Levels Of Surgical Experience Research Articles

Postoperative Complications of Third Molar Surgical Extraction in a Malaysian Sample

The most common impacted teeth in adults are the mandibular third molars which frequently require surgical extraction. There are many factors contributing to the occurrence of postoperative complications, one of which is surgeon’s experience. Hence, this study aimed to determine the prevalence of postoperative complications of third molar extractions by different level of surgical experience. Methods: A retrospective study was conducted in Kulliyyah of Dentistry, International Islamic University Malaysia. A total of 112 cases were collected from the records of surgical extraction of lower third molars performed by dental students, dental officers and specialists, collected data was transferred into special case sheets and analyzed using IBM SPSS 23. Results: From 112 cases, 64(57.1%) had presented with postoperative complications. The highest prevalence of postoperative complications was in dental students’ group 38 out of 62 patients (61.3%), followed by specialists’ group 20 out of 39 patients (51.3%) and dental officers’ group 6 out of 11 patients (51.6%). Meanwhile, the common complications observed were pain (33.9%), swelling (20.5%), trismus (12.5%), paresthesia (6.3%) and bleeding (3.0%). Conclusions: There is no statistically significant correlation between the postoperative complications and the level of surgeons’ experience.

Management of Cerebellopontine Angle Tumors

Abstract Background Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa. Most CPA tumors are benign, with 80-94% being vestibular schwannomas (acoustic neuromas), lipomas, vascular malformations, and hemangiomas. Treatment options include observation, radiosurgery, and microsurgery. Aim and Objectives Evaluation of the clinical presentation of various lesions in the Cerebellopontine Angle area and evaluate the different surgical approaches for management of these lesions. Subjects and Methods The study included cases of CPA tumors that were admitted and treated in the neurosurgical departments in Ain Shams University Hospital as well as Al Galaa Armed Forces Hospital and Al Maadi Armed ForcesHospital. Result Abnormal planter response were the most frequent neurological abnormality (72.0%). The most cranial nerve affected was the vestibulocochlear nerve (60.0%). Conclusion CPA tumors are challenging lesions to be treated surgically, which requires a high level of surgical experience. Retrosigmoid and middle fossa approaches accomplished significant outcome among patients with CPA tumors. Preoperative V-P shunt procedure improved noticeably the manifestations of increased intracranial tension.

Experimental evaluation of accuracy and efficiency of two control strategies for a novel foot commanded robotic laparoscope holders with surgeons

The implementation of a laparoscope-holding robot in minimally invasive surgery enhances the efficiency and safety of the operation. However, the extra robot control task can increase the cognitive load on surgeons. A suitable interface may simplify the control task and reduce the surgeon load. Foot interfaces are commonly used for commanding laparoscope-holding robots, with two control strategies available: decoupled control permits only one Cartesian axis actuation, known as decoupled commands; hybrid control allows for both decoupled commands and multiple axes actuation, known as coupled commands. This paper aims to determine the optimal control strategy for foot interfaces by investigating two common assumptions in the literature: (1) Decoupled control is believed to result in better predictability of the final laparoscopic view orientation, and (2) Hybrid control has the efficiency advantage in laparoscope control. Our user study with 11 experienced and trainee surgeons shows that decoupled control has better predictability than hybrid control, while both approaches are equally efficient. In addition, using two surgery-like tasks in a simulator, users’ choice of decoupled and coupled commands is analysed based on their level of surgical experience and the nature of the movement. Results show that trainee surgeons tend to issue more commands than the more experienced participants. Single decoupled commands were frequently used in small view adjustments, while a mixture of coupled and decoupled commands was preferred in larger view adjustments. A guideline for foot interface control strategy selection is provided.

Unravelling variations: an examination of entry point selection in proximal femoral cephalomedullary nailing

