Augmented reality simulation for laparoscopic training realistic haptic feedback and meaningful assessment

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Validated simulation models in pediatric surgery: A review

INTRODUCTION: This review evaluates the validation and availability of simulation models in the field of pediatric surgery that can be used for training purposes. METHODS: MEDLINE and EMBASE were searched for studies describing a simulation models in pediatric surgery. Articles were included if face, content and/or construct validity was described. Additionally, the costs and availability were assessed. Validation scores for each model were depicted as percentage (0-100), based on the reported data, to compare the outcomes. A score of >70% was considered adequate. RESULTS: Forty-three studies were identified, describing the validation process of 38 simulation models. Face validity was evaluated in 33 articles, content in 36 and construct in 19. Twenty-two models received adequate validation scores (>70%). The majority (27/38, 70%) was strictly inanimate. Five models were available for purchase and eleven models were replicable based on the article. CONCLUSION: The number of validated inanimate simulation models for pediatric surgery procedures is growing, however, few are replicable or available for widespread training purposes. LEVEL OF EVIDENCE: Level II

Evaluating the Use of a Take-Home Minimally Invasive Surgery Box Training for At-Home Training Sessions Before and During the COVID Pandemic.

Introduction: Acquiring and retaining minimally invasive surgery (MIS) skills may be aided by using MIS take-home box simulators. This study aims to evaluate the use of a take-home MIS box trainer for training sessions at-home. Methods: Trainees who previously bought the LaparoscopyBoxx (between 2016 and 2020) were asked to complete an online questionnaire. The first part was on their demographic data, and the second part was on their use and opinion on the box trainer (on a 5-point Likert scale). Results: A total of 39 participants (9 surgeons and 30 trainees) completed the questionnaire (response rate 40%). Overall, participants had a positive opinion on the use of the box trainer and would recommend it to others for training (mean 4.2). Basic tasks, such as needle trail and ring transfer, were practiced most often and were regarded most relevant (mean 4.1-4.3). They regarded practicing on the stimulator of added value to practicing in the clinic (mean 4.2), were more confident during clinical procedures (mean 3.9), and felt that their skills had improved (mean 4.1). Of quarter of the participants who bought the MIS box trainer during the COVID-19 pandemic reported an increased use during times of less clinical exposure. Conclusion: Surgeons and trainees have a positive opinion on using a take-home MIS box trainer for at-home training for general as well as for pediatric MIS skills. Especially during periods of less exposure in the clinical setting and less hands-on courses, such as during the COVID-19 pandemic, at-home training may be a valuable addition

Malrotation in Congenital Diaphragmatic Hernia: Is It Really a Problem?

Item does not contain fulltextINTRODUCTION:  Congenital diaphragmatic hernia (CDH) has been associated with other congenital malformations, such as intestinal rotation abnormalities. However, there is no standard evaluation and treatment of intestinal rotation during initial CDH repair. This study evaluates intestinal malrotation in CDH patients. MATERIALS AND METHODS:  All patients with a CDH treated in a high-volume center between 2000 and 2015 were retrospectively evaluated. Demographics, gastrointestinal characteristics, surgical treatment, and abdominal outcomes (acute surgery, small bowel obstruction, and volvulus) were described. RESULTS:  A total of 197 CDH patients were surgically repaired. In 76 (39%) patients, a malrotation was described at initial CDH repair, in 39 (20%) patients, a normal rotation, but 82 patients (42%) had no report on intestinal rotation. During follow-up (range: 2-16 years), 12 additional malrotations were diagnosed, leading to a prevalence of at least 45% (n = 88). These were mostly diagnosed due to acute small bowel obstruction, of which three had a volvulus. Of the 12 later diagnosed malrotations, 58% required acute surgery, compared to 3% of the 76 initially diagnosed patients (p < 0.001). CONCLUSION:  Malrotation is associated with CDH, with a prevalence of at least 45% and in 21% a normal intestinal rotation. "Missed" malrotations have a higher risk on need for acute surgery later in life

Assessment of Minimally Invasive Suturing Skills: Is Instrument Tracking an Accurate Prediction?

Introduction: Minimally invasive surgery (MIS) suturing demands advanced surgical skills. Therefore, it is important these skills are adequately trained and assessed. Assessment and feedback can consist of judgments and scores of expert observers or objective parameters using instrument tracking. The aim of this study was to determine to what extent objective parameters correspond to expert assessment. Methods: Participants performed an intracorporeal suturing task on the EoSim simulator repeatedly (maximum 20 repetitions) during training. The best discriminating parameters, which previously shown construct validation, were combined into a composite score, using regression analysis. All videos were blinded and assessed by 2 independent reviewers using the validated laparoscopic suturing competency assessment tool (LS-CAT). These scores were compared with the composite score. Results: A 100 videos of 16 trainees, during separate points on their learning curve, and 8 experts were used. The parameters "time" and "distance" were statistically significantly correlated with all LS-CAT domains. The composite score (calculated from "time" and "distance") showed improvement between the first and the last knot (57% versus 94%, P < .001). Also the LS-CAT score improved (28 versus 17, P < .001). However, the correlation of the composite score with the LS-CAT score was weak (R: 0.351), with an accuracy of 55/100 when pooling the outcomes based on inadequate, adequate, or good performance. Conclusion: Instrument tracking parameters (using Surgtrac) could give an indication of the skill level, however, it missed important elements, essential for reliable assessment. Therefore, expert assessment remains superior to determine the skill level in MIS suturing skills

