Surgeon Feedback Research Articles

The crucial role of 5G, 6G, and fiber in robotic telesurgery.

This paper explores the role of 5G-and future 6G networks-in advancing robotic telesurgery by minimizing latency and enhancing data reliability for real-time remote operations. With robotic telesurgery gaining prominence as a tool to democratize access to specialized surgical care, telecommunications infrastructure has become central to its feasibility and safety. Key elements include 5G's capacity for ultra-low latency and high data transfer rates, which support critical modalities such as kinesthetic, audiovisual, and tactile feedback in telesurgery. The paper outlines the differing latency demands of these modalities, noting that kinesthetic data are particularly sensitive, requiring ultra-low latency for effective surgeon feedback. In addition, the paper discusses the importance of network reliability and Quality-of-Service (QoS) agreements, alongside the potential for 6G networks to further reduce latency and integrate AI-driven predictive analytics. These advancements are positioned to not only broaden telesurgery's reach but also to enhance the precision and safety of procedures, setting the stage for a new paradigm in remote surgical care.

Comparative analysis of mechanical and drilling properties: Human skull vs. 3D-printed replicas for neurosurgical training

Neurosurgery is one of the most difficult surgical disciplines, making neurosurgical simulation crucial for learners. 3D printing is increasingly used for this simulation due to its accessibility and cost-effectiveness compared to conventional methods. Previous studies have qualitatively evaluated the efficacy of 3D printing models for burr hole and craniotomy simulation using surgeon feedback. This study quantitatively evaluates the mechanical properties of human skulls and compares them with 3D-printed skulls to identify the necessary materials and technologies for accurate replication in neurosurgical training. Vickers hardness, compression, and drilling simulation tests were conducted on human cadaveric skulls and 3D-printed models manufactured using Fused Filament Fabrication (FFF), Stereolithography (SLA), and Material Jetting (MJ) technologies. Uniaxial force during a simulated burr hole procedure was measured as drilling progressed through the outer table (OT), diploë and inner table (IT) of the skull. The results showed that different 3D printing technologies and materials have qualities corresponding to each of the three layers of the human skull. For instance, the White Resin 40 model was the closest match to the OT of human skull, exhibiting the lowest mean difference of drilling modulus of 1.98. The OT of the human skull had a Vickers hardness of 38.6 ± 5 HV0.05. The closest 3D-printed models were SLA White at 16.6 ± 0.3 HV0.05 and Rigid 10K at 65.7 ± 3 HV0.05. In terms of mechanical properties, the human skull demonstrated a compression modulus that closely matched the SkullSTN 2, PC 60, PEEK 40, and PEEK 60, with differences of less than 0.1 GPa. These findings demonstrate the effectiveness of drilling simulation tests in evaluating various materials and infills to refine models before neurosurgeon evaluation, enabling the identification of an optimal 3D-printed training model for simulating burr hole procedures.

Facial trauma education in radiology: using surgeon feedback as the benchmark for success

Rationale and objectivesInterpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports.Materials and methodsRadiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings.Results26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall’s W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits.ConclusionCompared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

OCCUPATIONAL THERAPY PRE-ASSESSMENT OF LOW GRADE GLIOMA PATIENT WITH COMPLEX NEEDS ALMOST HALVES POST-OPERATIVE LENGTH OF STAY

Abstract AIMS Due to tumour eloquence, patients with low grade gliomas (LGGs) often have complex Occupational Therapy (OT) needs post-operatively. This need can impact length of stay and OT resource. Limited studies have focused on pre-assessment for this patient group. To address these challenges, we aimed to identify the impact of a newly-introduced Occupational Therapy (OT) pre-surgical assessment service for low grade glioma patients. METHOD Patients (n=16, prospective, consecutive, Jan-Jul 2023) planned for LGG surgery at Leeds Teaching Hospitals NHS Trust were offered an OT pre-assessment. Mixed methods analysis. Assessments and data collected included existing needs and deficits, length of stay, and OT sessions (number/contacts, time spent). Comparison was made to patients (n=16, retrospective, consecutive, Jun-Dec 2022) planned for LGG surgery who had not received this service. Complexity was defined using standardised, clinically-accepted factors (social, cognitive and/or physical deficits). RESULTS Patients with complex needs (4 in each group) benefitted significantly from OT pre-assessment with reductions in: length of stay (11.9 v 6.5 days, 45.4% decrease), median time spent (134 v 95 mins, 29.1% decrease), median number of contacts (5.4 v 3.4, 37.0% decrease). Patient, surgeon, CNS and other AHP feedback was overwhelm-ingly positive. CONCLUSION Patients with complex needs undergoing surgery for low grade gliomas significantly benefit from pre- assessment; reducing length of stay and liberating occupational therapy resource. This also reduces costs and increases productivity/efficiency. Further work in more LGG patients, other brain tumour patients, and the identification of key pre-assessment variables and interventions will guide the development of the service.

