Improving patient safety in image-based procedures: Bridging the gap between preferred and actual proficiency

For patients less invasive image-based procedures (IBP) such as laparoscopy have many benefits in comparison to traditional open surgery, such as less pain, faster recovery, and fewer scars. However, to perform IBP effectively, efficiently, and above all safely, the surgical team is highly dependent on technology. The interaction with the surgical instruments and equipment requires extensive training. The proficiency level of the physician and the interaction with the instruments and equipment are key factors in ensuring quality of surgical performance in IBP and patient safety. During surgery, the surgeon should be able to concentrate on the therapeutic tasks. To achieve this, the gap between the preferred and actual level of proficiency of the physician should first of all be minimised by means of preclinical training using simulation tools. In this thesis, the validity of virtual reality simulators for training and assessment of basic psychomotor skills for laparoscopic surgery and flexible lower gastrointestinal endoscopy (colonoscopy) is established. The relation between different IBP skills was also investigated. The performance on two basic laparoscopy tasks (bimanual tissue manipulation and angled laparoscope navigation) proves to be not related; clinically-based expertise in laparoscopic tissue manipulation does not infer skilfulness in angled laparoscope navigation. Training in basic laparoscopy tasks does not affect performance of basic colonoscopy tasks (and vice versa). Training and assessment of basic IBP skills should thus focus on each IBP skill type independently. The influence of specific characteristics of the simulator interface on the efficacy of preclinical training on simulators was also studied. The angled laparoscope navigation task is performed better in an abstract virtual environment than in a virtual environment with simulated anatomic landmarks of the abdomen. And, for training of laparoscopic suturing tasks haptic feedback is a prerequisite. Furthermore, the quality of performance and patient safety should be better safeguarded by improving the interaction with the instruments and equipment in the operating room. Using an integrated operating room system together with the prototype of Pro/cheQ (a digital integrated procedural checklist tool) reduces the number of equipment and instrument related risk sensitive events further than using only an integrated operating room system.Industrial DesignIndustrial Design Engineerin

Hand supports to assist toilet use among the elderly

Improving the toilet environment holds promises for increasing the quality of life for elderly and disabled persons. This is one of the goals of the Friendly Rest Room (FRR) project. The study described in this article explored the preference and use of supports in the toilet environment during the entire toilet ritual. An adjustable test frame was built with a toilet and three types of supports. Fourteen subjects were asked which positions they favoured for each support. After using all three supports they were asked which support they found most comfortable. In general, the preferred positions depended on personal preferences more than on dimensions of the body. It was concluded that there is a preference for vertical supports for sitting down and standing up. During toilet use the side supports were equally appreciated.Industrial DesignIndustrial Design Engineerin

Criterion-based laparoscopic training reduces total training time

The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency. Methods During four training sessions within 1 week (one session per day) 34 medical interns (no laparoscopic experience) practiced on two basic tasks on the Simbionix LAP Mentor virtual-reality (VR) simulator: ‘clipping and grasping’ and ‘cutting’. Group C (criterion-based) (N = 17) trained to reach predefined criteria and stopped training in each session when these criteria were met, with a maximum training time of 1 h. Group T (time-based) (N = 17) trained for a fixed time of 1 h each session. Retention of skills was assessed 1 week after training. In addition, transferability of skills was established using the Haptica ProMIS augmented-reality simulator. Results Both groups improved their performance significantly over the course of the training sessions (Wilcoxon signed ranks, P\0.05). Both groups showed skill transferability and skill retention. When comparing the performance parameters of group C and group T, their performances in the first, the last and the retention training sessions did not differ significantly (Mann–Whitney U test, P[0.05). The average number of repetitions needed to meet the criteria also did not differ between the groups. Overall, group C spent less time training on the simulator than did group T (74:48 and 120:10 min, respectively; P\0.001). Group C performed significantly fewer repetitions of each task, overall and in session 2, 3 and 4. Conclusions Criterion-based training of basic laparoscopic skills can reduce the overall training time with no impact on training outcome, transferability or retention of skills. Criterion-based should be the training of choice in laparoscopic skills curricula.Industrial DesignIndustrial Design Engineerin

Abdominal cavity balloon for preventing a patient's bleeding

The invention relates to an abdominal cavity balloon for preventing a haemorrhage in a patient's pelvic region, comprising an inflatable balloon, wherein the balloon is pro vided with a smooth surface and with a strip that is flex- urally stiff and formed to follow the balloon's shape for po sitioning the balloon.Industrial Design Engineerin

The laparoscopic surgical skills programme: Preliminary evaluation of grade I Level 1 courses by trainees

