Instrument Handling Research Articles

Acquisition of endoscopic nasal surgery skills with a lamb’s head model

ObjectivesTo evaluate the acquisition of surgical skills by otolaryngology residents and established the minimum number of dissections of a lamb’s model to be performed before practicing on human patients. MethodsNineteen second-year otolaryngology residents performed ten dissections each, five on each nasal cavity, always practicing the same three surgical procedures on the lamb model. Each student’s training lasted 2-months, and the entire training intervention lasted 4-years, over four generations of residents. All dissections were recorded and were selected at random for examination by two independent otolaryngology surgeons, who were otherwise not involved in the research. Assessment of the 190 dissections used an instrument validated for surgical training of medical residents. ResultsTo a 1% significance level, statistical analysis revealed increased performance and satisfactory results were observed after the sixth dissection. Furthermore, after the eighth dissection, skill acquisition was relevant and sustained. ConclusionTraining in endoscopic nasal surgery on a lamb’s head model improves surgical skills and handling of surgical instruments. Our results showed the relevance of the lamb model for training in otolaryngology surgery, impacting on patient safety. Level of evidence2.

Can virtual reality surgical simulator improve the function of the non-dominant hand in ophthalmic surgeons?

Purpose:Phacoemulsification surgery requires the use of both hands; however, some surgeons may not be comfortable using their non-dominant hand, especially in critical steps such as chopping. This work aims at assessing whether a virtual reality simulator can help cataract surgeons train their non-dominant hand using the capsulorhexis module.Methods:This was a prospective observational study including thirty ophthalmic surgeons; none of them had previous training on the EyeSi surgical simulator. Twenty-three were experienced, and seven were intermediate surgeons. Surgeons were asked to perform capsulorhexis three times using their dominant hand and then using their non-dominant hand. A performance score based on efficiency, target achievement, instrument handling, and tissue treatment was calculated by the simulator.Results:A significant improvement in the score of surgeons using their non-dominant hand from the first trial (69.57 ± 18.9) to the third trial (84.9 ± 9.2) (P < 0.001) was found, whereas such improvement was not noted with the dominant hand (P = 0.12). Twenty-six surgeons managed to reach 90% of the mean score achieved by dominant hand by using their non-dominant hand, 11 (36.7%) from the first trial, seven (23.3%) from the second, and eight (26.7%) from the third.Conclusion:Cataract surgeons showed significant improvement in the scores of their non-dominant hands with simulator training. Thus, it is possible to safely train non-dominant hands for difficult tasks away from the operating room, which would be a fruitful addition to residency training programs.

Robotic Endoscope Control Via Autonomous Instrument Tracking

Many keyhole interventions rely on bi-manual handling of surgical instruments, forcing the main surgeon to rely on a second surgeon to act as a camera assistant. In addition to the burden of excessively involving surgical staff, this may lead to reduced image stability, increased task completion time and sometimes errors due to the monotony of the task. Robotic endoscope holders, controlled by a set of basic instructions, have been proposed as an alternative, but their unnatural handling may increase the cognitive load of the (solo) surgeon, which hinders their clinical acceptance. More seamless integration in the surgical workflow would be achieved if robotic endoscope holders collaborated with the operating surgeon via semantically rich instructions that closely resemble instructions that would otherwise be issued to a human camera assistant, such as “focus on my right-hand instrument.” As a proof of concept, this paper presents a novel system that paves the way towards a synergistic interaction between surgeons and robotic endoscope holders. The proposed platform allows the surgeon to perform a bimanual coordination and navigation task, while a robotic arm autonomously performs the endoscope positioning tasks. Within our system, we propose a novel tooltip localization method based on surgical tool segmentation and a novel visual servoing approach that ensures smooth and appropriate motion of the endoscope camera. We validate our vision pipeline and run a user study of this system. The clinical relevance of the study is ensured through the use of a laparoscopic exercise validated by the European Academy of Gynaecological Surgery which involves bi-manual coordination and navigation. Successful application of our proposed system provides a promising starting point towards broader clinical adoption of robotic endoscope holders.

