and (3) to define potential benefits and limitations of simulation training from the trainee’s perspective. These were achieved by undertaking the following studies (1) face, content and construct validity of the simulator, (2) reliability of scoring systems developed for the assessment of ultrasound in obstetrics and gynaecology, (3) validation of simulation scoring system against experts, and (4) evaluating the role of simulation on TVUS skill acquisition (learning curve) in the clinical training environment. Methods: The projects included observational, comparative and semi-qualitative studies and randomised controlled trial (RCT) comparing conventional with simulation supported training. Results: (1) Face and content validity study demonstrated high acceptability of the simulator. (2) Construct validity study showed significant differences between inovices and experts’ performances, p0.75). (4) In the RCT, the overall analysis according to the randomisation arm showed no statistically significant difference between the intervention and control groups. (5) Fifty-seven percent of trainees agreed that simulation was a flexible learning platform in practicing TVUS as an adjunct to clinical training. Conclusion: The ScanTrainer® simulator has high face, content and constructs' validity that support the research hypotheses. It also has a potential role in the assessment of clinical skills. However, the impact of simulation on the learning curves requires further evaluation

    Formaciones imaginarias del diseñador gráfico en el discurso del campo académico.

    Get PDF
    En este trabajo se describe un proyecto de tesis doctoral en el que se analiza el discurso sobre el diseñador gráfico. Se parte del supuesto de que existe una tricotomía de su perfil: 1) el campo profesional, 2) el campo educativo y, 3) el campo académico. Proponemos que dicha tricotomía permite la identificación de imaginarios sobre el tema, y no solo eso, sino que también aporta elementos que conforman la identidad (Bauman, 2002) de un diseñador gráfico. La pregunta de investigación es ¿Cuál es la identidad discursiva del diseñador gráfico en el campo académico? La investigación descrita es de tipo cualitativo y deductivo; para la construcción la identidad discursiva (Van Dijk, T; 2008) del diseñador gráfico, se toman en cuenta diversas publicaciones: principalmente investigaciones y breves artículos difundidos en comunidades/foros de reflexión y debate en torno a la temática, además de memorias de congresos y libros. En apoyo al desarrollo del proyecto se ha diseñado un Laboratorio de Intervención en el Diseño, cuyos objetivos son impulsar el desarrollo social y cultural de los diseñadores gráficos por medio de la investigación, educación continua, producción y vinculación. En un primer acercamiento a las formaciones imaginarias (Pêcheux, 1978) sobre la identidad del diseñador gráfico se centran en el grado de erudición para la ejecución de su trabajo, en la cultura que demuestran y en la autonomía con la que producen
    corecore