Surgery Training Research Articles

Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Vascular access surgery training in the United Kingdom is currently perceived (by trainees) to be inadequate.

Vascular access surgery (VAS) involves the creation and maintenance of arteriovenous access to facilitate haemodialysis. The prevalence of haemodialysis is rising despite increases in kidney transplants on a yearly basis. There is currently only one access surgery fellowship accredited by the Royal College of Surgeons of England. We aimed to establish the experience and perceived competence in access surgery of senior vascular surgery trainees. A short questionnaire (SurveyMonkey) was used to survey all senior (ST6-ST8) vascular surgery trainees in Health Education England (HEE) vascular surgery training programmes. The short survey asked trainees to report their: (1) training grade; (2) training deanery; (3) experience of access surgery; and (4) whether senior trainees thought they would be able to independently undertake primary access surgery post-completion of training (post Certificate of Completion of Training). The survey was circulated via HEE deaneries and the vascular surgery trainees' society: the Rouleaux Club. Twenty-eight senior (ST6-ST8) vascular surgery trainees responded to the survey: 29.6% were ST6 level, 33.3% were ST7 and 37.1% were ST8. Deanery respondence was evenly spread, although London was overrepresented (37.1%). In total, 28.6% had been involved in fewer than 10 cases, 35.7% in 10-25 cases, and 35.7% in more than 25 cases. Almost 54% of senior vascular surgery trainees believed they would not be able to undertake independent access surgery once they had completed training. Competence in access surgery is an increasing requirement of a consultant vascular surgeon. More formalised training is required to adequately train the next generation of vascular surgeons.

Vascular access surgery training in the United Kingdom is currently perceived (by trainees) to be inadequate.

Vascular access surgery (VAS) involves the creation and maintenance of arteriovenous access to facilitate haemodialysis. The prevalence of haemodialysis is rising despite increases in kidney transplants on a yearly basis. There is currently only one access surgery fellowship accredited by the Royal College of Surgeons of England. We aimed to establish the experience and perceived competence in access surgery of senior vascular surgery trainees. A short questionnaire (SurveyMonkey) was used to survey all senior (ST6-ST8) vascular surgery trainees in Health Education England (HEE) vascular surgery training programmes. The short survey asked trainees to report their: (1) training grade; (2) training deanery; (3) experience of access surgery; and (4) whether senior trainees thought they would be able to independently undertake primary access surgery post-completion of training (post Certificate of Completion of Training). The survey was circulated via HEE deaneries and the vascular surgery trainees' society: the Rouleaux Club. Twenty-eight senior (ST6-ST8) vascular surgery trainees responded to the survey: 29.6% were ST6 level, 33.3% were ST7 and 37.1% were ST8. Deanery respondence was evenly spread, although London was overrepresented (37.1%). In total, 28.6% had been involved in fewer than 10 cases, 35.7% in 10-25 cases, and 35.7% in more than 25 cases. Almost 54% of senior vascular surgery trainees believed they would not be able to undertake independent access surgery once they had completed training. Competence in access surgery is an increasing requirement of a consultant vascular surgeon. More formalised training is required to adequately train the next generation of vascular surgeons.

Kern's six-step approach allows for meaningful implementation of an orthognathic surgery training course.

This study investigated the effectiveness of simulation training in improving the confidence and competency of oral and maxillofacial surgery (OMS) residents in performing orthognathic surgery (OGS). Kern's six-step approach was applied when designing the simulation training for OMS residents. The difficulties encountered by the residents when learning OGS were considered when designing the training program. A training course consisting of didactic sessions, hands-on training on three-dimensional training models, and an assessment tool was implemented for OMS residents. Improvement in the confidence and competence of OMS residents in performing OGS, fidelity of the three-dimensional models, and satisfaction with the course was evaluated. All OMS residents (10/10) completed the course. The perceived difficulty in learning OGS was mainly related to the manipulation of the jawbones. While there were improvements in the median confidence and competence scores (3/5 to 4/5), only the differences in competence were found to be statistically significant (p<0.01, Wilcoxon signed-rank test). Improvements in confidence and competence did not correlate. The mean fidelity scores of both the maxillary and mandibular models were adequate at 3.2 out of 5. Overall, satisfaction with the course was high (5/5). The six-step approach provides a guided process for educators to formulate a training course directed toward the perceived needs of students. Targeted training can significantly enhance the students' competence. Greater efforts should also be put in place to allow simultaneous developments in the students' confidence along with their competence.