BackgroundThe exact positioning of the cephalomedullary (CM) nail entry point for managing femoral fractures remains debatable, with significant implications for fracture reduction and postoperative complications. This study aimed to explore the variability in the selection of the entry point among trauma surgeons, hypothesizing potential differences and their association with surgeon experience.MethodsIn this prospective multicenter study, 16 participants, ranging from residents to senior specialists, partook in a simulation wherein they determined the optimal entry point for the implantation of a proximal femoral nail antirotation (PFN-A; DePuy Synthes) in various femora. The inter- and intra-observer variability was calculated, along with comprehensive descriptive statistical analysis, to assess the variability in entry point selection and the impact of surgeon experience.ResultsIn this study, the mean distance from the selected entry points to the calculated mean entry point was 3.98 mm, with a smaller distance observed among surgeons with more than 500 implantations (ANOVA, p = 0.050). Intra-surgeon variability for identical femora averaged at 5.14 mm, showing no significant differences across various levels of surgical experience or training. Notably, 13.6% of selected entry points would not allow a proper intramedullary positioning of the implant, thereby rendering anatomical repositioning unfeasible. Among these impossible entry points, a significant skew towards anterior placement was observed (70.6% of the impossible entry points), with a smaller fraction being overly lateral (27.5%) or medial (13.7%). On a patient level, the impossibility rate varied widely from 0 to 35% among the different femora examined, with a significantly higher rate seen in younger patients (mean age 55.02 versus 60.32; t-test for independent samples, p = 0.04).ConclusionsSignificant variations exist in surgeons’ selection of entry points for proximal femoral nailing, underscoring the task’s complexity. Experience does not prevent the choice of unfeasible entry points, emphasizing the inadequacy of a universal approach and pointing towards the necessity for a patient-specific strategy for improved outcomes.Trial registration number: DRKS00032465.

A patient-specific, interactive, multiuser, online mixed-reality neurosurgical training and planning system.

Mixed-reality simulation is an emerging tool for creating anatomical models for preoperative planning. Its use in neurosurgical training (NT) has been limited because of the difficulty in real-time interactive teaching. This study describes the development of a patient-specific, interactive mixed-reality NT system. The authors took cases of intracranial tumor resection or neurovascular compression (NVC) as examples to verify the technical feasibility and efficacy of the mixed-reality NT system for residents' training and preoperative planning. This study prospectively enrolled 40 patients who suffered from trigeminal neuralgia, hemifacial spasms, or intracranial tumors. The authors used a series of software programs to process the multimodal imaging data, followed by uploading the holographic models online. They used a HoloLens or a standard iOS device to download and display the holographic models for training. Ten neurosurgical residents with different levels of surgical experience were trained with this mixed-reality NT system. Change in surgical strategy was recorded, and a questionnaire survey was conducted to evaluate the efficacy of the mixed-reality NT system. The system allows the trainer and trainee to view the mixed-reality model with either a HoloLens or an iPad/iPhone simultaneously online at different locations. Interactive manipulation and instant updates were able to be achieved during training. A clinical efficacy validation test was conducted. The surgeons changed their exploration strategy in 48.3% of the NVC cases. For residents with limited experience in surgery, the exploration strategy for 75.0% of all patients with NVC was changed after the residents were trained with the mixed-reality NT system. Of the 60 responses for intracranial tumors, the trainee changed the surgical posture in 19 (31.7%) cases. The change of the location (p = 0.0338) and size (p = 0.0056) of craniotomy are significantly related to the experience of the neurosurgeons. The mixed-reality NT system is available for local or real-time remote neurosurgical resident training. It may effectively help neurosurgeons in patient-specific training and planning of surgery for cases of NVC and intracranial tumor. The authors expect the system to have a broader application in neurosurgery in the near future.

Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience

Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P= 0.017) and attending neurosurgeon (P= 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P= 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P= 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P= 0.69). AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.

Binocular microscopes versus exoscopes: Experiences and performance in simulated otologic surgery.

Exoscopes represent a promising alternative to conventional binocular microscopes (OM) in otology offering potential advantages such as enhanced ergonomics and a more compact device design. While previous research has demonstrated the effectiveness of exoscopes in various surgical specialties, their objective assessment in the field of otology remains limited. Therefore, this investigation aims to assess task-based efficiency associated with exoscopes in the field of otology by use of simulated surgical models. A prospective cross-over study design was used to compare an OM to an exoscope in otolaryngology residents and medical students. Participants performed five tasks on 3D-printed ear models using both the exoscope and OM. Data collection included completion time, frequency of predefined errors, mental effort, and user experience. Subgroup analysis was performed based on level of experience. Fourteen students and fifteen residents participated. Participants completed four of five tasks faster with the OM and there was no difference in number of errors committed. When separated by surgical experience, residents performed four of five tasks faster using the OM while students completed one of five tasks faster with the OM. Students committed more errors with the exoscope for one task with no difference in errors for residents. There was no difference in perceived difficulty performing tasks with either visualization system. Exit survey results showed more favorable opinions of the OM among residents and more favorable opinions of the exoscope among students. The exoscope permits successful performance in simulated otologic tasks. Task performance and user experience between operative microscopes and exoscopes differ based on level of surgical experience. 2.