A review on analytical methods of cilnidipine and its combinations

Background - The chase to improve the quality of life has stimulated desirable changes in research to design and develop a new drug and enhance its safety and effectiveness. Thus, there is a gradual rise in demand to develop susceptible and specific analytical techniques for newly developed drugs. Thus, analysts are striving very hard to develop new and efficient analytical methods to achieve these targets. Main body of abstract - Analytical methods that analyze drug compounds in a given matrix need to be optimized and validated to ensure excellent selectivity, sensitivity, ease of use, speed of analysis, less expensive, and efficient analytical procedures. Developing a new analytical method should be considered critical, based on availability and accurate handling of different instruments. This review is a genuine venture of compiled literature of earlier and recent trends in the method developments for Cilnidipine (CLD) analysis alone and in combination with other drugs. It provides an in-depth assortment of practical aspects of various analytical techniques published for CLD. Conclusion - High-performance liquid chromatography and ultraviolet spectroscopy have been found the most acceptable for the analysis of CLD. Stability indicating studies and impurity profiling of CLD also prevailed in the assembled literature. Scanty work was observed with capillary electrophoresis, Fourier transform-infrared spectroscopy, and electroanalytical methods to analyze CLD. Applications mentioned for CLD are significant in their particular field and contribute to analytical assay in future endeavours. Keywords- Cilnidipine, Bioanalytical method, Stability indicating method, HPLC, Spectrophotometry.

510 Artificial Intelligence Tutoring Compared with Expert Instruction in Neurosurgical Simulation Training: A Randomized Controlled Trial

INTRODUCTION: Resection of subpial tumors adjacent to critical brain areas is one of the most high-stakes surgical procedures that lacks opportunities for safe deliberate practice. Furthermore, performance-based assessment in neurosurgical apprenticeship is inefficient and vulnerable to subjectivity. Utilizing Artificial Intelligence (AI) to classify neurosurgical psychomotor expertise, we developed the first AI-powered tutor in neurosurgical simulation training, known as the Virtual Operative Assistant (VOA), to augment technical skills acquisition training by providing intelligent feedback. METHODS: A multi-institutional randomized controlled trial compared VOA’s automated audiovisual metric-based feedback vs remote verbal debriefing with expert instruction and no-feedback controls. Medical students performed six simulated subpial brain tumor resections: five practice attempts followed with feedback and one complex realistic attempt evaluated skill retention and transfer. A deep learning model, Intelligent Continuous Expertise Monitoring System (ICEMS Expertise Score), and blinded Objective Structured Assessment of Technical Skills (OSATS) evaluated performance. Participants reported emotions before, during and after training and completed a cognitive load questionnaire following training. RESULTS: Seventy medical students from four institutions were randomly assigned to VOA (n=23), Instructor (n=24), and Control (n=23) Groups. 350 practice attempts were assessed by ICEMS, and 70 realistic attempts were evaluated by ICEMS and OSATS. During practice, VOA training resulted in a significant improvement of participants’ Expertise Scores that was on average 0.66 (95% CI 0.55-0.77) and 0.65 (95% CI 0.54-0.77) points higher than Instructor and Control Groups (p&lt;.001). Realistic attempt’s average Expertise Score was significantly higher in the VOA Group compared to Instructor and Control Groups (mean difference 0.53; 0.49, respectively, p&lt;.001). VOA and Instructor Group’s realistic attempt OSATS ratings were not significantly different. OSATS ratings demonstrated that VOA feedback resulted in significantly higher Respect for Tissue and Economy of Movement compared to Control while expert instruction significantly improved Instrument Handling compared to Control. There was no significant between-groups difference in cognitive load, positive-, and negative-activating emotions. CONCLUSION: VOA’s quantitative automated benchmark feedback demonstrated superior performance outcome, improved skill transfer, with equivalent OSATS ratings and similar cognitive and affective responses compared to remote expert instruction.

Use of a High-Fidelity Training Simulator for Minimally Invasive Lumbar Decompression Increases Working Knowledge and Technical Skills Among Orthopedic and Neurosurgical Trainees.

