Surgical Simulation Training Research Articles

Development and evaluation of a high-fidelity canine laparoscopic ovariectomy model for surgical simulation training and testing.

OBJECTIVE To develop and evaluate a high-fidelity simulated laparoscopic ovariectomy (SLO) model for surgical training and testing. DESIGN Evaluation study. SAMPLE 15 veterinary students (novice group), 5 veterinary surgical interns or residents (intermediate group), and 6 veterinary surgeons (experienced group). PROCEDURES Laparoscopic surgery experience was assessed by questionnaire and visual analog scales. Basic laparoscopic skills were assessed with a commercial training model. A commercial canine abdomen model was customized with a high-fidelity simulated canine female genital tract. Each subject's SLO performance (laparoscopic entry, dissection along marked planes, and left ovariectomy) was evaluated by measurement of surgical time and errors (splenic puncture and deviation from dissection marks) and with global and operative component rating scales. Construct and concurrent validity were assessed by correlation of SLO results with self-estimated measures of experience level and with basic laparoscopic skills test results, respectively. Face validity was assessed with a questionnaire completed by intermediate and experienced group participants. RESULTS 13 participants (3/15, 5/5, and 5/6 in the novice, intermediate, and experienced groups, respectively) completed SLO within the preset time. No difference in errors was found among groups. Completion time was significantly correlated with self-estimated experience level (r = -0.626), confirming construct validity, and with basic laparoscopic skills scores (r = -0.552) and global (r = -0.624) and operative component (r = -0.624) rating scale scores, confirming concurrent validity. Overall mean face validity score was low (64.2/100); usefulness of the model for surgical training received the highest score (8/10). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested the SLO model may be a useful surgical training tool. Further studies are needed to confirm usefulness of the model in veterinary laparoscopy training.

The Efficacy of Immersive Virtual Reality Surgical Simulator Training for Pedicle Screw Placement: A Randomized Double-Blind Controlled Trial

To assess efficacy of immersive virtual reality (VR) surgical simulator training for pedicle screw placement (PSP) in surgical graduate students. Sixteen inexperienced surgical graduate students were equally randomly assigned to an experimental group (VR group) and a control group (non-VR group). Students in the VR group performed PSP on the immersive VR surgical simulator, and students in the non-VR group were given a traditional introductory teaching session before a cadaver test. Eight adult fresh cadavers, 6 male and 2 female, were collected and randomly allocated to the 2 groups. Each group performed bilateral T11-L4 PSP on the cadavers independently, and the outcomes of PSP in terms of accuracy, success rate, and efficiency were assessed by computed tomography and compared between the 2 groups statistically. Accuracy rate of PSP in the VR group was 89.6% versus 60.4% in the non-VR group (P < 0.05), success rate was 100% versus 79.2% (P < 0.05), and mean time was 2.8 ± 1 minutes versus 4.9 ± 1 minutes (P < 0.05), all showing significant differences between the 2 groups. The immersive VR surgical simulator for PSP training model is superior to the traditional training model in terms of accuracy, success rate, and efficiency, showing potential in training new orthopedic spine surgeons.

Simulation-based training in maxillofacial surgery: are we going to be left behind?

Simulation is an important way both to optimise a trainee’s learning time and reduce morbidity and operating time for patients. We have reviewed the current use of simulation in training for maxillofacial surgery, and provide an overview of areas of practice where it may be useful. A web-based survey of trainees’ opinions of it was made in February 2018, and disseminated using the Junior and Fellows in Training group mailing lists. We also reviewed popular current simulation courses that are available. A total of 45 of the 57 trainees who replied agreed that simulation-based training would be beneficial in maxillofacial surgery, particularly with regard to maxillofacial surgical emergencies. A total of 54 of the 57 also agreed that simulation-based training would be a useful adjunct to their clinical training. However, most of the simulation-based courses available were priced beyond the budgets available to UK-based trainees for study, although funding changed in April 2018. While other surgical disciplines have adopted simulated clinical teaching and its benefits, maxillofacial surgery has limited the use of all types of formal simulation. Surgical simulation training is increasingly being used to complement the traditional surgical apprenticeship in other specialties, and ours needs to consider ways in which we can use it, given that trainees within the specialty think that it would be useful. Other specialties have shown that there is good transfer of skills from simulation to the actual clinical operating environment, and this increases satisfaction, decreases morbidity, and reduces the time required for intraoperative teaching.

The Role of Mixed Reality Simulation for Surgical Training in Spine: Phase 1 Validation.

