Laparoscopic Tasks Research Articles

Comparison of distance versus in-person laparoscopy training using a low-cost laparoscopy simulator-a randomized controlled multi-center trial.

Simulation training programs are essential for novice surgeons to acquire basic experience to master laparoscopic skills. However, current state-of-the-art laparoscopy simulators are still expensive, limiting the accessibility to practical training lessons. Furthermore, training is time intensive and requires extensive spatial capacity, limiting its availability to surgeons. New laparoscopic simulators offer a cost-effective alternative, which can be used to train in a digital environment, allowing flexible, digital and personalized laparoscopic training. This study investigates if training on low-cost simulators in a digital environment is comparable to in-person training formats. From June 2023 to December 2023, 40 laparoscopic novices participated in this multi-center, prospective randomized controlled trial. All participants were randomized to either the ‟distance" (intervention) or the "in-person" (control) group. They were trained in a standardized laparoscopic training curriculum to reach a predefined level of proficiency. After completing the curriculum, participants performed four different laparoscopic tasks on the ForceSense system. Primary endpoints were overall task errors, the overall time for completion of the tasks, and force parameters. In total, 40 laparoscopic novices completed digital or in-person training. Digital training showed no significant differences in developing basic laparoscopic skills compared to in-person training. There were no significant differences in median overall errors between both training groups for all exercises combined (intervention 3 vs. control 4; p value = 0.74). In contrast, the overall task completion time was significantly lower for the group trained digitally (intervention 827.92s vs. control 993.42; p value = 0.015). The applied forces during the final assessment showed no significant differences between both groups for all exercises. Overall, over 90% of the participants rated the training as good or very good. Our study shows that students that underwent digital laparoscopic training completed tasks with a similar number of errors but in a shorter time than students that underwent in-person training. Nevertheless, the best strategies to implement such digital training options need to be evaluated further to support surgeons' personal preferences and expectations.

The Effect of External Distractions on Simulated Laparoscopic Performance.

Background: Surgeons are exposed to unavoidable distractions while operating. Distractions can cause stress, and stress can impair cognition and motor skills to the detriment of surgeon performance. This study assessed the impact of distractions on surgeon stress levels and surgeon performance during simulated laparoscopic tasks. Methods: Twelve surgical trainees completed a peg-thread transfer task three times on a laparoscopic simulator in a neutral environment. Six trainees then completed the task three more times in an environment overlain with distractions commonly found in the operating theatre. Six others completed three more tasks in a neutral environment. Stress was measured by recording heart rate and by assessing responses to the NASA Task Load Index. Performance was measured using instrument tracking metrics and time to complete the task. Results: The distracted participants reported significantly higher effort, frustration, and physical demand than the neutral group, as measured by the NASA Task Load Index, (P = .001, .031, and .044, respectively). The neutral group completed their final task significantly faster compared with baseline (P = .049), while the distracted group failed to show this improvement. The distracted group showed higher hand discordance, suggesting reduced ambidexterity. Conclusion: Distraction negatively impacted some aspects of performance and resulted in subjective increased stress. In future, simulation may have a role in "stress inoculation," enabling surgeons to maintain performance, despite distractions.

Virtual Reality (VR) Technology in Laparoscopy Surgery: The Effect of Large Viewing Angle from the Head-Mounted Display (HMD) and Laparoscopic Performance

Background: A vital component of laparoscopic surgery is its display monitor. The viewing angle of the laparoscopic monitor impacts on the performance of the surgeon. Given that head-mounted display (HMD), an integral part of Virtual Reality (VR) technology, offers a large viewing angle, this project aimed to determine the potential benefits of using HMD in performing laparoscopic tasks. Methods: 54 laparoscopic/endoscopic clinicians performed a simulated laparoscopic task with three different monitors (HMD, 21-inch and 15-inch monitor) in a random order. Duration of task, distance travelled by graspers and manipulation errors were recorded and analyzed. Simulation Sickness Questionnaires (SSQs) were also given to participants. Results: There were statistically significant differences in all performance metrics recorded across all groups when compared to each other (P<0.05). HMD had the longest task completion duration followed by 15-inch and 21-inch monitors. However, the distance travelled by the graspers and error rate was lowest in the HMD group followed by 21-inch and 15-inch monitors. The SSQ questionnaire showed that eye strain and headache are the two most common transient side effects recorded by users of HMD. Conclusion: The study shows that HMD users perform fewer mistakes and are more precise with the movement of graspers compared to other groups. As such, HMD has the potential to enhance laparoscopic performance. HMD is cost effective and has the added benefit of improving surgical ergonomics. Further research should focus on ensuring that HMD is a viable and safe alternative to conventional laparoscopic monitor as well as in identifying barriers to adoption.