Prospective comparative study. To quantify the educational benefit to surgical trainees of using a high-fidelity simulator to perform minimally invasive (MIS) unilateral laminotomy for bilateral decompression (ULBD) for lumbar stenosis. Twelve orthopedic and neurologic surgery residents performed three MIS ULBD procedures over 2weeks on a simulator guided by established AO Spine metrics. Video recording of each surgery was rated by three blinded, independent experts using a global rating scale. The learning curve was evaluated with attention to technical skills, skipped steps, occurrence of errors, and timing. A knowledge gap analysis evaluating participants' current vs desired ability was performed after each trial. From trial 1 to 3, there was a decrease in average procedural time by 31.7 minutes. The cumulative number of skipped steps and surgical errors decreased from 25 to 6 and 24 to 6, respectively. Overall surgical proficiency improved as indicated by video rating of efficiency and smoothness of surgical maneuvers, most notably with knowledge and handling of instruments. The greatest changes were noted in junior rather than senior residents. Average knowledge gap analysis significantly decreased by 30% from the first to last trial (P = .001), signifying trainees performed closer to their desired technical goal. Procedural metrics for minimally invasive ULBD in combination with a realistic surgical simulator can be used to improve the skills and confidence of trainees. Surgical simulation may offer an important educational complement to traditional methods of skill acquisition and should be explored further with other MIS techniques.

Review on people's trust on home use medical devices during Covid-19 pandemic in India.

With the rapid development of the medical device against COVID-19 is an excellent achievement. There are numerous obstacles effectively facing the worldwide population, from manufacture to distribution, deployment and, acceptance. Many manufacturers have entered the market rivalry as people's knowledge and demand for home-use medical equipment has increased. India represents a compelling market opportunity for global medical device manufacturers. Substantial growth for the Indian medical device industry is expected to be driven by the current low per-person spending rate for medical devices. The growth of the medical devices industry in India raises competition law issues (anti-trust) and therefore maintaining public trust in home-use medical devices during COVID-19 will be as essential. The review article aims to create awareness among people about commonly used medical devices during the COVID-19 pandemic and to survey people’s trust in home usable medical devices in India. In a worldwide pandemic, manufacturers of medical devices face insufficient storage and the impossibility of meeting the requirements of the health centre. The sale of some of the most significant medical devices has increased, making it more difficult for the medical device industry to satisfy demand with high-quality goods since the quality of COVID-19 items plays a vital part in the present scenario. Despite the difficulty in providing enough medical equipment during a pandemic, they are striving to adapt to the circumstance. After recognizing the need to promote awareness and grasp the selling, and production, handling of medical instruments during COVID-19 at home was conducted. In addition, medical equipment manufacturers and distributors look at this scenario as an opportunity to profit more. This review article would enable researchers during COVID-19 to build more knowledge and widespread trust in medical technologies respectively.

Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study.

Pelvic ring injuries or acetabular fractures present a challenge to trauma surgeons. Recently, endoscopic dissection techniques for visualization of the anterior pelvic ring and acetabulum have been presented. Robotic-assisted surgical systems offer advantages in terms of improved visualization and easier instrument handling. The aim of this pilot anatomic study was to verify the feasibility of robotic-assisted plate osteosynthesis on the anterior pelvic ring and acetabulum. The experiment was performed on a human whole body specimen. The DaVinci system with standard instruments as used in RARP was used. After docking the system, the anterior pelvic ring was first prepared as previously described for the endoscopic techniques. This was followed by dissection of both acetabula analogous to pelvic lymphadenectomy as performed during RARP. After the dissection was performed along the pelvic brim up to the iliosacral joint, the complete anterior column of the acetabulum including quadrilateral surface and incisura ischiadica major could be visualized. Finally, robotic-assisted endoscopic plate osteosynthesis was performed on the symphysis and anterior acetabular column as previously described in the endoscopic techniques. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum is feasible with the available robotic-assisted systems. Due to the excellent freedom of movement of the robotic arms, combined with the magnifying 3D visualization of the system, highly accurate preparation of the situs in preparation for plate osteosynthesis can be performed. The question of reduction of dislocated fractures remains open and is the subject of further investigation. Compared with conventional laparoscopy, robotic-assisted preparation nevertheless appears to offer an advantage in view of the complexity of the operation.

