Training In Surgical Techniques Research Articles

Establishment of a selective puncture method of the temporomandibular joint targeting the superior and inferior joint spaces using a human cadaver under the guidance of an ultrasound device

To investigate an ultrasound-guided selective puncture method for the temporomandibular joint (TMJ), targeting superior (SJS) and inferior joint spaces (IJS), using a human cadaver. The study utilized five cadavers donated by members of our university. The cadaver's left side was aimed at the SJS, while the right side was at the IJS. Nonionic contrast was injected into each joint using a crossing technique, with the linear ultrasound probe placed parallel to the long axis of the mandibular branch and punctured perpendicularly into the joint cavity. Cone-beam computed tomography scans assessed both the TMJs examining discs and other components for damage using a gross anatomical technique. Computed tomography images confirmed successful contrast agent injection into all joint spaces without damaging the articular discs or cartilage of the mandibular head. Our findings suggest that the ultrasound device can selectively puncture the TMJ in the SJS and IJS. In the future, the success rate is expected to improve with additional cadaver punctures. We aim to establish this technique as a viable treatment method that can be performed by oral surgeons with limited clinical experience in cadaver surgery training and a surgical technique training program using human cadavers.

Anatomic and Surgical Aspects of Total Pancreatectomy in Swine

IntroductionThe swine is valuable model for preclinical research and surgical technique training. From the induction of Diabetes through total pancreatectomy, these animals can be used in many research studies, such as islet transplantation. In view of the lack of elucidation in literature, the purpose of this work is to describe anatomical aspects, surgical technique of total pancreatectomy, intra- and postoperative complications and autopsy results Material and MethodFive male pigs, hybrids (Large White/Landrace), 20-35 kg, submitted to total pancreatectomy with duodenum, bile duct and spleen preservation. Postoperatively, daily clinical assessment and capillary blood glucose collection were performed. At the end of the 30-day limit or in the occurrence of serious clinical complications, euthanasia and autopsy were performed ResultsThe average duration of surgery was 128 minutes, without intraoperative deaths or anesthesia induction failures. Median survival was 6.6 days. Postoperative complications were weight loss (3), emesis (2), constipation (2), abdominal distension (2), diarrhea (1) and loss of appetite (1). All animals were euthanized due to serious complications. Two animals presented surgical complications (duodenal necrosis with gastroparesis and internal hernia with intestinal necrosis). The other three animals presented serious clinical complications related to exocrine pancreatic insufficiency due to deficiency of pancreatic enzymes. Glycemic values above 200 mg/dL were found on the first postoperative day and above 300 mg/dL on the seventh day in all animals Discussion and ConclusionsIn this experiment, a model of total pancreatectomy with duodenum, spleen and bile duct preservation in pigs was established. All animals had diabetes, however animals without postoperative complications were euthanized due to serious complications related to pancreas exocrine insufficiency.

How Much Experience is Required to Acquire the Skills to Independently Perform Spine Surgery? What Milestones are Needed for Successful Surgery?

To assess the number of surgeries needed to acquire the necessary skills to perform spine surgery independently. A questionnaire on 12 different spinal procedures was sent to orthopedic surgeons affiliated with the spine teams of orthopedic departments at either the Akita University or Sapporo Medical University. Participants were asked to identify whether they (A) could independently perform each procedure, (B) could perform each procedure with the assistance of a senior doctor, or (C) were unable to perform each procedure. Those whose response was (A) were asked how many surgeries were required to acquire the necessary skills. Those who responded to (B) or (C) were asked how many surgeries they believed were required to acquire the skills necessary to operate independently. Participants also responded to 10 questions on surgical training techniques and rated the usefulness of each method. A total of 55 spine surgeons responded to the questionnaire. Group A required significantly fewer surgeries in the following categories to become independent than required Group C: upper cervical spine surgery (7.3/19.3), anterior cervical decompression/fusion (6.7/28.8), posterior cervical decompression/fusion (9.5/27.3), lumbar discectomy (12.6/26.7), endoscopic lumbar discectomy (10.2/24.2), spinal tumor resection (6.5/37.2), and spinal kyphosis surgery (10.3/32.3). Over 80% of participants responded that the following were effective methods: "surgeries where a senior doctor is the main surgeon, and the respondent is the assistant and observer"; "surgeries where the respondent is the main surgeon, and a senior doctor is an assistant"; "self-study using surgery manuals, articles, and textbooks"; and "training through video surgery sessions". Surgeons who do not perform specific procedures independently require more surgical experience than those who operate independently. Our results may help develop more efficient training methods for spine surgeons.

