Objective Structured Assessment Of Technical Skills Scores Research Articles

Comparing the impact of three-dimensional digital visualization technology versus traditional microscopy on microsurgeons in microsurgery: a prospective self-controlled study.

Emerging three-dimensional digital visualization technology (DVT) provides more advantages than traditional microscopy in microsurgery; however, its impact on microsurgeons' visual and nervous systems and delicate microsurgery is still unclear, which hinders the wider implementation of DVT in digital visualization for microsurgery. Forty-two microsurgeons from the Zhongshan Ophthalmic Center were enrolled in this prospective self-controlled study. Each microsurgeon consecutively performed 30min conjunctival sutures using a three-dimensional digital display and a microscope, respectively. Visual function, autonomic nerve activity, and subjective symptoms were evaluated before and immediately after the operation. Visual functions, including accommodative lag, accommodative amplitude, near point of convergence and contrast sensitivity function (CSF), were measured by an expert optometrist. Heart rate variability was recorded by a wearable device for monitoring autonomic nervous activity. Subjective symptoms were evaluated by questionnaires. Microsurgical performance was assessed by the video-based Objective Structured Assessment of Technical Skill (OSATS) tool. Accommodative lag decreased from 0.63 (0.18) diopters (D) to 0.55 (0.16) D ( P =0.014), area under the log contrast sensitivity function increased from 1.49 (0.15) to 1.52 (0.14) ( P =0.037), and heart rate variability decreased from 36.00 (13.54) milliseconds (ms) to 32.26 (12.35) ms ( P =0.004) after using the DVT, but the changes showed no differences compared to traditional microscopy ( P >0.05). No statistical significance was observed for global OSATS scores between the two rounds of operations [mean difference, 0.05 (95% CI: -1.17 to 1.08) points; P =0.95]. Subjective symptoms were quite mild after using both techniques. The impact of DVT-based procedures on microsurgeons includes enhanced accommodation and sympathetic activity, but the changes and surgical performance are not significantly different from those of microscopy-based microsurgery. Our findings indicate that short-term use of DVT is reliable for microsurgery and the long-term effect of using DVT deserve more consideration.

SimLife®: A New Dynamic Model for Head and Neck Surgical Oncology Simulation.

The SimLife® model consists in a human cadaver dynamized by pulsatile vascularization. The objective was to evaluate the face, contents, and constructs validity of the SimLife® model in head and neck surgical oncology simulation. Head and neck surgical oncology simulation sessions on SimLife® models were organized with lateral neck dissection and total laryngectomy. Face and contents validity were addressed by questionnaires. Constructs validity was assessed by objective structured assessment of technical skills (OSATS) score. High realism was demonstrated for consistency of tissues (7.1 ± 1.4), color of arteriesand veins (7.3 ± 1.9, 8.5 ± 1.1, respectively), and vein consistency (8.5 ± 1.2). The mean OSATS score was 19.7 ± 5.4 for residents and 32.7 ± 1.9 for senior surgeon (P = .0022). SimLife® is a hyperrealistic model for head and neck surgical oncology simulation and it might become a core component of the surgical resident curriculum.

Inanimate 3D printed model for thoracoscopic repair of esophageal atresia with tracheoesophageal fistula.

Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator. By using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency. A total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the "flow of task" (p = 0.018) and scores for the "overall MIS skills" (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002). Our study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.

A comparison between augmented reality and traditional in-person teaching for vascular anastomotic surgical skills training

