Surgical Simulation Research Articles

Phacoemulsification to MSICS: A transfer of skills study in a simulated environment.: Transfer of phacoemulsification surgical skills to MSICS.

To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Copenhagen Academy for Medical Education and Simulation, Denmark. Prospective controlled experimental study. The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis. The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.

Vitreoretinal surgical performance after acute alcohol consumption and hangover

AimRoutine alcohol testing of practicing physicians remains controversial since there are no uniform guidelines or legal regulations in the medical field. Our aim was to quantitatively study the acute and...

Rudeness and team performance: Adverse effects via member social value orientation and coordinative team processes.

A growing body of research shows that rudeness negatively affects individual functioning and performance. Considerably less is known about how rudeness affects team processes and outcomes. In a series of five studies aimed at extending theories of the social-cognitive implications of rudeness to the team level, we show that rudeness is detrimental to team functioning. Using an experimental design, Study 1 shows that teams encountering rudeness perform worse than other teams. Study 2, a medical simulation study, explains this effect by showing that medical teams exposed to rudeness are less likely than other teams to share information and workload and, in turn, execute a variety of medical procedures less well. Studies 3a and 3b highlight the mediating role played by social value orientation (SVO), demonstrating that rudeness elicits these effects by diminishing members' SVO (i.e., making team members less prosocial and more pro-self). In turn, Study 4 shows that rudeness-diminished SVO explains reduced information sharing in teams. Finally, Study 5, a laboratory study, tests a full serial mediation model, demonstrating that rudeness decreases team members' SVO, which in turn reduces team information sharing and, as a result, encumbers team performance. Overall, these findings show that rudeness can have severe implications for team functioning and may even have life-threatening consequences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Looking ahead: Incorporation of objective assessment methods, surgical simulation and 3D-printed models to improve technical skills of a cardiac surgeon in training in the Indian context

Looking ahead: Incorporation of objective assessment methods, surgical simulation and 3D-printed models to improve technical skills of a cardiac surgeon in training in the Indian context

An in vitro model study of the accuracy and operation time of oral surgery robot-assisted endodontic microsurgery

Objective: To explore the operational accuracy and operative time of oral surgery robot-assisted endodontic microsurgery on a head-simulator for clinical reference. Methods: Three pairs of surgical simulation models were set up on head-simulator. Each model included 10 positions anteriorly and posteriorly, 20 teeth for each technique, for a total of 60 teeth. An attending physician with more than 3 years clinical experience in endodontic microsurgery completed fixed-point osteotomy and apicoectomy in three groups of endodontic microsurgery under freehand (FH), static navigation (SN), and surgery robot (SR). The duration of each operation was recorded. Cone-beam CT was taken before the operation and the surgical path was planned in the software; after surgery, a plug gauge (precision gauge for measuring hole dimensions) was inserted into the surgical path for intraoral scanning. Surgical accuracy (starting point, end point, and angular deviation) was assessed in all 3 groups, and surgery time was compared. Results: The deviation at the starting point and the end point, and angular deviation was (0.37±0.11), (0.37±0.10) mm, and 0.71°±0.17°in the SR group. The deviations in the SR group were significantly lower than those in the SN group [(0.59±0.14), (0.65±0.18) mm, and 2.64°±0.75°] (P<0.05), and both groups were significantly lower than the FH group [(1.37±0.31), (1.10±0.21) mm, and 9.84°±3.15°] (P<0.05). The operative time in the SN group [(1.20±0.03) min] was significantly less than that in the SR group [(2.18±0.03) min] (P<0.05), and both groups were significantly less than that in the FH group [(8.70±3.15) min] (P<0.05). Starting point deviation, end point deviation, and angular deviation [(1.09±0.10), (0.90±0.07) mm, 7.22°±1.13°] in anterior teeth using the FH was significantly lower than the starting deviation, endpoint deviation, and angular deviation [(1.65±0.14), (1.30±0.06) mm, 12.46°±2.10°] in the posterior teeth using FH (P<0.05), and the operative time in the anterior teeth using the FH [(5.75±0.57) min] was significantly less than that in the posterior teeth using [(11.65±1.14) min] (P<0.05). The difference in accuracy and operative time between using SN and SR on anterior and posterior teeth was not statistically significant (P>0.05). Conclusions: Oral surgery robot-assisted endodontic microsurgery helps improving the accuracy of clinicians' operations and shorten the operation time.

