Bimanual Dexterity Research Articles

P.140 Development and predictive validation of an intelligent surgical bimanual skills continuous assessment system

Background: Surgeons’ bimanual dexterity may correlate with the surgical outcome. Continuous assessment of psychomotor performance enables action-oriented feedback and error avoidance guidance. We outline an artificial intelligence (AI) application to continuously assess surgical bimanual skills and its predictive validation on surgical trainee performance throughout a neurosurgery residency program. Methods: Participants (n=50, 14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 novices/medical students) performed two simulated subpial tumour resections a total of 300 times. A deep neural network was developed using expert/neurosurgeon and novice/medical student data to score bimanual performance at 0.2-second intervals between a score of 1.00 and -1.00. An average score was calculated for each task. Results: The average performance score differentiated among four expertise levels, p<.001. Neurosurgeons scored significantly higher than senior residents (p=.045) and junior residents scored significantly higher than medical students (p=.04). The intelligent system also differentiated between senior and junior trainee levels (p=.004). The performance score linearly correlated with resident year of neurosurgical training (adjusted R2=27.7%). Conclusions: The AI-powered intelligent system outlined is the first expert surgeon-data-based technical skills continuous assessment system, with predictive validity throughout a neurosurgical residency program. Intelligent systems may aid in the competency-based approach in surgery by accurately assessing trainee skills.

The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study

ObjectivesTo investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes.BackgroundLaparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency.MethodA longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training.ResultsLaparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months.ConclusionIn this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.

Bimanual performance in children with unilateral perinatal arterial ischaemic stroke or periventricular haemorrhagic infarction.

Long term outcome data on bimanual performance in children with perinatal arterial ischaemic stroke (PAIS) and periventricular haemorrhagic infarction (PVHI) with and without unilateral spastic cerebral palsy (USCP) is sparse. To assess bimanual performance in children with PAIS or PVHI with and without USCP and to explore the relationship with unilateral hand function and full-scale IQ (FSIQ) in a cross-sectional study. Fifty-two children with PAIS (n=27) or PVHI (n=25) participated at a median age of 12 years and 1 month (range 6-20 years). The Bruininks Oseretsky Test of Motor Proficiency-2 (bimanual precision and dexterity subtest), Assisting Hand Assessment, Purdue Pegboard Test and Wechsler Intelligence scale were administered. Bimanual dexterity was worse in children with USCP (p<0.02) without a difference for the pathology groups. In children without USCP (n=21), those with PAIS showed a better bimanual precision compared to children with PVHI (p<0.04). The AHA score and the Purdue Pegboard score of the dominant hand explained 51% of the variance in bimanual precision and dexterity in children with USCP. In absence of USCP, FSIQ together with AHA scores explained 66% of the variance in bimanual precision and FSIQ together with the Purdue Pegboard Test score of the dominant hand, 71% of the variance in bimanual dexterity. Children with PAIS without USCP have a more favourable bimanual hand function compared to children with PVHI. This difference appears to be associated with a preserved FSIQ.

Blinded intraoperative skill evaluations avoid gender-based bias.

Gender bias has been identified consistently in written performance evaluations. Qualitative tools may provide a standardized way to evaluate surgical skill and minimize gender bias. We hypothesized that there is no difference in operative time or GEARS scores in robotic hysterectomy for men vs women surgeons. Patients undergoing robotic hysterectomies performed between June 2019 and March 2020 at 8 hospitals within the same hospital system were captured into a prospective database. GEARS scores were assigned by crowd-sourced evaluators by a third party blinded to any surgeon- or patient-identifying information. One-way ANOVA was used to compare the mean operative time and GEARS scores for each group, and significant variables were included in a one-way ANCOVA to control for confounders. Two-tailed p-value < 0.05 was considered significant. Seventeen women and 13 men performed a total of 188 hysterectomies; women performed 34 (18%) and men performed 153 (81%). Women surgeons had a higher mean operative time (133 ± 58 vs 86.3 ± 46min, p = 0.024); after adjustment, there were no significant differences in operative time (p = 0.607). There was no significant difference between the genders in total GEARS score (20.0 ± 0.77 vs 20.2 ± 0.70, p = 0.415) or GEARS subcomponent scores: bimanual dexterity (3.98 ± 0.03 vs 4.00 ± 0.03, p = 0.705); depth perception (4.04 ± 0.04 vs 4.05 ± 0.02, p = 0.799); efficiency (3.79 ± 0.02 vs 3.82 ± 0.02, p = 0.437); force sensitivity (4.01 ± 0.04 vs 4.05 ± 0.05, p = 0.533); or robotic control (4.16 ± 0.03 vs 4.26 ± 0.01, p = 0.079). There was no difference in GEARS score between men vs womensurgeons performing robotic hysterectomies. Video-based blinded assessment of skills may minimize gender biases when evaluating surgical skill for competency evaluation and credentialing.