BackgroundAugmented reality (AR) superimposes computer-generated content to a real-world environment through multitudinous devices, and is used across multiple training fora. Its use in vascular surgery education is yet to be formally investigated. The aim is to assess feasibility and effectiveness of remote teaching of vascular anastomosis skills enhanced by AR in the form of the HoloLens2 Head-Mounted Display technology with traditional in-person skills teaching. A remote trainer used video, gestures and images superimposed over participants' field of vision via the HoloLens2 to teach the skills. MethodsTwenty-eight participants underwent a preassessment performing an end-to-end vascular anastomosis on an artificial vessel. They were allocated randomly to an AR or in-person group, and underwent two teaching sessions. Individuals were asked to complete a postsession feedback form and assessment (video recorded and anonymized). The videos were marked by two blinded, independent assessors using the Objective Structured Assessment of Technical Skills (OSATS) scoring. ResultsThere was an overall improvement in both cohorts in OSATS score after the intervention by +7.083 in the in-person group and +8.275 in the AR. Independent t test was performed and a P value of .422 was obtained, indicating no statistically significant difference in the change in OSATS scores when comparing the skills teaching received in-person with that through AR. ConclusionsRemote teaching enhanced by AR is feasible and effective for the teaching of vascular surgical anastomosis skills and noninferior to in-person teaching. There is scope for development of the use of AR in vascular surgical skills training.

Feedback Versus Compliments Versus Both in Suturing and Knot Tying Simulation: A Randomized Controlled Trial

IntroductionSuturing is an expected skill for students graduating from health professions programs. Previous studies investigated student experience with teaching sessions utilizing constructive feedback versus compliments but did not investigate the combination of both. MethodsIn this parallel, randomized controlled trial, participants were divided into three groups: feedback (F), compliments (C), or feedback and compliments (FC). Participants received standardized instruction on simple interrupted suturing and two-handed knot-tying, and were videotaped performing this skill before and after the intervention. Performance was evaluated using a validated Objective Structured Assessment of Technical Skills (OSATS) instrument. Participants completed a preintervention and postintervention survey rating their task enjoyment and self-assessment of performance. Analysis was performed to determine differences between and within the groups using Kruskal–Wallis, Wilcoxon rank-sum, and Mann–Whitney U tests. ResultsA total of 31 students participated: 11 in C, 10 in F, and 10 in FC. The groups had similar preintervention OSATS scores. The F and FC groups demonstrated significant improvement in OSATS score after intervention, group C was not significantly different: F median of 11.25-19.75 points (P = 0.002); FC median of 11.75-21 points (P = 0.002); C median of 13-14 points (P = 0.2266). Between the groups FC and F both had significant performance improvement compared with C (P < 0.001 and P = 0.001 respectively). The FC group had a significantly higher rating of their enjoyment of the task on the postintervention survey compared with both the C and F groups with a median rating of 10 compared with 8 and 8 (P = 0.0052 and P = 0.0126, respectively). ConclusionsThe combination of feedback and compliments was associated with improvement in performance on suturing and knot-tying similar to the feedback-only group. The FC group rated a higher level of enjoyment of the activity compared to feedback or compliments alone.

Comparison of practice vs theory model training for vacuum-assisted delivery: A randomized controlled trial

ObjectiveTo assess the effect of two modalities of simulation training on acquisition/retention of skills for performing operative vaginal delivery. DesignRandomized, controlled, single-centre study. SettingA tertiary referral hospital in Italy. ParticipantsTwenty residents from a single university programme and two young specialists. InterventionGroup 1 had an individual training session with a single senior specialist using a fixed simulator model. After the session, trainees watched a pre-recorded 1-h lecture on vacuum-assisted operative vaginal delivery. Group 1 repeated the simulator session using the same test after 8–12 weeks and 12 months. Group 2 watched the pre-recorded lecture then undertook the same sessions as Group 1. Video recordings of all test performances were evaluated by five specialists in a blinded manner. Main outcome measureEach procedure was evaluated using a Global Rating Scale (GRS), scored with 0–5 points for each item on an Objective Structured Assessment of Technical Skills (OSATS) dataset with seven items (total 35 points). OSATS were evaluated over time, compared for the whole population, and weighted for route and year of residency. The primary outcome was comparison of the effectiveness of training between the two groups based on year of residency by assessing videos of the baseline test and GRS for OSATS scores. The secondary outcome was overall retention of skills at 8–12 weeks and 12 months. ResultsTwenty-two participants were recruited and randomized to either Group 1 (n = 11) or Group 2 (n = 11). Five participants did not complete follow-up. The primary outcome of GRS for OSATS scores at time 0 differed significantly between groups for total GRS score, and ‘Call for help’ and ‘Explanation to woman and relatives’ item scores (p = 0.002 and p = 0.007, respectively). In a multiple linear regression analysis, OSATS scores were not independently influenced by year of residency. At 8–12-week follow-up, the ‘Call for help’ item score showed a significant improvement in Group 1 (p = 0.018), although this was not confirmed when year of residency was included as an independent variable. At 12-month follow-up, none of the item scores demonstrated a significant change (p = 0.033). Year of residency did not influence the difference between groups. One-way analysis of variance found significant differences between the groups for ‘Localization of the flexion point’ (p = 0.005), ‘Traction of vacuum cup’ (p = 0.039) and ‘Use of second hand of the operator’ (p = 0.009) item scores and total GRS score (p = 0.007). The values weighted by year of residency did not demonstrate any significant difference. The secondary outcomes evaluated all the candidates of both groups for retention of technical skills over time. A significant effect of time was found for total GRS score (p < 0.001) and OSATS item scores. ConclusionsIndependent of the sequence of theoretical teaching and simulation training, trainees demonstrated high retention – and, actually, improvement – of technical skills for operative vaginal delivery at 12-month follow-up.