Reported Variability in General Surgery Training Across Integrated Plastic Surgery Residency Programs.

Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs. Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups. All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations. These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.

Cleft lip and palate surgery simulator: Open source simulation model

ObjectiveCleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. DesignThe soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. SettingTwo groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. ResultsMore than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80–90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. ConclusionThis open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

Resident’s training in vaginal natural orifice transluminal endoscopic surgery (vNOTES)

Resident’s training in vaginal natural orifice transluminal endoscopic surgery (vNOTES)

Senning Procedure: Use of a 3D Printed, Silicone Molded Model for Surgical Training

The atrial switch is a technically complex procedure that requires considerable judgement and appreciation of the 3-dimensional anatomy of the heart. It is now rarely performed other than as part of the double-switch procedures for congenitally corrected transposition (ccTGA). Silicone moulded models based on 3D printed hearts are the latest, and most realistic simulation models for practicing and training in congenital heart surgery – and the atrial switch is an ideal substrate since the procedure is difficult to teach and rarely performed. The Senning procedure has become the most widely used type of atrial switch as it is associated with the best long term outcomes and freedom from baffle obstructions or leaks.

Towards engineering a portable platform for laparoscopic pre-training in virtual reality with haptic feedback

BackgroundLaparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body. For some time, efforts have been made to improve surgical pretraining through practical exercises on abstracted and reduced models. MethodsThe authors strive for a portable, easy to use and cost-effective Virtual Reality-based (VR) laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens. Current VR controllers are limited regarding haptic feedback. Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training, the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback, a commercially available head-mounted display, a VR environment for simulating a laparoscopic surgery, and a training concept. ResultsTo take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training, the system shall not require a tissue sample for haptic feedback. It is currently calculated and visually displayed to the user in the VR environment. On the prototype controller, a first axis was provided with perceptible feedback for test purposes. Two of the prototype VR controllers can be combined to simulate a typical both-handed use case, e.g., laparoscopic suturing. A Unitybased VR prototype allows the execution of simple standard pre-trainings. ConclusionsThe first prototype enables full operation of a virtual laparoscopic instrument in VR. In addition, the simulation can compute simple interaction forces. Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback. Mechanical weaknesses were identified in the first hardware prototype, which will be improved in subsequent versions. All degrees of freedom of the controller are to be provided with haptic feedback. To make forces tangible in the simulation, characteristic values need to be determined using real tissue samples. The system has yet to be validated by cross-comparing real and VR haptics with surgeons.

The Evolving Plastic Surgery Applicant: How Far Have We Come in 30 Years?