This study shows the first phase of validation of a new model for realistic training on spine surgery, conducted from January 2014 to November 2015. To propose and validate a new tool for neurosurgical education, associating virtual and realistic simulation (mixed reality), for spine surgery. Surgical simulation is a relatively new filed that has a lot to offer to neurosurgical education. Training a new surgeon may take years of hands-on procedures, increasing the risk to patient's safety. The development of surgical simulation platforms is therefore essential to reducing the risk of potentially serious risks and improving outcome. Sixteen experienced spinal surgeons evaluated these simulators and answered the questionnaire regarding the simulation as a beneficial education tool. They evaluated the simulators in regard to dissection by planes, identification of pathology (lumbar canal stenosis), instrumentation and simulation of cerebrospinal fluid (CSF) leak, and the relevant aspects of the computerized tomography (CT) imaging. The virtual and physical simulators for spine surgery were approved by an expert surgery team, and considered adequate for educational purposes. The proportion of the answers was estimated by the confidence intervals. The surgery team considered that this virtual simulation provides a highly effective training environment, and it significantly enhances teaching of surgical anatomy and operative strategies in the neurosurgical field. A mixture of physical and virtual simulation provided the desired results of enhancing the requisite psychomotor and cognitive skills, previously acquired only during a surgical apprenticeship. The combination of these tools may potentially improve and abbreviate the learning curve for trainees, in a safe environment. 3.

Transapical NeoChord mitral valve repair.

Transapical off-pump mitral valve repair (MVr) with NeoChord implantation has become widely applied in Europe for patients presenting with severe mitral regurgitation due to leaflet prolapse or flail. The procedure is performed under real-time 2D- and 3D-transesophageal echocardiography (TEE) for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery. Preoperative anatomic and echocardiographic selection criteria, procedure refinement, as well as innovative ex-vivo surgical simulator training have been developed and strategically employed in the past few years, to generate a robust precision-based procedural framework with significantly enhanced operator use, patient safety and clinical outcomes. The procedure has evolved into a reproducibly successful and safe approach, which complements existing surgical treatment strategies available to eligible patients with chronic severe degenerative mitral regurgitation.

Development of a technical checklist for the assessment of suturing in robotic surgery.

With the increased use of simulation for surgical training, there is a need for objective forms of assessment to evaluate trainees. The Global Evaluative Assessment of Robotic Skills (GEARS) is widely used for assessing skills in robotic surgery, but there are no recognised checklist scoring systems. This study aimed to develop a checklist for suturing in robotic surgery. A suturing checklist for needle driving and knot tying was constructed following evaluation of participants performing urethrovesical anastomoses. Key procedural steps were identified from expert videos, while assessing novice videos allowed identification of common technical errors. 22 novice and 13 expert videos were marked on needle driving, while 18 novices and 10 experts were assessed on knot tying. Validation of the finalised checklist was performed with the assessment of 39 separate novices by an expert surgeon and compared to GEARS scoring. The internal consistency of the preliminary checklist was high (Cronbach's alpha = 0.870 for needle driving items; 0.736 for knot tying items), and after removal of poorly correlating items, the final checklist contained 23 steps. Both the needle driving and knot tying categories discriminated between novices and experts, p < 0.005. While the GEARS score demonstrated construct validity for needle driving, it could not significantly differentiate between novices and experts for knot tying, p = 0.286. The needle driving category significantly correlated with the corresponding GEARS scores (rs = 0.613, p < 0.005), but the correlation for knot tying was insignificant (rs = 0.296, p = 0.127). The pilot data indicates the checklist significantly correlated with the GEARS score (p < 0.005). This study reports the development of a valid assessment tool for suturing in robotic surgery. Given that checklists are simple to use, there is significant scope for this checklist to be used in surgical training.

A Network-Based Virtual Reality Simulation Training Approach for Orthopedic Surgery

The focus of this article is on the adoption of immersive and haptic simulators for training of medical residents in a surgical process called Less Invasive Stabilization System (LISS) plating surgery . LISS surgery is an orthopedic surgical procedure to treat fractures of the femur bone. Development of such simulators is a complex task which involves multiple systems, technologies, and human experts. Emerging Next Generation Internet technologies were used to develop the standalone on-line haptic-based simulator accessible to the students 24/7. A standalone immersive surgical simulator was also developed using HTC Vive. Expert surgeons played an important role in developing the simulator system; use cases of the target surgical processes were built using a modeling language called the engineering Enterprise Modeling Language (eEML) . A detailed study presenting the comparison between the haptic-based simulator and the immersive simulator has been also presented. The outcomes of this study underscore the potential of using such simulators in surgical training.