Preoperative Preparatory Talk (PPT): Developing Operative Expertise of Plastic Surgery Trainees by Three Rounds of Preceptor-Trainee Discussions.

Background Plastic surgery training requires the trainee to assist in surgeries to improve their on-table decision making and hone their surgical skills, but this results in an increased risk of intraoperative complications and increased operative time. It is important to have a training method that orients the trainee toward the surgery to ensure patient safety. Materials and Methods A training method called preoperative preparatory talk (PPT) was devised in which the preceptor orients the trainee toward the planned surgery in three phases. Comparison and statistical analysis of mean operative times of four stages of free flap surgeries after PPT and without PPT were done. Objective Structured Assessment of Technical Skill (OSATS) scores of surgical trainees were also documented for surgeries done with and without PPT and statistical analysis was done for comparing these scores. Results Statistical analysis via unpaired t -test confirmed that after applying PPT, there was a significant decrease in time taken in three out of four stages of free flap surgeries: flap planning and harvesting, recipient site preparation and vessel dissection, and flap division and partial inset. Trainees were found to be better oriented toward the surgery which resulted in a better performance on table that was confirmed by statistical analysis of OSATS score via unpaired t -test. Conclusion PPT ensures better learning for the resident and improves patient safety because of better orientation of the operating team toward the procedure and operating steps. This reduces the operative time of free flap surgeries. We recommend this training method to be incorporated in plastic surgery training programs.

SP11.8 Deep learning for performance assessment of laparoscopic sleeve gastrectomy (LSG): validation against objective structured assessment of technical skills (OSATS) and clinical outcomes

Abstract Background Current methods of surgeon performance assessment are unstructured, labour-intensive and subjective. Machine learning could provide rapid, automated and subjective assessment. We design a custom deep learning model to output performance metrics from videos of LSG and validate these against OSATS and clinical outcomes. Methods A novel dataset of 3210 images from videos of LSG was annotated to train an instrument segmentation framework based on Mask R-CNN, a state-of-the-art deep learning algorithm. Spatial outputs of detected instruments were used to determine workflow through a Markov chain and secondly to determine instrument metrics for assessment of surgical performance. Metrics including time spent in stage and instrument time, distance, smoothness, concentration, and efficiency were then validated against OSATS ratings from 2 independent scorers and clinical outcomes from 35 LSGs. Results Grasper and ligasure efficiency and smoothness were higher in videos rated within the top quartile by OSATS score when compared to those in the bottom quartile and when comparing consultants to trainees. Videos in the top quartile for grasper smoothness had higher total OSATS scores (17.31±2.27) compared to those in the lowest quartile (15.69±2.93) and across all 5 individual OSATS domains in addition to higher percentage of total weight loss at 3, 6, and 12 months. Conclusions This study demonstrates how vision based deep learning can be used for surgeon performance assessment. Future work will aim to validate this against a large number of videos, expand upon the range of metrics produced, and look towards the steps needed for clinical translation.

Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score

BackgroundNeurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). MethodsNovice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model – identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. ResultsFifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10–19) for novices and 22/25 (IQR 20–22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7–17) for novices compared to 19/20 (IQR 18.5–19.5) for experts (p < 0.05). ConclusionThe RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.

Mental workload during endoscopic sinus surgery is associated with surgeons' skill levels.

Surgeons' mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient's anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models. Forty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons' mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training. The total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons' mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = -2.3664, p = 0.0091, effort; z = -2.1704, p = 0.0346, and performance; z = -2.5992, p = 0.0017), the independent factors were increased (mental demand; z = -2.5992, p = 0.0023 and physical demand; z = -2.2509, p = 0.0213), and frustration did not change (p = 0.3625). Some of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars' mental burdens would be necessary during surgical training to sustain their mental health.

Developing an Objective Structured Assessment of Technical Skills (OSATS) for Microlaryngoscopy.

Microlaryngoscopy is a basic technical skill in Oto-HNS. It is essential for residency programs to have a competency-based assessment tool to evaluate residents' performance of this procedure. An Objective Structured Assessment of Technical Skills (OSATS) is a procedure-specific assessment, which consists of the following: (a) Operation-Specific Checklist and (b) Global Rating Scale (GRS). The objective of this study was to create an OSATS for adult microlaryngoscopy. This was a prospective study, with an initial qualitative phase for OSATS development (Phase I), and a clinical pilot phase (Phase II). In Phase I, interviews were conducted with three laryngologists to establish a stepwise description of adult microlaryngoscopy and review a previously validated GRS for relevance to microlaryngoscopy. Responses were used to create a framework for the OSATS. The OSATS was then presented to Oto-HNS residents and laryngologists in an alternating fashion, for review of clarity and relevance. A pilot study was then performed to evaluate the resident performance of adult microlaryngoscopy. Multiple regression analysis was carried out to investigate whether training level, case complexity, and previous OSATS exposure could predict participant scores. Phase I of this study led to the creation of a 34-item OSATS. The pilot study (N=28 procedures) revealed that training level was significantly correlated with increased OSATS scores. There was no statistically significant correlation between case complexity and resident scores. Assessors reported the perceived utility of the OSATS and intent for use in residency training. Application of the proposed OSATS will allow for competency-based assessment of the resident performance of microlaryngoscopy. NA Laryngoscope, 133:2719-2724, 2023.

Development and evaluation of a portable and soft 3D-printed cast for laparoscopic choledochojejunostomy model in surgical training

BackgroundLaparoscopic choledochojejunostomy (LCJ) is an essential basic skill for biliary surgeons. Therefore, we established a convenient and effective LCJ 3D printing model to evaluate whether the model could simulate the actual operation situation and determine its effectiveness and validity in surgical training.MethodsA 3D printing dry laboratory model was established to simulate LCJ. The face and content validity of the model were evaluated by six experienced biliary surgeons based on 5-point Likert scale questionnaires. A total of 15 surgeons with different levels of experience performed LCJ on the model and evaluated the structural validity of the model using the objective structured assessment of technical skills (OSATS). Simultaneously, the operation time of each surgery was also recorded. A study was also performed to further evaluate the learning curve of residents.ResultsThe operating space score of the model was 4.83 ± 0.41 points. The impression score of bile duct and intestinal canal was 4.33 ± 0.52 and 4.17 ± 0.41 points, respectively. The tactile sensation score of bile duct suture and intestinal canal suture was 4.00 ± 0.63 and 3.83 ± 0.41points, respectively. The OSATS score for model operation in the attending group was 29.20 ± 0.45 points, which was significantly higher than that in the fellow group (26.80 ± 1.10, P = 0.007) and the resident group (19.80 ± 1.30, P < 0.001). In addition, there was a statistical difference in operation time among surgeons of different experience levels (P < 0.05). Residents could significantly improve the surgical score and shorten the time of LCJ through repeated training.ConclusionsThe 3D printing LCJ model can simulate the real operation scenes and distinguish surgeons with different levels of experience. The model is expected to be one of the training methods for biliary tract surgery in the future.