Introduction: New training models are needed to maintain safety and quality of surgical performance. A simulated setting using virtual reality, synthetic, and/or organic models should precede traditional supervised training in the operating room. Aim: The aim of the paper is to describe the Laparoscopic Surgical Skills (LSS) programme and to provide information about preliminary evaluation of Grade I Level 1 courses, including overall quality, applicability of the course content in practice and the balance between theory and hands-on training modules, by participating trainees. Material and methods: During 5 accredited LSS Grade I Level 1 courses held in Eindhoven (the Netherlands), Kosice (Slovak Republic), and Lisbon (Portugal) between April 2011 and January 2012, demographic data and pre-course surgical experience in laparoscopic surgery of the participants were recorded. The final course evaluation form was completed by each participant after the course (anonymous) to evaluate course progress, course materials, assessment, staff, location and overall impression of the course on a 1-10 scale to obtain feedback information. Results: Forty-seven surgeons of 5 different nationalities were enrolled in an LSS Grade I Level 1 programme. Most participants were first or second year residents (n = 25), but also already established surgeons took part (n = 6). The mean age of the participants was 31.2 years (SD = 2.86), the male/female ratio was 32/15, and previous experience with laparoscopic surgery was limited. Overall impression of the course was rated with 8.7 points (SD = 0.78). The applicability of the course content in practice and the balance between theory and hands-on training were also rated very well – mean 8.8 (SD = 1.01) and 8.1 points (SD = 0.80) respectively. Conclusions: Laparoscopic Surgical Skills Grade I Level 1 courses are evaluated as well balanced, with content applicable in clinical practice, meeting the expectations of individual participants. International interest in the programme suggests that LSS might become the future European standard in surgical education in laparoscopic surgery. Further conclusions concerning success of the programme may be drawn after the completion of clinical assessment of enrolled participants.Industrial DesignIndustrial Design Engineerin

Camera navigation and tissue manipulation: Are these laparoscopic skills related?

Background: It is a tacit assumption that clinically based expertise in laparoscopic tissue manipulation entails skilfulness in angled laparoscope navigation. The main objective of this study was to investigate the relation between these skills. To this end, face and construct validity had to be established for the place arrow (PA) and camera navigation (CN) tasks on the SimSurgery SEP. Methods: Thirty-three novices (no laparoscopy experience) and 33 experienced participants (>50 laparoscopic procedures and familiar with angled laparoscopy) performed both tasks twice, on one of two hardware platforms (SimSurgery SimPack or Xitact/Mentice IHP), and rated the realism and didactic value of SimSurgery SEP on five-point scales. Results: Both tasks were rated by the experienced participants as realistic (CN: 3.7; PA: 4.1) and SimSurgery SEP as a user-friendly environment to train basic skills (4.1). Both tasks were performed in less time by the experienced group, with shorter tip trajectories. For both groups jointly, the time to accomplish each task correlated with the tip trajectory and also with the time and tip trajectories of the opposite task (Spearman's correlation, p â\u89¤ 0.05). Within the groups however, the performances on both tasks did not always correlate. Conclusions: A correlation was not always found between the performances on the two tasks, which suggests that clinically based expertise in tissue manipulation does not automatically entail skilfulness in angled laparoscope navigation, and vice versa. Training and assessment of basic laparoscopic skills should focus on these tasks independently. More research is needed to better identify the skills and required proficiency levels for different laparoscopic tasks.Industrial DesignIndustrial Design Engineerin

Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy

Objectives The main objectives of this study were to establish expert validity (a convincing realistic representation of colonoscopy according to experts) and construct validity (the ability to discriminate between different levels of expertise) of the Simbionix GI Mentor II virtual reality (VR) simulator for colonoscopy tasks, and to assess the didactic value of the simulator, as judged by experts. Methods Four groups were selected to perform one hand–eye coordination task (EndoBubble level 1) and two virtual colonoscopy simulations on the simulator; the levels were: novices (no endoscopy experience), intermediate experienced (1,000 colonoscopies performed before). All participants filled out a questionnaire about previous experience in flexible endoscopy and appreciation of the realism of the colonoscopy simulations. The average time to reach the cecum was defined as one of the main test parameters as well as the number of times view of the lumen was lost. Results Novices (N = 35) reached the cecum in an average time of 29:57 (min:sec), intermediate experienced (N = 15) in 5:45, experienced (N = 20) in 4:19 and experts (N = 35) in 4:56. Novices lost view of the lumen significantly more often compared to the other groups, and the EndoBubble task was also completed significantly faster with increasing experience (Kruskal Wallis Test, p < 0.001). The group of expert endoscopists rated the colonoscopy simulation as 2.95 on a four-point scale for overall realism. Expert opinion was that the GI Mentor II simulator should be included in the training of novice endoscopists (3.51). Conclusion In this study we have demonstrated that the GI Mentor II simulator offers a convincing realistic representation of colonoscopy according to experts (expert validity) and that the simulator can discriminate between different levels of expertise (construct validity) in colonoscopy. According to experts the simulator should be implemented in the training programme of novice endoscopists.Applied Ergonomics and DesignIndustrial Design Engineerin

The laparoscopic surgical skills programma: Setting the European standard

This paper presents the overall outline of the Laparoscopic Surgical Skills programme (LSS) and the first level (LSS Grade 1 Level 1). In addition, preliminary results of the first LSS accredited courses are presented, of which one recently took place in Hospital Universitario de Santa Maria in LisbonIndustrial DesignIndustrial Design Engineerin

Acquiring basic endoscopy skills by training on the GI Mentor II

Industrial Design Engineerin