Real-time surgical simulation training for recurrent laryngeal nerve and facial nerve dissection

BackgroundHead and neck surgical simulation training (SST) is an important part in otolaryngology head and neck surgical education. In this study, we provide a live porcine model for SST in recurrent laryngeal nerve (RLN) and facial nerve (FN) dissection for otolaryngology head and neck residents. MethodsA lecture with surgical manual is provided to illustrate the surgical landmarks of pig, and step-by-step procedures for thyroid and parotid surgery, as well as neck dissection. We used 4-month-old pig weighting 32 kg for the SST. The mentor demonstrated result of RLN injury with continuous nerve monitoring. Participants used monopolar stimulation probe (4 pulse/s, 100 μs, 3-8 mA; Medtronic) to identify and intermittent monitor the RLN and FN during the SST. After the dissection course, we conducted a questionnaire survey to check the effectiveness of this training model. ResultsTotal 30 participants were recruited, including 16 female and 14 male resident doctors. There were 1, 4 and 25 learners for 3rd year, 4th and 5th years residents, respectively. Before this training course, 53 % (16/30) and 63 % (19/30) had successful experience in finding the RLN and FN, respectively. After the SST, all of our participants had successful identify the RLN and FN (p-value <0.01); all had positive response to stimulation and familiar with the procedure. ConclusionsThe live porcine model is effectiveness in SST for RLN and FN dissection. Live porcine model with real-time RLN and FN monitoring should be provided for otolaryngology head and neck resident training.

Assessment of the Effects of the COVID-19 Pandemic on Orthopaedic Surgery Training Among Orthopaedic Residents in Southern Nigeria.

Surgical training is hands-on, with residents requiring optimal exposure to patients for optimal training and adequate experience. Thus, despite the increased usage of virtual, non-physical resources for medical education during the pandemic, orthopaedic surgical training still suffered adversely. To explore the overall impact of the COVID-19 pandemic on Orthopaedic surgery training, teaching and practice amongst residents in southern Nigeria. This was a cross-sectional prospective study involving 54 senior orthopaedic surgery residents in southern Nigeria. Data were collected using a semi-structured online-based questionnaire created on the Google Forms and sent via online platforms (e.g., WhatsApp and Telegram). Descriptive and inferential analysis was done using Statistical Package for Social Sciences (SPSS). Consent was also obtained from all respondents. A total of 54 orthopaedic surgery residents responded to our questionnaire. About 71.7% of the residents surveyed reported reduced exposure to surgical cases in general, and 70.3% reported reduced operative teaching exposure. About 68.5% of the respondents reported reduced opportunities for surgical skills acquisition training. More than half of respondents (63%) reported no changes in morbidity/mortality of orthopaedic cases witnessed and performed. The majority of the respondents agreed to a slight decrease in the availability of implants and courses (40.7%) whereas 44.4% affirmed an increase in the cost of training. Overall, 70.4% believed that the impact of COVID-19 on orthopaedic surgical training has been slightly negative. The average rating for experience on alternative learning methods - virtual video conferences, pre-recorded lectures, in-person small group meetings and surgical simulation activities was 2.26 on a scale of 1-4 (decreasing order of satisfaction). The COVID-19 pandemic caused significant changes in orthopaedic surgery training, with low cases exposure and reduction in operative teaching being the most significant changes and the resultant increase in alternative forms of training and skill acquisition.

Experience of the medical accreditation and simulation center of the “National Medical Research Center for Hematology” from March 2021 to January 2024

The article presents the experience of the medical accreditation and simulation center of the "National Medical Research Center for Hematology" from March 2021 to January 2024.

Narrative review of patient-specific 3D visualization and reality technologies in skull base neurosurgery: enhancements in surgical training, planning, and navigation.

