Surgical Skills Research Articles

POSNA Leadership Program (PLP): Developing surgeon leaders for patients, organizations, and our society

POSNA initiated a Leadership Program in 2022. The POSNA Leadership Program (PLP) is designed to enhance emotional intelligence (social skills, empathy, communication, self-regulation, and self-awareness) and in-depth leadership skill development for selected participants in a year-long seminar. Disruptive behaviors detrimental to health care professionals, patients, and care delivery organizations can be identified and lessened through education.Most surgeons rightfully focus their learning intently on specific surgical knowledge and technical expertise, especially in the early and middle career stages. Despite this, surgical errors still occur secondary to limitations of non-technical surgical skills (NOTSS): decision making, communication, leadership and teamwork. More senior surgeons are also prone to leadership and communication errors. By gaining education and expertise in NOTSS, improved team building with more professional staff engagement, empowerment, and trust can result in lower risk.POSNA is focusing on subspecialty specific leadership education for mid-career pediatric orthopaedic surgeons to foster an enhanced future for our local and national organizations. The PLP leaders understand leadership is not about their own “fame and fortune”, but rather the success of “those they are privileged to lead” through career and programmatic development that enhances our mission of improving musculoskeletal care for children. The JPOSNA Leadership series will bring the PLP knowledge and expertise to the entire membership. Key concepts(1)leadership, followership, emotional intelligence, non-technical surgical skills

Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction.

Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.

Enhancing the Microneurosurgical Training: Development of the Folded Placenta Model for Simulation of the Deep Operative Field Challenges of Cranial Procedures

Neurosurgery relies heavily on advanced manual skills, necessitating effective training models for skill development. While various models have been utilized, the human placenta has emerged as a promising candidate for microneurosurgical training due to its anatomical similarities with cerebral vasculature. However, existing placenta models have primarily focused on simulating superficial procedures, often neglecting the complexities encountered in deep operative fields during cranial surgeries. This study obtained ethical approval and implemented a modified placenta model to address the limitations of existing training models. The key modification involved folding the placenta and placing it within a rigid container, closely mimicking the structural challenges of cranial procedures. The placenta preparation followed a standardized protocol, including the use of specialized equipment for documentation. The primary feature of the modified model is the folded placenta within the rigid container, which replicates cranial anatomy. This innovative approach enables trainees to engage in a comprehensive range of microsurgical exercises, encompassing vessel dissection, aneurysm clipping, tumor resection, and more. The model successfully mirrors the complexities of real cranial procedures, providing a realistic training experience. The presented modified placenta model serves as an effective tool for simulating the conditions encountered in deep cranial surgeries. By accurately replicating the challenges of deep operative fields, the model significantly enhances the training of neurosurgical residents. It successfully prepares trainees to navigate the intricacies and difficulties inherent in real cranial surgeries, thus contributing to improved surgical skills and readiness for neurosurgical practice.

Educating Trainees to Treat Peripheral Arterial Disease: Challenges and Opportunities

Educating trainees to treat Peripheral Artery Disease (PAD) carries specific contemporary challenges. The national increase of the prevalence of PAD combined with a significant shortage of vascular surgeons creates a need for concern for future management of this complex disease. Over the past two decades, traditional (5+2) and integrated (0+5) paradigms have fostered trainee annual growth and comparable case distribution and volumes in endovascular and open surgical treatment options have been maintained. Close evaluation into not only the absolute numbers of surgical cases, but the level of trainee involvement in each logged case is recommended. Future implementation of the Entrustable Professional Activity (EPA) modules will hopefully assist in ensuring linear development of surgical skill and judgement. Additionally, advances in individual and systems level techniques to enhance skill acquisition in the form of “off-the job training” and simulation-based training may provide an enhancement to traditional technical training methods. Finally, the possibility and role of Artificial Intelligence in vascular surgery skill training must not be ignored, but carefully explored and utilized to modernize cognitive and technical skill preparation for trainees in the and delivery of care for PAD patients. Overall, the training residents for the treatment of PAD patients will be associated with new challenges that vascular surgery must embrace and surmount to advance our specialty.