Development of virtual ophthalmic surgical skills training

BackgroundThis study aims to assess whether ophthalmic surgical skills can be taught successfully online to a diverse international and interprofessional student group.MethodsMixed methods study involving 20 students and 5 instructors. Each student completed a pre-session and post-session questionnaire to assess their perceptions regarding online instruction. Changes in questionnaire responses were analysed using Wilcoxon signed rank (SPSS 25). Semi-structured interviews were conducted to assess instructor perceptions towards virtual surgical skills teaching. Thematic analysis was undertaken using NVivo 12.0 software.ResultsThere was a 100% completion rate of pre- and post-session questionnaires. Prior to the session, lack of instructor supervision and inability to provide constructive feedback were emergent themes from students. Pre-session concerns regarding online delivery: 40% of students thought their view of skills demonstration would be negatively impacted, 60% their level of supervision and 55% their interaction with instructors. Following the session 10%, 15% and 5% held this view respectively. All students were ‘satisfied’ or ‘very satisfied’ regarding the ‘Surgeon’s View’ camera angle as well as the use of breakout rooms. 75% perceived an improvement in their confidence in instrument handling, 80% in cable knot tying and 70% in suture tying. Overall student rating for the virtual surgical skills session was 8.85 (±1.19) out of 10 (10 being most satisfied).ConclusionsWe demonstrate that successful delivery of a virtual ophthalmic surgical skills course is feasible. We were able to widen accessibility and participation through virtual delivery, which has future implications for ophthalmic surgical teaching and its reach.

AN ALTERNATIVE MODEL FOR TEACHING TENDON REPAIR AND SURGICAL TECHNIQUE IN HAND SURGERY.

At the beginning of the medical career, the orthopedic surgeon in academic training needs valid methodologies for training complex surgeries in tissues that simulate real situations. With training in animal tissue, adapted to approach human tissue, it is possible to simulate procedures and decisions that will be necessary in real situations. This study consists in presenting a simple and reproducible simulation model for surgical repair of tendons by training on fresh tendons fixed on a wooden frame. The model construction consists of a flat piece of Medium Density Fiberboard (MDF) and two threaded hooks were used on the board, to which Nylon threads are attached to tie the tendon, allowing a satisfactory simulation of a human tendon. This is a simple, inexpensive, and effective method for tendon suturing training, through which the trainee can develop repair techniques and basic surgical principles, such as instrument handling, safety, and sharps disposal. This approach aims to improve the trainee's skills and dexterity when placed in live surgery. The surgical techniques developed include the modified Kessler and Bunnel sutures. Level of Evidence IV, Descriptive Study .

Validation of a Newly Developed Competency Assessment Tool for the Posterior Sagittal Anorectoplasty

The correction of an anorectal malformation (ARM) is complex and relatively infrequent. Simulation training and subsequent assessment may result in better clinical outcomes. Assessment can be done using a competency assessment tool (CAT). This study aims to develop and validate a CAT for the posterior sagittal anorectoplasty (PSARP) on a simulation model. The CAT-PSARP was developed after consultation with experts in the field. The PSARP was divided into five steps, while tissue and instrument handling were scored separately. Participants of pediatric colorectal hands-on courses in 2019 and 2020 were asked to participate. They performed one PSARP procedure on an ARM simulation model, while being assessed by two objective observers using the CAT-PSARP. A total of 82 participants were enrolled. A fair interobserver agreement was found for general skills (intraclass correlation coefficient [ICC] = 0.524, p < 0.001), a good agreement for specific skills (ICC = 0.646, p < 0.001), and overall performance (ICC = 0.669, p < 0.001). The experienced group scored higher on all steps (p < 0.001), except for "anoplasty (p = 0.540)," compared with an inexperienced group. The CAT-PSARP is a suitable objective assessment tool for the overall performance of the included steps of the PSARP for repair of an ARM on a simulation model.