Virtual-reality Cataract Surgery Simulator Using Haptic Sensory Substitution in Continuous Circular Capsulorhexis.

Cataract is one of the most common geriatric diseases, and surgery is known to be the best treatment. Despite the increasing demand for cataract surgery, the opportunity for novice residents to practice cataract surgery is gradually diminishing as the patient and animal ethics become strict. Therefore, there have been many attempts to overcome the lack of experience by using virtual reality training system. So far, most of the surgical training simulation devices so far focused on visual training, and when they have a haptic sense, they are tethered to a fixed station, which is different from the feeling of moving the actual surgical tool. In this study, we have developed a haptic surgical training tool with sensory substitution and virtual-reality-based cataract surgery simulator. To assess and reproduce the tactile senses during surgery, we prepared viscoelastic lens dummies and measured vibrations in contact and motion required during Continuous Circular Capsulorhexis (CCC). Based on measurement we designed vibration models for haptic sensory substitution and applied them to virtual reality simulator. With complete virtual reality training system, the contact vibration was successfully implemented for virtual contacts to reproduced realistic haptic senses.

Use of thiel embalmed cadavers in elective hand surgery – Exploring attitudes to simulated surgical training

Use of thiel embalmed cadavers in elective hand surgery – Exploring attitudes to simulated surgical training

Soft tissue deformation estimation by spatio-temporal Kalman filter finite element method.

BACKGROUND: Soft tissue modeling plays an important role in the development of surgical training simulators as well as in robot-assisted minimally invasive surgeries. It has been known that while the traditional Finite Element Method (FEM) promises the accurate modeling of soft tissue deformation, it still suffers from a slow computational process.OBJECTIVE: This paper presents a Kalman filter finite element method to model soft tissue deformation in real time without sacrificing the traditional FEM accuracy.METHODS: The proposed method employs the FEM equilibrium equation and formulates it as a filtering process to estimate soft tissue behavior using real-time measurement data. The model is temporally discretized using the Newmark method and further formulated as the system state equation.RESULTS: Simulation results demonstrate that the computational time of KF-FEM is approximately 10 times shorter than the traditional FEM and it is still as accurate as the traditional FEM. The normalized root-mean-square error of the proposed KF-FEM in reference to the traditional FEM is computed as 0.0116.CONCLUSIONS: It is concluded that the proposed method significantly improves the computational performance of the traditional FEM without sacrificing FEM accuracy. The proposed method also filters noises involved in system state and measurement data.

Improving Haptic Transparency for Uncertain Virtual Environments Using Adaptive Control and Gain-Scheduled Prediction

The realism or transparency of haptic interfaces is becoming more critical as they are applied to training in fields like minimally invasive surgery (MIS). Surgical training simulators must provide a transparent virtual environment (VE) at a high update rate. Complex, deformable, cuttable tissue models have nonlinear dynamics and are computationally expensive, making it difficult to provide sufficient update rates. The objective of this work is to improve the transparency for this type of VE by formulating the unknown nonlinear dynamics as a quasi-linear parameter varying (LPV) system and designing a predictor to provide an output at a much higher update rate. An adaptive controller based on gain-scheduled prediction is considered for a nonlinear haptic device and a nonlinear, delayed, and sampled VE. The predictor uses feedback from the more accurate but slow-updating VE to update a simplified dynamic model. The predictor is designed based on numerical solutions to a linear matrix inequality derived using Lyapunov-based methods. Experimental results demonstrate the effectiveness of the gain-scheduled predictor approach and compare it to previous work using a constant-gain predictor. The gain-scheduled predictor results in significant performance improvements compared to a haptic system without prediction, but less significant improvement compared to the constant-gain approach.

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.

