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... One of the weaknesses in previous studies was the inability to assess whether newly learned surgical skills were retained over time as has been done in other specialities. 9,[19][20][21] The surgeons in this study were able to retain their learnt skills up to 14 months after their initial session and improved further with practice. As expected, technical performance on averaged dropped after the delay (attempts 2 vs 3), but still performed better when compared with the first attempts (attempts 1 vs 3). ...
Background
The monthly In-House Hands-On Surgical Training (HOST) program was incorporated into the congenital heart surgery(CHS) curriculum for surgical trainees within our institution. This study evaluated whether there was an improvement and retention of technical skills throughout the curriculum via objective assessment methods.
Methods
Twelve 3D-printed surgical heart models were included into the year-long curriculum. The monthly sessions were attended by all trainees and staff surgeons. Proctors demonstrated the operation on a model, which was followed by two attempts by each trainee. Attempts were recorded for objective assessment. On completion of the curriculum trainees repeated four procedures an additional two times following a delay to assess skill retention.
Results
Twelve sessions were completed by 7 trainees within the curriculum. Objective assessments were performed in 7 sessions. Eighty-one percent of trainees’ scores improved between the two attempts with a mean improvement of 13%(Attempt 1[HOST-CHS:79],Attempt 2[HOST-CHS:89],p=<0.0001). Similarly,91% of procedural times improved by a mean of 25%(Attempt 1,1:22:00[h:mm:ss],Attempt 2,1:01:21[h:mm:ss],p=<0.0001]. During individual procedure analysis, statistical significance remained in 3-of-7 procedures[p=<0.05].Four procedures were assessed for skill retention following a delay(2-14months). Scores decreased by 4% in 47% of trainees during Attempt 3(Attempt 2[HOST-CHS: 94],Attempt 3[HOST-CHS: 91],p=0.34), but improved in 79% during Attempt 4(Attempt 3[HOST-CHS: 91],Attempt 4[HOST-CHS: 99],p=0.004) matching their previous performance.
Conclusions
The monthly HOST course was successfully incorporated into a training curriculum for CHS surgeons using objective assessments to measure technical performance. Trainees demonstrated an improvement across all evaluated procedures and retained their skills when reassessed following a delay highlighting its value in CHS training.
... An additional benefit provided by a hybrid solution is the combination of robotic precision with the direct control of the endoscope movements by the surgeon. 9 Significant advances in surgical robotics have been made, but a role for robot-based applications in transnasal endoscopic skull base surgery has not yet been defined. 10 Furthermore, although surveys on robotics from both a neurosurgeon (NS) and otorhinolaryngologist (ENT) point of view are available, 11,12 they are not dedicated to skull base surgery, but rather other subspecialties from both disciplines. ...
Background:
A robotic endoscope holder should theoretically provide various advantages in transnasal endoscopic skull base surgery, but only recently a robotic system has become commercially available.
Aim of the study:
To provide a pre-clinical evaluation of potential advantages and surgeons' first impression of this robotic hybrid solution.
Methods:
Thirty skull base surgeons, attending the Joint European Diploma of Endoscopic Skull Base Surgery 2018-2019 in Paris, were enrolled. A questionnaire, mainly concerning personal surgical experience and habits, was administered. The test phase consisted of two different dry-lab tasks, performed with and without EndoscopeRobot®, according to randomization and in two different days. A modified NASA-Task Load Index test was subsequently administered via e-mail to all participants. Completion times and modified GEARS-E scores of the videotaped tasks were recorded.
Results:
Nineteen ENT-surgeons and eleven neurosurgeons, with different surgical habits and endoscopic experience, were enrolled. No-one appeared unfavorable a priori to robotic endoscopic surgery. While the robot did not provide an advantage in the simple grasping task 1, a trend towards better completion times and efficacy was evident in the bimanual task 2, when performed with the robot and bimanually. According to the modified NASA-Task Load Index test, surgeons felt more successful with the robot in task 2, finding it less stressful and mentally demanding.
Conclusions:
Endoscopic skull base surgeons seem to view a hybrid robotic solution positively. EndoscopeRobot® seems to provide a benefit to the single surgeon with experience in bimanual endoscopic surgery. Further pre-clinical and clinical evaluation of this technology is necessary.
... Motion stability is an essential feature of motion control skill, which contains two meanings: first, the kinematic parameters of motion such as direction, range and speed are combined in specific ways and performed with regularity, which is mildly affected by the external environment to become unstable or inaccurate; second, the time to keep the state of skill is more persistent. 8 The formation of motion control skill must experience a period of correction, to gradually make perfect movement patterns and finally achieve the level of skillful handling. Generally speaking, the high-level motion control skill includes the maximum certainty to achieve the goal, the minimum energy consumption and the shortest motion time. ...
... Previous studies show that kinematic metrics grounded in motion data have been proposed to quantify surgical performance. We can learn from that, the commonly used evaluation metrics include completion time, [8][9][10]12 movement speed and its second or third derivatives (acceleration or jerk), [8][9][10]13 path curvature, 8,9,12 etc. However, it is not clear whether these metrics reflect completely skill difference between experienced surgeons and novices, or the former's superiority indicated at the level of operation. ...
... Previous studies show that kinematic metrics grounded in motion data have been proposed to quantify surgical performance. We can learn from that, the commonly used evaluation metrics include completion time, [8][9][10]12 movement speed and its second or third derivatives (acceleration or jerk), [8][9][10]13 path curvature, 8,9,12 etc. However, it is not clear whether these metrics reflect completely skill difference between experienced surgeons and novices, or the former's superiority indicated at the level of operation. ...
Background:
The performance of robotic end-effector movements can reflect the user's operation skill difference in robot-assisted minimally invasive surgery. This study quantified the trade-off of speed-accuracy-stability by kinematic analysis of robotic end-effector movements to assess the motion control skill of users with different levels of experience.