Plastic surgery training has undergone tremendous change and transitioned through many models over the years, including independent, combined, and integrated. This study evaluates how these changes and others have affected plastic surgery applicants' demographics and academic qualifications over the last 30 years. Data on applicant demographics and academic qualifications were extracted from multiple sources including the National Resident Matching Program, the American Association of Medical Colleges, and cross-sectional surveys of plastic surgery applicants for the years 1992, 2005, 2011, and 2022. Data were compared using pairwise χ2 goodness of fit tests. The sex distribution of plastic surgery applicants changed significantly over the last 30 years: whereas men predominated in 1992 (86% male vs 14% female), by 2011, the distribution was nearly equal (54% male vs 46% female in both 2011 and 2022, P < 0.001).The racial makeup of applicants also changed over time (P < 0.05). White applicants decreased from 73% in 1992 to 55% in 2011, and 53% in 2022. While there was an increase in Asian (7% to > 17% to > 20%) and other (13% to > 14% to > 21%) applicants over time, whereas the proportion of Black applicants remained stagnant (5% to > 6% to > 8%).Applicants with prior general surgery experience declined precipitously over the years: 96% in 1992, 64% in 2005, 37% in 2011, and 26% in 2022 (P < 0.001). When compared with 1992, Alpha Omega Alpha status increased significantly in 2011 (36% vs 12%, P < 0.05) but did not change considerably in 2005 (22%) and 2022 (23%). Research experience increased dramatically over the years, with the proportion of applicants with at least one publication going from 43% in 1992, to 75% in 2005, to 89% in 2011, and to 99% in 2022 (P < 0.001). Applicant interest in academic plastic surgery did not change considerably over the years at roughly ranging from 30% to 50% of applicants (P = ns). There has been a shift in the demographics and academic qualifications of plastic surgery applicants over the last 3 decades. Understanding this evolution is critical for reviewing and evaluating the makeup of our specialty, and enacting changes to increase representation where necessary.

SP19. Plastic Surgery In Burn Care: A Call For Enhanced Burn Surgery Training Within Plastic Surgery Residency Programs

SP19. Plastic Surgery In Burn Care: A Call For Enhanced Burn Surgery Training Within Plastic Surgery Residency Programs

129 LaparoscopiX: Expanding Minimally Invasive Surgery Training in Kenya

OBJECTIVES/GOALS: Open surgery prevails in low- and middle-income countries (LMICs) due to scarcity of laparoscopic equipment and poor access to training. LaparosopiX is a box trainer system designed for teaching hospitals in LMICs; it includes an open-source laser print design and an app to allow surgical trainees to receive feedback from laparoscopic experts. METHODS/STUDY POPULATION: This study aims to assess the usability of Laparoscopix for surgical trainees and mentors at five large teaching hospitals in Kenya. Surgical trainees and mentors who participate in this study will be observed while setting up and using the app to identify natural pain-points. A post-session survey will be conducted to assess immediate perceptions of the platform including ease of navigation and intuitive design. Over three months, aggregate data regarding platform usage at these hospital sites will be collected and analyzed to assess user retention rates, usage and traffic patterns, and skill progression over time. Surveys will be sent out to assess attitudes towards the platform and to elucidate any aspects of the system we can improve. RESULTS/ANTICIPATED RESULTS: We hope to find overall positive impressions towards the LaparoscopiX system during this study. We expect there to be some pain-points that arise during navigation of the app, but we expect no large changes to the application architecture required. We anticipate an immediate increase and eventual plateau of users recruited. We hope to see that surgical trainees are advancing through the app while gaining practice and confidence. We will gather insightful data on which aspects of the app were helpful for trainees, and which can be improved. We also hope to learn what factors may play into trainee and mentor retention in the system. DISCUSSION/SIGNIFICANCE: Through this study, we hope to elucidate ways in which we can improve the LaparoscopiX platform, identify which features to prioritize, and determine the direction of future app development. We believe and hope that LaparoscopiX can expand access to laparoscopic surgical mentorship to improve surgical outcomes and health equity worldwide.

Assessment of Quality of Lıfe in Patients with Anorectal Malformations

Objective: Our main purpose in this study is to examine the effects of patients on their quality of life (QOL) according to anorectal malformations (ARM) types, and to compare them to patients with stool incontinence in the healthy population.&#x0D; Methods: The research group was selected from 116 patients who were operated due to ARM between 2004-2018 and fulfilled the inclusion criteria, in University of Health Science İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital. The control group was composed of 12 participants among 348 children between the ages 5-15 who were operated for phimosis in 2018 -2019. Fecal Incontinence Related Life Quality Questionnaire (QQVCFCA) scales were applied to both groups. SPSS 22.0 program was used.&#x0D; Results: The research group was completed with 75 participants and the control group with 12 participants. The QQVCFCA score of the low-type ARM was significantly higher than the participants with the high-type ARM (p

Virtual Reality Simulation of Airway Management Post-Cleft Palate Surgery: A Model for Sustainable and Equitable Education.