Recent advances in medical imaging, computer vision, 3-dimensional (3D) modeling, and artificial intelligence (AI) integrated technologies paved the way for generating patient-specific, realistic 3D visualization of pathological anatomy in neurosurgical conditions. Immersive surgical simulations through augmented reality (AR), virtual reality (VR), mixed reality (MxR), extended reality (XR), and 3D printing applications further increased their utilization in current surgical practice and training. This narrative review investigates state-of-the-art studies, the limitations of these technologies, and future directions for them in the field of skull base surgery. We begin with a methodology summary to create accurate 3D models customized for each patient by combining several imaging modalities. Then, we explore how these models are employed in surgical planning simulations and real-time navigation systems in surgical procedures involving the anterior, middle, and posterior cranial skull bases, including endoscopic and open microsurgical operations. We also evaluate their influence on surgical decision-making, performance, and education. Accumulating evidence demonstrates that these technologies can enhance the visibility of the neuroanatomical structures situated at the cranial base and assist surgeons in preoperative planning and intraoperative navigation, thus showing great potential to improve surgical results and reduce complications. Maximum effectiveness can be achieved in approach selection, patient positioning, craniotomy placement, anti-target avoidance, and comprehension of spatial interrelationships of neurovascular structures. Finally, we present the obstacles and possible future paths for the broader implementation of these groundbreaking methods in neurosurgery, highlighting the importance of ongoing technological advancements and interdisciplinary collaboration to improve the accuracy and usefulness of 3D visualization and reality technologies in skull base surgeries.

Simulating blood accumulation with improved smoothed particle hydrodynamics in surgical simulation system.

Blood accumulation often occurs during bleeding in surgery. Simulating the blood accumulation in surgical simulation system not only enhances the realism and immersion of surgical training, but also helps researchers better understand the physical properties of blood flow. To realistically simulate the blood accumulation during the bleeding, this paper proposes a novel kernel function with non-negative second derivatives to improve the SPH method. Meanwhile, a simple form of boundary force equation is constructed to impose the solid boundary condition. We simulate the blood accumulation during liver bleeding and vessel bleeding respectively in the surgical simulation system. The simulation results show that there is no occurrence of blood physically penetrating the boundary. Applying the solid boundary condition to the blood by using the method proposed in this paper is not only convenient but can also eliminate compression instability in the blood accumulation simulation.

895 Innovating Automated Progress Tracking System (APS) for Laparoscopic Simulation Training in Low-Middle-Income-Countries Using LaApSi Models: Low-Cost High-Fidelity Performance Assessment System with Microcontroller Connectivity

Abstract Aim To develop a Low-Cost Automated Progress tracking system (APS) embedded in the silicon based Laparoscopic Appendicectomy Simulation (LaApSi) Model which enables real-time assessment of Laparoscopic Appendicectomy (LA). To assess its application and validity in the low-resource setting via Laparoscopic Surgery courses. Method APS architecture includes thin insulated wires embedded in the LaApSi Models at the mesoappendix, appendicular artery, and the base of the appendix which acts as an indicator when cut during the appendicectomy. These wires are further connected to the Printed Circuit Board (PCB) located at the base of the model which connects with the microcontroller and establishes communication with the computer giving real-time data. Results The prototyped APS model was able to establish key features: 1. Total duration of the procedure 2. Identify potential surgical hazard: blood vessel injury 3. Length at which the appendicectomy is performed 4. Injury to surrounding structures. These performance data were recorded in the database for further review, analysis, and comparison for progression in the simulation training. The system is set up on a points basis hence when a user makes a surgical error e.g., blood vessel injury during the surgical simulation in the APS LaApSi Model, -20 points (Blood Vessels Cut) appear on the computer screen (images available). Further assessment and validity of the APS models are planned to be carried out in low-resource settings in the next 8 weeks. Conclusions The availability of a model blueprint of this cost-effective APS system (&amp;lt;20£) to LMICs will address the key barrier of surgical simulation in low-resource settings.