A versatile low-cost, high-fidelity cystoscopy simulation model

The objective of this video is to describe the design of a versatile low-cost, high-fidelity water balloon model for OBGYN resident cystoscopy simulation training. In this video, we present a unique design for a life-like water balloon model for teaching cystoscopy to OBGYN residents. While water balloon models for cystoscopy have been described previously, limitations include: poor water seal, restricted urethral mobility, limited diversity in simulated tasks, and cost. We demonstrate step-by-step instructions on how to construct the model using materials found at most arts and crafts stores, for a total cost of about $46 per model. The design incorporates the use of a large 24-inch water balloon which may be customized to allow for a range of simulation tasks, including: identifying abnormal bladder lesions or markings, identifying presence of ureteral efflux, and practicing ureteral catheterization or stenting (via addition of simulated ureters). Unique to this bladder model, is the use of a foam housing system which stabilizes the water balloon bladder model and allows the trainee to focus on bimanual dexterity in manipulating the cystoscope. This innovative cystoscopy model serves as an easy, affordable way to incorporate cystoscopy simulation training in other OBGYN programs. Benefits of this model include: low cost, unique housing system that stabilizes the bladder model for ease-of-use, enhanced urethral mobility, easy in-out manipulation of the cystoscopy with minimal water leakage, and versatility in creating different training tasks by interchanging balloon models. Future studies will aim to compare the efficacy of this tool to other high-fidelity models in improving resident cystoscopic skills.

Correlations between Hand Dexterity and Bimanual Coordination on the Activities of Daily Living in Older Adults with Mild Cognitive Impairment

Background/Aims: Many motor impairments are present in older adults with cognitive decline. One of them is the impairment of hand dexterity and bimanual coordination that result in poor functional ability in the activities of daily living (ADL). This study investigated the effects of hand dexterity and bimanual coordination declination on the sub-domains of ADL in older adults with mild cognitive impairment (MCI). Methods: Thirty-one senior individuals with MCI were recruited in this study. The Purdue Pegboard Test was used to measure hand dexterity, and bimanual coordination was assessed by the continuous circle-drawing task. Their ADL were assessed with the General Activity Daily Living questionnaire. Results: The correlations analysis showed an association between the dominant hand and bimanual dexterity with the domestic domain of ADL and all conditions of hand dexterity with the complex domain of ADL. Moreover, the multiple regression analysis showed that the predictor of the greatest effect for domestic and complex domains was dominant hand dexterity. Discussion/Conclusion: These results revealed that dominant hand dexterity strongly affected domestic and complex ADL in older adults with MCI. There were age-related changes regarding lateral asymmetrical motor reduction, especially in cognitive tasks. However, complex tasks involving cognitive function may need dominant, nondominant and bimanual hand dexterity.

Validation of a novel virtual reality simulation system with the focus on training for surgical dissection during laparoscopic sigmoid colectomy

BackgroundMastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system.MethodsA total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience < 100 LS, and five without previous experience in LS. The participants’ surgical performance was evaluated by three blinded raters using Global Operative Assessment of Laparoscopic Skills (GOALS).ResultsThere were significant differences (P-values < 0.044) in all GOALS items between the non-medical professionals and surgeons. The experts were significantly superior to the novices in one item of GOALS: efficiency ([4(4–5) vs. 4(3–4)], with a 95% confidence interval, p = 0.042). However, both bimanual dexterity and total score in the experts were not statistically different but tended to be higher than in the novices.ConclusionsOur study demonstrated a full validation of our new system. This could detect the surgeons' ability to perform surgical dissection and suggest that this VR simulator could be an effective training tool. This surgical VR simulator might have tremendous potential to enhance training for surgeons.

