Level Of Surgical Skill Research Articles

Role of minimally invasive surgery in early ovarian cancer.

Despite having revolutionized the management of multiple types of gynecologic cancers laparoscopy and robotic surgery have had limited utility in ovarian cancer until recently. The development in medical technology allows surgeons to perform minimally invasive surgery (MIS) not only in early ovarian cancer, but also in advanced ovarian cancer. Thus far, most prospective studies showed feasible results of MIS in ovarian cancer. Even with many proven advantages of the MIS, there is no concrete evidence of the disparity in survival rate between laparoscopic, robotic surgery and laparotomy surgery. We reviewed the results of MIS in ovarian cancer thus far and suggest how the gynecologists can apply MIS in ovarian cancer in the future. Until the further prospective studies show solid evidence of safety in the MIS in ovarian cancer, comprehensive discussion about the benefits and risk with the patient and the level of surgical skill of the gynecologist should be considered in determining the type of surgery.

Utility of a 3-dimensionally printed color-coded bone model to visualize impinging osteophytes for arthroscopic débridement arthroplasty in elbow osteoarthritis

The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis require a high level of experience and surgical skill. We have developed a new technique to identify impinging osteophytes on a computer display by simulating elbow motion using the multiple positions of 3-dimensional (3D) elbow models created from computed tomography data. Moreover, an actual color-coded 3D model indicating the impinging osteophytes was created with a 3D printer and was used as an intraoperative reference tool. This study aimed to verify the efficacy of these new technologies in arthroscopic débridement for elbow osteoarthritis. We retrospectively studied 16 patients treated with arthroscopic débridement for elbow osteoarthritis after a preoperative computer simulation. Patients who underwent surgery with only the preoperative simulation were assigned to group 1 (n = 8), whereas those on whom we operated using a color-coded 3D bone model created from the preoperative simulation were assigned to group 2 (n = 8). Elbow extension and flexion range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the severity of osteoarthritis were compared between the groups. Although preoperative elbow flexion and MEPS values were not significantly different between the groups, preoperative extension was significantly more restricted in group 2 than in group 1 (P = .0131). Group 2 tended to include more severe cases according to the Hastings-Rettig classification (P = .0693). ROM and MEPS values were improved in all cases. No significant differences in postoperative ROM or MEPS values were observed between the groups. There were no significant differences in the improvement in ROM or MEPS values between the 2 groups. The use of preoperative simulation and a color-coded bone model could help to achieve as good postoperative ROM and MEPS values for advanced elbow osteoarthritis as those for early and intermediate stages.

Enhanced Training Benefits of Video Recording Surgery With Automated Hand Motion Analysis

BackgroundHand motion analysis by video recording during surgery has potential for evaluation of surgical performance. The aim was to identify how technical skill during open surgery can be measured unobtrusively by video recording during a surgical procedure. We hypothesized that procedural-step timing, hand movements, instrument use and Shannon entropy differ with expertise and training and are concordant with a performance-based validated individual procedure score.MethodsSurgeon and non-surgeon participants with varying training and levels of expertise were video recorded performing axillary artery exposure and control (AA) on un-preserved cadavers. Color-coded gloves permitted motion-tracking and automated extraction of entropy data from recordings. Timing and instrument-use metrics were obtained through observational video reviews. Shannon entropy measured speed, acceleration and direction by computer-vision algorithms. Findings were compared with individual procedure score for AA performanceResultsExperts had lowest entropy values, idle time, active time and shorter time to divide pectoralis minor, using fewer instruments. Residents improved with training, without reaching expert levels, and showed deterioration 12–18 months later. Individual procedure scores mirrored these results. Non-surgeons differed substantially.ConclusionsHand motion entropy and timing metrics discriminate levels of surgical skill and training, and these findings are congruent with individual procedure score evaluations. These measures can be collected using consumer-level cameras and analyzed automatically with free software. Hand motion with video timing data may have widespread application to evaluate resident performance and can contribute to the range of evaluation and testing modalities available to educators, training course designers and surgical quality assurance programs.