Insights from surgeons’ eye-movement data in a virtual simulation surgical training environment: effect of experience level and hand conditions

ABSTRACTToday, with the advancements in the eye-tracking technology, it has become possible to follow surgeons’ eye movements while performing surgical tasks. Despite the availability of studies providing a better understanding of surgeons’ eye movements, research in the particular field of endoneurosurgery is very limited. Analysing surgeons’ eye-movement data can provide general insights into how to improve surgical education programmes. In this study, four simulation-based task-oriented endoscopic surgery training scenarios were developed and implemented by 23 surgical residents using three different hand conditions; dominant, non-dominant, and both. The participants’ recorded eye data comprised fixation number, fixation duration, saccade number, saccade duration, pursuit number, pursuit duration, and pupil size. This study has two main contributions: First, it reports on the eye-movement behaviours of surgical residents, demonstrating that novice residents tended to make more fixations and saccades than intermediate residents. They also had a higher fixation duration and followed the objects more frequently compared to the intermediates. Furthermore, hand conditions significantly affected the eye movements of the participants. Based on these results, it can be concluded that eye-movement data can be used to assess the skill levels of surgical residents and would be an important measure to better guide trainees in surgical education programmes. The second contribution of this study is the eye-movement event classifications of 10 different algorithms. Although the algorithms mostly provided similar results, there were a few conflicted values for some classifications, which offers a clue as to how researchers can utilise these algorithms with low sampling frequency eye trackers.

PD58-10 VIRTUALLY COMPETENT: A COMPARATIVE ANALYSIS OF VIRTUAL REALITY AND DRY-LAB ROBOTIC SIMULATION TRAINING

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2018PD58-10 VIRTUALLY COMPETENT: A COMPARATIVE ANALYSIS OF VIRTUAL REALITY AND DRY-LAB ROBOTIC SIMULATION TRAINING Nicholas Raison, Andrea Gavazzi, Takashige Abe, Kamran Ahmed, and Prokar Dasgupta Nicholas RaisonNicholas Raison More articles by this author , Andrea GavazziAndrea Gavazzi More articles by this author , Takashige AbeTakashige Abe More articles by this author , Kamran AhmedKamran Ahmed More articles by this author , and Prokar DasguptaProkar Dasgupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Virtual Reality (VR) and dry-Lab simulation have been widely validated for robotic surgical training. Both modalities are used during the early stages of the learning curve yet no comparative analysis of the two modalities has been undertaken. This study compared VR and dry-lab simulation for basic and intermediate robotic surgical skill training. METHODS A comparative study of 43 robotic novices was undertaken at two centres in the UK and Italy. Participants were allocated to either VR or dry-lab simulation and all completed an equivalent three-session training programme. This consisted of basic robot skills training followed by intracorporeal suturing. On completion of the programme all participants were assessed by performing a urethrovesical anastomosis on a synthetic model. Technical proficiency was measured by two trained raters using the Global Evaluative Assessment of Robotic Skills (GEARS) tool. All participants completed a qualitative post-training assessment questionnaire. RESULTS Baseline characteristics were equal between the two groups. As a result of the training, mean GEARS scores increased by 5.6 and 2.5 following dry-lab and VR simulation training respectively. This difference in training outcomes was confirmed by repeated measures ANOVA. An overall significant difference in training effects was found between the two training modalities across the three training sessions (p= 0.034). On individual analysis of session outcomes, a difference in training only reached significant after the third training session when a more complex task was attempted (Table 2). However, whilst dry-lab training shows a progressive rise in GEARS score across the session, this effect is far less pronounced with the VR training. CONCLUSIONS Both VR and dry-lab simulation were effective in improving robotic surgical skill but they were not equivalent. For more advanced skills training, dry-lab training was found to be superior to VR simulation. Dry-lab training offers significant benefits to robotic surgical training and should remain a core component of the robotic training curriculum. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1137 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nicholas Raison More articles by this author Andrea Gavazzi More articles by this author Takashige Abe More articles by this author Kamran Ahmed More articles by this author Prokar Dasgupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The evolution of British neurosurgical selection and training over the past decade

Selection of junior doctors into the British neurosurgical training program and subsequent speciality training have undergone several key changes over the past decade. Shift patterns in the era of the European Working Time Directive (EWTD) have had a major impact on surgical training. We discuss the national selection process, formalization of surgical simulation training and the need to encompass generic professional capabilities within the neurosurgical curriculum in order to create the “well-rounded surgeon”. Future directions including hybrid cerebrovascular training, training in stereotactic radiosurgery, and dedicated training opportunities in spinal surgery.

Surgical simulation training in orthopedics: current insights.