772 Assessing the Impact of Gaming Skills on Robotic Surgical Skill Acquisition and Learning Curves

Abstract Robotic surgery has rapidly advanced across various medical specialties over the past decade. Extensive research has confirmed the benefits of robotic surgery, leading to improved surgical outcomes and patient satisfaction. Historically, only highly experienced consultants in laparoscopic and open surgery received training in robotic surgery to the detriment of junior surgical trainees. Virtual reality simulators have introduced gamification to enhance surgical skills. Studies have shown that individuals with gaming experience, musical aptitude, and sports backgrounds exhibit improved psychomotor skills relevant to surgery, including hand-eye coordination, reaction time, and visuospatial awareness. Despite this, there is a lack of research on how gaming and musical abilities impact robotic surgical skill acquisition and learning curves. This prospective, observational, and comparative study involved 15 novice surgeons with no prior robotic experience recruited from various UK medical institutions. Participants were divided into two groups based on their video game experience. While statistical significance was not reached (p 0.26), an observed trend favoured the gaming cohort's performance (M 56.29, SD 57.85) on the robotic surgical simulator compared to the non-gamer group (M 38.41, SD 46.77) possibly due to the limited sample size. Gamers exhibited notably superior reaction time scores (p 0.037) Additionally, gamers demonstrated enhanced overall performance in spatial reasoning and the Beat Saber game, assessing hand-eye coordination, though these differences did not reach statistical significance. This study suggests that video gaming experience may provide novice surgeons with certain advantages when beginning training on the high-fidelity dVSS robotic surgical simulator. Further research with larger participant groups may confirm these findings.

HVSMR-2.0: A 3D cardiovascular MR dataset for whole-heart segmentation in congenital heart disease

Patients with congenital heart disease often have cardiac anatomy that deviates significantly from normal, frequently requiring multiple heart surgeries. Image segmentation from a preoperative cardiovascular magnetic resonance (CMR) scan would enable creation of patient-specific 3D surface models of the heart, which have potential to improve surgical planning, enable surgical simulation, and allow automatic computation of quantitative metrics of heart function. However, there is no publicly available CMR dataset for whole-heart segmentation in patients with congenital heart disease. Here, we release the HVSMR-2.0 dataset, comprising 60 CMR scans alongside manual segmentation masks of the 4 cardiac chambers and 4 great vessels. The images showcase a wide range of heart defects and prior surgical interventions. The dataset also includes masks of required and optional extents of the great vessels, enabling fairer comparisons across algorithms. Detailed diagnoses for each subject are also provided. By releasing HVSMR-2.0, we aim to encourage development of robust segmentation algorithms and clinically relevant tools for congenital heart disease.

Clinical Workflow Algorithm for Preoperative Planning, Reduction and Stabilization of Complex Acetabular Fractures with the Support of Three-Dimensional Technologies.

Background: Treatment of pelvic injuries poses serious problems for surgeons due to the difficulties of the associated injuries. The objective of this research is to create a clinical workflow that integrates three-dimensional technologies in preoperative planning and performing surgery for the reduction and stabilization of associated acetabular fractures. Methods: The research methodology consisted of integrating the stages of virtual preoperative planning, physical preoperative planning, and performing the surgical intervention in a newly developed clinical workflow. The proposed model was validated in practice in a pilot surgical intervention. Results: On a complex pelvic injury case of a patient with an associated both-column acetabular fracture (AO/OTA-62C1g), we presented the results obtained in the six stages of the clinical workflow: acquisition of three-dimensional (3D) images, creation of the virtual model of the pelvis, creation of the physical model of the pelvis, preoperative physical simulation, orthopedic surgery, and imaging validation of the intervention. The life-size 3D model was fabricated based on computed tomography imagistics. To create the virtual model, the images were imported into Invesalius (version 3.1.1, CTI, Brazil), after which they were processed with MeshLab (version 2023.12, ISTI-CNR, Italy) and FreeCAD (version 0.21.2, LGPL, FSF, Boston, MA, USA). The physical model was printed in 21 h and 37 min using Ultimaker Cura software (version 5.7.2), on an Ultimaker 2+ printing machine through a Fused Deposition Modeling process. Using the physical model, osteosynthesis plate dimensions and fixation screw trajectories were tested to reduce the risk of neurovascular injury, after which they were adjusted and resterilized, which enhanced preoperative decision-making. Conclusions: The life-size physical model improved anatomical appreciation and preoperative planning, enabling accurate surgical simulation. The tools created demonstrated remarkable accuracy and cost-effectiveness that support the advancement and efficiency of clinical practice.