Movement-level process modeling of microsurgical bimanual and unimanual tasks

PurposeMicrosurgical techniques require highly skilled manual handling of specialized surgical instruments. Surgical process models are central for objective evaluation of these skills, enabling data-driven solutions that can improve intraoperative efficiency.MethodWe built a surgical process model, defined at movement level in terms of elementary surgical actions (n=4) and targets (n=4). The model also included nonproductive movements, which enabled us to evaluate suturing efficiency and bi-manual dexterity. The elementary activities were used to investigate differences between novice (n=5) and expert surgeons (n=5) by comparing the cosine similarity of vector representations of a microsurgical suturing training task and its different segments.ResultsBased on our model, the experts were significantly more efficient than the novices at using their tools individually and simultaneously. At suture level, the experts were significantly more efficient at using their left hand tool, but the differences were not significant for the right hand tool. At the level of individual suture segments, the experts had on average 21.0 % higher suturing efficiency and 48.2 % higher bi-manual efficiency, and the results varied between segments. Similarity of the manual actions showed that expert and novice surgeons could be distinguished by their movement patterns.ConclusionsThe surgical process model allowed us to identify differences between novices’ and experts’ movements and to evaluate their uni- and bi-manual tool use efficiency. Analyzing surgical tasks in this manner could be used to evaluate surgical skill and help surgical trainees detect problems in their performance computationally.

Virtual Reality Simulation Has Weak Correlation with Overall Trainee Robot-Assisted Laparoscopic Hysterectomy Performance

Both simulator practice and intraoperative performance serve to inform surgical trainee training, but the skill transfer from simulation to the intraoperative setting remains unclear. This study evaluates the correlation between trainee performance on virtual reality simulation and (1) overall intraoperative performance during robotic-assisted laparoscopic hysterectomy (RALH) procedures and (2) suturing performance during vaginal cuff closure portion of the case. Retrospective subgroup analysis of randomized controlled trial. Academic hospital. Patients with RALH (N=29). Gynecological trainees (N=21) performed simulation tasks using the da Vinci skills simulator on the day of surgery before performing RALH. Attending surgeons assessed participants' intraoperative performance using Global Evaluative Assessment of Robotic Skills (GEARS). Performance of the vaginal cuff closure step was subsequently assessed using GEARS scoring of anonymized videos. Spearman's correlation was used to quantify the relationship between simulation and intraoperative performances. Trainees achieved a median intraoperative GEARS score of 18.5/30 (interquartile range: 17-22) and a median total simulator score of 84.4/100 (interquartile range: 78.1-87.5). More advanced residents exhibited worse overall simulator performance (median score 86.6/100 compared with 78.8/100, p=.03) and similar intraoperative GEARS scores during overall RALH and vaginal cuff closure compared with less experienced trainees. Total simulation performance score was negatively correlated with GEARS Bimanual Dexterity (ρ=-0.46, p=.02) and Force Sensitivity subscores (ρ=-0.39, p=.05). There was no correlation between total GEARS intraoperative vaginal cuff closure scores and overall simulation performances; however, total Tubes simulation score was correlated with higher GEARS Force Sensitivity subscore (ρ=0.73, p=.05). In this study, there was limited correlation between simulation score metrics and trainees' overall intraoperative performance. Furthermore, we identified that GEARS scores could not distinguish between similar trainee skill levels. These findings underscore the need to develop intraoperative assessment tools that can better discriminate different but similar skill levels.

Modeling the influence of motor skills on literacy in third grade: Contributions of executive functions and handwriting.