428 Artificial Intelligence Training Versus In-person Expert Training in Teaching Simulated Tumor Resection Skills - A Cross-Over Randomized Controlled Trial

INTRODUCTION: Neurosurgical simulations equipped with artificial intelligence systems provide an objective quantitative assessment of surgical technical skills and tailored intelligent feedback. These systems allow for repeated practice of complex skills such as subpial brain tumor resection. However, more work is needed to assess the utility of intelligent systems in teaching tumor resection skills, compared to traditional human instruction. METHODS: Twenty-five trainees who are currently enrolled in four Canadian medical schools participated in two training sessions, during which they completed a simulated subpial tumor resection five times. Participants were randomly assigned to two feedback groups: (1) real-time intelligent instruction, and (2) in-person human instruction. They were then assigned to the other feedback group in the second (cross-over) session. A composite-score was given by the intelligent system to assess technical skills during each task. RESULTS: Trainees who received real-time intelligent instruction significantly improved their composite-score in the first and second training sessions (p = .017, p = .005, respectively). Trainees who received in-person human instruction in the first training session had no statistically significant changes in their composite-score from the first to the last task repetition (p = .119). The composite-score decreased significantly in the second training session with in-person human instruction (p = .004). CONCLUSIONS: Real-time intelligent instruction provides an effective way of teaching simulated brain tumor resection skills. Artificial intelligence systems may be a useful addition to current surgical training curricula, providing objective, and tailored assessment and teaching of surgical technical skills in risk-free realistically simulated patient cases. Educators can benefit from these systems to guide their supervision, while trainees can use them for self-guided skill acquisition. Further research may assess the generalizability of these findings to other surgical procedures.

AOFAS Diabetic Foot Survey Results

Introduction: Foot and ankle pathology in patients with diabetes mellitus is prevalent in the United States and may be associated with significant morbidity. Patient outcomes can be improved by optimal medical management; deformity management and correction to limit the development of infection and ulceration; and timely, appropriate treatment of infection and ulceration when it occurs. Orthopaedic foot and ankle surgeons are well-qualified to treat these patients, either individually or as members of a healthcare professional team. However, there are some healthcare professionals and members of the public who are under the impression that orthopaedic foot and ankle surgeon are either unwilling or uninterested in treating this patient population. The authors hypothesized that this impression was a misconception and this study was designed to address this question. Methods: An online survey was sent to 1376 AOFAS members practicing in the United States. There were six questions, two of which were demographic and one that asked for additional comments. The survey was completed by 297 (22%) members from 45 states and the District of Columbia. Results: Nonoperative treatment of foot and ankle disorders in patients with diabetes mellitus was performed by 98.7% of responders including 98.7% for fractures; 97.6% for common disorders (e.g., bunions, hammer toes, flatfeet, plantar fasciitis, osteoarthritis, tendon disorders); 89.9% for Charcot arthropathy; 77.1% for infections; and 69.0% for ulcers. Operative treatment of foot and ankle disorders in patients with diabetes mellitus was performed by 98.7% of responders including 97.0% for fracture fixation; 96.3% for gastrocnemius recession and/ or Achilles tendon lengthening; 94.6% for arthrodesis for osteoarthritis; 94.3% for hammer toe surgery; 92.6% for bunion surgery; 89.6% for Charcot exostectomy; 83.8% for Charcot reconstruction; 83.5% for amputations within foot; 81.1% for below knee amputations; 74.8% for operative debridement of infections/ ulcers; and 57.9% for total ankle replacement. When asked which healthcare professionals treat diabetic patients in their community, 96.6% listed podiatrists; 91.3% listed orthopaedic foot and ankle surgeons; 69.0% listed other MD/ DO surgeons (e.g. general, plastics, vascular); 64.0% listed nurses (e.g., APRN, wound care specialist); 37.4% listed other orthopaedic surgeons; 31.7% listed non- surgeon MD/ DO physicians; 32.3% listed physician assistants; and 2% listed other. Conclusion: The vast majority of orthopaedic foot and ankle surgeons practicing in the United States who responded to the survey provide operative and nonoperative treatment to patients with diabetes mellitus and foot and ankle disorders. Given the extensive medical education and training of orthopaedic foot and ankle surgeons, their knowledge and surgical skill, and the benefits patients with diabetes receive from appropriate and timely foot and ankle care, efforts should be made to educate the public and other healthcare professionals of the availability of most orthopaedic foot and ankle surgeons to provide this care.