Real-Time Surgical Problem Detection and Instrument Tracking in Cataract Surgery.

Surgical skill levels of young ophthalmologists tend to be instinctively judged by ophthalmologists in practice, and hence a stable evaluation is not always made for a single ophthalmologist. Although it has been said that standardizing skill levels presents difficulty as surgical methods vary greatly, approaches based on machine learning seem to be promising for this objective. In this study, we propose a method for displaying the information necessary to quantify the surgical techniques of cataract surgery in real-time. The proposed method consists of two steps. First, we use InceptionV3, an image classification network, to extract important surgical phases and to detect surgical problems. Next, one of the segmentation networks, scSE-FC-DenseNet, is used to detect the cornea and the tip of the surgical instrument and the incisional site in the continuous curvilinear capsulorrhexis, a particularly important phase in cataract surgery. The first and second steps are evaluated in terms of the area under curve (i.e., AUC) of the figure of the true positive rate versus (1—false positive rate) and the intersection over union (i.e., IoU) obtained by the ground truth and prediction associated with the region of interest. As a result, in the first step, the network was able to detect surgical problems with an AUC of 0.97. In the second step, the detection rate of the cornea was 99.7% when the IoU was 0.8 or more, and the detection rates of the tips of the forceps and the incisional site were 86.9% and 94.9% when the IoU was 0.1 or more, respectively. It was thus expected that the proposed method is one of the basic techniques to achieve the standardization of surgical skill levels.

Renal transplantation in patients with an augmentation cystoplasty.

BackgroundThe effects of renal transplantation in patients with augmentation cystoplasty are still controversial. We retrospectively analyzed nine patients who underwent renal transplantation after augmentation cystoplasty.MethodsA total of nine patients who underwent augmentation cystoplasty prior to renal transplantation between January 1990 and May 2020 were reviewed. Basic information on augmentation cystoplasty, transplant procedures, and long-term outcomes of renal transplantation were analyzed.ResultsThe bowel segments utilized for augmentation cystoplasty were the stomach in two patients (one patient needed revision using the ileum), the ileum in four patients, the ileocolic pouch in one patient, the sigmoid in one patient, and the ureter in one patient. All the cystoplasties were performed prior to renal transplantation. The mean follow-up period after transplantation was 161 months (range, 2–341 months). Two patients had an episode of acute rejection each; however, their graft functions were well-maintained. Five patients had recurrent urinary tract infections, and three of these patients progressed to allograft failure. One patient died from bladder cancer with a functioning graft. Five of nine patients showed well-maintained graft function.ConclusionsRenal transplantation after bladder augmentation surgery is a major operation requiring a high level of surgical skill. Based on our long-term experiences, we recommend diligent postoperative monitoring for urinary tract infections, optimal catheter use, and use of appropriate antibiotic prophylaxis to avoid severe complications.

Assessment of Mandibular Ascending Ramus Cortical Plates for Reconstruction of Atrophic Maxillary Ridges Versus Chin Cortical Plates [A Randomized Clinical Trial

Aim of the study: Assessment of the quality and quantity of horizontal bone gain upon using the rami cortical blocks versus chin blocks for horizontal augmentation of atrophic maxillary ridges Patients and Methods: Twenty operation sites in 18 patients suffering from partial edentulism in the maxilla with an inadequate bone width to allow favorable implant placement were selected from the outpatient clinic of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. They were classified after being included in the study into (10 chin group candidate) & (10 ascending ramus candidate). Results: A total of 20 atrophic sites (cases) in 18 patients ranging from 29-54 years old with a mean of 43.4 years were included in the present study (Table 2). The enrolled subjects were randomly divided by alternation into two groups. 10 sites received autogenous block graft harvested from the mandibular symphysis (symphyseal group). Other 10 sites received autogenous block graft harvested from the ascending ramus (ramus group). Conclusion: Thus within the limits of this study the following could be concluded: Ascending ramus onlay blocks showed significant better results than symphyseal onlay blocks regarding both the quality and stability of the grafted volume of bone. Ramus graft harvesting is a more sensitive procedure as compared to symphyseal block graft and requires certain level of surgical skill and experience to be performed successfully.

