e-MIS Contents: Multimedia Contents for e-Learning Environments in Minimally Invasive Surgery

This work describes the design and application of multimedia contents for web technologies-based training in minimally invasive surgery (MIS). The chosen strategy allows knowing the deficiencies of the current training methods so new multimedia contents can cover them. This study is concluded with the definition of three different types of multimedia contents accordingly to the development degree and didactic objectives that they present: Didactic resources are basic contents such as videos or documents that can be enhanced with contributions of users. On the other hand, case reports and didactic units have a defined structure. Didactic resources and case reports provide an informal training while didactic units are included in a more regulated training

E-MIS validity applied to TELMA enhanced learning environment

Enhanced learning environments are arising with great success within the field of cognitive skills training in minimally invasive surgery (MIS) because they provides multiple benefits since they avoid time, spatial and cost constraints. TELMA [1,2] is a new technology enhanced learning platform that promotes collaborative and ubiquitous training of surgeons. This platform is based on four main modules: an authoring tool, a learning content and knowledge management system, an evaluation module and a professional network. TELMA has been designed and developed focused on the user; therefore it is necessary to carry out a user validation as final stage of the development. For this purpose, e-MIS validity [3] has been defined. This validation includes usability, contents and functionality validities both for the development and production stages of any e-Learning web platform. Using e-MIS validity, the e-Learning is fully validated since it includes subjective and objective metrics. The purpose of this study is to specify and apply a set of objective and subjective metrics using e-MIS validity to test usability, contents and functionality of TELMA environment within the development stage

Adaptación de la usabilidad del entorno de formación TELMA a las necesidades de los cirujanos expertos

Uno de los principales inconvenientes manifestados por los cirujanos a la hora de llevar a cabo su formación continuada es la elevada carga asistencial que les limita la posibilidad de asistir a cursos y estancias presenciales. Por tanto, los cirujanos necesitan otros métodos formativos distintos a la formación in situ y para ello son de gran utilidad las tecnologías web, como es el caso de la plataforma de e-Learning TELMA, que ofrezcan contenidos didácticos adaptados a cada usuario para que puedan complementar su formación con contenidos multimedia online. Estudios previos de validación de TELMA detectaron diferentes problemas respecto a su diseño y usabilidad, propiciando mayores dificultades de accesibilidad para los cirujanos expertos en relación a los cirujanos noveles. Para corregirlos, en este trabajo se han analizado las deficiencias encontradas y se han propuesto una serie de medidas fundamentadas en un conjunto de directivas de diseño web que se deberían adoptar en futuras versiones de la plataforma TELMA para tratar de solventar estas desigualdades, ofreciendo a todos los usuarios tanto expertos como noveles, las mismas facilidades de accesibilidad

Evaluación objetiva de destrezas laparoscópicas básicas a partir de métricas obtenidas con el simulador virtual SINERGIA

Las técnicas laparoscópicas se han convertido en patrón oro en muchos procedimientos quirúrgicos, pero implican un proceso de adquisición de destrezas más complejo que en el caso de la cirugía abierta. En esta fase formativa, los simuladores virtuales tienen un papel muy importante puesto que permiten evaluar de forma objetiva la ejecución de una tarea quirúrgica mediante la extracción automática de métricas. Este trabajo de investigación presenta un análisis de las métricas calculadas por el simulador virtual SINERGIA con el fin de poder llevar a cabo una evaluación objetiva de las destrezas laparoscópicas básicas

Intrapericardial Administration of Secretomes from Menstrual Blood-Derived Mesenchymal Stromal Cells: Effects on Immune-Related Genes in a Porcine Model of Myocardial Infarction.