Impact of Operative Room Noise on Laparoscopic Performance—A Prospective, Randomized Crossover Trial

IntroductionSurgeons are often exposed to different types of operative room (OR) noise, for instance machine alarms, phone calls, and interacting objects. The aim of this study was to evaluate the effect of OR noise on the surgeons’ laparoscopic performance. MethodsA total of 30 laparoscopic novices participated in this single-center, prospective, randomized cross-over trial after completing a standardized laparoscopic training until reaching proficiency. Afterward, all participants performed four different laparoscopic tasks (peg transfer, circle cutting, balloon resection, suture, and knot) twice, once under noise exposure (intervention group), and once without any noise (control group). Primary endpoints were the force exertion and motion analyses. To assess the psychological workload the NASA task load index score was used. ResultsThe error rates varied and were significantly different between the noise and the control group. More complex tasks like the circle cutting and suture and knot task revealed higher error rates concerning precision (circle cutting: P < 0.01; suture and knot: P < 0.01). In line with increased error rates in the circle cutting task, increased NASA task load index scores were observed in this task (P = 0.03). However, no significant differences were found in force parameters, such as the maximal force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) and the mean force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) between the groups. ConclusionsExposure to normal OR noise led to higher error rates in two of four tasks. This effect could be linked to an increased psychological workload that was present under normal OR noise exposure. However, normal OR noise does not appear to impact surgical novices' laparoscopic task performance regarding applied forces and instrument motion.

Can you feel the force just right? Tactile force feedback for training of minimally invasive surgery—evaluation of vibration feedback for adequate force application

BackgroundTissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills.MethodsStandard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion.ResultsA total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities.ConclusionContinuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.

Effect of three training programs on surgical performance in single-port laparoscopic surgery.

The aim of this study was to evaluate the effect of three training methodologies on the acquisition of psychomotor skills for laparoendoscopic single-site surgery (LESS), using straight and articulating instruments. A prospective study was conducted with subjects randomly divided into three groups, who performed a specific training for 12 days using three laparoscopic tasks in a laparoscopic simulator. Group-A trained in conventional laparoscopy setting using straight instruments and in LESS setting using both straight and articulating instruments. Group-B trained in LESS setting using straight and articulating instruments, whereas Group-C trained in LESS setting using articulating instruments. Participants' performance was recorded with a video-tracking system and evaluated with 12 motion analysis parameters (MAPs). All groups obtained significant differences in their performance in most of the MAPs. Group-C showed an improvement in nine MAPs, with a high level of technical competence. Group-A presented a marked improvement in bimanual dexterity skills. Training in LESS surgery using articulating laparoscopic instruments improves the quality of skills and allows smoother learning curves.

Assistance by adaptative damping on a complex bimanual task in laparoscopic surgery.