Several nonlanguage factors influence literacy development, and motor skills are among those most studied. Despite the publication of several studies that have supported the existence of this relationship, the type of influence and underlying mechanisms have been little explored. Herein, we propose modeling the relationship between motor skills and literacy through structural equation modeling, testing the contribution of executive functions and handwriting skills as the possible mediators of this relationship. In a study of 278 third-grade children, we used a wide range of measures related to written language (reading, spelling, reading comprehension, and written production), fine motor skills (dominant hand, nondominant hand, and bimanual dexterity), executive functions (verbal and visuospatial working memory, inhibition, and shifting), and handwriting. Structural equation modeling of the relationship between these different variables indicated that in the third grade, the influence of fine motor skills on literacy is fully mediated by both executive functions and handwriting skills. These motor skills effects are observed for both low levels of processing (reading, spelling) and high levels of processing (reading comprehension, written production). The results are discussed in terms of the potential mechanisms underlying different literacy skills and their implications for pedagogical programs.

A cost-effective IoT learning environment for the training and assessment of surgical technical skills with visual learning analytics

BackgroundSurgeons need to train and certify their technical skills. This is usually done with the intervention of experts who monitor and assess trainees. Nevertheless, this is a time-consuming task that is subject to variations among evaluators. In recent decades, subjectivity has been significantly reduced through 1) the introduction of standard curricula, such as the Fundamentals of Laparoscopic Surgery (FLS) program, which measures students’ performance in specific exercises, and 2) rubrics, which are widely accepted in the literature and serve to provide feedback about the overall technical skills of the trainees. Although these two elements reduce subjectivity, they do not, however, eliminate the figure of the expert evaluator, and so the process remains time consuming. ObjectivesThe objective of this work is to automate those parts of the work of the expert evaluator that the technology can measure objectively, using sensors to collect evidence, and visualizations to provide feedback. We designed and developed 1) a cost-effective IoT (Internet of Things) learning environment for the training and assessment of surgical technical skills and 2) visualizations supported by the literature on visual learning analytics (VLA) to provide feedback about the exercises (in real time) and overall performance (at the end of the training) of the trainee. MethodsA hybrid approach was followed based on previous research for the design of the sensor based IoT learning environment. Previous studies were used as the basis for getting best practices on the tracking of surgical instruments and on the detection of the force applied to the tissue, with a focus on reducing the costs of data collection. The monitoring of the specific exercises required the design of sensors and collection mechanisms from scratch as there is little existing research on this subject. Moreover, it was necessary to design the overall architecture to collect, process, synchronize and communicate the data coming from the different sensors to provide high-level information relevant to the end user. The information to be presented was already validated by the literature and the focus was on how to visualize this information and the optimal time for its presentation to end users. The visualizations were validated with 18 VLA experts assessing the technical aspects of the visualizations and 4 medical experts assessing their functional aspects. ResultsThis IoT learning environment amplifies the evaluation mechanisms already validated by the literature, allowing automatic data collection. First, it uses IoT sensors to automatically correct two of the exercises defined in the FLS (peg transfer and precision cutting), providing real-time visualizations. Second it monitors the movement of the surgical instruments and the force applied to the tissues during the exercise, computing 6 of the high-level indicators used by expert evaluators in their rubrics (efficiency, economy of movement, hand tremor, depth perception, bimanual dexterity, and respect for tissue), providing feedback about the technical skills of the trainee using a radar chart with these six indicators at the end of the training (summative visualizations). ConclusionsThe proposed IoT learning environment is a promising and cost-effective alternative to help in the training and assessment of surgical technical skills. The system shows the trainees’ progress and presents new indicators about the correctness of each specific exercise through real-time visualizations, as well as their general technical skills through summative visualizations, aligned with the 6 more frequent indicators in standardized scales. Early results suggest that although both types of visualizations are useful, it is necessary to reduce the cognitive load of the graphs presented in real time during training. Nevertheless, an additional evaluation is needed to confirm these results.