Variational Autoencoder feature clustering for tissue classification in robotic palpation

Abstract Minimally Invasive Robotic Surgery (MIRS) has emerged as a transformative approach in surgical practice, offering reduced patient trauma and enhanced precision. However, challenges persist, including the loss of tactile feedback for surgeons. This study explores the application of machine learning algorithms, specifically variational autoencoders, in vibro-acoustic (VA) signal analysis to address this issue. Our comparative analysis evaluates the potential of supervised learning in surgical data analysis, contributing to advancements in surgical technology. Despite achieving an accuracy of 81%, our results indicate opportunities for further refinement, considering the superior accuracies reported in previous studies. This research underscores the importance of innovative approaches in medical data analysis for optimizing patient care in minimally invasive surgery.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. University-affiliated hospital. Six laparoscopic surgeons. CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

Biodesign: Engineering an aortic endograft explantation tool

Endovascular aortic repair (EVAR) graft failure can be as high as 16% to 30% owing to endoleak, graft migration, or infection, often necessitating explantation, leading to potential morbidity (31%) and mortality (6.3%). Graft prongs frequently tear through the endothelium during explantation, leading to endothelial damage and subsequent fatal bleeding. The current standard of care involves different suboptimal techniques such as the syringe technique in which a cylinder is improvised by cutting a syringe in half and pushed over the graft hooks in a rotating motion, until covered for manual explantation. Because there is no commercially available product to address this shortcoming in graft explantation, we engage in the biodesign process to produce a functional explantation device. We designed and prototyped multiple potential solutions to remove EVAR endografts safely. Silicone tubing with EVAR endografts deployed in the lumen were used to simulate a grafted aorta and test each prototype. Prototypes were compared in their ability to meet design criteria including decrease in graft diameter, prevention of arterial dissection, ease of use, and decrease in procedure time. After determining the single best prototype, surgeon feedback was elicited to iteratively improve the original design. The most effective design uses a tapered lumenal geometry that decreases the EVAR graft diameter and uses stainless steel beads to prevent shear stress to the simulated aorta. A distal grip allows for easy single hand manipulation of the device, while a latching mechanism allows for smooth placement and removal over the endograft. After rigorous prototyping, our device proved feasible and effective for safe EVAR explantation, allowing this procedure to be performed safely.

191 Online Multi-media Teaching Modules are Effective for Surgical Education in Electrodiagnostic Interpretation

INTRODUCTION: Though electrodiagnostic studies are the gold standard for diagnosing nerve injuries, most surgeons are not trained to interpret these studies, and therefore typically rely on interpretation from a non-surgical electrodiagnostician. This discrepancy between interpretation and treatment of nerve injuries can lead to suboptimal surgical planning and patient outcomes. METHODS: Hand surgeons at various stages of training were recruited from professional surgical societies. All surgeons completed an educational module, which consisted of a pre-intervention knowledge assessment, an educational video, and a post-intervention assessment. The educational video was a 45-minute lecture on electrodiagnostic indications for nerve injury and included either traditional PowerPoint or Prezi formatting. Participants were randomized into receiving one of the two video formats. A retention assessment, including surgeon satisfaction and feedback, was administered at three-months after initial evaluation. RESULTS: Sixty-three surgeons completed the pre-intervention knowledge assessment, educational video, and post-intervention assessment, 30 of whom underwent the three-month retention assessment. The average assessment score improved by 2 points between pre- and post-intervention (12-point scale, p < 0.001). The majority of participants responded that the educational video was a “perfect” length (81%), was engaging (86%), improved their knowledge (86%), and that they would incorporate the information into their clinical practice (86%). Seventy-two percent of the surgeons preferred the online teaching module compared to a traditional in-person conference presentation. There was no significant difference in assessment performance and surgeon satisfaction between Prezi and PowerPoint formatting (p > 0.05). CONCLUSIONS: Our results demonstrate the feasibility and efficacy of an online educational module to support continuing professional development in nerve injury surgery, irrespective of the presentation style (i.e., Prezi vs. PowerPoint). This study highlights the potential behind online educational content and provides a framework for future multimedia modules for surgical education.