The contribution of wet labs in the education of ophthalmologists

BackgroundThe need for pre-training in experimental eye surgery is considered necessary. It is an essential way to assess trainees in ophthalmology based on their instrument and tissue handling and skills. This article aims to underline this necessity and demonstrate the ocular health professionals' opinion on this issue. Methods74 participants (45 females and 29 males) were included in the study. Ophthalmology residents, ophthalmologists participated in the wet lab session. The evaluation of the contribution of the wet labs were provided by filling a new questionnaire form. In this way, an interactive questionnaire was developed. ResultsRegarding trainees' grading of wet labs' significance as a first step for guiding their surgical career, it was positively correlated with their subjective view of labs' utility to both improve their surgical skills (p = 0.001) and maintain pre-existing ones (p < 0.001). We should also note that all of them (100%) stated that wet labs were necessary during residency, especially in repeated sessions, and that they would recommend them to their colleagues. ConclusionThe surgical skills improved significantly after participation in a wet lab, according to participants, who rated the experience as highly educational. Wet labs can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and treat patients safely and effectively.

Efficacy of simulation training for beating heart coronary anastomosis using BEAT + YOUCAN simulator.

We sought to evaluate our distributed practice program developed for training for beating heart anastomosis by employing a novel beating heart simulator. Eleven trainees watched and reviewed instructional video recordings of coronary anastomosis methods with a BEAT + YOUCAN training device, then performed coronary anastomosis procedures under a beating condition. Next, they participated in a four-hour training program developed by faculty surgeons. Ten different anastomosis components were assessed on a five-point rating scale (5, good; 3, average; 1, poor). After finishing the training program, each trainee again performed a coronary anastomosis procedure. Component scores were then compared before and after the training program. The mean time to completion of the procedure improved from 1033 ± 424 to 795 ± 201 s (p < 0.05). Assessment scores improved from 1.88 ± 0.41 to 2.57 ± 0.30 (p < 0.05). Improvements in some technical components related to handling of instruments were noted (p < 0.05), whereas no significant improvement was seen with arteriotomy, graft orientation, suture management, or knot tying after finishing the training program. Trainees who participated in our four-hour focused training program for coronary anastomosis with a novel beating heart simulator showed improved ability under the beating condition in regard to technical skills related to handling instruments.

Meniscal Root Repair With Mini-Open Medial Collateral Ligament Release

Meniscal root repair is becoming more common with increasing knowledge regarding the function of the meniscal root and its role in long-term joint preservation, as well as improved surgical techniques and instrumentation. Despite this, adequate visualization of the posterior horn of the medial meniscus may be challenging, particularly in those with tight medial compartments. Instrument handling and attempt to visualize and repair the meniscal tear may lead to iatrogenic chondral injuries in these instances. We describe our preferred technique for improved visualization via mini-open release of the distal medial collateral ligament that allows for increased joint distension, increased access to the posterior horn of the medial meniscus, and the ability to repair the released medial collateral ligament.

Fiddler’s neck: Cultural influences modify clinical presentation influences

&lt;p&gt;Fiddler’s neck which is also referred to as a “violin hickey” is a benign dermatologic occupational disease associated with the use of certain instruments like the violin, viola, cello etc. It is believed to be a type of allergic contact dermatitis, manifesting as an acute or chronic eczematous lesion typically at the submandibular and/or supraclavicular region on the side of neck. It can present as erythema, oedema and/or vesicles in the acute stage and as scaling, lichenification, hyperpigmentation and scarring in the chronic stage. Acne mechanica has also been considered by some authors as a presentation of fiddler’s neck. Occasionally, there may be associated swelling redness or a cystic lesion that makes it difficult to differentiate from lymphedema or a salivary gland tumor. PubMed search for articles about this entity resulting in instrument-induced dermatitis yielded few results of this forgotten entity which mimics a love bite (love hickey). For diagnosis, history of the usage of a string instrument which is held between the shoulder and neck, local physical examination and a positive patch test are pre-requisites. Management of fiddler’s neck includes application of topical mild steroid, emollient, proper instrument handling, neck padding, changing the material and polish of the instrument, and/or reducing the amount of playing time. Surgical intervention is usually not advisable unless cystic or tumorous lesions are the manifesting feature. The authors intend to revisit this entity and report an improvised modality that is being used by these instrumentalists in India which may help in prevention of this condition.&lt;/p&gt;