TP8.2.9 Development &amp; Evaluation of LapPass™: The Laparoscopic Passport

Abstract Aims Laparoscopic surgery is technically challenging and assessment of competency is necessary to ensure patient safety and guide training. Existing tools of assessment are mostly subjective, with a growing need for objective credentialing. LapPass™ was developed by a UK-based laparoscopic society as an accessible simulation assessment tool. The aim of this study was to report on its development and preliminary findings of usability and validity. Methods LapPass™ consists of 4 tasks that test: bimanual dexterity, simulated appendicectomy, dissection and intracorporeal suturing. Participants were prospectively recruited from testing events. Online surveys were sent to assessors and participants to assess the usability, face and content validity of the tool. Options to respond were on a five-point Likert scale with ratings from strongly disagree (1) to strongly agree (5). Results LapPass was launched and offered to trainees as free-of-charge assessment tool. 31 participants and 12 assessors took part. The 1st time pass rate for bimanual dexterity was 19/29 (65.5%), appendicectomy 13/23 (56.5%), dissection 20/27 (74.1%) and intracorporeal suturing 6/19 (31.5%). The mean scores for participants’ usability and validity were 3.8 and 4.12 for bimanual dexterity; 3.96 and 4.37 for appendicectomy; 4.5 and 4.16 for dissection and 3.84 and 4.52 for intracorporeal suturing. Assessors' mean score of usability was 4.5 across all tasks. Assessors scored validity of bimanual dexterity 4.35, appendicectomy 4.42, dissection 3.71 and intracorporeal suturing 4.65. Conclusion LapPass™ is a an accessible objective assessment tool for laparoscopic basic surgical skills with preliminary data to confirm its usability and face and content validity.

Training on a virtual reality laparoscopic simulator improves performance of live laparoscopic surgery.

IntroductionTo determine whether training laparoscopic nephrectomy (LN) with a virtual reality (VR) simulator improves the performance of porcine LN.MethodsTwelve urological residents were assigned to two groups: a training and a non‐training group. All participants performed baseline assessments of LN skills and time on the LapPASS® simulator. The training group received preoperative LapPASS® training. Both groups then performed LN using a porcine model. The operations were videotaped and evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) system. After porcine LN, the training group performed a final LN with the LapPASS® simulator.ResultsThere was no significant difference in the operation time required for porcine LN. There were no significant differences in the total A (autonomy), B (bimanual dexterity), D (depth perception), or T (tissue handling) GOALS scores. However, the total E (efficiency) score in the training group was higher than that in the non‐training group (P = .030). The final LN score with LapPASS® was significantly higher than the baseline (P = .004).ConclusionsThe results of this study demonstrated that VR LN training improved performance in an actual operation. VR‐based procedural simulation could become a vital part of the laparoscopic training program for residents.

Benchmarks for 3-D Systems (Simbionix) Bladder Flap Module for the Xi Robot: Differentiating Novice from Experienced and Expert Surgeons