The effectiveness of virtual-reality (VR) simulation-based training in cleft surgery has not been tested. The purpose of this study was to evaluate learners' acceptance of VR simulation in airway management of a pediatric patient post-cleft palate repair. This VR simulation was developed through collaboration between BioDigital and Smile Train. 26 medical students from a single institution completed 10 min of standardized VR training and 5 min of standardized discussion about airway management post-cleft palate repair. They spent 4-8 min in the VR simulation with guidance from a cleft surgery expert. Participants completed pre- and post-surveys evaluating confidence in using VR as an educational tool, understanding of airway management, and opinions on VR in surgical education. Satisfaction was evaluated using a modified Student Evaluation of Educational Quality questionnaire and scored on a 5-point Likert scale. Wilcoxon signed-rank tests were performed to evaluate responses. There was a significant increase in respondents' confidence using VR as an educational tool and understanding of airway management post-cleft palate repair after the simulation (P < .001). Respondents' opinions on incorporating VR in surgical education started high and did not change significantly post-simulation. Participants were satisfied with VR-based simulation and reported it was stimulating (4.31 ± 0.88), increased interest (3.77 ± 1.21), enhanced learning (4.12 ± 1.05), was clear (4.15 ± 0.97), was effective in teaching (4.08 ± 0.81), and would recommend the simulation (4.2 ± 1.04). VR-based simulation can significantly increase learners' confidence and skills in airway management post-cleft palate repair. Learners find VR to be effective and recommend its incorporation in surgical education.

A Review and Discussion of Full-Time Equivalency and Appropriate Compensation Models for an Adult Intensivist in the United States Across Various Base Specialties.

Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE). Nevertheless, hospitals often consider FTEs in assessing hiring needs, salary, and eligibility for benefits. Review of existing literature, expert opinion. Not applicable. Not applicable. Not applicable. Understanding how an FTE is calculated, and the fraction of an FTE to be assigned to a particular cost center, is therefore important for intensivists of different specialties, as many employment models assign salary and benefits to a base specialty department and not necessarily the ICU.

Modified Graham Patch Repair of Small Bowel Anastomotic Leak.

The modified Graham patch repair is a well-established technique for management of perforating foregut injuries, often learned by surgeons during general surgery training. There is, however, little to no data regarding the utilization of this technique for perforation of the distal midgut or in the re-operative field. We present two cases of midgut anastomotic complications successfully managed with modified graham patch repair at our institution. The first case is a 79-year-old female who underwent an emergent right hemicolectomy at an outside institution for management of an iatrogenic perforation during endoscopic polypectomy. Over the course of two years she underwent numerous abdominal operations, due to various complications, ultimately resulting in multiple resections and end ileostomy creation. She then had her ileostomy reversed by laparoscopic single incision (SILS) technique at our institution. This was also complicated by anastomotic leak. Intraoperatively, adequate mobilization of the anastomosis for resection was deemed not safe due to dense fibrosis and adhesions in the re-operative field; therefore, she underwent a SILS modified Graham patch repair of an ileocolic anastomotic defect with diverting loop ileostomy. Post-operatively, she had no radiographic evidence of leak from the repaired anastomosis, which facilitated successful loop ileostomy reversal five months later. Our second case is a 64-year-old male referred to our institution for management of his stage IV colon cancer. He underwent an open right hemicolectomy and hepatic metastectomy, which was complicated by anastomotic leak. The small defect was repaired via a SILS modified Graham patch technique. Five months postoperatively, he had neither radiographic nor endoscopic evidence of a leak; therefore, he successfully underwent ileostomy reversal without complication. We encourage further investigation and reporting of the role of the modified graham patch repair in management of midgut anastomotic complications, particularly when resection and re-anastomosis is unsafe due to a hostile re-operative field.

