Interprofessional Development and Evaluation of a Virtual Reality Haptic Surgical Training System for Retropubic Midurethral Slings

Purpose and background: Procedures like the midurethral sling, performed without open visual or camera access rely on the surgeon’s spatial orientation of anatomical landmarks and haptic sensation. The “Blind” nature of this technique can results in serious complications^1–4. Surgeons are typically trained via an apprenticeship on live patients, static models, or, cadaver labs. These methods carry higher potential risks for patient safety, significant expense, often require travel, and are limited by distortion of anatomy after multiple uses. Adding haptics and AI to VR simulators has been shown to improve fidelity, realism, and educational value^ 5–10.We formed a transdisciplinary team to develop an innovative, low-risk, cost-effective method to teach operations that require “learning by feel”. The objective of this study was to evaluate the usability and potential of this SlingVR training system. Description of Innovative Practice: SlingVR Development. A transdisciplinary team of surgeons, engineers, motor control scientists, human factors experts, and programmers representing the College of Engineering, School of Medicine, and College of Health Professions was assembled. A clear development plan was created including required expertise, resource availability, and communication schedule to facilitate collaboration. To begin, deidentified CT/MRI images using artificial intelligence algorithms to provide high accuracy of anatomy in a 3D VR model. High-resolution haptic and visual alerts were then integrated to provide real-time feedback when approaching at-risk anatomy and generate a competency score. Weekly surgeon feedback lead to iterative development and generated a prototype for broader user evaluation. SlingVR EvaluationPilot evaluation was conducted using multi-trial testing to collect initial perceptions from subject matter expert surgeons. A cognitive task analysis using a think aloud protocol was used to understand how design characteristics impacted learning and fidelity of the SlingVR system. Qualitative comments and investigator observations during the sessions were reviewed and summarized into themes by the study investigators. Results: Three surgeons participated in feedback sessions: Two were expert subspecialists: fellowship-trained and board-certified in urogynecology with 5 and 7 years of community practice experience. Third surgeon was a PGY3 urology resident from an academic center. Both experts are high-volume, performing weekly retropubic slings, but trained at different programs with different approaches (gynecology focused vs urology focused) and currently used different manufacturers’ devices. The resident has assisted and performed many retropubic slings using the device and technique featured in the curriculum. 6 main themes were initially identified. Cognitive tasks, instruction, knowledge improvement I would break down steps for each level even further: like lighting the optimal pathway initially for a novice to follow exactly” System Feedback amount and type (ex. Continuous vs. intermittent, audio vs. visual) “I like continuous visual and audio alerts but would save the scoring feedback until a final one at the end” Scoring and Competency “I would like to see a comparison of the perfect pathway vs. mine at the end” Immersion and Realism “I would like to feel with my nondominant hand too, I use that one more during a case” Design elements and Aesthetics “I am colorblind and can’t read that shade of green well” Gestalt/Impression “This technology is great, the haptics add a lot, it could be used for hernias or trigger point injections too” Conclusion: Most valuable in evaluation was including surgeons with diverse training, practice settings, procedure approaches and commercial products used. All 3 consense in the key elements of learning the procedure and the importance of realistic haptics. Our transdisciplinary team and diverse participants are key to successfully identifying themes that provide the blueprint for next steps in the iterative device development of SlingVR

The Use of Interactive Holographic Technology to Teach Surgical Anatomy and Improve Self-Perceived Preparedness for Surgery in Urogynecology