A mixed-method evaluation of cadaver surgery training for gynecologic oncology.

Traditional surgical training techniques with using patients, and new advances with live animals, artificial models, and simulation methods have several shortcomings. There are a few reports on the usefulness of cadaver surgery training (CST) in gynecology. Herein, we used a mixed-method evaluation to qualitatively and quantitatively explore the educational efficacy of CST by conducting CST programs at the Sapporo Medical University, Japan. In 2020, we conducted two CST programs with 45 participants-13 residents, 8 specialists recognized by Japan Society of Obstetrics and Gynecology, 23 certified endoscopists recognized by Japan Society of Gynecology and Obstetrics Endoscopy and Minimally Invasive Therapy, 15 specialists recognized by Japan Society of Gynecologic Oncology, and 14 certified endoscopists cum oncology. Three participants observed the procedure virtually and 42 were physically present. Laparoscopic radical hysterectomy and pelvic exenteration were performed on five Thiel-embalmed cadavers. Participants were asked to complete pre- and post-training surveys that included qualitative questions, concerning the purpose and cost of CST, and quantitative questions, testing anatomical knowledge. We observed that the rate of score improvement to the quantitative questions increased from 58.6% pre-CST to 75.6% post-CST. Furthermore, oncology specialists and those who performed more surgeries and faced more complications during surgeries recorded high percentage of correct answers. Multiple regression analysis statistically confirmed these results. This study confirmed the educational efficacy of CST.

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

BackgroundTo develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training.MethodsFourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty.ResultsThe results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods—mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures—mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence—mean score: 4.24/5.00, high score: 4.47/5.00.ConclusionThe developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included ‘a more realistic training experience’ and ‘improved facilitation of decision-making and damage control practice during trauma surgery’.

Development of a Gastight Thoracotomy Model for Investigation of Carbon Dioxide Field-Flooding Efficacy.

Carbon dioxide (CO2) field-flooding during cardiac surgery is a prevention technique to avoid blood-air contact and subsequent embolization. Although it was first used more than 60 years ago, there is still some perplexity around its efficacy, mainly because the gas is invisible and air embolization is difficult to quantify.An accurate assessment of field-flooding can, therefore, best be performed in models where various methods can be tried in a controlled environment and evaluated with industrial-grade sensors. Multiple options are available for anatomically correct models that reproduce a sternotomy situation, but models for minimally invasive cardiac surgery are expensive and normally meant for training of surgical techniques where only the top side of the model is important.We created a low-cost and “home-made” gastight mini-thoracotomy model with internal organs and left atrial incision to investigate CO2 insufflation in a simulated minimally invasive mitral valve surgery. The model was validated with CO2 field-flooding tests with a commercial diffuser, while three sensors continuously registered the local concentration of CO2 gas.

徳島大学病院耳鼻咽喉科・頭頸部外科における頭頸部手術の進歩と手術手技トレーニング

徳島大学病院耳鼻咽喉科・頭頸部外科における頭頸部手術の進歩と手術手技トレーニング

Development of a Simulation Surgical Cricothyroidotomy Curriculum for Novice Providers: A Learning Curve Study.