Image-guided orbital surgery: a preclinical validation study using a high-resolution physical model

ObjectivePreclinical validation study to assess the feasibility and accuracy of electromagnetic image-guided systems (EM-IGS) in orbital surgery using high-fidelity physical orbital anatomy simulators.MethodsEM-IGS platform, clinical software, navigation instruments and reference...

Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy.

Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.

A Conduit for a Culturally Competent Consent: Medical Interpreters' Perspectives on Surgical Informed Consent Discussions.

To understand medical interpreter's perspectives on surgical informed consent discussions and provide feedback for surgeons on improving these conversations. Informed consent is a critical component of patient-centered surgical decision-making. For patients with limited English proficiency (LEP), this conversation may be less thorough, even with a medical interpreter, leaving patients with an inadequate understanding of their diagnosis or treatment options. A semi-structured interview guide was developed with input from interpreters and a qualitative research expert. We purposively sampled medical interpreters representing multiple languages until thematic saturation was achieved. Participants discussed their experience with the surgical consent discussion and process. Interview transcripts were analyzed using emergent thematic analysis. Among 22 interpreters, there were ten languages represented and an average experience of 15 years (range 4-40y). Four major themes were identified. First, interpreters consistently described their roles as patient advocates and cultural brokers. Second, interpreters reported unique patient attributes that influence the discussion, often based on patients' cultural values/expectations, anticipated decisional autonomy, and family support. Third, interpreters emphasized the importance of surgeons demonstrating compassion and patience, using simple terminology, conversing around the consent, providing context about the form/process, and initiating a pre-encounter discussion. Finally, interpreters suggested reducing legal terminology on consent forms and translation into other languages. Experienced interpreters highlighted multiple factors associated with effective and culturally tailored informed consent discussions. Surgeons should recognize interpreters' critical and complex roles, be cognizant of cultural variations among patients with LEP, and improve interpersonal and communication skills to facilitate effective understanding.

PiDeeL: metabolic pathway-informed deep learning model for survival analysis and pathological classification of gliomas.

Online assessment of tumor characteristics during surgery is important and has the potential to establish an intra-operative surgeon feedback mechanism. With the availability of such feedback, surgeons could decide to be more liberal or conservative regarding the resection of the tumor. While there are methods to perform metabolomics-based tumor pathology prediction, their model complexity predictive performance is limited by the small dataset sizes. Furthermore, the information conveyed by the feedback provided on the tumor tissue could be improved both in terms of content and accuracy. In this study, we propose a metabolic pathway-informed deep learning model (PiDeeL) to perform survival analysis and pathology assessment based on metabolite concentrations. We show that incorporating pathway information into the model architecture substantially reduces parameter complexity and achieves better survival analysis and pathological classification performance. With these design decisions, we show that PiDeeL improves tumor pathology prediction performance of the state-of-the-art in terms of the Area Under the ROC Curve by 3.38% and the Area Under the Precision-Recall Curve by 4.06%. Similarly, with respect to the time-dependent concordance index (c-index), PiDeeL achieves better survival analysis performance (improvement of 4.3%) when compared to the state-of-the-art. Moreover, we show that importance analyses performed on input metabolite features as well as pathway-specific neurons of PiDeeL provide insights into tumor metabolism. We foresee that the use of this model in the surgery room will help surgeons adjust the surgery plan on the fly and will result in better prognosis estimates tailored to surgical procedures. The code is released at https://github.com/ciceklab/PiDeeL. The data used in this study are released at https://zenodo.org/record/7228791.