A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery

To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. Self-controlled cohort study. Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P= 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P= 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P= 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P= 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P= 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P= 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P= 0.005) decrease the following morning. This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. The authors have no proprietary or commercial interest in any materials discussed in this article.

Objective Evaluation of Laparoscopic Experience Based on Muscle Electromyography and Accelerometry Performing Circular Pattern Cutting Tasks: A Pilot Study.

Purpose.The aim of this work is to present a new physical laparoscopy simulator with an electromyography (EMG)/accelerometry-based muscle activity recording system, EvalLap EMG-ACC, and perform objective evaluation of laparoscopic skills based on the quantification of muscle activity of participants with different levels of laparoscopic experience. Methods. EMG and ACC signals were obtained from 14 participants (6 experts, 8 medical students) performing circular pattern cutting tasks using a laparoscopic box trainer with the Trigno (Delsys Inc, Natick, MA) portable wireless system of 16 wireless sensors. Sensors were placed on the proximal and distal muscles of the upper extremities. Seven evaluation metrics were proposed and compared between skilled and novice surgeons. Results. The proximal and distal arm muscles (trapezius, deltoids, biceps, and forearms) were most active while executing laparoscopic tasks. Laparoscopic experience was associated with differences in EMG amplitude (), muscle activity (), hand acceleration (), user movement (), and muscle fatigue. For the cutting task, the deltoid, bicep, forearm EMG amplitude, and user movement significantly differed between experience groups. Conclusion. This pilot study demonstrates that different muscle groups are preferentially activated during laparoscopic tasks depending on the level of surgical experience. Expert surgeons showed less muscle activity compared with novices. EvalLap EMG-ACC represents a promising means to distinguish surgeons with basic cutting skills from those who have not yet developed these skills.

8. Learning Curve of Wrist Level Tendon Repairs using a Novel Tendon Stapler Device vs. Traditional Suture Methods

Background: Tendon repairs in spaghetti wrists, wrist level replantation, or vascularized composite hand allotransplantations are time-consuming. Experience and skill greatly influence overall time in the operating room. A novel tendon stapler device (TSD) has the potential to mitigate these discrepancies among surgeons of varying levels of experience by enhancing the speed and consistency of primary tendon repairs. Methods: Participants of varying levels of surgical experience (novice, intermediate, expert) performed tendon repairs via suture method or TSD. Comparisons were performed on wrist level flexors and extensors from human cadaver arms. Suture repairs were performed using 3.0 braided polyester modified Kessler with horizontal mattress for a 4-strand repair. On matched, contralateral donor arms, TSD repairs were completed with a single simple 5.0 polypropylene stitch to approximate the tendon ends prior to device deployment. All repairs were timed by a non-participating data recorder. Learning curves were compared across repair types and surgeons with scatterplots fitted with Loess curves. Statistical analyses utilized one-way ANOVA, Tukey pairwise comparisons, two-sided independent samples t-test, and Fisher’s exact test. Results: A total of 228 tendon repairs from 12 donor arms were analyzed. Mean suture repair times were 3.25, 4.08, and 4.46 minutes for expert, intermediate, and novice, respectively with the expert being faster than the other two groups (p≤0.001). Mean TSD repair times were 1.32, 1.31, 1.28 minutes for expert, intermediate, and novice respectively, with no difference between groups. TSD repairs were significantly faster than suture repair (p<0.01). Suture repairs decreased to stable or “learned” level around repair #30, and then demonstrated small increases at the end of the session, suggesting user fatigue. TSD repairs showed faster, less variable time that stabilized around repair #23, consistent with a more efficient learning curve. Educational time required for both novice and intermediate groups to achieve competency was higher for the suture technique (106 and 54 minutes) than for the TSD (60 and 38 minutes). Conclusion: The TSD demonstrates tremendous potential for complex multi-tendon traumas by drastically reducing the learning curve, operative and warm ischemia times, overall cost, and surgeon variability based on experience and repair strength.