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment.

We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.

Distinguishing Intermediate and Novice Surgeons by Eye Movements.

Surgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.

Survey on the surgical skills of orthopedics and traumatology residents from accredited and nonaccredited institutions in İstanbul.

To investigate whether orthopedic and traumatology residents who are undergoing training achieve competence in surgical techniques after completion of their specialization and to determine whether there are significant differences between the responses of residents from accredited and nonaccredited institutions. A total of 131 orthopedics and traumatology residents from nine institutions in the İstanbul province answered the questionnaire during the morning training meeting. In addition to basic demographic data, level of seniority, equipment competence, and theoretical and practical training, the residents were asked about their opinion on what type of surgeries they could perform after their specialization, considering the surgery and follow-up of the case as well as the complications occurring during this period. The residents responded to questions on 46 surgeries under the main headings of trauma, arthroscopy, arthroplasty, spine, pediatric orthopedics, hand surgery, deformity, and bone and soft tissue tumors. In addition to descriptive statistical methods, one-way analysis of variance, Tukey's multiple comparison test, and chi square test were used to evaluate the data. The significance level for the results was set at p<0.05. In total, 131 orthopedics and traumatology residents answered the questionnaire. Furthermore, 53 (40.5%) specialization students were employed at accredited institutions and 78 (59.5%) at nonaccredited institutions. According to the responses, case presentations, article-writing sessions, and in-province meetings held regularly at accredited institutions showed a significant difference compared to non-accredited institutions (p<0.05), and the residents at the accredited institutions benefited significantly more from the availability of books and electronic media in gaining theoretical knowledge (p<0.05). When the responses of the residents from accredited and nonaccredited institutions regarding 46 different surgeries were compared, a significant difference was found in 17 of them (p<0.05). There was a significant difference between the averages of residents' responses on the surgical fields they have interest for (p<0.05). It was determined that the residents believed that they could mostly perform surgeries in the fields of trauma, followed by arthroplasty, deformity, arthroscopy, pediatric orthopedics, hand surgery, and spine and tumor surgery. According to their level of seniority, a significant difference was found between the averages of residents' opinions regarding their surgical skill levels (p=0.02). We believe that it would be beneficial for the trainers to take necessary precautions to increase the skill levels of the residents of orthopedic surgery. Accreditation significantly contributes to the standardization of education as well as quality improvement. Further action should be taken to increase the number of accredited clinics.

Assessing the Correlation Between a Surgeon's Ability to Draw a Procedure and Ability to Perform the Procedure

The ability to assess a trainee's technical skill in a manner that maintains patient safety is critical to resident education. To do so, senior plastic surgery educators frequently ask residents to draw their proposed operation, presuming that a surgeon's ability to perform a surgery is reflected in his or her ability to diagram the procedure, independent of artistic ability. The purpose of this study was to delineate the relationship between the ability to draw a surgical procedure and execute it in a simulated model, and to determine if the ability to draw a procedure depends on artistic ability. Participants in varying levels of knowledge and surgical skill were asked to draw a 4-strand cruciate tendon repair and subsequently perform the procedure on a validated, simulated model. The participants were graded according to Objective Structured Assessment of Technical Skills scales by 2 blinded hand surgeon examiners. Statistical analysis was performed in SAS 9.4 with Spearman's rank correlation coefficient. The study was performed at Baylor Scott and White Health in Temple, TX in an office-based laboratory setting. Participants Forty participants comprised of senior medical students, plastic/orthopedic surgery residents, and plastic/hand surgery attendings. All 40 participants entered and completed the study. A statistically significant strongly positive correlation was found between overall assessment of drawing and overall assessment of performing the surgical procedure (p = 0.004). At the same time, the assessment of ability to draw the procedure was not associated with a general ability to draw or previous art training (p = 0.28). Our findings support the use of drawing a specific procedure as an assessment tool to evaluate a surgeon's ability to perform a procedure.