Airway obstruction is the third most common cause of preventable death on the battlefield, accounting for 1%-2% of total combat fatalities. No previous surgical cricothyroidotomy (SC) studies have analyzed the learning curve required to obtain proficiency despite being studied in numerous other surgical technique training experiments. The aims of this study were to establish expert SC performance criteria, develop a novel standardized SC curriculum, and determine the necessary number of practice iterations required by a novice to reach this pre-determined performance goal. A standardized checklist and SC performance standards were established based on the performance of 12 board certified Military Health System surgeons with prior experience on performing a SC using a simulated trauma mannequin. Expert-level criteria were defined as a SC time to completion of 40 s or less and checklist score of at least 9/10, including all critical steps. Study subjects included 89 novice providers (54 active-duty first- and second-year medical students and 35 Navy corpsmen). Subjects received instruction on performing a SC using the principles of mastery learning and performed a final test of SC proficiency on a trauma mannequin within a realistic simulated MEDEVAC helicopter. The total number of subject practice attempts, checklist scores, and time to completion were measured and/or blindly scored. Learning curve and exponential plateau equations were used to characterize their improvement in mean time to SC completion and checklist scores. Mean pre-test knowledge scores for the entire group were 11.8 ± 3.1 out of 24 points. Total mean practice learning plateaued at checklist scores of 9.9/10 after 7 iterations and at a mean completion time of 30.4 s after 10 iterations. During the final test performance in the helicopter, 67.4% of subjects achieved expert-level performance on the first attempt. All subjects achieved expert-level performance by the end of two additional attempts. While a significantly larger proportion of medical students (79.9%) successfully completed the helicopter test on the first attempt compared to corpsmen (54.3%), there were no statistically significant differences in mean SC completion times and checklist scores between both groups (P > 0.05). Medical students performed a SC only 1.3 s faster and scored only 0.16 points higher than corpsmen. The effect size for differences were small to negligible (Cohen's d range 0.18-0.33 for SC completion time; Cohen's d range 0.45-0.46 for checklist scores). This study successfully defined SC checklist scores and completion times based on the performance of experienced surgeons on a simulator. Using these criteria and the principles of mastery learning, novices with little knowledge and experience in SC were successfully trained to the level of experienced providers. All subjects met performance targets after training and overall performance plateaued after approximately seven iterations. Over two-thirds of subjects achieved the performance target on the first testing attempt in a simulated helicopter environment. Performance was comparable between medical student and corpsmen subgroups. Further research will assess the durability of maintaining SC skills and the timing for introducing refresher courses after initial skill acquisition.

Strictly following the indications during the promotion of micro-invasive glaucoma surgeries

Lots of new micro-invasive glaucoma surgeries (MIGS) are clinically available in recent two decades. The common characters of these surgeries are micro-invasive and non-filter bleb dependent. There are some problems during the promotion of the MIGS in China, like performing the MIGS with inappropriate indications. The MIGS procedures have more strict indications than traditional trabeculectomy and need more technical skills. To promote the popularization of MIGS and improve the clinical treatment of glaucoma, strictly following the indications and standardizing the surgical technique training are needed. (Chin J Ophthalmol, 2021, 57: 641-643).

Integration of Robotics in Urology Residency Programs: an Unchecked Technological Revolution.

To review the integration of robotics in urology residency programs and evaluate how it has impacted a graduates' level of surgical competence. Surgical technique training has shown a dramatic shift towards robotics with the most profound occurring in oncology. However, integration of robotics is not uniform across programs nor even among residents themselves. Robotics require graduates to garner a broader skill set within the same prescribed training time. Unfortunately, in this modern era, graduates are feeling more ill-equipped to start independent practice and show an increased need to pursue fellowship training to achieve technical proficiency. The dissemination of robotics in residency programs has gone unchecked. Modulating existing training structures through (1) development of procedure- and surgical technique-specific target metrics for graduation and (2) integration of a formalized robotic curriculum may improve the overall quality and outcome of the educational experience.

Current Status of Surgical Technique Training Such as Off the Job Training

Current Status of Surgical Technique Training Such as Off the Job Training

ПЕРВЫЙ ШАГ В ОБУЧЕНИИ ХИРУРГИЧЕСКОЙ ТЕХНИКЕ

Great attention is deservedly given to the practical training of the surgeon, but uniform training approach has not been formed. The systematic development of hands of future surgery specialist is an urgent problem. It takes years to reach the optimal level of manual technique, and early training start contributes to this. It is important to have a clear idea of what skills to train and what to strive for. The aim of the work was assumed to determine the factors affecting the training of surgical techniques and effectiveness of the new training program. We have formed 5 groups of 7—8 people in the group. Each group was trained, which included 8 hours of practical training with a teacher in the curriculum "Fundamentals of surgical techniques". All students were provided: a textbook "Basics of surgical equipment", tools and a basic surgical simulator. 28 different skills were mastered, of which 63.4 % were for students absolutely new. Recommendations were given and allocated 4 months on independent training after the end of practical classes.We have identified that 90.9 % of students coped with the development of the program "Fundamentals of surgery", which, with the final questionnaire, estimated the effectiveness of the entire rate of 9.76 points (on a 10-point scale). According to the recommendation of students expressed when surveying, the training of a video course has begun, which is located on YouTube at https://www. youtube. com/c/L earningSurgicalTechnique. The program "Fundamentals of surgical technique" corresponds to the possibilities of students of 2—3 courses; can be mastered by them during one semester of training.