Acute myocardial infarction (AMI) is a manifestation of ischemic heart disease where the immune system plays an important role in the re-establishment of homeostasis. We hypothesize that the anti-inflammatory activity of secretomes from menstrual blood-derived mesenchymal stromal cells (S-MenSCs) and IFNγ/TNFα-primed MenSCs (S-MenSCs*) may be considered a therapeutic option for the treatment of AMI. To assess this hypothesis, we have evaluated the effect of S-MenSCs and S-MenSCs* on cardiac function parameters and the involvement of immune-related genes using a porcine model of AMI. Twelve pigs were randomly divided into three biogroups: AMI/Placebo, AMI/S-MenSCs, and AMI/S-MenSCs*. AMI models were generated using a closed chest coronary occlusion-reperfusion procedure and, after 72 h, the different treatments were intrapericardially administered. Cardiac function parameters were monitored by magnetic resonance imaging before and 7 days post-therapy. Transcriptomic analyses in the infarcted tissue identified 571 transcripts associated with the Gene Ontology term Immune response, of which 57 were differentially expressed when different biogroups were compared. Moreover, a prediction of the interactions between differentially expressed genes (DEGs) and miRNAs from secretomes revealed that some DEGs in the infarction area, such as STAT3, IGFR1, or BCL6 could be targeted by previously identified miRNAs in secretomes from MenSCs. In conclusion, the intrapericardial administration of secretome early after infarction has a significant impact on the expression of immune-related genes in the infarcted myocardium. This confirms the immunomodulatory potential of intrapericardially delivered secretomes and opens new therapeutic perspectives in myocardial infarction treatment.This study was supported by competitive grants, such as: “PFIS” contract (FI19/00041) from the National Institute of Health Carlos III (ISCIII, 2019 Call Strategic Action in Health 2019) to M.Á.d.P.; Santander Bank “Convenio de colaboración empresarial en actividades de interés general” to F.M.; “Sara Borrell” grant (CD19/00048) from ISCIII to E.L.; grant “TE-0001-19” from Consejería de Educación y Empleo (co-funded by European Social Fund -ESF- “Investing in your future”), ayuda para el fomento de la contratación de personal de apoyo a la investigación en la Comunidad Autónoma de Extremadura to M.P. Costs for experimental development were funded by grant “CB16/11/00494” from CIBER-CV ISCIII, RD21/0017/0014 from ISCIII (co-funded by NextGenerationEU. Plan de Recuperación Transformación y Resiliencia) and Ayuda Grupos catalogados de la Junta de Extremadura (GR21201) from Junta de Extremadura, Consejería de Economía, Ciencia y Agenda Digital (co-funded by European Regional Development Fund—ERDF) to F.M.S.-M.; J.G.C. received fundings from the ISCIII through a “Miguel Servet I” grant (MS17/00021) co-funded by ERDF/ESF “A way to make Europe” “Investing in your future”, funding from the projects “CP17/00021” and “PI18/0911” (co-funded by ERDF/ESF), and by Junta de Extremadura. V.C. received fundings from ISCIII (grant number “PI16/01172” and “PI20/00247”). E.L. received fundings from Junta de Extremadura through a “IB20184” grant (co-funded by ERDF/ESF). The funders had no role in study designs, data collection and analysis, decision to publish, or preparation of the manuscript.S

Porcine Model In The Laparoscopic Liver Surgery Training

The aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery

Interpretation of motion analysis of laparoscopic instruments based on principal component analysis in box trainer settings

Background Motion analysis parameters (MAPs) have been extensively validated for assessment of minimally invasive surgical skills. However, there are discrepancies on how specific MAPs, tasks, and skills match with each other, reflecting that motion analysis cannot be generalized independently of the learning outcomes of a task. Additionally, there is a lack of knowledge on the meaning of motion analysis in terms of surgical skills, making difficult the provision of meaningful, didactic feedback. In this study, new higher significance MAPs (HSMAPs) are proposed, validated, and discussed for the assessment of technical skills in box trainers, based on principal component analysis (PCA). Methods Motion analysis data were collected from 25 volunteers performing three box trainer tasks (peg grasping/PG, pattern cutting/PC, knot suturing/KS) using the EVA tracking system. PCA was applied on 10 MAPs for each task and hand. Principal components were trimmed to those accounting for an explained variance >80% to define the HSMAPs. Individual contributions of MAPs to HSMAPs were obtained by loading analysis and varimax rotation. Construct validity of the new HSMAPs was carried out at two levels of experience based on number of surgeries. Results Three new HSMAPs per hand were defined for PG and PC tasks, and two per hand for KS task. PG presented validity for HSMAPs related to insecurity and economy of space. PC showed validity for HSMAPs related to cutting efficacy, peripheral unawareness, and confidence. Finally, KS presented validity for HSMAPs related with economy of space and knotting security. Conclusions PCA-defined HSMAPs can be used for technical skills’ assessment. Construct validation and expert knowledge can be combined to infer how competences are acquired in box trainer tasks. These findings can be exploited to provide residents with meaningful feedback on performance. Future works will compare the new HSMAPs with valid scoring systems such as GOALS