Automatic assessment of laparoscopic surgical skill competence based on motion metrics

The purpose of this study was to characterize the motion features of surgical devices associated with laparoscopic surgical competency and build an automatic skill-credential system in porcine cadaver organ simulation training. Participants performed tissue dissection around the aorta, dividing vascular pedicles after applying Hem-o-lok (tissue dissection task) and parenchymal closure of the kidney (suturing task). Movements of surgical devices were tracked by a motion capture (Mocap) system, and Mocap-metrics were compared according to the level of surgical experience (experts: ≥50 laparoscopic surgeries, intermediates: 10-49, novices: 0-9), using the Kruskal-Wallis test and principal component analysis (PCA). Three machine-learning algorithms: support vector machine (SVM), PCA-SVM, and gradient boosting decision tree (GBDT), were utilized for discrimination of the surgical experience level. The accuracy of each model was evaluated by nested and repeated k-fold cross-validation. A total of 32 experts, 18 intermediates, and 20 novices participated in the present study. PCA revealed that efficiency-related metrics (e.g., path length) significantly contributed to PC 1 in both tasks. Regarding PC 2, speed-related metrics (e.g., velocity, acceleration, jerk) of right-hand devices largely contributed to the tissue dissection task, while those of left-hand devices did in the suturing task. Regarding the three-group discrimination, in the tissue dissection task, the GBDT method was superior to the other methods (median accuracy: 68.6%). In the suturing task, SVM and PCA-SVM methods were superior to the GBDT method (57.4 and 58.4%, respectively). Regarding the two-group discrimination (experts vs. intermediates/novices), the GBDT method resulted in a median accuracy of 72.9% in the tissue dissection task, and, in the suturing task, the PCA-SVM method resulted in a median accuracy of 69.2%. Overall, the mocap-based credential system using machine-learning classifiers provides a correct judgment rate of around 70% (two-group discrimination). Together with motion analysis and wet-lab training, simulation training could be a practical method for objectively assessing the surgical competence of trainees.

Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance".

The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.

Feasibility and comparison of laparoscopic laser speckle contrast imaging to near-infrared display of indocyanine green in intraoperative tissue blood flow/tissue perfusion in preclinical porcine models.

To determine if laser speckle contrast imaging (LSCI) mitigates variations and subjectivity in the use and interpretation of indocyanine green (ICG) fluorescence in the current visualization paradigm of real-time intraoperative tissue blood flow/perfusion in clinically relevant scenarios. De novo laparoscopic imaging form-factor detecting real-time blood flow using LSCI and blood volume by near-infrared fluorescence (NIRF) of ICG was compared to ICG NIRF alone, for dye-less real-time visualization of tissue blood flow/perfusion. Experienced surgeons examined LSCI and ICG in segmentally devascularized intestine, partial gastrectomy, and the renal hilum across six porcine models. Precision and accuracy of identifying demarcating lines of ischemia/perfusion in tissues were determined in blinded subjects with varying levels of surgical experience. Unlike ICG, LSCI perfusion detection was real time (latency < 150ms: p < 0.01), repeatable and on-demand without fluorophore injection. Operating surgeons (n = 6) precisely and accurately identified concordant demarcating lines in white light, LSCI, and ICG modes immediately. Blinded subjects (n = 21) demonstrated similar spatial-temporal precision and accuracy with all three modes ≤ 2min after ICG injection, and discordance in ICG mode at ≥ 5min in devascularized small intestine (p < 0.0001) and in partial gastrectomy (p < 0.0001). Combining LSCI for near real-time blood flow detection with ICG fluorescence for blood volume detection significantly improves precision and accuracy of perfusion detection in tissue locations over time, in real time, and repeatably on-demand than ICG alone.

Overcoming Gender Bias in Assessment of Surgical Skills

Female and male surgical residents are treated differently based on their gender. The use of assessment tools can help obtain objectivity in surgical skills assessment, avoid gender bias, and promote equal learning opportunities. The objective of the study was to explore whether knowledge of gender causes bias in the rating of surgical skills, and whether the raters' gender, surgical specialty, or experience affect ratings. The study is designed as a cross-sectional study, where an anonymous video showing surgical performance was rated by surgeons from different surgical specialties and different levels of surgical experience. The same video was presented to two randomized groups as either a male or female surgical trainee performing the procedure. The participants used Objective Structured Assessment of Technical Skills (OSATS) to rate a video-recorded exam from a surgical skills course at Copenhagen Academy for Medical Education and Simulation (CAMES). The video rating was done through an internet-based platform and could thus be performed at home or at another location of choice. Novice and experienced surgeons from departments of gastrointestinal surgery, gynaecology, and urology in Denmark. There was no difference in OSATS rating score of the perceived female and male trainee (female trainee (n = 50):12.26 (SD = 3.08), male trainee (n = 57): 12.00 (SD = 3.28), p-value = 0.67). Rater characteristics: gender, age, surgical experience, and surgical specialty did not affect ratings. When OSATS a systematic assessment tool was used in rating surgical trainees we did not find any significant implicit gender bias. The rating was unaffected by the raters' gender, age, surgical specialty, or experience.