Methods:
Using 'MicroHand S' system, 10 experts, 10 residents and 10 novices performed single-hand test and bimanual coordination test. Eight metrics based on the movements of robotic end-effectors were applied to evaluate the users' performance.
Results:
In the single-hand test, experts outperformed other groups except for movement speed; in the bimanual coordination test, experts also performed better except for movement time and movement speed. No statistically significant difference in performance was found between residents and novices.
Conclusions:
The kinematic differences obtained from the movements of robotic end-effectors can be applied to assess the motion control skill of users with different skill levels.
... There is some evidence to support retraining for skill maintenance, but there is little consensus regarding appropriate intervals for skill-retention testing. In one study of skill retention in training for robotic-assisted surgery, the authors reported no skill decay at one and three months of retention testing 21 . In another study of simulation-based training in laparoscopy, minor skill decay was noted in the first two weeks following training, but skills then stabilized in the sevenmonth follow-up, with no retraining in the interim 19 . ...
Background
Simulation-based learning is increasingly prevalent in many surgical training programs, as medical education moves toward competency-based curricula. In orthopaedic surgery, developmental dysplasia of the hip is a commonly treated condition, where the standard of care for patients less than six months of age is an orthotic device such as the Pavlik harness. However, despite widespread use of the Pavlik harness and the potential complications that may arise from inappropriate application, we know of no previously described formal training curriculum for Pavlik harness application.
Methods
We developed a video and model-based simulation learning module for Pavlik harness application. Two novice groups (residents and allied health professionals) were exposed to the module and, at pre-intervention, post-intervention, and retention testing, were evaluated on their ability to apply a Pavlik harness to the model. Evaluations were completed using a previously validated Objective Structured Assessment of Technical Skills (OSATS) and a global rating scale (GRS) specific to Pavlik harness application. A control group that did not undergo the module was also evaluated at two time points to determine if exposure to the Pavlik harness alone would affect skill acquisition. All groups were compared with a group of clinical experts, whose scores were used as a competency benchmark. Statistical analysis of skill acquisition and retention was conducted using t tests and analysis of variance (ANOVA).
Results
Exposure to the learning module improved resident and allied health professionals’ competency in applying a Pavlik harness (p < 0.05) to the level of the expert clinicians, and this level of competency was retained one month after exposure to the module. Control subjects who were not exposed to the module did not improve, nor did they achieve competency.
Conclusions
The simulation-based learning module was shown to be an effective tool for teaching the application of a Pavlik harness, and learners demonstrated retainable skills post-intervention. This learning module can form the cornerstone of formal teaching of Pavlik harness application for developmental dysplasia of the hip.
Background
The purpose of this study was to verify whether a spine robotic system was useful for junior surgeons.
Methods
Twenty-seven patients underwent posterior spinal fusion with open surgery using a spine robotic system (Mazor X Stealth Edition, Medtronic Inc., Dublin, Ireland) from April to August 2021. Pedicle screw insertions were performed by five surgeons. The surgeon and insertion time were recorded for each pedicle screw. Two surgeons who are board-certified spine surgeons by the Japanese Society for Spine Surgery and Related Research (JSSR) were defined as the expert surgeon group. Three surgeons who were training to acquire qualifications as JSSR board certified spine surgeons were defined as the junior surgeon group. In postoperative CT images, the deviation of 255 pedicle screws was evaluated using the Gertzbein-Robbins (GR) grades.
Results
In the expert surgeon group, the GR grades were Grade A for 79 screws (90.8%), Grade B for 6 (6.9%), Grade C for 2 (2.3%), and 0 (0%) for Grades D and E. I In the junior surgeon group, the GR grades were Grade A for 162 screws (96.4%), Grade B for 6 (3.6%), and 0 (0%) for Grades C, D, and E. There was no significant difference in the deviation rate between surgeon groups (p = 0.08). The mean insertion times were 174.5 ± 83.0 s in the expert surgeon group and 191.0 ± 111.0 s in the junior surgeon group. There was no significant difference in the insertion time between surgeon groups (p = 0.22).
Conclusions
There were no significant differences in the deviation rate and the insertion time of robotic-assisted pedicle screw placement between expert surgeons and junior surgeons who were training to acquire qualifications as JSSR board certified spine surgeons. Robotic-assisted pedicle screw placement can be effectively employed by junior surgeons.
Purpose:
To develop and investigate an evidence-based performance test for assessment of vitreoretinal surgical skills on the EyeSi Surgical Simulator.
Methods:
Ten junior residents without any surgical experience, eight senior residents with prior experience in cataract surgery and five vitreoretinal surgeons were included in the study. The test consisted of seven modules and was completed twice by all groups during a single session. Validity evidence was evaluated using Messick's validity framework. Senior residents completed four additional test sessions and were retested 3 months after to assess skill acquisition and retention.
Results:
Content was aligned with vitreoretinal surgical skills as evaluated by expert surgeons. Response process was ensured through standardized instruction and data collection. The test showed satisfactory internal consistency with Cronbach's α = 0.76 (internal structure) and significant discriminative ability between the residents and the experienced surgeons (relation to other variables). A pass/fail level was determined at 596 using the contrasting groups' method. Consequences of applying this standard resulted in no false positive and no false negative. Senior residents significantly improved their simulator skills over time, reaching a plateau at the fifth iteration and equalling expert performance (p = 0.420). This level of competency was retained during the post-3-month retention testing (p = 0.062).
Conclusion:
We established a performance test with solid evidence for assessment of vitreoretinal surgical skills on the EyeSi Simulator and determined a benchmark criterion that may be used for future implementation of proficiency-based training for novices.