Deep neural network architecture for automated soft surgical skills evaluation using objective structured assessment of technical skills criteria.

Classic methods of surgery skills evaluation tend to classify the surgeon performance in multi-categorical discrete classes. If this classification scheme has proven to be effective, it does not provide in-between evaluation levels. If these intermediate scoring levels were available, they would provide more accurate evaluation of the surgeon trainee. We propose a novel approach to assess surgery skills on a continuous scale ranging from 1 to 5. We show that the proposed approach is flexible enough to be used either for scores of global performance or several sub-scores based on a surgical criteria set called Objective Structured Assessment of Technical Skills (OSATS). We established a combined CNN+BiLSTM architecture to take advantage of both temporal and spatial features of kinematic data. Our experimental validation relies on real-world data obtained from JIGSAWS database. The surgeons are evaluated on three tasks: Knot-Tying, Needle-Passing and Suturing. The proposed framework of neural networks takes as inputs a sequence of 76 kinematic variables and produces an output float score ranging from 1 to 5, reflecting the quality of the performed surgical task. Our proposed model achieves high-quality OSATS scores predictions with means of Spearman correlation coefficients between the predicted outputs and the ground-truth outputs of 0.82, 0.60 and 0.65 for Knot-Tying, Needle-Passing and Suturing, respectively. To our knowledge, we are the first to achieve this regression performance using the OSATS criteria and the JIGSAWS kinematic data. An effective deep learning tool was created for the purpose of surgical skills assessment. It was shown that our method could be a promising surgical skills evaluation tool for surgical training programs.

Video Grading of Pancreatic Anastomoses During Robotic Pancreatoduodenectomy to Assess Both Learning Curve and the Risk of Pancreatic Fistula: A Post Hoc Analysis of the LAELAPS-3 Training Program.

To assess the learning curve of pancreaticojejunostomy during robotic pancreatoduodenectomy (RPD) and to predict the risk of postoperative pancreatic fistula (POPF) by using the objective structured assessment of technical skills (OSATS), taking the fistula risk into account. RPD is a challenging procedure that requires extensive training and confirmation of adequate surgical performance. Video grading, modified for RPD, of the pancreatic anastomosis could assess the learning curve of RPD and predict the risk of POPF. Post hoc assessment of patients prospectively included in 4 Dutch centers in a nationwide LAELAPS-3 training program for RPD. Video grading of the pancreaticojejunostomy was performed by 2 graders using OSATS (attainable score: 12-60). The main outcomes were the combined OSATS of the 2 graders and POPF (grade B/C). Cumulative sum analyzed a turning point in the learning curve for surgical skill. Logistic regression determined the cutoff for OSATS. Patients were categorized for POPF risk (ie, low, intermediate, and high) based on the updated alternative fistula risk scores. Videos from 153 pancreatic anastomoses were included. Median OSATS score was 48 (interquartile range: 41-52) points and with a turning point at 33 procedures. POPF occurred in 39 patients (25.5%). An OSATS score below 49, present in 77 patients (50.3%), was associated with an increased risk of POPF (odds ratio: 4.01, P =0.004). The POPF rate was 43.6% with OSATS < 49 versus 15.8% with OSATS ≥49. The updated alternative fistula risk scores category "soft pancreatic texture" was the second strongest prognostic factor of POPF (odds ratio: 3.37, P =0.040). Median cumulative surgical experience was 17 years (interquartile range: 8-21). Video grading of the pancreatic anastomosis in RPD using OSATS identified a learning curve and a reduced risk of POPF in case of better surgical performance. Video grading may provide a valid method to surgical training, quality control, and improvement.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

ObjectiveTo correlate the utility of the Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance. MethodsThe Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates’ basic laparoscopic skills were assessed using three different training models (peg transfer, precision cutting, and intra-corporeal suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale. ResultsFrom March 2016 to March 2019, a total of 81 certified urologists participated in the course, with a median of 5 years of post-residency experience. Although differences in task time did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (peg transfer time: r=−0.331, r2=0.110; precision cutting time: r=−0.240, r2=0.058; suturing with intra-corporeal knot time: r=−0.451, r2=0.203). ConclusionFLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although the FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS, respectively.