Intraoperative practices to prevent wrong-level spine surgery: a survey among 105 spine surgeons in the United Kingdom

BackgroundCurrent literature suggests that wrong-level spine surgery is relatively common with far-reaching consequences. This study aims to assess the current practices of spinal surgeons across the UK with respect to the techniques implemented for correct level verification.MethodsTo assess the current practices of spinal surgeons across the UK with respect to the techniques implemented for level verification. The authors hypothesise the absence of a standardised technique used across spine surgeons in the UK. Practices amongst respondents will be ascertained via an electronic questionnaire designed to evaluate current practices of spinal surgeons whom are members of the British Association of Spinal Surgeons (BASS). The study data will include key information such as; the level of surgical experience, specific techniques used to perform level checks for each procedure and prior involvement with wrong-level spine surgery. Responses were collected over the period of 1 month with a reminder sent 2 weeks prior to closure of the survey. The data were collated and descriptive analyses performed on multiple-choice question answers and common themes established from free text answers.ResultsA total of 27% (n = 105/383) members responded. The vast majority had greater than 10 years’ experience. Intraoperative practices varied greatly with varying practices present for cervical, thoracic and lumbar level surgery. Only 38% (n = 40) of respondents re-checked the level intra-operatively, prior to instrumentation. Of the respondents 47.5% (n = 29/61) of surgeons had been involved in wrong level spinal surgery.ConclusionThis study highlights the varying practices amongst spinal surgeons and suggests root cause for wrong-level spine surgery; where the level identified pre-incision was subsequently not the level exposed. We describe a novel safety-check adopted at our institute using concepts and lessons learnt from the WHO Checklist.

Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component.

BackgroundAchieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty.MethodsWe used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version.ResultsUsing either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA.ConclusionsEven in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.

Action-related eye measures to assess surgical expertise.

BackgroundEye-tracking offers a new list of performance measures for surgeons. Previous studies of eye-tracking have reported that action-related fixation is a good measuring tool for elite task performers. Other measures, including early eye engagement to target and early eye disengagement from the previous subtask, were also reported to distinguish between different expertise levels. These parameters were examined during laparoscopic surgery simulations in the present study, with a goal to identify the most useful measures for distinguishing surgical expertise.MethodsSurgical operators, including experienced surgeons (expert), residents (intermediate), and university students (novice), were required to perform a laparoscopic task involving reaching, grasping, and loading, while their eye movements and performance videos were recorded. Spatiotemporal features of eye–hand coordination and action-related fixation were calculated and compared among the groups.ResultsThe study included five experienced surgeons, seven residents, and 14 novices. Overall, experts performed tasks faster than novices. Examining eye–hand coordination on each subtask, it was found that experts managed to disengage their eyes earlier from the previous subtask, whereas novices disengaged their eyes from previous subtask with a significant delay. Early eye engagement to the current subtask was observed for all operators. There was no difference in action-related fixation between experienced surgeons and novices. Disengage time was strongly associated with the surgical experience score of the operators, better than both early-engage time and action-related fixation.ConclusionThe spatiotemporal features of surgeons’ eye–hand coordination can be used to assess level of surgical experience.