Study Objective To develop competency benchmarks for the 3-D Systems (Simbionix) Bladder Flap Module for the Xi Robotic System. Design Prospective cohort. Setting Multi-center, academic medical institutions. Patients or Participants Residents, fellows, and faculty in OBGYN were invited to participate at 3 institutions. Participants were categorized by hysterectomy experience level: <10 (novice), 10-49 (experienced), and 50+ (expert). Ten novice and 22 experienced/expert surgeons were included. Interventions The 3-D Systems Hysterectomy Modules for the DaVinci Xi, released in 2017, include ureter dissection, bladder flap development, colpotomy, and full hysterectomy. In a prior study, recordings of participant simulator performance were graded in duplicate using the Modified Global Evaluative Assessment of Robotic Skills (GEARS) tool. The bladder flap module demonstrated correlation with experience. Competency benchmarks were developed for this module using contrasting group methods. Results were analyzed by comparing the novice participants to a combined experienced/expert group. Distributions of scores from both groups were plotted for domains of assessment where correlation had previously been demonstrated, and a cutoff score and its associated false positive (FP) and false negative (FN) rates were calculated. Measurements and Main Results Cutoff scores were developed for Depth Perception (cutoff=3.3), Bimanual Dexterity (cutoff 2.8), Efficiency (cutoff=3.25), Force Sensitivity (cutoff=3.15), and Overall Score (cutoff=1.9). Overall Score is scored from 1-3, while the other domains are on a 5-point Likert scale. Using the established cutoffs, the observed FP and FN rates for each domain were as follows: Depth Perception 0% (0/10) and 22.7% (5/22), Bimanual Dexterity 20% (2/10) and 27.3% (6/22), Efficiency 20% (2/10) and 40.9% (9/22), and Overall Score 30% (3/10) and 27.3% (6/22). Conclusion The development of target competency benchmarks is helpful to guide trainees and educators in the application of simulation tools. Using the robotic 3-D systems (Simbionix) simulator module with the strongest evidence of validity, we established benchmarks to aid in interpreting and anchoring resident simulator performance to experienced surgeons. To develop competency benchmarks for the 3-D Systems (Simbionix) Bladder Flap Module for the Xi Robotic System. Prospective cohort. Multi-center, academic medical institutions. Residents, fellows, and faculty in OBGYN were invited to participate at 3 institutions. Participants were categorized by hysterectomy experience level: <10 (novice), 10-49 (experienced), and 50+ (expert). Ten novice and 22 experienced/expert surgeons were included. The 3-D Systems Hysterectomy Modules for the DaVinci Xi, released in 2017, include ureter dissection, bladder flap development, colpotomy, and full hysterectomy. In a prior study, recordings of participant simulator performance were graded in duplicate using the Modified Global Evaluative Assessment of Robotic Skills (GEARS) tool. The bladder flap module demonstrated correlation with experience. Competency benchmarks were developed for this module using contrasting group methods. Results were analyzed by comparing the novice participants to a combined experienced/expert group. Distributions of scores from both groups were plotted for domains of assessment where correlation had previously been demonstrated, and a cutoff score and its associated false positive (FP) and false negative (FN) rates were calculated. Cutoff scores were developed for Depth Perception (cutoff=3.3), Bimanual Dexterity (cutoff 2.8), Efficiency (cutoff=3.25), Force Sensitivity (cutoff=3.15), and Overall Score (cutoff=1.9). Overall Score is scored from 1-3, while the other domains are on a 5-point Likert scale. Using the established cutoffs, the observed FP and FN rates for each domain were as follows: Depth Perception 0% (0/10) and 22.7% (5/22), Bimanual Dexterity 20% (2/10) and 27.3% (6/22), Efficiency 20% (2/10) and 40.9% (9/22), and Overall Score 30% (3/10) and 27.3% (6/22). The development of target competency benchmarks is helpful to guide trainees and educators in the application of simulation tools. Using the robotic 3-D systems (Simbionix) simulator module with the strongest evidence of validity, we established benchmarks to aid in interpreting and anchoring resident simulator performance to experienced surgeons.

Are there predictors of flexible ureteroscopic aptitude among novice trainees? objective assessment using simulation-based trainer.

Non-surgical skills involving hand-eye coordination and bimanual dexterity may have a transferable impact on the acquisition of ureteroscopy skills. In this study, we aim to investigate the predictors of initial flexible ureteroscopy skills among novice trainees. This was a prospective study involving students with no prior ureteroscopy exposure. Non-surgical parameters were assessed with a detailed survey, including demographics, video game, and musical history. Musical ability was objectively evaluated with the mini-Profile of Music Perception Skills test. Ureteroscopic performance was evaluated using a Boston Scientific© flexible ureteroscope on a bench model. Each participant completed diagnostic ureteroscopy and stone extraction. Outcomes included both speed and quality of performance, based on an Objective Structured Assessment of Technical Skills rubric. A total of 28 pre-clerkship medical students and 10 urology residents were included. Age and musical background were not associated with ureteroscopic aptitude. Those with video game history tended to perform ureteroscopy tasks faster with a higher OSATS score, although no statistical significance was reached. Male gender was associated with faster task completion with statistically higher OSATS score independent of video game activities (p = 0.011), however, the absolute score difference was small. Among novice trainees, musical and video game experience was not predictive of ureteroscopy skills. Male gender was associated with slightly faster and higher ureteroscopy technique scores, however, the differences are small and unlikely to represent clinical significance. Nevertheless, the use of ureteroscopy trainer provides useful insights and should be adopted in training programs as a marker of skills progression.