Laparoscopic surgery has improved outcomes in abdominal surgery, but presents kinematic restrictions for surgeons. Robotic comanipulation with adaptative damping has been investigated in simple laparoscopic tasks. The present protocol aimed to determine the contribution of adaptive damping in complex bimanual tasks approaching clinical setting. Fourteen residents in general surgery performed three exercises, and for each three repetitions without (classic repetitions) and three with robotic assistance (robotic repetitions) in a randomised order. The exercises chosen were trajectory, modified Pea on a Peg and intracorporeal suture. Task performance, gesture performance, workload and impression were measured. Also, a semi-directed interview was performed to collect the participants' feeling about companipulated robots and their potential application in clinical practice. Adaptative damping assistance did not impact task performance, but allowed an economy of movement in the non-dominant hand during suture exercise (distance 916 ± 500mm in classic vs. 563 ± 261mm in robotic, p < 0.001). Perceived workload (p = 0.12) and user's impression were not different between classic and robotic repetitions, except novelty (p < 0.001). Participants' interviews revealed their interest for the robotic devices, particularly the gravity compensation, and were ready to use the adaptative damping provided an intermittent use, for example to dissect dangerous areas. Adaptative damping applied by comanipulated robots does not influence the performance of the task, but improves the performance of the gesture itself, particularly for the non-dominant hand, and during the realisation of a complex task like suturing. For residents in digestive surgery, this assistance does increase workload, and they would use this help in the operating room under certain conditions.

10. COMPARISON OF ERGONOMICS BETWEEN ROBOTIC AND CONVENTIONAL SURGERY: A STUDY OF MUSCLE ACTIVITY AND BODY POSTURE

Abstract Introduction The objective of this study is to compare the ergonomics of surgeons during surgical procedures using the Versius robot (CMR Surgical) and conventional laparoscopic surgery. The study assesses surgeons' body posture and muscle activity to objectively identify ergonomic distinctions between the two surgical approaches. Methods A set of surgeons were asked to perform both tasks in a box trainer and surgical procedures in an experimental model. Laparoscopic tasks and procedures were performed both with the robotic platform and conventionally. During the study, surgeons wore electromyography sensors to measure the activity of 14 muscles. Participants also wore inertial sensors to record body movements. Postures were compared with ergonomic guidelines for conventional and robotic laparoscopic surgery. Results In terms of muscle activity in box trainer and in vivo surgeries, the activity distribution of the gastrocnemius, vastus lateralis, erector spinae and medial trapezius muscles was concentrated around a lower median in robotic procedures compared to conventional ones. However, for the brachioradialis, triceps and upper trapezius, the distribution was concentrated at a higher median for robotic procedures. Regarding surgeon posture, a more ergonomically suitable posture is obtained for flexion-extension of the knee and ulnar-radial deviation of the wrist during robotic surgery. Conclusion The study concludes that the use of robotic surgery improves certain aspects of ergonomics in laparoscopy.

How long do we need to reach sufficient expertise with the avatera® robotic system?

To investigate the learning curve in four basic surgical skills in laparoscopic and robotic surgeries, and evaluate the approximate time needed to reach sufficient expertise in performing these tasks with the avatera® system. Twenty urology residents with no previous experience in dry-lab and robotic surgery were asked to complete four basic laparoscopic tasks (peg transfer, circle cutting, needle guidance, and suturing) laparoscopically and robotically. All participants were asked to complete the tasks first after watching the Uroweb educational material and, second, after undertaking a 2-hour training in robotic and laparoscopic dry-lab. Thereafter, all trainees continued to undertake 2-hour training programs until being able to complete the tasks with the avatera® robot at the desired time. Paired t test and one-way ANOVA test were used to analyze time differences between the groups. Time needed to complete all tasks either robotically or laparoscopically was significantly less in the second compared to the first attempt for all Groups in each Task. In the robotic dry-lab, time needed to complete the tasks was significantly less than in the laparoscopic dry-lab. A significant effect of previous laparoscopic experience of the participants on the training time needed to achieve most of the goal times was detected. The results of the study highlight the role of previous laparoscopic experience in the training time needed to achieve the performance time goals and demonstrate that the learning curve of basic surgical skills using the avatera® system is steeper than the laparoscopic one.

Skin-stretch Haptic Feedback Augmentation Improves Performance in a Simulated Laparoscopic Palpation Task.