5G-Assisted Remote Guidance in Laparoscopic Simulation Training Based on 3D Printed Dry Lab Models.

This is a pilot study to assess the utility of applying 5G-assisted remote guidance in laparoscopic simulation training. A single trainee of a junior surgeon was recruited to complete three steps of tasks including basic task 1, basic task 2, and model task, and the performance was recorded and evaluated. The operator completed each task three times. Except for basic task 1, all tasks were remotely guided by a more experienced surgeon using 5G technology. Tasks completion time and a 30-point objective structured assessment of technical skills (OSATS) score were utilized to assess the results of simulation training. All remote guidance processes were successfully completed without significant network latency. Through basic task 1, the operator quickly became familiar with the trained laparoscopic instruments. For basic task 2, OSATS scores increased from 16 to 24 points, and completion time decreased from 1500 to 986 s after training under 5G-assisted remote guidance. For model tasks, OSATS scores increased from 15 to 26 points, and completion time decreased from 1734 to 1142 s. This is a novel mode of laparoscopic simulation training to increase the convenience of training. Perhaps in the near future, surgeons can simulate difficult operations at home or in the office, and accurately grasp the possible situations that may occur in actual operations in advance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12262-022-03590-2.

Robotic Hernia Curriculum Improves Resident Performance on Inguinal and Ventral Hernias

INTRODUCTION: Hernia repairs are one of the most common procedures performed in general surgery. The widespread incorporation of the robotic approach in this procedure warrants the presence of a proficiency-based curriculum to assist novice surgeons in credentialing and safe implementation. This study evaluates the construct validity of a robotic hernia curriculum in a cohort of general surgery residents. METHODS: PGY3 general surgery residents were asked to complete four inguinal hernia (IHR) and four ventral hernia (VHR) drills. These were graded according to the modified objective structured assessment of technical skills (OSATS) by two independent blinded graders in addition to drill time. The hernia drills were completed by three attending surgeons establishing gold standard benchmarks. RESULTS: 20 residents started the curriculum, 19 completed all IHR and 17 completed all VHR. Attending total OSATS scores and times were significantly better than those of the trainees on first attempt (p < 0.05). When comparing the 4th to the 1st attempts for residents, OSATS scores improved significantly for IHR (15.5 vs 23.3, p < 0.001) and VHR (16.8 vs 23.3, p<0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 mins, p < 0.001 and VHR: 29.6 vs 21.2 mins, p < 0.001). Residents were able to achieve attending scores by their fourth attempt for VHR, but not for the IHR (Fig. 1). Residents were not able to achieve attending times for either hernia drill after four attempts.Figure 1CONCLUSION: The robotic hernia curriculum improves resident performance. More procedure specific curricula are needed to better prepare trainees for the operating room.

The "chicken-leg anastomosis": Low-cost tissue-realistic simulation model for esophageal atresia training in pediatric surgery.

IntroductionShifting the training from the operating room (OR) to simulation models has been proven effective in enhancing patient safety and reducing the learning time to achieve competency and increase the operative efficiency. Currently the field of pediatric surgery only offers few low-cost trainers for specialized training and these feature predominantly artificial and often unrealistic tissue. The aim of this study was to develop an easy access low-cost tissue-realistic simulation model for open training of esophageal atresia and to evaluate the acceptance in trainees and junior pediatric surgeons.Materials and methodsThe model is fashioned using reconfigured chicken skin from a chicken leg. To create a model of esophageal atresia, the chicken skin is dissected off the muscle and reconfigured around a foley catheter balloon to recreate the proximal pouch and a feeding tube to recreate the distal pouch. Surrounding structures such as the tracheo-esophageal fistula and the azygos vein can be easily added, obtaining a realistic esophageal atresia (Type C) prototype. Evaluation of model construction, usage and impact on user were performed by both a self-assessment questionnaire with pre- and post-training questions as well as observer-based variables and a revised Objective Structured Assessment of Technical Skills (OSATS) score.ResultsA total of 10 participants were constructing and using the model at two different timepoints. OSATS score for overall performance was significantly higher (p = 0.005, z = −2.78) during the second observational period [median (MD): 4,95% confidence interval CI: 3.4, 5.1] compared to the first (MD: 3, 95% CI 2.4, 4.1). Self-reported boost in confidence after model usage for performing future esophageal atresia (EA) repair and bowel anastomosis (BA) in general was significantly higher (EA: U = 1, z = −2.3, p = 0.021, BA: U = 1, z = −2.41, p = 0.016) in participants with more years in training/attending status (EA MD:5, BA MD: 5.5) compared to less experienced participants (EA MD: 1.5, BA: 1).ConclusionOur easy access low-cost simulation model represents a feasible and tissue realistic training option to increase surgical performance of pediatric surgical trainees outside the OR.