BackgroundWhile the knowledge required of residents training in orthopedic surgery continues to increase, various factors, including reductions in work hours, have resulted in decreased clinical learning opportunities. Recent work suggests residents graduate from their training programs without sufficient exposure to key procedures. In response, simulation is increasingly being incorporated into training programs to supplement clinical learning. This paper reviews the literature to explore whether skills learned in simulation-based settings results in improved clinical performance in orthopedic surgery trainees.Materials and methodsA scoping review of the literature was conducted to identify papers discussing simulation training in orthopedic surgery. We focused on exploring whether skills learned in simulation transferred effectively to a clinical setting. Experimental studies, systematic reviews, and narrative reviews were included.ResultsA total of 15 studies were included, with 11 review papers and four experimental studies. The review articles reported little evidence regarding the transfer of skills from simulation to the clinical setting, strong evidence that simulator models discriminate among different levels of experience, varied outcome measures among studies, and a need to define competent performance in both simulated and clinical settings. Furthermore, while three out of the four experimental studies demonstrated transfer between the simulated and clinical environments, methodological study design issues were identified.ConclusionOur review identifies weak evidence as to whether skills learned in simulation transfer effectively to clinical practice for orthopedic surgery trainees. Given the increased reliance on simulation, there is an immediate need for comprehensive studies that focus on skill transfer, which will allow simulation to be incorporated effectively into orthopedic surgery training programs.

Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents.

This retrospective consecutive case series examined whether training on a surgical simulator reduces intraoperative complication rates among novice ophthalmology residents learning cataract surgery. Beginning July 2014, training on the Eyesi simulator became mandatory for novice postgraduate year 3 ophthalmology residents before live cataract surgery at our institution. Complication rates of the 11 simulator-trained residents (study group) were compared with their immediate 11 simulator-naive predecessors (comparison group). Only straightforward cataract cases (according to standardized preoperative criteria) where postgraduate year 3 residents served as the primary surgeon were included. Complication data were obtained from Morbidity and Mortality records and compared using Fisher exact test. A survey was administered to the residents to gauge the perceived utility of simulation training. The simulator-trained group (n = 501 cataract cases) and the simulator-naive comparison group (n = 454 cases) were analyzed. The complication rate in the simulator group was 2.4% compared with 5.1% in the comparison group (P = 0.037, Fisher exact test). Both the mean posterior capsule tear rate and vitreous prolapse rate in the simulator group were 2.2% compared with 4.8% in the comparison group (P = 0.032, Fisher exact test). The survey had a response rate of 100% (11/11), and 91% (10/11) of respondents felt that the training was "extremely worthwhile" and should be mandatory. The addition of surgical simulation training was associated with a significantly reduced rate of complications, including posterior capsule tears and vitreous prolapse, among novice postgraduate year 3 residents. There is a perceived utility among residents to incorporate virtual simulation into surgical training.

Three-Dimensional Printed Skull Base Simulation for Transnasal Endoscopic Surgical Training.

Transnasal endoscopic skull base surgery (SBS) presents a major challenge for inexperienced neurosurgeons because of the complicated anatomic structures, 2-dimensional endoscopic view, limited operative field, and required skills. We designed a personalized multimaterial and multicolor three-dimensional (3D)-printed SBS simulation to reproduce the complex anatomy of the skull base. The fidelity and feasibility for anatomic education and surgical training were assessed. Two-dimensional computer tomography and magnetic resonance images were collected from a 42-year-old healthy male volunteer. After 3D modeling and spatial alignment, personalized SBS simulations were produced using a multimaterial 3D printer. The fidelity of the models was assessed by 3 experienced neurosurgeons, and the effects for anatomic education and surgical training were evaluated by 10 resident trainees. Both evaluations were based on 5-point Likert questionnaires. The mean scores for fidelity of tissue structure ranged from 3.7 to 4.7, and scores for aid in anatomic education and surgical training ranged from 3.5 to 4.9. The 3D-printed SBS simulation is a practical, economical, high-fidelity model. It has great potential for anatomic education and operative training in transnasal endoscopic surgery.

Representation of Contact Sensation to Hard Tissue in Surgical Training Simulator Using Bone Chisel

Representation of Contact Sensation to Hard Tissue in Surgical Training Simulator Using Bone Chisel

Innovative Use of Abdominoplasty Specimen.

Simulator training is important for understanding nipple–areolar complex reconstruction. Human tissue is the best tissue simulator for surgical training. Abdominoplasty specimen is a useful tissue simulator, which is suitable for practicing nipple–areolar complex reconstruction. It is similar to the natural mound created in breast reconstruction. Authors have shared their experience of using abdominoplasty specimen for simulator training of nipple–areolar complex reconstruction for plastic surgery residents. Abdominoplasty specimen is cost-effective, readily available, and an efficient tool for plastic surgery training for the residents.