Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery.

PURPOSE: To develop and test the validity of a surgical competency assessment tool for simulated small-incision cataract surgery (SICS). SETTING: Participating ophthalmologists contributed from 8 countries. DESIGN: Qualitative and quantitative development and evaluation of face and content validity of an assessment rubric, and evaluation of construct validity and reliability. METHODS: The SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR) was developed and assessed for face and content validity by an international group of experienced ophthalmologists. Groups of novice and competent surgeons from 4 countries were recorded performing surgery, and masked assessments were performed by 4 expert surgeons, to determine construct validity and reliability. RESULTS: The Sim-OSSCAR for SICS was assessed by a panel of 12 international experts from 8 countries. In response to the question, "Do you think the OSSCAR represents the surgical techniques and skills upon which trainees should be assessed?," all respondents either agreed or strongly agreed. Face validity was rated as 4.60 (out of 5.0). The content was iteratively agreed to by the panel of experts; final content validity was rated as 4.5. Interobserver reliability was assessed, and 17 of 20 items in the assessment matrix had a Krippendorff ? correlation of more than 0.6. A Wilcoxon rank-sum test showed that competent surgeons perform better than novices (P = .02). CONCLUSIONS: This newly developed and validated assessment tool for simulation SICS, based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, has good face and content validity. It can play a role in ophthalmic surgical education

High Fidelity Haptic Rendering for Deformable Objects Undergoing Topology Changes

International audienceThe relevance of haptic feedback for minimally invasive surgery has been demonstrated at numerous counts. However, the proposed methods often prove inadequate to handle correct contact computation during the complex interactions or topological changes that can be found in surgical interventions. In this paper, we introduce an approach that allows for accurate computation of contact forces even in the presence of topological changes due to the simulation of soft tissue cutting. We illustrate this approach with a simulation of cataract surgery, a typical example of microsurgery

Studies on machine learning-based aid for residency training and time difficulty in ophthalmology

兵庫県立大学大学院工学(博士)2023doctoral thesi

Comparación entre controles hápticos y tradicionales en educación y entrenamiento para RV

Virtual Reality (VR) as an immersive environments generator currently presents a notable expansion and has made an appearance on multiple investigations concerning various study fields. Acknowledging the virtues presented by this technology, such as a rise in both motivation and learning effectiveness (by bringing an increased immersion and satisfaction levels on performed activities) on educational and training scopes, it’s been proposed to assess which control configuration (haptics or traditional) is more relevant to improve performance and usability on the mentioned scopes. Therefore, this article presents corresponding details to elaborating a prototype that allows the accomplishment of basic tasks for educational and training purposes in a virtual reality environment. In this document, we focus on the prototype's tests to determine the most usable interaction based on the criteria of the experiment’s participants.La Realidad Virtual (RV) como tecnología generadora de ambientes inmersivos actualmente presenta una notable expansión, y se ha presenciado en múltiples investigaciones en diversos campos de estudio. Reconociendo las virtudes que aporta esta tecnología, como el aumento en motivación y en la efectividad del aprendizaje (por comprender un mayor nivel de inmersión y satisfacción en las actividades realizadas) en los ámbitos educativos y de entrenamiento, se propone evaluar cuál es la configuración de controles (hápticos o tradicionales) más pertinente para mejorar el desempeño y la percepción de usabilidad en los ámbitos mencionados. Así pues, este articulo presenta detalles correspondientes a la elaboración de un prototipo que permita la finalización de tareas básicas para fines educativos y de entrenamiento, en un ambiente de realidad virtual. En este documento nos centramos en las pruebas realizadas al prototipo para definir la interacción más usable a criterio de los participantes del experimento

Simulation der Phakoemulsifikation im Augenoperationssimulator Eyesi

Diese Arbeit beschäftigt sich mit der Simulation der Phakoemulsifikation zur Ausbildung von Augenchirurgen. Besonderer Wert wurde auf die Übertragung der für die reale Operation benötigten Phakomaschine in die virtuelle Realität gelegt. Damit entstand der einzige Trainingssimulator, der über eine Maschinensimulation verfügt

Improved Performance of d₃₁-Mode Needle-actuating Transducer with PMN-PT Piezocrystal

Prototypes of a PZT-based ultrasound needle-actuating device have shown the ability to reduce needle penetration force and enhance needle visibility with color Doppler imaging during needle insertion for tissue biopsy and regional anesthesia. However, the demand for smaller, lighter devices and the need for high performance transducers have motivated investigation of a different configuration of needle-actuation transducer, utilizing the d 31 -mode of PZT4 piezoceramic, and exploration of further improvement in its performance using relaxor-type piezocrystal. This paper outlines the development of the d 31 -mode needle actuation transducer design from simulation to fabrication and demonstration. Full characterization was performed on transducers for performance comparison. The performance of the proposed smaller, lighter d 31 -mode transducer is comparable with that of previous d 33 -mode transducers. Furthermore, it has been found to be much more efficient when using PMN-PT piezocrystal rather than piezoceramic