Replacing the Scalpel With a Computer Mouse: An Evaluation of Time Spent on Electronic Health Record for Plastic Surgery Residents and Its Impact on Resident Training.

Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents. Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600-1759) and off-duty (1800-0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA). Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1-3) spent 123 ± 99 minutes versus seniors (postgraduate years 4-6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19). Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.

Interns' Perceived Level of Proficiency After General Surgery Rotation: A Cross-Sectional Study From Saudi Arabia.

The role of interns during general surgical rotation is crucial in shaping their future careers as surgeons. Surgical rotation offers a unique opportunity to gain valuable hands-on experience in fast-paced and challenging environments. However, interns often face significant challenges in obtaining the necessary practical training to develop proficiency in surgical techniques. This article aims to analyze some aspects of the accumulated competency of interns during their general surgery rotation, focusing on the range of skills and knowledge gained, in addition to the challenges faced. We conducted a cross-sectional study using an anonymous web-based self-assessment questionnaire. The target population of the study included all Jazan University medical interns enrolled in the academic year 2022-2023. Most participants showed low-to-average levels of proficiency in monitoring clinical evolution and treatment plans, ranging from fundamental awareness (n = 17, 17.5%) to working knowledge (n = 51, 52.6%), with only three participants (3.1%) reporting an expert level of proficiency. The same pattern was observed in the documentation of patient records (range: 7.2%, n = 7 for fundamental awareness to 42.3%, n = 41 for working knowledge). However, a significant proportion saw themselves as either proficient (n = 23, 23.7%) or experts (n = 15, 15.5%) in this aspect. Regarding bedside procedures, such as venipuncture, proctoscopy, nasogastric tube insertion, and urethral catheterization, the participants showed different proficiency levels, with the lowest in proctoscopy, where 66 (68.0%) of the participants reported only fundamental awareness. The results also revealed low perceived proficiency in performing surgical skin incisions, wound suturing, knot tying, application of surgical skin clips, and abscess drainage, with the lowest proficiency observed in the excision of superficial lumps as more than half of the participants reported only fundamental awareness (n = 51, 52.6%). The results of this study indicate that documentation and monitoring of patient progress are the competencies mastered most by the majority of interns during their rotations in general surgery. However, the interns' overall level of proficiency in bedside procedures and basic surgical skills acquired during their rotation was low to average. Additionally, interns were dissatisfied with their training and the opportunities provided for them to actively engage in performing procedures in the operating room. This low proficiency is unrelated to pre-internship academic achievement, sex, or interest in future surgical careers. This suggests that efforts are needed to develop strategies to enhance interns' satisfaction and engagement, ultimately improving their overall experience during internships.

Vaso-Lock for sutureless anastomosis in a pig arteriovenous loop model

A vascular anastomosis is a critical surgical skill that involves connecting blood vessels. Traditional handsewn techniques can be challenging and resource intensive. To address these issues, we have developed a unique sutureless anastomotic device called Vaso-Lock. This intraluminal device connects free vascular ends using anchors to maintain traction and enable a rapid anastomosis. We tested the anastomotic capability of Vaso-Locks in a pig common carotid-internal jugular arteriovenous model. The use of Vaso-Lock allowed us to accomplish this procedure in less than 10 min, in contrast to the approximately 40 min required for a handsewn anastomosis. The Vaso-Lock effectively maintained patency for at least 6 weeks without causing significant tissue damage. Histological analysis revealed that the device was successfully incorporated into the arterial wall, promoting a natural healing process. Additionally, organ evaluations indicated no adverse effects from using the Vaso-Lock. Our findings support the safety and effectiveness of the Vaso-Lock for arteriovenous anastomosis in pigs, with potential applicability for translation to humans. Our novel sutureless device has the potential to advance surgical practice and improve patient outcomes.