1006 Supersized-Simulation vs Traditional Cardiothoracic Surgery Education: A Prospective, Randomised Controlled Trial

Abstract Aim Exposure to cardiothoracic surgery is limited during medical school in the United Kingdom. This study evaluated the effectiveness of a supersized simulation model (SSM) compared to traditional methods (TM) in developing coronary anastomosis surgical skills. Method This was a prospective, randomised controlled trial with a 1:1 allocation ratio. Undergraduate medical students with no prior cardiothoracic surgical skills training were eligible for inclusion. Both groups received a guided didactic lecture followed by modified Objective Structured Assessment of Technical Skills (OSATS) assessment for baseline. The control group then received traditional teaching and the intervention group received additional teaching with SSM before being reassessed. Modified OSATS score were the primary outcome, adjudicated by two senior cardiothoracic registrars. Performance time (PT), self-assessment (SA), confidence (CON) and global rating scale (GRS) were secondary outcomes. Results 48 novice medical students were randomised. OSATS scores were significantly higher in SSM group compared to TM group (13.2 vs 9.8, p&amp;lt;0.01). The secondary outcomes PT (17.7 minutes vs 22.2 minutes, p&amp;lt;0.01) and CON (3.04 vs 1.73, p&amp;lt;0.01) were also significantly different between groups, favouring SSM. SSM participants were more likely to want to pursue a career in cardiothoracic surgery (12 participants vs 2 participants). All participants agreed that SSM improved visualisation and comprehension of surgical procedure. SSM cost £0.75 per model. Conclusions Supersized simulation is effective for coronary anastomosis surgical training with technical skills successfully transferred to a clinical task. Supersized models can accelerate the novice trainee's surgical skill progression and represents a valuable resource in one's educational armamentarium.

A Validated 3D Printed Laryngeal Suturing Simulator for Endoscopic Laryngeal Cleft Repair.

Endoscopic laryngeal cleft repair (ELCR) with endolaryngeal suturing is an advanced surgical skill. This study objective was to assess the validity of 3-dimensionally (3D) printed laryngeal suturing simulator for ELCR. Development and validation of a simulator for ELCR. An ELCR model was developed using 3D printed and readily available materials. Participants were surveyed before and after a simulation session using five-point Likert scale questions. Performance data was assessed using blinded expert video review and rated using a novel objective structured assessment of technical skills (OSATS) for endoscopic laryngeal suturing. Twenty-one participants ranging from residents to attendings completed the simulation session. Survey respondents reported on a five-point Likert scale that the model was "easy to use" and "quite realistic" (both mean of 4). Confidence improved significantly in 86% of participants (p < 0.01). Overall OSATS scores (out of a total of 55) showed a median improvement in technical skills of 11.7 points (p=0.004). OSATS demonstrated good intra-rater (κ=0.689 and 0.677) and moderate inter-rater (κ=0.573) reliability. Completion times improved from the first to the last suture by a median time of 512 to 350 s (decrease of 202 s, p=0.002). Participants with no prior ELCR experience improved more than those with in vivo experience. This study demonstrates the validity of a simulator utilizing 3D printed larynges for ELCR. A novel OSATS for endoscopic laryngeal suturing was successfully implemented. Confidence, technical skills, and completion times improved with the use of the model across a variety of participants. Laryngoscope, 133:785-791, 2023.