Abstract Purpose: One of the biggest challenges teaching urogynecologic surgery is developing a spatial understanding of the 3-Dimensional relationships of musculature, ligamentous supports and neurovasculature of the pelvic floor. Therefore, we created an innovative curriculum to improve trainee-preparedness for complex vaginal surgery. The aim of the study is to determine if an interactive holographic curriculum will improve self-perceived preparedness, surgical knowledge and learner-satisfaction compared to usual self-study. Methods: This is a prospective study of 18 OB/GYN residents. Participants prepared like they were “scrubbing into a case of uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF).” They then completed a self-perceived preparedness survey and knowledge-test of surgical anatomy and intraoperative complications. Each participant used the HoloLens curriculum independently and surveys were re-administered. Data were analyzed with paired non-parametric statistics. Results: 16/18 residents were females at a median PGY3 level (range 1-6). Self-perceived preparedness score ranged 7-35 with a median baseline score 22 for USLS and 20.5 for SSLF. These scores increased significantly for both procedures after using the modules: mean difference USLS 3.6 points p=.0001 and SSLF 3.7 points p=.0034. Knowledge scores also improved from baseline median 42.5% (range 25-85%) to 82.5% (55-100%): mean difference 35% p\u3c.0001. Compared to usual preparation, 88% ranked the modules as “much” or “very much better” and 81% would be “likely” or “very likely” to use HoloLens to prepare for surgery. Discussion: This interactive holographic curriculum significantly improved self-perceived preparedness, surgical knowledge and trainee-satisfaction in urogynecologic surgery compared to usual self-study

Temperature-dependent differences between readily releasable and reserve pool vesicles in chromaffin cells

AbstractStatistical differences between amperometric traces recorded from chromaffin cells using K+ and Ba2+ secretagogues support the assertion that readily releasable pool (RRP) and reserve pool (RP) vesicles can be probed with pool-specific secretagogues. Release from the RRP was evoked by K+ while release from the RP was evoked by Ba2+. Similar temperature-dependent changes in spike area and half-width for both pools suggest that the content of RRP and RP vesicles is similar and packaged in the same way. Differences between the vesicle pools were revealed in the temperature dependence of spike frequency. While the burst spike frequency of the RRP, which is comprised of pre-docked and primed vesicles, increased 2.8% per °C, the RP spike frequency increased 12% per °C. This difference is attributed to a temperature-dependent mobilization of the RP. Furthermore, the RP exhibited more foot events at room temperature than the RRP but this difference was not apparent at 37 °C. This trend suggests that RP vesicle membranes have a compromised surface tension compared to RRP vesicles. Collectively, the changes of release characteristics with temperature reveal distinctions between the RRP and the RP

Instructor’s and Students’ Perspectives on Hyflex Learning: A Collaborative Self-Study

The paper reports a collaborative self-study on instructor’s and students’ experiences in a HyFlex course in a higher education institution. The COVID-19 pandemic acted as a catalyst for the resurgence of multi-modal course delivery such as HyFlex instruction in higher education settings. The reported collaborative self-study aimed to examine both the instructor’s and the student’s perspectives on HyFlex learning. One instructor and seven students in a HyFlex class participated in the study through shared individual and collaborative reflections on their experiences. The findings indicated the benefits, potential, and challenges of HyFlex learning and instruction

Intraoperative Cystoscopic Evaluation of Ureteral Patency: A Randomized Controlled Trial.

OBJECTIVE: To compare different modalities to aid in the evaluation of intraoperative ureteral patency on cystoscopy in the postindigo carmine era. METHODS: In a randomized controlled trial, participants undergoing pelvic surgery were randomized into one of four groups: saline distention (control), 10% dextrose distention, oral phenazopyridine, or intravenous sodium fluorescein. Our primary outcome was visibility of the ureteral jets. Secondary outcomes included surgeon satisfaction; adverse reactions including allergies, urinary tract infections, urinary retention, cystoscopy times, and ureteral obstruction; and delayed diagnosis. Participants were followed for 6 weeks. A sample size of 176 participants was planned to demonstrate a 30% difference in the visibility scale. All analyses were performed in an intention-to-treat fashion. RESULTS: From February 25, 2015, through August 2015, 176 participants were enrolled; 174 completed the trial, and two did not undergo intervention. Forty-four participants were included in the phenazopyridine, dextrose, saline, and sodium fluorescein groups. Sodium fluorescein and 10% dextrose resulted in significantly improved visibility and satisfaction when compared with the control group (P CONCLUSION: Compared with the control, 10% dextrose and sodium fluorescein resulted in improved visibility and provided significantly more satisfaction in the evaluation for ureteral patency with no considerable increase in operative time or morbidity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02476448