Assessment of the training program for Versius, a new innovative robotic system for use in minimal access surgery

ObjectivesThe Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program.DesignA 3.5-day program following...

PD58-10 UTILIZATION OF SKILL ASSESSMENT TOOL AT HEALTH SYSTEM LEVEL - SCORE DISTRIBUTION AND TRENDS AMONG VARIOUS SURGICAL SPECIALTIES

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (PD58)1 Sep 2021PD58-10 UTILIZATION OF SKILL ASSESSMENT TOOL AT HEALTH SYSTEM LEVEL - SCORE DISTRIBUTION AND TRENDS AMONG VARIOUS SURGICAL SPECIALTIES David Mikhail, Samuel Pettit Portland, ME, Sia Boulourani, Brian Dinerman, Arun Rai, Michael Feuerstein, Filippo Filicori, Anthony Antonacci, and Lee Richstone David MikhailDavid Mikhail More articles by this author , Samuel Pettit Portland, MESamuel Pettit Portland, ME More articles by this author , Sia BoulouraniSia Boulourani More articles by this author , Brian DinermanBrian Dinerman More articles by this author , Arun RaiArun Rai More articles by this author , Michael FeuersteinMichael Feuerstein More articles by this author , Filippo FilicoriFilippo Filicori More articles by this author , Anthony AntonacciAnthony Antonacci More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002092.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CSATS (Crowd-Sourced Assessment of Technical Skills) is a validated surgical skill assessment tool allowing for surgeon feedback via GEARS scoring. Limited data exists regarding the applicability of CSATS across a health system. We report the largest experience implementing CSATS across a multi- hospital system. We assessed implementation, trends in utilization, and score distribution. METHODS: Surgeons voluntarily submitted robotic cases for CSATS evaluation. Case data and CSATS scores were extracted for 111 robotic surgeons for four specialties - general surgery (GS), thoracic (TH), gynecology (GYN) and urology (URO) from 2018-19. Total robotics cases, CSATS utilization rates, scores and percentiles were compared. Linear regression was used to assess the significance between a surgeon's total robotic volume (SRV), specialty and CSATS scores. RESULTS: 2664 of 7506 (36%) robotic cases were submitted to CSATS. Utilization increased from 24% to 44% between both years. Table 1 shows utilization, CSATS scores and percentiles. GS had lowest per-surgeon usage (27%; p<0.05). Average CSATS scores were highest for GYN compared to other specialties, with GYN and GS statistically di!erent (p<0.05). URO was significantly higher in efficiency and bimanual dexterity on average (p<0.05). Significant improvement on GEARS scores was observed in all specialties except urology between 2018 and 2019. Total SRV showed a positive correlation with CSATS Score and average percentile (p<0.001). CONCLUSIONS: Our experience with CSATS showed implementation across a large health system is feasible, with increasing utility over time. Scores differ significantly between specialties, surgeons and procedures. Surgeon robotic experience correlates with scores and national percentile rankings. Further analysis will determine the correlation of CSATS with measurable outcomes to serve as a quality improvement metric. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1020-e1021 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Mikhail More articles by this author Samuel Pettit Portland, ME More articles by this author Sia Boulourani More articles by this author Brian Dinerman More articles by this author Arun Rai More articles by this author Michael Feuerstein More articles by this author Filippo Filicori More articles by this author Anthony Antonacci More articles by this author Lee Richstone More articles by this author Expand All Advertisement Loading ...