Laparoscopic surgery brings substantial benefits to patients. However, it remains challenging for surgeons because of motion constraints and perception limitations. Notably, the perception of interactions with organs is largely compromised. This paper evaluates the effectiveness of a forearm-based skin-stretch haptic feedback system rendering surgical tool tip force. Twenty novice participants had to discern the stiffness of samples to investigate stiffness perception in a simulated laparoscopic task. The experimental protocol involved manipulating samples with three difficulty levels and testing three feedback conditions: no augmentation, visual feedback, and tactile feedback. The results demonstrate that feedback significantly enhances the success rate of laparoscopic palpation tasks. The proposed tactile feedback boosts confidence and task speed and reduces peak force and perceived workload. These benefits become even more pronounced when difficulty increases. These promising findings affirm the value of skin-stretch haptic feedback augmentation in improving performance for simulated laparoscopy tasks, paving the way for more integrated and deployable devices for the operating room.

Contextual Interference Effect in Learning of Simulated Laparoscopic Tasks

Laparoscopy, a minimally invasive surgical technique involving fine motor movements of the hands and fingers, has proven to be an invaluable tool in surgical care. Expediting the learning process of surgeons to reach proficiency in this surgical technique directly impacts patient outcomes, recovery times, and time management in hospitals [1]. Within motor learning, blocked and random practice has been identified as having correspondingly low or high levels of contextual interference, with different effects on learning and retention of motor skills. Contextual interference can be described as the level of mental interference created during the practice of motor skills. So far, research has been equivocal in identifying the best practice schedule for optimizing the acquisition and retention of fine and gross motor skills. This study examines the role of contextual interference in the acquisition, short-term retention (10-minute), and long-term retention (10-day) of three variations of a simulated laparoscopic task in 60 adults aged 18-65, 30 males and 30 females. The index of performance was represented by the total time taken to complete each task using curved laparoscopic graspers. Results showed that both blocked and random practice groups significantly improved acquisition performance over 54 acquisition trials. Participants undergoing a blocked practice schedule improved their pattern time-to-completion by 46%, retaining most of their performance in the 10-minute retest while maintaining their skill as well after 10 days. The random practice group improved acquisition performance by 38%, maintaining most of their performance in the short-term retention test, with only a slight decrease in speed in the long-term retention test. No statistically significant differences in the efficiency of blocked versus random practice schedules were found for both acquisition and retention, suggesting that both practice schedules can be viable options for learning and retention of simulated laparoscopic surgical tasks. We suggest tailoring training programs to individual skill levels to provide each learner with the optimal amount of contextual interference to reach their optimal challenge point according to subjective task difficulty experienced.

Optical angle and visuospatial ability affect basic laparoscopic simulator task performance

Surgical trainees show decreased performance during laparoscopic surgery when the laparoscope (camera) is not aligned with their line of sight towards the operating area. In this study we investigate the influence of visuospatial ability on laparoscopic simulator performance under such non-zero optical angles. Novices were invited to participate in a laparoscopic training session. After completing a visuospatial ability assessment, they performed a simplified laparoscopic task on an in-house developed laparoscopic simulator under eight different optical angles ranging between 0° and 315° in steps of 45°. Data-analysis showed decreased performance under all non-zero optical angles for task duration (mean difference between 1506 and 5049 ms, standard error between 499 and 507, p < .05) and for accuracy under optical angles greater than ±45° (mean difference between 1.48 and 2.11, standard error 0.32, p < .01). Performance-zones were identified for various optical angle ranges and differed for task duration and accuracy. Participants of high visuospatial ability performed significantly better under non-zero angles for accuracy compared to participants of low visuospatial ability (mean difference 0.95, standard error 0.34, p < .01), except for the 180° optical angle (no difference).

Impact of dehydration on laparoscopic performance: a prospective, open-label, randomized cross-over trial