An Overview of Analysis of Learning Curve of Laproscopic Procedures in General Surgery Residents in Khyber Teaching Hospital, Peshawar

Aim: An Overview of Analysis of Learning Curve of Laparoscopic Procedures in General Surgery Residents in Khyber Teaching Hospital, Peshawar. Methodology: A descriptive KAP (knowledge attitude and practice) study was conducted in Khyber teaching hospital (KTH) from January 2021 to March 2021. A total of 24 surgical residents of 3rd and 4th year residency working in different surgical units were part of the study. Experience of residents performing procedures under supervision, assistance or by means of observation was recorded by a self administered questionnaire. Results: A number of 24 surgical residents of 3rd and 4th year residency of general surgery were part of the study. Frequency of 3rd yr residents was 13(54.2%) and that of 4th yr was 11(45.8%). Number of 6(25%) observed basic laparoscopy, 8(33%) advanced procedures and 10(41.7%) observed both types of procedure. 23(95.8%) participants were regularly briefed on principles of laparoscopy and 21(87.5%) strongly agreed upon the need of video simulation sessions. According to 22(91.7%) participants instrument handling was the most difficult part to learn. And 17(70.8%) participants laparoscopy enhances visualization of disease process. 18(75%) participants said that it improves postoperative recovery and 20(83.3%) were of opinion that it minimizes hospital stay. 16(66.7%) residents stated it has a steep learning curve. All participants agreed that it is necessary to assist large number of procedures to attain confidence of performing laparoscopic procedures. Conclusion: The study showed that almost all residents were in favor of the use of laparoscopic procedures rather than open surgeries. Keywords: Laparoscopy, learning curve

EP.TU.40Tendon Repair Training: An Alternative Approach

AimsThe COVID-19 pandemic has seen reduced training opportunities for surgical trainees. Tendon repair is an important surgical skill for all core surgical trainees. It is particularly essential for those training within Plastic and Orthopaedic surgery. Tendon repair simulation often involves the use of expensive materials or animal tissues, posing ethical predicament. Here we aimed to devise a simple and reproducible method for tendon repair simulation.MethodsOur tendon simulation model is an inexpensive and easily set up arrangement consisting of edible strawberry laces.ResultsThe tendon simulator gives reasonable replication of a tendon, with the laces depicting an inner and outer core of a severed tendon. In addition the materials are easy to acquire, handle, dispose of and are free from ethical limitations.ConclusionsSurgical trainees will be able to practice varying tendon repair techniques on this model, applying basic surgical principles such as instrument and tissue handling and develop their expertise.

Robotic Gynecologic Surgery: A Beginner's Guide to Becoming an Effective Bedside Assistant

<h3>Study Objective</h3> Learning to become an effective bedside assistant during robotic gynecologic surgery is a difficult task with many real-world nuances. The authors aim to create a video to be a guide for those individuals beginning to fill the role of the bedside assistant in robotic gynecologic surgery, such as residents, physician assistants, and operating room staff. <h3>Design</h3> Instructional video footage was filmed to demonstrate appropriate handling of the robotic system at the bedside. Additional footage was selected that illustrates concepts of best practices in robotic gynecologic surgery. <h3>Setting</h3> This video takes place within a Minimally Invasive Gynecology operating room using a standard robotic system. <h3>Patients or Participants</h3> This video is intended for those beginning to fill the role of bedside assistant in robotic gynecologic surgery (i.e., residents, physician assistants, and surgical scrub technicians/nurses). <h3>Interventions</h3> This video reviews components of the patient cart, cannulas, and instruments in a common robotic system. The video also distills the key points of docking the patient cart, mounting cannulas, and handling of robotic instruments. It highlights safe techniques with use of standard laparoscopic instruments through the assistant port. Additionally, it helps identify ways to be a helpful bedside assistant, including multiple ways to improve the surgeon's visualization of the operative field and anticipate the needs of the primary surgeon. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> The skills of being able to efficiently handle robotic equipment, optimize the surgeon's visualization, and be prepared for next steps in the surgery are illusive to the novice bedside assistant. Review of high yield concepts can help prepare those beginning to fill the role of the bedside assist in robotic gynecologic surgery. This video illustrates many of these concepts and techniques with the intention of guiding those who are new to this role.