The simulated ocular surgery (SOS) trials: randomised-controlled trials comparing intense simulation-based surgical edication for cataract and glaucoma surgery to conventional training alone in East and Southern Africa

Cataract remains the most common cause of blindness globally, and glaucoma is the third after uncorrected refractive error. Surgical management remains a priority, yet surgical training of ophthalmologists continues in the outdated apprentice model. Simulation-based surgical education is yet to be tested to the level of a randomised-controlled trial in ophthalmology. We designed two separate and independent multi-centre multi-country investigator-masked randomised controlled educational-intervention parallel group efficacy trials. Post-graduate doctors in ophthalmology training programmes at collaborating institutions in five East and Southern African countries were assessed for eligibility for inclusion (not having performed the procedure as primary surgeon) into either the OLIMPICS (ophthalmic learning and improvement initiative in cataract surgery) or GLASS (glaucoma simulated surgery) trials. Fifty-one surgical trainees were recruited into the GLASS trial, and 50 into the OLIMPICS trial. Surgical competency was assessed by video recordings, which were double marked by independent experts who were masked to group assignment and timing of the assessment. The intervention was an intense simulation-based cataract or glaucoma surgical training course over 5 days. Primary outcome measure was surgical competency at three-months assessed with validated simulated surgical competency assessment rubrics, the Sim-OSSCARs (ophthalmic simulation surgical competency assessment rubric), for both trials. The trials were registered in March 2017 on the Pan-African Clinical Trial Registry (PACTR201803002159198) and are currently closed to recruitment. Baseline characteristics of age, sex, year of training, baseline knowledge and competency scores were balanced between both arms, for both trials. In total 1,361 surgical videos from across different time-points were independently graded by two separate graders in both trials. In the OLIMPICS trial, 50 participants were recruited between November 2017 and May 2018 and 49 included in the final intention-to-treat analysis with one dropout from the control group. Intervention group participants increased mean simulated surgical competence scores from a baseline of 10.8 of 40 points (27.0%) to 33.7 (84.2%) at 3-months after the training intervention, an increase of 212%. Control group participants’ mean baseline scores were 12.8 (31.9%) and 3-month scores 17.9 (44.7%). We found strong evidence (linear regression p<0.0001) that those in the intervention arm were estimated to have higher scores at three months than those in the control arm, after adjusting for baseline score. Among individuals with the same baseline score, those who received the training were estimated to have scores 16.6 points higher (95%CI 14.5 to 18.8) at three months, compared to those who had not received the training. Intervention participants performed a mean of 22 cataract surgeries as primary surgeon in the one year following the training intervention, compared to 9 by control participants (Poisson regression p<0.0001). Surgical complications were reported for the one year period, and posterior capsule rupture (PCR) rates were 7.4% for the intervention group compared to 26.2% for controls (p<0.0001). Confidence rating scores were assessed using a ten-point Likert scale anchored at 1=’not confident at all’, and 10=’very confident’. Confidence as cataract surgeons increased from 2.2 (of 10) to 6.3 at three-months in the intervention group, compared to 3.4 at baseline to 4.2 for the control group. Among individuals with the same baseline confidence score, those receiving the training were estimated to have scores 2.7 points higher (95%CI 1.6 to 3.7) (p<0.001). In the GLASS trial, 53 trainee ophthalmologists were assessed for eligibility, and 51 were enrolled and randomised. Forty-nine participants were included in the final intention-to-treat analysis: 23 intervention and 26 control, following two drop outs from the intervention group. Baseline surgical competency scores for intervention were a mean of 9.1/40 (22.6%) [median 7.3, IQR 5.4-12.1]; and for control: 8.7/40 (21.8%) [median 8.2, IQR 6.3-12.0] participants. Mean Sim-OSSCAR scores at three-months were 30.4 (76.1%) [median 30.3 IQR 27.8-33.5] and 9.8 (24.4%) [median 9.2 IQR 7.5-11.7] for intervention and control groups respectively. We found strong evidence (linear regression p<0.0001) that those in the intervention arm were estimated to have higher scores at three months than those in the control arm, after adjusting for baseline score as a fixed effect. Among individuals with the same baseline score, those who received the training were estimated to have scores 20.5 points (of 40) higher (95%CI 18.4 to 22.6) at three months, compared to those who had not received the training (linear regression p<0.0001). Baseline mean self-reported confidence in glaucoma surgical skills was 3.0/10 for intervention and 3.2 for control participants. This increased to mean 6.4 and 3.7 at three months respectively (p=0.002). Trainee participants in the intervention group performed a mean of 3.1 live surgical trabeculectomies as primary surgeon over one year following training (median 2, range 0-15, IQR 0-4). Over the same period (and before their simulation training) the control group performed a mean of 0.15 (only one of the 26 control participants performed any glaucoma surgery, compared to 14 of the 23 intervention participants). These are the first multi-centre ophthalmic simulation surgery educational-intervention randomised controlled trials ever conducted. Intense simulation training affords a rapid and sustained increase in surgical competence, confidence as a surgeon, and impacts the number of live surgeries performed. Simulation education in cataract surgery affords a striking benefit in terms of patient safety