Eye-mounting goggles to bridge the gap between benchtop experiments and in vivo robotic eye surgery

A variety of robot-assisted surgical systems have been proposed to improve the precision of eye surgery. Evaluation of these systems has typically relied on benchtop experiments with artificial or enucleated eyes. However, this does not properly account for the types of head motion that are common among patients undergoing eye surgery, which a clinical robotic system will encounter. In vivo experiments are clinically realistic, but they are risky and thus require the robotic system to be at a sufficiently mature state of development. In this paper, we describe a low-cost device that enables an artificial or enucleated eye to be mounted to standard swim goggles worn by a human volunteer to enable more realistic evaluation of eye-surgery robots after benchtop studies and prior to in vivo studies. The mounted eye can rotate about its center, with a rotational stiffness matching that of an anesthetized patient’s eye. We describe surgeon feedback and technical analyses to verify that various aspects of the design are sufficient for simulating a patient’s eye during surgery.

Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome

Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. This is a retrospective review of patients referred for PAES at a single institution. We reviewed non-invasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software (PACS). Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak-systolic velocity (PSV) of 78 cm/sec at rest. With forced plantar flexion, the PSV increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n=35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (p=0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm) while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should therefore be the gold standard for the diagnosis of PAES.

Preclinical evaluation of the Versius surgical system: A next-generation surgical robot for use in minimal access prostate surgery.

To evaluate the Versius surgical system for robot-assisted prostatectomy in a preclinical cadaveric model using varying system setups and collect surgeon feedback on the performance of the system and instruments, in line with IDEAL-D recommendations. Procedures were performed in cadaveric specimens by consultant urological surgeons to evaluate system performance in completing the surgical steps required for a prostatectomy. Procedures were conducted using either a 3-arm or 4-arm bedside unit (BSU) setup. Optimal port placements and BSU layouts were determined and surgeon feedback collected. Procedure success was defined as the satisfactory completion of all steps of the procedure, according to the operating surgeon. All four prostatectomies were successfully completed; two were completed with a 3-arm BSU setup and two using a 4-arm BSU setup. Small adjustments were made to the port and BSU positioning, according to surgeon preference, in order to complete the surgical steps. The surgeons noted some instrument difficulties with the Monopolar Curved Scissor tip and the Needle Holders, which were subsequently refined between the first and second sessions of the study, in line with surgeon feedback. Three cystectomies were also successfully completed, demonstrating the capability of the system to perform additional urological procedures. This study provides a preclinical assessment of a next-generation surgical robot for prostatectomies. All procedures were completed successfully, and port and BSU positions were validated, thus supporting the progression of the system to further clinical development according to the IDEAL-D framework.

The perioperative utility of 3D printed models in complex surgical care: feedback from 106 cases.

3D models are an emerging tool for surgical planning, providing an augmented method for the visualisation of a patient's anatomy. As their use increases, more data about the utility of these models is critical to inform budget allocation. This study provides the most comprehensive analysis to date for the use of 3D models in perioperative management. 3D models for complex surgical cases in NHS hospitals were delivered alongside a surgeon feedback survey. The survey on the model's utility had been designed alongside the university data analytical team and focused on five areas: surgical planning and diagnosis, economic impact, impact on intraoperative and preoperative time, effect on communication and direct impact on the patient. There were 106 models used by 63 surgeons for complex surgical cases between May 2020 and March 2021, across multiple surgical specialties. The models were reported to have benefits in all perioperative areas, with 92.5% of responses agreeing that the 3D model was a better method for diagnosis and planning than traditional 2D techniques. Benefits were reported on preoperative planning (92.4%), economic savings due to equipment selection (54.4%), reduction in surgical time (41.5%) and surgeon-to-surgeon communication (92.6%). 3D models were shown to have a wide range of benefits in a surgical setting. The reduction in surgical time could have the potential to help alleviate surgical backlogs. With more widespread use and optimisation of costs the use of 3D models could become the standard for unusual and complex surgical cases.

A High-Fidelity Artificial Urological System for the Quantitative Assessment of Endoscopic Skills.