PD02-01 DEVELOPMENT AND VALIDATION OF AN OBJECTIVE SCORING TOOL TO EVALUATE SURGICAL DISSECTION: DISSECTION ASSESSMENT FOR ROBOTIC TECHNIQUE (DART)

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-01 DEVELOPMENT AND VALIDATION OF AN OBJECTIVE SCORING TOOL TO EVALUATE SURGICAL DISSECTION: DISSECTION ASSESSMENT FOR ROBOTIC TECHNIQUE (DART) Erik Vanstrum, Runzhuo Ma, Jacqueline Maya-Silva, Daniel I. Sanford, Jessica H. Nguyen, Alireza Ghoreifi, Xiaomeng Lei, Steven Cen, and Andrew J. Hung Erik VanstrumErik Vanstrum More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Jacqueline Maya-SilvaJacqueline Maya-Silva More articles by this author , Daniel I. SanfordDaniel I. Sanford More articles by this author , Jessica H. NguyenJessica H. Nguyen More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Xiaomeng LeiXiaomeng Lei More articles by this author , Steven CenSteven Cen More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a need for effective surgical competency assessment to ensure safe and efficient transfer of skills to training robotic surgeons. Additionally, competency assessment has important implications for credentialing and improving patient outcomes. This project aimed to develop an objective scoring tool that comprehensively evaluates surgical dissection quality. METHODS: The study was conducted in two phases. During phase 1, development, the Delphi method was used to validate content of Dissection Assessment for Robotic Technique (DART). A multi-institutional and multi-disciplinary (n=12 Urology, n=1 OBGYN, n=1 General Surgery) panel of expert surgeons systematically evaluated each element; those with content validity index (CVI) of ≥ 0.8 were included in the final product (Figure 1). During phase 2, validation, 10 blinded reviewers evaluated 46 de-identified videos of the pelvic lymph node and seminal vesicle dissection steps during robot-assisted radical prostatectomy. Inter-rater reliability was calculated using prevalence-adjusted and bias-adjusted kappa (PABAK). Expert and trainee surgeons were defined by prior robotic caseload >100 and ≤100, respectively. Mann-Whitney U test was used to compare between groups. RESULTS: In phase 1, Delphi method achieved content validity in 27/28 elements after 4 rounds. The element that did not reach consensus was use of a 3-point or 5-point scale (CVI=0.64). Most surgeons (93%) agreed that it is important to maximize agreement between raters. In phase 2, the 3-point scale showed greater inter-rater reliability for each domain as compared with the 5-point scale (PABAK≥0.52, ≥0.38, respectively). When rated on the 3-point scale, total scores between experts and trainees exhibited a significant difference (median 17.2 (IQR 16.9-17.4) vs. 15.7 (14.8-16.3), p<0.001). CONCLUSIONS: DART is an objective and reproducible 3-point surgical assessment that effectively differentiates between levels of surgical experience. Source of Funding: Research reported in this publication was supported in part by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number K23EB026493 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e37-e37 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erik Vanstrum More articles by this author Runzhuo Ma More articles by this author Jacqueline Maya-Silva More articles by this author Daniel I. Sanford More articles by this author Jessica H. Nguyen More articles by this author Alireza Ghoreifi More articles by this author Xiaomeng Lei More articles by this author Steven Cen More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement Loading ...

Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery-A Virtual Surgical Training Model.

The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon’s work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants’ professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient’s safety.

Study to Evaluate Stress Among Ophthalmic Surgeons with Different Levels of Surgical Experience.

AimTo assess and quantify the stress in two different groups of ophthalmic surgeons while performing cataract surgery.Materials and MethodsThis is a prospective observational institutional study. Healthy ophthalmic surgeons (4 trainee surgeons and 4 consultants) and 4 OT assistants without any history of systemic illness were studied while performing uncomplicated and uneventful cataract surgery. Resting state and post-operative (immediately after surgery) systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), and oxygen saturation (SPO2) were measured by a Comen C80 multi-parameter monitor. Blood cortisol levels were measured by chemiluminescent assay (CLIA) and urine catecholamines levels (adrenaline, nor-adrenaline and dopamine) were measured by high performance liquid chromatography (HPLC). For assessment of stress among one group, paired t-test is used and for comparison of stress levels between trainee surgeons and consultants unpaired t-test is used.ResultsConsultants performed phacoemulsification and trainee surgeons performed small incision cataract surgery. In both the groups, the post-operative values of SBP, DBP, PR, blood cortisol, and urine catecholamines were significantly higher than the pre-operative values. This difference was statistically significant. There was a significantly higher increase in SBP, DBP, PR, blood cortisol, urine adrenaline, and urine dopamine in trainee surgeons as compared to consultants whereas there was a significantly higher increase in urine nor-adrenaline in consultants as compared to trainee surgeons.ConclusionOur study reveals that every surgeon is under stress irrespective of experience though the level of stress is different among surgeons.