Towards near real-time assessment of surgical skills: A comparison of feature extraction techniques

Background and ObjectiveSurgical skill assessment aims to objectively evaluate and provide constructive feedback for trainee surgeons. Conventional methods require direct observation with assessment from surgical experts which are both unscalable and subjective. The recent involvement of surgical robotic systems in the operating room has facilitated the ability of automated evaluation of the expertise level of trainees for certain representative maneuvers by using machine learning for motion analysis. The features extraction technique plays a critical role in such an automated surgical skill assessment system. MethodsWe present a direct comparison of nine well-known feature extraction techniques which are statistical features, principal component analysis, discrete Fourier/Cosine transform, codebook, deep learning models and auto-encoder for automated surgical skills evaluation. Towards near real-time evaluation, we also investigate the effect of time interval on the classification accuracy and efficiency. ResultsWe validate the study on the benchmark robotic surgical training JIGSAWS dataset. An accuracy of 95.63, 90.17 and 90.26% by the Principal Component Analysis and 96.84, 92.75 and 95.36% by the deep Convolutional Neural Network for suturing, knot tying and needle passing, respectively, highlighted the effectiveness of these two techniques in extracting the most discriminative features among different surgical skill levels. ConclusionsThis study contributes toward the development of an online automated and efficient surgical skills assessment technique.

Novel quantitative and objective structured assessment of technical skill for slip knotting.

Currently, no quantitative and objective method has been established for evaluating competencies in basic surgical techniques. The aim of this study was to develop a structured assessment tool for slip knotting and verify how well current board certification system discriminates the level of basic surgical skill. We examined 171 cardiovascular surgical fellows using a novel assessment method for slip knotting that was developed by the committee of the Under-Forty of the Japanese Society of Cardiovascular Surgery. We compared the scores and examinees' surgical experience for validation. We analyzed the relationship between board certification and the scores. The scores differentiated the general surgical board-certified surgeons from those without certification. Surgical experiences such as training years and number of operated cases and scores were correlated. Among the board-certified surgeons, the group with daily off-the-job training, or simulator-based skill training had a significantly higher mean score (67.4 ± 3.0 vs 55.4 ± 3.1, p = 0.008) and lower rate of poor scorers (7.1% vs 38.5%, p = 0.004). A multivariate analysis revealed that board certification did not predict high scores. Daily off-the-job training was the only independent predictor of high scores (odds ratio: 2.41, 95% confidence interval: 0.01-1.20, p = 0.014). This novel quantitative and objective assessment tool for technical skill in slip knotting was found to be valid to examine the skill for slip knotting. In this study, current board certification discriminated the level of basic surgical skill. However, it could not distinguish extremely low scorers perfectly. Some board-certified surgeons showed poor technical competency, especially those without off-the-job training.

Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study.

ObjectiveTo evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis.MethodsThis is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5–62 years). The operative method was selected according to the indications. A total of 33 patients underwent one‐stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one‐stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed.ResultsAll cases were followed up for approximately 36–96 months post‐surgery (average, 39 months). At the last follow‐up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001).ConclusionThe choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications.

Surgical skill levels: Classification and analysis using deep neural network model and motion signals

Background and ObjectivesCurrently, the assessment of surgical skills relies primarily on the observations of expert surgeons. This may be time-consuming, non-scalable, inconsistent and subjective. Therefore, an automated system that can objectively identify the actual skills level of a junior trainee is highly desirable. This study aims to design an automated surgical skills evaluation system. MethodsWe propose to use a deep neural network model that can analyze raw surgical motion data with minimal preprocessing. A platform with inertial measurement unit sensors was developed and participants with different levels of surgical experience were recruited to perform core open surgical skills tasks. JIGSAWS a publicly available robot based surgical training dataset was used to evaluate the generalization of our deep network model. 15 participants (4 experts, 4 intermediates and 7 novices) were recruited into the study. ResultsThe proposed deep model achieved an accuracy of 98.2%. With comparison to JIGSAWS; our method outperformed some existing approaches with an accuracy of 98.4%, 98.4% and 94.7% for suturing, needle-passing, and knot-tying, respectively. The experimental results demonstrated the applicability of this method in both open surgery and robot-assisted minimally invasive surgery. ConclusionsThis study demonstrated the potential ability of the proposed deep network model to learn the discriminative features between different surgical skills levels.