426 Effect of Visuospatial Feedback Versus Numeric Scores on Neurosurgical Tumor Resection Skills Among Medical Students in Virtual Reality Simulation Randomized Control Trial

INTRODUCTION: Virtual reality (VR) simulation can be implemented with various feedback modalities to optimize learners’ surgical skills acquisition. The systems can present benchmark scores as either a numeric report or a visuospatial performance assessment. In this context, the optimal feedback methodology to enhance learning remains undefined. METHODS: One hundred and twenty medical students (mean age [SD], 23.1 [3.6] years, 41% women) from four institutions were recruited to practice a simulated subpial tumor resection in five attempts. They were randomly assigned to receive one of four interventions between each attempt: (1) no feedback (n = 30), (2) numerical feedback (n = 30), (3) visual feedback (n = 29), or (4) visuospatial feedback (n = 31). Performance on the first task determined baseline. Skill was evaluated using previously established 14-expert performance benchmarks. The primary outcome was the number of performance benchmarks achieved throughout the five attempts. RESULTS: Participants in all feedback groups significantly improved their performance compared to baseline. Between-subjects comparison demonstrated a significant increase in the number of metrics achieved with visual (mean difference 1.80, p = 0.001) and visuospatial (mean difference 1.89, p &lt; 0.001) feedback compared to control, and no significant increase with numeric assessment (mean difference 1.10, p = 0.093). In the third attempt, visual feedback was significantly superior to numeric assessment (mean difference 1.63, p = 0.016). CONCLUSIONS: Neurosurgical skill acquisition is enhanced with visual and visuospatial feedback in VR simulation training. These engaging modes of performance assessment result in more accelerated rate of benchmark acquisition compared to numerical scores alone. Further research is warranted to explore the potential benefits of visual and visuospatial feedback in other domains of surgical training.

228 Expert Hand Motion During Microvascular Anastomosis Simulation: Big Data Analysis Using Machine Learning Hand Detection

INTRODUCTION: Microanastomosis is a complex surgical technique that demands delicate and coordinated hand movement. Advances in machine learning technology have enabled new methods to study human motion. Convolutional neural networks are algorithms specialized in visual tasks that enable discrete object detection and tracking including the hands of a surgeon. METHODS: A machine learning hand detector was developed using a pre-trained convolutional neural network capable of tracking 21 hand landmarks without sensors attached. En-to-side microanastomosis was simulated using 2 mm polyvinyl-alcohol vessels and 10/0 micro-suture and recorded with a video camera capturing hand movement in the surgical field. Participants (n = 4) were expert cerebrovascular surgeons with significant operative experience in cerebral bypass surgery. Calculation of motion of 14 hand joint angles was performed using a vectorization method from landmark detections. Time series analysis was performed to calculate the absolute angular motion for each joint of the hand. RESULTS: Four minutes of simulation for each surgeon yielded a total of 784.294 angular detections (14 hand joints total). For the dominant hand, the mean (SD) absolute angular motion was expert 1: 178.2 rad (98.3); expert 2: 261.8 rad (164.3); expert 3: 449.9 rad (307); expert 4: 380.1 rad (198.1).For the non-dominant hand, the mean (SD) absolute angular motion was expert 1: 132.9 rad (64.6), expert 2: 149.2 rad (72.3); expert 3: 389.2 rad (243); expert 4: 162.6 rad (87.2). CONCLUSIONS: A machine learning hand detector system can calculate hand joint motion during microvascular anastomosis. The absolute angular motion is a quantitative performance metric providing information about hand stability during microanastomosis simulation. Such studies using powerful artificial intelligence detection algorithms may have educational potential in the assessment of complex and delicate surgical skills and supervision of surgical training.

Descriptions of trainee surgical skill in letters of recommendation for urogynecology fellowship

Descriptions of trainee surgical skill in letters of recommendation for urogynecology fellowship

Stepping into the virtual realm: Examining the utility of non-immersive VR on medical residents' self-efficacy, performance, and satisfaction

Central Venous Catheterization (CVC) is conducted in more than 5 million patients annually in the United States. Currently, CVC theoretical knowledge is typically taught with didactic lectures with minimal assessment of knowledge before simulation training and clinical environment. To assess CVC theoretical knowledge, virtual reality (VR) can develop residents’ surgical skills and can provide feedback on performance. While all types of VR can be used to assess improvements in residents’ knowledge prior to simulation training, few studies have compared the impact of non-immersive VR on improving resident knowledge. The current study was developed to identify the utility of a non-immersive CathSim VR on improvements in resident CVC theoretical knowledge, self-efficacy, and satisfaction when compared to a traditional multiple-choice assessment This was completed through an empirical investigation with 34 medical residents. The results showed that when compared to a traditional multiple-choice assessment, the non-immersive CathSim VR assessment led to improvements in self-efficacy and potentially better learning experience. Meanwhile, results also showed that there were no differences in assessment score, number of attempts, and overall satisfaction. Thus, we can conclude that non-immersive VR has the potential to be more effective than traditional multiple-choice test in improving self-efficacy and is as effective for residents’ assessment score, number of attempts, and overall satisfaction.