PD58-02 ROBOTIC SURGERY SKILL TRANSFERENCE BETWEEN MULTI-PORT (MP) AND SINGLE-PORT (SP) ROBOTIC PLATFORMS

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (PD58)1 Sep 2021PD58-02 ROBOTIC SURGERY SKILL TRANSFERENCE BETWEEN MULTI-PORT (MP) AND SINGLE-PORT (SP) ROBOTIC PLATFORMS Rachel Melnyk, Patrick Saba, Michael Witthaus, Tyler Holler, Beilei Xu, Wencheng Wu, Alexis Steinmetz, Kit Yuen, Karen Doersch, Elizabeth Ellis, Mahmoud Khalil, Jacob Gantz, William Tabayoyong, Jonathan Bloom, Hani Rashid, Nicholas Kavoussi, and Ahmed Ghazi Rachel MelnykRachel Melnyk More articles by this author , Patrick SabaPatrick Saba More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Tyler HollerTyler Holler More articles by this author , Beilei XuBeilei Xu More articles by this author , Wencheng WuWencheng Wu More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Kit YuenKit Yuen More articles by this author , Karen DoerschKaren Doersch More articles by this author , Elizabeth EllisElizabeth Ellis More articles by this author , Mahmoud KhalilMahmoud Khalil More articles by this author , Jacob GantzJacob Gantz More articles by this author , William TabayoyongWilliam Tabayoyong More articles by this author , Jonathan BloomJonathan Bloom More articles by this author , Hani RashidHani Rashid More articles by this author , Nicholas KavoussiNicholas Kavoussi More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002092.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As surgeons adopt the new da Vinci single-port (SP) robotic platform, we aim to identify if multi-port (MP) robotic skills are readily transferable to SP surgery. METHODS: 5 MP robotic experts (>200 cases) and 5 MP novices (<10 cases) all with no prior SP experience independently completed a validated urethrovesical anastomosis (UVA) simulation using the MP followed by the SP robot. GEARS and RACE scores were assigned by 2 blinded reviewers. Objective [galvanic skin response (GSR)] and subjective [Surg-TLX (/100) and difficulty ratings (/20) of camera movement, endowrist movement, and avoiding instrument collisions] cognitive load measurements were collected. RESULTS: Experts achieved significantly greater GEARS and RACE scores on MP (27 v 17.3, p<0.001; 26.9 v 15.9, p<0.001, respectively) and SP (24.1 v 18.1, p=0.002; 21.8 v 16.3, p=0.017) than Novices. Experts had significantly higher Surg-TLX (+13 pts, p=0.015) and difficulty ratings using SP compared to MP (+11.8, p<0.01; +13.6, p<0.01; +14 pts, p<0.01) while Novices maintained high Surg-TLX and difficulty scores on both platforms [rating only the SP camera movement to be significantly more difficult (+7.2, p=0.03)]. GSR demonstrated similar trends. Experts’ UVA performance (GEARS and RACE) significantly decreased from MP to SP (27→24.1, p=0.047; 26.9→21.8, p=0.011, respectively).On subanalysis, Experts had significant decreases in GEARS subscores of force sensitivity and robotic control (-0.7, p=0.04; -0.9, p=0.02), but maintained subscores of depth perception, bimanual dexterity, and efficiency. RACE subscores of needle entry, needle driving, and tissue approximation (-0.9, p=0.01; -1.0, p=0.02; -1.0, p<0.01) significantly decreased while maintaining subscores of needle positioning and suture placement. Both Experts and Novices were rated significantly lower at the knot tying skill on the SP robot (-1.0, p=0.03; -1.2, p=0.02, respectively). CONCLUSIONS: For experts proficient in MP, specific SP training should be developed due to partial skill transference. Cognitive load remained steady for novices across robots, suggesting that concurrent SP and MP training may be possible. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1016-e1017 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Melnyk More articles by this author Patrick Saba More articles by this author Michael Witthaus More articles by this author Tyler Holler More articles by this author Beilei Xu More articles by this author Wencheng Wu More articles by this author Alexis Steinmetz More articles by this author Kit Yuen More articles by this author Karen Doersch More articles by this author Elizabeth Ellis More articles by this author Mahmoud Khalil More articles by this author Jacob Gantz More articles by this author William Tabayoyong More articles by this author Jonathan Bloom More articles by this author Hani Rashid More articles by this author Nicholas Kavoussi More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement Loading ...

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis.

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING

Abstract INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.