Endométriose : évaluation du score Ultrasound-Based Endometriosis Staging System (UBESS) dans la prédiction de la difficulté chirurgicale

ObjectivesSurgical management of endometriosis may require different levels of surgical skill which influences the orientation of the patient. The Ultrasound-Based Endometriosis Staging System (UBESS) is a score developed in 2016 to predict the difficulty of surgery. To study the correlation between UBESS score and two main surgical classifications in the literature. MethodsStudy performed at the center of Poissy, France, between July 2016 and December 2017. Patients who underwent prospective UBESS staging then operated of their endometriosis were included. The patients were classified according to the levels of surgical difficulty of the Royal College of Obstetricians and Gynecologists (RCOG) and the classification created by Chi et al. The criterion of judgment was the correlation between the UBESS stages and RCOG and CHI levels. In a second analysis, we determined the predictive value of the operative plan for items included in the systematic sonographic evaluation described by Menakaya et al. ResultsThirty-three patients were included in the study. Correlation was found to be low between UBESS and RCOG (θ=0.22) and between UBESS and CHI (θ=0.30). The prediction of the operative plan was good for endometrioma, sites specific tenderness, sliding sign, vaginal and digestive tract involvement; but modest for the anterior compartment and uterosacrals ligaments. ConclusionIn our study on a small number of patients, the UBESS score does not adequately predict the surgical difficulty. Taken separately, the items of systematic sonographic evaluation based on 5 domains successfully predict the operative plan.

Simulation-based surgical skill training in internship program

Background: Objective structured assessment of technical skills (OSATS) are crucial in assessing operative skills. The education of basic surgical skill (BSS) depends on precise assessment of their surgical skill levels and competency level. Hence, this study aimed to determine the effectiveness of BSS module on intern's competency and confidence. Materials and Methods: Fifty-four interns were included in the module. Three faculty members were included in the module. The module has been prepared on: (1) Asepsis – surgical hand scrubbing, gloving, gowning. (2) Simple interrupted suturing. Intervention: Small group teaching was given to each batch, and hands-on training in dry skill laboratory on simulation was given. Interns were assessed by OSATS, and feedbacks were taken at the end of the assessment. Results: The score of global rating scale for each trainee increased within the 15 days of posting. The knowledge domain of posttest score also improved. Conclusion: BSS module was found to be effective, aiding for the interns to improve their knowledge and skills.

Evidence based classification/staging system for Obstetric Fistula: Planning and preliminary intervention in Nigeria

Aims: To review the classification systems of obstetric fistula (OF). &#x0D; Methods: A two-day stakeholders’ meeting in Nigeria involving fistula surgeons, nurses, anesthetists, trainee, fistula desk officers at the federal and state government levels and other stakeholders was facilitated by Engender health. The meeting involved presentation of common classifications of obstetric fistula, critical analysis of each classification, group and plenary discussions. Presentation involved a critical analysis of classification parameters, strength and weakness. Three working groups designed classification criteria, prognostic scoring and suggested level of surgical skills needed to manage the patient. Outcome of each group work was presented and discussed in plenary. Each of the classification scenarios were modified by consensus and ratified at subsequent follow up meeting.&#x0D; Results: Three new classification systems of the OF were developed, and from these, a consensus classification was also developed in plenary. The initial three classifications developed from group work were similar to each other. Each classification considered size, location, previous repair, scaring, associated morbidity involvement of closing mechanism of the bladder neck, degree of urethral involvement and presence of transection of bladder neck (circumferential defect). The consensus classification, that was adopted, considered classification and prognostic scoring system. The four classification systems will be field tested to generate evidence for reliability and reproducibility.&#x0D; Conclusions: We believe a new classification system of obstetric fistula that will provide robust information to the managing team and patient is long overdue. This modest idea is a wake-up call for practitioners to design appropriate tool that is back up with reproducible evidence.

One Hundred Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center.