Enhancing neuro-ophthalmic surgical education: The role of neuroanatomy and 3D digital technologies - An overview.

Neuro-ophthalmology, bridging neurology and ophthalmology, highlights the nervous system's crucial role in vision, encompassing afferent and efferent pathways. The evolution of this field has emphasized the importance of neuroanatomy for precise surgical interventions, presenting educational challenges in blending complex anatomical knowledge with surgical skills. This review examines the interplay between neuroanatomy and surgical practices in neuro-ophthalmology, aiming to identify educational gaps and suggest improvements. A literature search across databases such as PubMed, Scopus, and Web of Science was conducted, focusing on the implications of neuroanatomy in neuro-ophthalmic surgery education and practice. The review synthesizes insights from both recent and foundational studies to highlight current understandings and future research directions, particularly in educational approaches. Findings indicate that 3D digital modeling and virtual reality have significantly enhanced neuroophthalmic surgical education by providing immersive and engaging learning experiences. For instance, detailed 3D brain atlases offer comprehensive resources for understanding the central nervous system's normal and pathological states. Although studies show that 3D and traditional 2D methods achieve similar post-test results, 3D methods notably improve engagement and motivation, suggesting a shift toward more interactive learning environments. Integrating both traditional and innovative educational tools is crucial for the progression of neuro-ophthalmic surgical training. This balance helps overcome educational hurdles and better prepare future surgeons. Continuous research and collaboration are essential to refine educational strategies, ultimately aiming to enhance patient care in neuro-ophthalmology.

Sustaining Military Surgeons and the Joint Trauma System: Current Efforts, Unique Challenges, and Proposed Strategies in an Era of Global Uncertainty.

Mini abstract US military assets have been integral to the response to global pandemics, natural disasters, civilian casualties, and combat care. Strategies are being implemented to strengthen the military health care system and curtail the erosion of relevant surgical skills and knowledge during periods of low combat intensity. However, additional challenges remain. We describe these strategies and obstacles but also explore potential solutions that may strengthen the readiness of military surgeons and combat trauma teams.

Evaluation of Functional Outcomes After Reconstruction of Post-burn Contracture of the Hand in the Pediatric Age Group: A Prospective Study.

Background Injuries on the hand due to burns affect the quality and functions of activities of daily living (ADL). Severe burns cause lasting complications and deformities, such as contracture of the hand, which require multiple staged surgeries and rehabilitation for extended periods to regain function. This is of major significance to children, as they are in the growing and developmental age group, which should be considered while planning a reconstructive procedure. Psychological counselling is equally important for these patients to accept the residual deformity and cosmesis of the hand following surgery. Methods A prospective interventional study was conducted on 40 patients to assess the functional outcomes of various reconstructive procedures for post-burn contracture of the hand and to find out which is the better surgical intervention for restoring the hand functions needed for ADL. Functional outcomes were analyzed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months. Results In the group of children operated on with flap procedures, the maximum number of patients had average functional outcomes. Functional outcomes were assessed using the Modified JHFT, in which fine motor, weighted, and non-weighted hand function activities were assessed and analyzed. However, in the group of children operated on by the Z-plasty procedure and skin graft procedure, the maximum number of patients had poor functional outcomes. Conclusion The management of burn injuries on the hand and subsequent contractures is often challenging, especially in pediatric patients. Timely intervention, patient education, and surgical skills with an appropriate choice of reconstructive procedures play a vital role in achieving good postoperative results. This study showed that hands reconstructed using flap procedures had good functional outcomes compared to graft and Z-plasty procedures.

Is the robotic revolution stunting surgical skills?

This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow. Key messageThe large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.