IntroductionDuring laparoscopic surgery, surgeons may experience prolonged periods without fluid intake, which might impact surgical performance, yet there are no objective data investigating this issue. Therefore, the aim of this study was to elucidate the effect of prolonged dehydration on laparoscopic surgical performance and tissue handling.MethodsA total of 51 laparoscopic novices participated in a single-center, open-label, prospective randomized cross-over trial. All participants were trained to proficiency using a standardized laparoscopic training curriculum. Afterward, all participants performed four different laparoscopic tasks twice, once after 6 h without liquid intake (dehydrated group) and once without any restrictions (control group). Primary endpoints were tissue handling defined by force exertion, task time, and error rate. The real hydration status was assessed by biological parameters, like heart rate, blood pressure, and blood gas analysis.Results51 laparoscopic novices finished the curriculum and completed the tasks under both hydrated and dehydrated conditions. There were no significant differences in mean non-zero and peak force between the groups. However, dehydrated participants showed significantly slower task times in the Peg transfer task (hydrated: 139.2 s vs. dehydrated: 147.9 s, p = 0.034) and more errors regarding the precision in the laparoscopic suture and knot task (hydrated: 15.7% accuracy rate vs. dehydrated: 41.2% accuracy rate, p < 0.001).ConclusionProlonged periods of dehydration do not appear to have a substantial effect on the fundamental tissue handling skills in terms of force exertion among surgical novices. Nevertheless, the observed impact on speed and precision warrants attention.

Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study

BackgroundTraining programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty.DesignProspective, observational study.SettingHealth...

745 The Effect of 3D Versus 2D Training Models in Laparoscopic Skills Acquisition: A Randomised Controlled Trial of Novice Medical Students

Abstract Aim Determining whether the effect of laparoscopic technical skills acquisition will be superior with the use of low-fidelity 3D training models with contours compared to flat, 2D LapPass training models in novice medical students. Method This was a prospective, single-centre, two-arm, randomised controlled trial. Participants were randomised equally into either 3D or 2D group and performed two standardised laparoscopic tasks: (1) grasping and manipulation and (2) intracorporeal suturing on separate days. Performance was based on the GOALS tool, completion time and number of errors via 3 assessments (baseline, interim and post-training) each session. A post-study survey was used to measure participant-perceived confidence and performance. Results Sixty-two participants completed the study from April to June 2022. The two groups were homogenous regarding demographic data (p&amp;gt;0.05). Both groups had significantly superior performance post-training compared to baseline in the two tasks via the intra-group comparison (p&amp;lt;0.017). In the inter-group comparison, the 3D group had statistically significantly greater improvements in GOALS score parameter and depth perception domain in all comparisons in the two tasks (p&amp;lt;0.05). The time improvement and error reduction also favoured the 3D group. In the post-study survey, the 3D group reported significantly greater perceived post-training confidence and performance in the suturing task only (p&amp;lt;0.05). Conclusions The 3D training models resulted in a superior laparoscopic skills acquisition for novices in two tasks compared to 2D LapPass training models and should be incorporated into laparoscopic training curricula. Further work should focus on their long-term efficacy on a competency-based endpoint.

M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition

The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.

WTP6.11 Are surgical technical errors inherited from lack of mental cognitive framework or lack of motor skills for a given surgical task? results of a pilot study

Abstract Aims To study the impact of augmented terminal feedback designed by error type learning for developing surgical skill. Methods Twenty medical students were randomised in two groups, based on feedback they received; Video Feedback (VF) and Online Feedback (OF). Laparoscopic double square knot was selected as the task. Task was divided into subtasks and steps. Potential errors were studied and divided into types: Cognitive Based (CB) &amp; Skill Based (SB). Laparoscopic Task was executed in four stages and feedback was provided after each stage. Error types and numbers were studied. Results 9178 errors were studied in 80 tasks, 320 subtasks and 2080 steps in four stages. 5091 (55%) CB errors and 4087 (45%) SB errors were recorded. VF group enacted 2251 CB errors in stages (46%,29%, 18%,7%) and 1692 SB errors (41%, 28%, 18%, 13%). OF group enacted 2840 CB errors (29%, 26%, 25%, 20%): whereas, 2396 SB errors (22%, 23%, 21%, 34%). Both groups were comparable in enacting SB &amp; CB errors in early stage of skill; nevertheless, highly significant difference was noted in 3 stages when SB errors are considered (p &amp;lt; 0.01 vs OF group). Although, there was steady improvement in CB type errors, but no significant different was noted (p &amp;gt; 0.5 vs OF group) in all stages of learning. Conclusions Augmented terminal feedback in the form of videos feedback is superior to current standards in terms of reducing cognitive based errors; whereas, skill based errors rely on time and experience rather than type of feedback.

Expert laparoscopist performance on virtual reality simulation tasks with and without haptic features.

Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback's effect on skill development. Our objective is to compare expert laparoscopists' skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces. Five expert laparoscopists performed seven skills tasks on two laparoscopic simulators, one with and one without haptic features. Tasks consisted of 2-handed instrument navigation, retraction and exposure, cutting, electrosurgery, and complicated object positioning. Laparoscopists alternated platforms at default difficulty settings. Metrics included time, economy of movement, completed task elements, and errors. Progressive change in performance for the final three iterations were determined by repeated measures ANOVA. Iteration quartile means were determined and compared using paired t-tests. No change in performance was noted in the last three iterations for any metric. There were no significant differences between platforms on the final two quartiles for most metrics except avoidance of over-stretch error for retraction; and cutting task was significantly better with haptics on all iteration quartiles (p < 0.03). Economy of movement was significantly better with haptics for both hands for clip application (p < 0.01) and better for right hand on complex object positioning (p < 0.05). Accuracy was better with haptics for retraction and cutting (p < 0.05) and clip application (p < 0.05). Results showed higher performance in accuracy, efficient instrument motion, and avoidance of excessive traction force on selected tasks performed on VR simulator with haptic feedback compared to those performed without haptics feedback. Laparoscopic surgeons interpreted machine-generated haptic cues appropriately and resulted in better performance with VR task requirements. However, our results do not demonstrate an advantage in skills acquisition, which requires additional study.

Surgical Rehabilitation for Research Residents: A Pilot Program to Offset Surgical Skill Decay

Select general surgery residents in the surgeon-scientist pipeline dedicate time away from clinical residency to conduct research. However, these research residents (RR) are vulnerable to operative skill decay. The aim of this study is to assess the feasibility of implementation and impact of an organized intervention designed to combat skill decay experienced by RR. RR were enrolled in a pilot Surgical Rehabilitation Program (SRP). The SRP is comprised of 12 cadaver-based simulation sessions and supplemented with Fundamentals of Laparoscopic Surgery-based simulation workouts. The RR were integrated with the clinical residents (CR) during the cadaver sessions and were subsequently performance tested, surveyed, and interviewed. One academic general surgery residency program graduating 8 chief residents yearly in New York. General surgery CR and residents on dedicated research years. Data were collected for all local RR (n = 8) and 77% (n = 37) of CR. Local RR conducted research within the same health system that sponsors the residency. RR experienced gaps in training ranging from 2 to 4 years. All RR were permitted to moonlight on surgical services, however performed 0 operations and only 0.88 procedures on average per shift. Although RR performed similarly to level-matched CR on basic laparoscopic tasks, they required significantly more time on laparoscopic suturing-based skills than CR (p < 0.001). RR had significantly lower confidence levels precadaver sessions but gained confidence postcadaver sessions (p < 0.05), whereas CR confidence was unchanged. Regarding the SRP, qualitative interviews revealed major themes emphasizing the integration of RR, exposure to CR and faculty, technical skill development, maintenance of surgical know-how, and improved confidence for RR. The implementation of such structured interventions, like our SRP, aimed at supporting RR over gap years is essential to help residents maintain skills and confidence needed to achieve their goals of becoming surgeon scientists.

Artificial intelligence based real-time video ergonomic assessment and training improves resident ergonomics

BackgroundSurgery demands long hours and intense exertion raising ergonomic concerns. We piloted a sensorless artificial intelligence (AI)-assisted ergonomics analysis app to determine its feasibility for use with residents. MethodsSurgery residents performed simulated laparoscopic tasks before and after a review of the SCORE ergonomics curriculum while filmed with a sensorless app from Kinetica Labs that calculates joint angles as a metric of ergonomics. A survey was completed before the session and a focus group was conducted after. ResultsThirteen surgical residents participated in the study. The brief intervention took little time and residents improved their ergonomic scores in neck and right shoulder angles. Residents expressed increased awareness of ergonomics based on the session content and AI information. All trainees desired more training in ergonomics. ConclusionsErgonomic assessment AI software can provide immediate feedback to surgical trainees to improve ergonomics. Additional studies using sensorless AI technology are needed.