Structured Exposure Achieves High Acceptance of Immersive Technology Among Medical Students and Educators.

Virtual reality (VR) is a potent educational tool with untapped potential in medical training. However, its integration into medical schools faces challenges such as cybersickness and hesitancy among medical students and professionals. Notably, there has been no systematic assessment of the acceptance of medical educational VR applications by both students and educators. In our single-center study, we enrolled 133 medical students and 14 medical educators. Following a practical demonstration of the established VR anatomy application, Sharecare YOU VR, participants completed a self-reporting survey based on the Technology Acceptance Model (TAM), exploring user acceptance of information technologies and focusing on perceived usefulness (PU), perceived ease of use (PEU), and attitude toward using (ATU). We also sought insights into potential future applications of VR in medical education. Our findings indicate a high level of acceptance among medical students and educators upon structured exposure to VR with significantly positive responses for all three TAM variables (PU, PEU, and ATU). Intriguingly, hands-on experience influenced acceptance. Students envisioned VR's benefits in anatomy, surgery, emergency medicine, and communication skill training with patients. Both students and educators believed that VR could enhance traditional approaches and complement the existing curriculum, anticipating improved preparedness for medical students through VR training applications. In conclusion, our results demonstrate the receptivity of both students and educators to immersive technologies, including VR, in medical education. Importantly, the data suggest that the adoption of VR in this field would be welcomed rather than resisted, potentially enhancing students' self-efficacy and enriching the medical school curriculum.

Design and development of a personalized virtual reality-based training system for vascular intervention surgery

Background and objectivesVirtual training has emerged as an exceptionally effective approach for training healthcare practitioners in the field of vascular intervention surgery. By providing a simulated environment and blood vessel model that enables repeated practice, virtual training facilitates the acquisition of surgical skills in a safe and efficient manner for trainees. However, the current state of research in this area is characterized by limitations in the fidelity of blood vessel and guidewire models, which restricts the effectiveness of training. Additionally, existing approaches lack the necessary real-time responsiveness and precision, while the blood vessel models suffer from incompleteness and a lack of scientific rigor. MethodsTo address these challenges, this paper integrates position-based dynamics (PBD) and its extensions, shape matching, and Cosserat elastic rods. By combining these approaches within a unified particle framework, accurate and realistic deformation simulation of personalized blood vessel and guidewire models is achieved, thereby enhancing the training experience. Furthermore, a multi-level progressive continuous collision detection method, leveraging spatial hashing, is proposed to improve the accuracy and efficiency of collision detection. ResultsOur proposed blood vessel model demonstrated acceptable performance with the reduced deformation simulation response times of 7 ms, improving the real-time capability at least of 43.75 %. Experimental validation confirmed that the guidewire model proposed in this paper can dynamically adjust the density of its elastic rods to alter the degree of bending and torsion. It also exhibited a deformation process comparable to that of real guidewires, with an average response time of 6 ms. In the interaction of blood vessel and guidewire models, the simulator blood vessel model used for coronary vascular intervention training exhibited an average response time of 15.42 ms, with a frame rate of approximately 64 FPS. ConclusionsThe method presented in this paper achieves deformation simulation of both vascular and guidewire models, demonstrating sufficient real-time performance and accuracy. The interaction efficiency between vascular and guidewire models is enhanced through the unified simulation framework and collision detection. Furthermore, it can be integrated with virtual training scenarios within the system, making it suitable for developing more advanced vascular interventional surgery training systems.

Cardiothoracic surgery training in Africa: History and developments

ObjectiveCardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. MethodThrough a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. ResultsAfrican countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. ConclusionsCardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

A New Model of Global Reconstructive Surgery Training With Reduced Carbon Footprint of Outreach

This economic evaluation compares carbon dioxide emissions from air transportation for surgical mission trips vs team training trips.