Integrating Artificial Intelligence Into the Visualization and Modeling of Three-Dimensional Anatomy in Pediatric Surgical Patients

BackgroundPediatric surgeons often treat patients with complex anatomical considerations due to congenital anomalies or distortion of normal structures by solid organ tumors. There are multiple applications for three-dimensional visualization of these structures based on cross-sectional imaging. Recently, advances in artificial intelligence (AI) applications and graphics hardware have made rapid 3D modelling of individual structures within the body accessible to surgeons without sophisticated and expensive hardware. In this report, we provide an overview of these applications and their uses in preoperative planning for pediatric surgeons. MethodsDeidentified DICOM files containing cross-sectional imaging of preoperative pediatric surgery patients were loaded from an institutional PACS database onto a secure PC with dedicated graphics and AI hardware (NVIDIA Geforce RTX 4070 laptop GPU). Visualization was obtained using an open-source imaging platform (3D Slicer). AI extensions to the platform were utilized to delineate the anatomy of interest. ResultsSegmentations of skeletal and visceral structures within a scan were obtained using the TotalSegmentator extension with an average processing time under 5 min. Additional AI modules were utilized for providing detailed mapping of the airways (AirwaySegmentation), lungs (Chest Imaging Platform), liver (SlicerLiver), or vasculature (SlicerVMTK). Other extensions were used for delineation of tumors within the hepatic parenchyma (MONAI Auto3DSeg) and hepatic vessels (RVesselX). ConclusionAI algorithms for image interpretation and processors dedicated to AI functions have significantly decreased the technical and financial requirements for obtaining detailed three-dimensional images of patient anatomy. Models obtained using AI algorithms have potential applications in preoperative planning, surgical simulation, patient education, and training. Level of EvidenceV, Case Series, Description of Technique.

Surgical Simulation of Meningioma Removal Using 3D Images

The basics of meningioma surgery are represented in the '4Ds': Detachment, Devascularization, Debulking, and Dissection. When considering the 4Ds, surgical simulation using 3D images is useful, as it allows the surgeon to understand the 3D relationship between the tumor, feeding vessels, and surrounding tissues. However, the hardness of the tumor and the degree of adhesion between the tumor and surrounding tissue are difficult to determine based on 3D images, and must therefore be confirmed using MRI, such as T2-weighted images.

Stress and resilience among military medical students completing a high-fidelity military medical simulation

Background High-fidelity medical simulations can help students successfully navigate the stressors of medical training and practice. Because sufficiently high stress levels can interfere with learning, the balance of stress and resilience factors during simulation training should be carefully curated. However, student experiences of stress and resilience during high-fidelity simulations are seldom well characterized, especially in military medical training. With this in mind, the authors investigated students’ lived experiences of stress and resilience during a well-established high-fidelity simulation at a military medical school. Methods Fourth-year active-duty military medical students (n = 23) from the United States Air Force, Army, and Navy who were attending Operation Bushmaster – a 5-day, high-fidelity military medical simulation – were interviewed during and after the simulation. Data were analyzed via a hermeneutic phenomenological qualitative approach. Another 21 students reported their stress levels and trait mindfulness. Experts rated their performance at Operation Bushmaster. Results Participant narratives pointed towards major internal stressors, including chronic uncertainty and fluctuating motivation, and external stressors, such as weather and equipment-related challenges. Narratives also identified multiple factors that mitigated stress, including the use of mindfulness skills (especially mindful/tactical breathing), giving/receiving social support, shifting perspectives to centre connections between Operation Bushmaster and students’ professional purpose, and positive self-talk that gave participants permission to make mistakes and learn from them. There was a moderate positive correlation between mindfulness and performance at Operation Bushmaster. Conclusions These stress and resilience factors are critical leverage points for educators seeking to optimize learning during Operation Bushmaster and other high-fidelity simulation trainings. Future research should continue to examine how the balance of these factors impacts medical students’ immediate learning (e.g. regarding medical decision-making, skill and leadership) and longer-term ability to successfully navigate the stressors of the medical profession.

734 Perceptions to Gamification in Surgical Simulation Training

734 Perceptions to Gamification in Surgical Simulation Training

Turning up the HEAT Surgical simulation of the Moses 2.0 laser in an anatomic model.

With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. Using high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time.

347 Perspectives of Surgical Simulation Training in Medical Students: A Narrative Synthesis

347 Perspectives of Surgical Simulation Training in Medical Students: A Narrative Synthesis