The role of virtual endoscopy in surgical practice of otolaryngology head and neck surgery: a review article

Virtual endoscopy involves the acquisition of data to generate a three-dimensional view of hollow anatomical structures. This interface would allow for the realistic integration of anatomical structures in complex cavities involving sinuses, larynx, and ears. Current literature lacks updated review on the role virtual endoscopy in otolaryngological practice. This paper serves to highlight the use of virtual endoscopy in amongst three main domains: otology, rhinology and laryngology. Review of literature were conducted using various databases including, Pubmed, Scopus, Embase, Web of Science, google scholar. Only papers in full text, English language, and relevant to our objectives were included. A critical descriptive review of the papers were performed to illustrate the strength and weakness on the utilization of virtual endoscopy as a surgical planning tool in otorhinolaryngology practice. The advantages of applying VE in our practice serves two folds; as an educational tool for novice trainees mainly for surgical skill acquisition and as a pre-op planning to understand complex anatomical narrow operative fields. Our paper is the first to demonstrate the most updated commentary review article of the application of virtual endoscopy in sinus surgery, laryngeal airway evaluation and the assessment of ear surgery.

AIxSuture: vision-based assessment of open suturing skills

PurposeEfficient and precise surgical skills are essential in ensuring positive patient outcomes. By continuously providing real-time, data driven, and objective evaluation of surgical performance, automated skill assessment has the potential to greatly improve surgical skill training. Whereas machine learning-based surgical skill assessment is gaining traction for minimally invasive techniques, this cannot be said for open surgery skills. Open surgery generally has more degrees of freedom when compared to minimally invasive surgery, making it more difficult to interpret. In this paper, we present novel approaches for skill assessment for open surgery skills.MethodsWe analyzed a novel video dataset for open suturing training. We provide a detailed analysis of the dataset and define evaluation guidelines, using state of the art deep learning models. Furthermore, we present novel benchmarking results for surgical skill assessment in open suturing. The models are trained to classify a video into three skill levels based on the global rating score. To obtain initial results for video-based surgical skill classification, we benchmarked a temporal segment network with both an I3D and a Video Swin backbone on this dataset.ResultsThe dataset is composed of 314 videos of approximately five minutes each. Model benchmarking results are an accuracy and F1 score of up to 75 and 72%, respectively. This is similar to the performance achieved by the individual raters, regarding inter-rater agreement and rater variability. We present the first end-to-end trained approach for skill assessment for open surgery training.ConclusionWe provide a thorough analysis of a new dataset as well as novel benchmarking results for surgical skill assessment. This opens the doors to new advances in skill assessment by enabling video-based skill assessment for classic surgical techniques with the potential to improve the surgical outcome of patients.

Technical skills teaching to MD students: a blinded, randomized controlled trial investigating video assistance in the education of the single-handed knot tie

BackgroundThe COVID-19 pandemic has brought significant changes to medical education, particularly for procedural and surgical skills, which inherently require face-to-face education. The utility of adding an instructional video remains uncertain. To guide future curricula, our aim was to assess whether the addition of an optional instructional video improves the acquisition and retention of one-handed surgical knot-tying.MethodsNaïve year one medical students were randomised to video before face-to-face instruction versus face-to-face instruction only. Blinded surgeons assessed their performance at the end of a workshop and 4 weeks later by counting the number of knots tied in 1 min and a global Likert score assessing knot quality. The students also completed surveys for qualitative assessment and feedback.ResultsStudents with access to the video tied significantly more knots in 1 min than the control group (median ± IQR: 15 ± 4 N = 14, vs 12.5 ± 10 N = 15, p = 0.012). After 4 weeks, the intervention group showed a non-significant trend towards being able to tie more knots (16.5 ± 6 N = 6, vs 3.5 ± 16 N = 8, p = 0.069), and the knots tied were of significantly better quality (global score: 3 ± 1.4 vs 1 ± 1.8, p = 0.027). Compared to the control group, the intervention group expressed greater confidence in their ability to retain their skills after the workshop and at follow-up (p = 0.04). Additionally, they experienced significantly less stress during the workshop (p = 0.028).ConclusionA non-interactive video can improve learning and retention of single-handed knot tying. As medical education continues to evolve, supplementary videos should be considered an important part of new surgical skill curricula.