Development and Implementation of a Robotic Surgery Training Curriculum

<h3>Study Objective</h3> To evaluate efficacy of instituting a formal robotic surgery curriculum as part of residency training. <h3>Design</h3> Resident survey prior to and after implementing a new robotic surgery training curriculum. <h3>Setting</h3> Obstetrics and gynecology resident simulation at robotic simulation center located in the medical school of a large, urban, academic medical center. <h3>Patients or Participants</h3> 17 PGY1 through PGY4 residents who are currently training at Temple University Hospital obstetrics & gynecology program. <h3>Interventions</h3> We created a robotic surgery curriculum that includes online robotic training followed by hands-on robotic bedside assistant training. Residents were trained on proper instrument terminology, handling, robotic docking and bedside assisting. <h3>Measurements and Main Results</h3> Each resident was given a pre-intervention survey that included training level, number of times assisted in a robotic surgery, subjective comfort level with assisting in robotic surgery, and 12 objective questions regarding assisting in robotic surgery. Pre-intervention responses were compared to post-intervention responses. Number of mean correct objective questions pre-intervention was 5.3 independent of training year or experience with bedside assisting and mean correct objective questions post-intervention was 10 (p <0.0001). Median comfort level with bedside assisting pre-intervention was somewhat uncomfortable and post-intervention was neutral (p = 0.16). When asked if residents would like to have another structured robotic training exercise, 16 residents (94%) agreed or strongly agreed and one resident (6%) was neutral. <h3>Conclusion</h3> Resident knowledge of bedside assisting during robotic surgery increased as a result of the new robotic surgery training curriculum. Median comfort level with bedside assisting increased, however results were non-significant. Residents expressed interest in further robotic surgery training during residency, leaving comments such as "This was great! I feel like I learned a lot and will feel less clueless in the future. Please do again" and "Wish we could have had this earlier in residency" and "This was useful- made me more comfortable to assist in the OR."

823 The ‘Blue Blood' Chicken Thigh Model: Microsurgery Simulation Teaching for Surgical Trainees

Abstract Introduction The simulation of microsurgery via various models helps surgical trainees to further their instrument handling and techniques. This model allows trainees to strengthen hand-microscope-eye coordination; a crucial ability required when handling critical vessels and tissues. The ‘Blue Blood’ Chicken Thigh Model imitates delicate vessels enabling the enhancement of dexterity. Aim To raise awareness amongst trainees in how the model may be used as a simulation tool for learning. To outline the arrangement of the ‘Blue Blood’ chicken thigh model allowing the practice of exceptionally fine suturing such as end-end anastomosis and end-side anastomosis. To improve trainee confidence in instrument handling and technique. Method A Microsurgery course was set up for maxillofacial surgical trainees within the West Midlands Deanery in November 2019. Detailed steps of dissecting the femoral vessels and preparing the ‘Blue Blood’ Chicken Thigh Model were presented. Microsurgical tools were then used to practise end-end and end-side anastomosis. Results The feedback received from the trainees was positive and it is hoped this will become an annual session for all trainees. Many trainees felt this was a resourceful tool to help them practise - even at home. Conclusions It is important for trainees to be able to display precise hand-eye movements especially when concerned with anastomosis techniques. This model will allow trainees to be able to simulate such an environment outside of theatre where they can spend time to hone skills and become comfortable with handling finer tissues and instruments.