Meaningful assessment method for laparoscopic suturing training in augmented reality

To be an effective training tool, a laparoscopic simulator has to provide metrics that are meaningful and informative to the trainee. Time, path length and smoothness are often used parameters, but are not very informative on the quality of the performance. This study aims to validate a newly developed assessment method for laparoscopic suturing on the ProMIS augmented reality simulator, and compares it with scores of objective observers. Methods Twenty-four participants practised their suturing skills on the augmented reality suturing module: experienced participants (n = 10), >50 clinical laparoscopic suturing experience; and novice participants (n = 14), without laparoscopic experience. The performances were recorded and assessed by two unrelated observers and compared with the assessment scores. The assessment score was a calculation of time spent in the correct area and quality (strength) of the knot. To test the accuracy of the individual assessment parameters, we compared these with each other. Results The experienced participants had significantly higher performance scores than the novice participants in the beginner-level mode (mean 95.73 vs. 60.89, standard deviation 2.63 vs. 17.09, p < 0.001, independent t-test). The performance scores of the assessment method (n = 43) correlated significantly with the scorings of the objective observers (Spearman’s rho 0.672; p < 0.001). The parameter time spent in correct area had a calculated significant correlation with the strength of the knot (n = 229, Spearman’s rho 0.257, p < 0.001), but this was clinically irrelevant. Conclusion This assessment method is a valid tool for objectively assessing laparoscopic suturing skills. Although assessment parameters can correlate, to provide informative feedback it is important to combine meaningful measurements in the assessment of suturing skills.Applied Ergonomics and DesignIndustrial Design Engineerin

Objective assessment for open surgical suturing training by finger tracking can discriminate novices from experts.

It is difficult, time consuming and expensive to assess manual skills in open surgery. The aim of this study is to investigate the construct validity of a low-cost, easily accessible tracking technique for basic open suturing tasks. Medical master students, surgical residents, and surgeons at the Radboud University Medical Center were recruited between September 2020 until September 2021. The participants were divided, according to experience, in a novice group (≤10 sutures performed) and an expert group (>50 sutures performed). For objective tracking, a tablet with SurgTrac software was used, which tracked a blue and a red tag placed on respectively their left and right index finger. The participants executed four basic tasks on a suturing model: 1) knot tying by hand, 2) transcutaneous suturing with an instrument knot, 3) 'Donati' (vertical mattress suture) with an instrument knot and 4) continuous intracutaneous suturing without a knot. In total 76 participants were included: 57 novices and 19 experts. All four tasks showed significant differences between the novice group and expert group for the parameters time (p<0.001), distance (p<0.001 for Task 1, 2 and 3 and p=0.034 for Task 4) and smoothness (p<0.001). Additionally, Task 3 showed a significant difference for the parameter handedness (p=0.006) and Task 4 for speed (p=0.033). Tracking index finger movements using SurgTrac software on a tablet while executing basic open suturing skills on a simulator shows excellent construct validity for time, distance and motion smoothness in all four suturing tasks

Training the component steps of an extra-corporeal membrane oxygenation (ECMO) cannulation outside the clinical setting

Contains fulltext : 229812.pdf (Publisher’s version ) (Open Access)Extra-corporeal membrane oxygenation (ECMO) cannulation can be a stressful procedure because a fast cannulation is vital for the patient's survival. Therefore, it is important to train the steps of cannulation outside the clinical setting. A relatively low budget, easy to use model, was developed to train the most important steps of an ECMO cannulation. Following this, it was evaluated by experts and target group participants. They all completed a questionnaire regarding their experience and opinions on the ECMO model on general aspects and the training of the component steps, rated on a 5-point Likert scale. Twenty-one participants completed the questionnaire. The features and steps of the model were rated with a mean of 3.9 on average. The haptics of the landscape scored least, with a mean of 3.6, although the haptics of the vessels scored highest with 4.0. The rating of the component steps showed that only 'opening of the vessels' was scored significantly different between the expertise levels (means experts: 4.0, target group: 3.4, p = 0.032). This low budget model is considered to be a valid tool to train the component steps of the ECMO cannulation, which could reduce the learning curve in the a stressful clinical setting. Level of evidence: II prospective comparative study

A software-based tool for video motion tracking in the surgical skills assessment landscape

Contains fulltext : 191950.pdf (publisher's version ) (Open Access