The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation. Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods. During the initial period, 3 (2.6%) donors experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 minutes vs 344.4 minutes; P < 0.001) and hospital stay (7.3 days vs 8.3 days; P = 0.002) were significantly shorter during the more recent period. Also, Δhemoglobin (Hb)%, calculated as ΔHb% = [(preoperative Hb - postoperative Hb)/preoperative Hb] × 100 (14.9% vs 17.5%; P = 0.042), and Δaspartate aminotransferase (AST)%, calculated as ΔAST% = [(peak AST - preoperative AST)/preoperative AST] × 100 (1048.9% vs 1316.6%; P = 0.009), were significantly lower during the recent period. Pure laparoscopic donor right hepatectomy is both feasible and safe when performed at a center experienced in adult living donor liver transplantation. Performance of about 60 PLDRHs over 1 year is sufficient to standardize the procedure.

Ultrasound-Based Endometriosis Staging System: Validation Study to Predict Complexity of Laparoscopic Surgery

To validate the preoperative ultrasound-based endometriosis staging system (UBESS) for predicting the correct Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and Australasian Gynaecological Endoscopy and Surgery (AGES) Society's level of laparoscopic skill required for endometriosis surgery. Multi-center retrospective cohort study (Canadian Task Force classification II-2). Tertiary teaching hospital and a private gynecologic clinic. 155 women presenting with chronic pelvic pain and/or a history of endometriosis. Women underwent detailed specialized transvaginal ultrasound (TVS) in a tertiary referral unit to diagnose and stage endometriosis using the 3 stages of the UBESS. The UBESS was correlated to RANZCOG/AGES laparoscopic skill levels. The UBESS classifications were correlated as follows: UBESS I to predict RANZCOG/AGES surgical skill level 1/2, UBESS II to predict RANZCOG/AGES skill level ¾, and UBESS III to predict RANZCOG/AGES skill level 6. The accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the UBESS I to predict the RANZCOG/AGES surgical skill levels 1/2 were 99.4%, 98.9%, 100%, 100%, 98.5%, not applicable, and .011; those of UBESS II to predict surgical skill levels 3/4 were: 98.1%, 96.8%, 98.4%, 93.8%, 99.2%, 60 and .033, respectively, and those for UBESS III to predict surgical skill level 6 were: 98.7%, 97.2%, 99.2%, 97.2%, 99.2%, 115.7, and 0.028, respectively. The rate of correctly predicting the exact level of skills needed was 98.1%, and Cohen's kappa statistic for the agreement between UBESS prediction and levels of training required at surgery was 0.97, indicating almost perfect agreement. The UBESS can be used to predict the level of complexity of laparoscopic surgery for endometriosis based on the RANZCOG/AGES skills levels for laparoscopy. It now awaits external validation in multiple centers with various surgical skill level classification systems to assess its general applicability.

Laparoscopic training using a quantitative assessment and instructional system.

Laparoscopic surgery requires complex surgical skills; hence, surgeons require regular training to improve their surgical techniques. The quantitative assessment of a surgeon's skills and the provision of feedback are important processes for conducting effective training. The aim of this study was to develop an inexpensive training system that provides automatic technique evaluation and feedback. We detected the instrument using image processing of commercial web camera images and calculated the motion analysis parameters (MAPs) of the instrument to quantify performance features. Upon receiving the results, we developed a method of evaluating the surgeon's skill level. The feedback system was developed using MAPs-based radar charts and scores for determining the skill level. These methods were evaluated using the videos of 38 surgeons performing a suturing task. There were significant differences in MAPs among surgeons; therefore, MAPs can be effectively used to quantify a surgeon's performance features. The results of skill evaluation and feedback differed greatly between skilled and unskilled surgeons, and it was possible to indicate points of improvement for the procedure performed in this study. Furthermore, the results obtained for certain novice surgeons were similar to those obtained for skilled surgeons. This system can be used to assess the skill level of surgeons, independent of the years of experience, and provide an understanding of the individual's current surgical skill level effectively. We conclude that our system is useful as an inexpensive laparoscopic training system that might aid in skill improvement.