Minimally-invasive surgery is rapidly growing and has become a standard approach for many operations. However, it requires intensive practice to achieve competency. The current training often relies on animal organ models or physical organ phantoms, which do not offer realistic surgical scenes or useful real-time feedback for surgeons to improve their skills. Furthermore, the objective quantitative assessment of endoscopic skills is also lacking. Here, we report a high-fidelity artificial urological system that allows realistic simulation of endourological procedures and offers a quantitative assessment of the surgical performance. The physical organ model was fabricated by 3D printing and two-step polymer molding with the use of human CT data. The system resembles the human upper urinary tract with a high-resolution anatomical shape and vascular patterns. During surgical simulation, endoscopic videos are acquired and analyzed to quantitatively evaluate performance skills by a customized computer algorithm. Experimental results show significant differences in the performance between professional surgeons and trainees. The surgical simulator offers a unique chance to train endourological procedures in a realistic and safe environment, and it may also lead to a quantitative standard to evaluate endoscopic skills.

The Vision Correction Questionnaire: an electronic patient-reported outcome measure for refractive surgery.

To develop a psychometrically robust electronic patient reported outcome measure (ePROM) for refractive surgery. Moorfields Eye Hospital, London, United Kingdom. Questionnaire development study. Items were derived in 6 domains (spectacle dependence, visual quality, eye comfort, functional freedom, emotional wellbeing, and satisfaction with treatment) from existing Rasch adjusted instruments, patient and surgeon feedback, and refinement in semistructured interviews before administration to a field test cohort (n = 360) of patients undergoing routine refractive surgery. Spectacle dependence and satisfaction with treatment items were used to provide descriptive statistical information only. Contemporary criteria for item reduction and Rasch modeling were applied to the remaining domains. The finalized questionnaire was then administered to a second patient cohort (n = 120) before and after surgery to assess sensitivity to change. A 5-item scale derived for emotional wellbeing was unidimensional and a good fit to the Rasch model with ordered category response profiles, adequate precision (person separation 2.22 logits, reliability coefficient 0.83), and no misfitting items. Mean logit scores were 0.91 higher after treatment (effect size 1.26) suggesting a positive impact on emotional wellbeing. Functional scales could not be derived for visual quality, eye comfort, or functional freedom. Single-item ratings for visual quality and eye comfort were retained in our final 11-item questionnaire. This short ePROM should integrate well with routine clinical care and clinical trials in refractive surgery. The Rasch adjusted emotional wellbeing scale may help quantify the way patients feel about refractive surgery, with the remaining items providing useful descriptive information.

Commentary: Associating Surgeon Feedback With Material Physical Properties in the Development Process of a Resective Epilepsy Surgery Simulator.

Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, Kentucky, USA Correspondence: Farhan A. Mirza, MD, Department of Neurological Surgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, 800 Rose St, MS102, Lexington, KY40536, USA. Email: [email protected]

AMPATH surgical app: Low-cost simulator for the open appendectomy

BackgroundDue to a shortage and maldistribution of surgeons within Kenya, doctors with limited formal surgical training often perform emergency surgical procedures such as appendectomy. This lack of training can compromise patient outcomes and complicate care delivery. Our aim was to develop a low-cost simulator and skills curriculum to effectively teach open appendectomy. MethodsSurgeons from 4 countries participated in semi-structured interviews to define the steps and technique of open appendectomy using cognitive task analysis. Using this input, our Academic Model Providing Access to Healthcare surgical team developed a curriculum, including a simulator and feedback mechanism. Surgeons and surgical trainees from Kenya and the United States tested the simulator prototype and provided feedback for its refinement based on clarity, utility, and realism. ResultsInstructions for a self-constructed simulator were developed at the cost of 70 Kenyan shillings (0.64 US dollars). Fifteen surgeons and surgical residents gave feedback on the simulator and curriculum, and each was presented with an updated version based on feedback. Overall, the curriculum was clear, with each sub-step receiving a median score of ≥83.5 out of 100 for clarity; however, through iterative design, the utility of sub-steps on the simulator improved. ConclusionA comprehensive open appendectomy curriculum, including a low-cost appendectomy simulator model, was developed and refined using surgeon feedback. Such curricula may benefit trainees in low-resource settings who may otherwise have limited access to quality training material.