Prevalence and effectiveness of innovative techniques in ophthalmic surgical training during COVID-19 pandemic in India.

Purpose:This study aimed to determine the various innovative surgical training techniques prevalent among ophthalmology residents in India during the COVID-19 pandemic.Methods:This was a prospective cross-sectional study. An online survey questionnaire was completed by ophthalmology residents from different parts of the country. The survey consisted of questions related to the impact of the pandemic on training, innovative training techniques adapted during the pandemic and their effectiveness, and COVID-19 duty-related information.Results:A total of 147 responses were obtained. The mean age was 29.3 years (range: 24–40 years, SD: ±3.82). Of which, 87 (59.2%) respondents were females. A total of 61 (41.5%) respondents reported practicing steps of ocular surgeries on goat eye, 69 (46.9%) on model eye/vegetables/fruits, 30 (20.4%) on surgical simulators, and 26 (17.7%) utilized 3-D virtual images and videos. In addition, 22 (15%) respondents reported never using any such techniques. Furthermore, 130 (88.4%) respondents reported practicing steps of cataract surgery, 52 (35.4%) practiced steps of open globe repair, and steps of trabeculectomy were reported by 24 (16.3%). The steps that were reported to be practiced most are incision or tunnel construction by 108 (73.5%), suturing by 92 (62.6%), capsulorrhexis by 91 (61.9%), primary wound repair by 82 (55.8%), and conjunctival peritomy by 75 (51%).Conclusion:The present study demonstrates that residents across the country are adapting to the present scenario by utilizing several innovative methods to sharpen their surgical acumen. The current pandemic situation can serve as an impetus to emphasize upon the institutes and medical regulatory bodies to appropriately remodel the residency curriculum.

Is Beef Tongue an Alternative Similar to Human Skin for Training in Surgical Technique?

Is Beef Tongue an Alternative Similar to Human Skin for Training in Surgical Technique?

The road to becoming a certified robotic surgeon

Surgical educators are challenged with introducing new technologies into general surgery training. There has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks were conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon. A structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of basic robotic skills in the dry and wet lab setting along with achievement of individual and team-based non-technical skills, modular console training under supervision, and finally independent practice. There is a need for a standardized curriculum for training and assessment of robotic surgeons to proficiency, followed by high stakes testing for certification. A standardized process for certifying the skills of a robotic surgeon has begun to emerge.

AAA 3. Video Presentation: Open Paravisceral Aneurysm Repair

Aortic disease is among the top 20 leading causes of death in the United States. The open repair of abdominal aortic aneurysm was first described in 1952 and since then has been the “gold standard,” but with the newer endovascular procedures being less invasive, its use has decreased. In 2014, Dua et al1Dua A. Upchurch Jr., G.R. Lee J.T. Eidt J. Desai S.S. Predicted shortfall in open aneurysm experience for vascular surgery trainees.J Vasc Surg. 2014; 60: 945-949Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar raised concerns that the volume of open aneurysm repair procedures is no longer conducive to an adequate vascular trainee education and that by 2020, vascular trainees are expected to do half of the open aneurysm repair cases that were done in 2010. The purpose of this video presentation is to keep the newer vascular surgeons in touch with this procedure because the next generation will require the use of high-fidelity simulation systems, the creation of a dedicated open repair vascular fellowship, or a combination of these approaches. After consent and deidentification, we used a high-definition LoupeCam (VizVOCUS Inc, Scottsdale, Ariz) to make a video of the surgical procedure. We also did a retrospective review of the patient’s chart and images. As part of our new project, creating an open surgical technique video library, we presented a case of a supraceliac aneurysm that required a retroperitoneal open abdominal aortic aneurysm repair. We reviewed why this was the surgical option and developed a surgical steps video of the procedure. In the endovascular era, there are still cases in which an open procedure can be the shortest and safest option. There is also need for options to train the next generation of surgeons in open procedures. This combination of a case presentation with surgical technique and procedural video can be one of the options to include in open surgical technique training.

Development of a model for laparoscopic cholecystectomy video assisted training. A randomized study

To identify the surgical trainee benefits through the use of video assisted training (VAT). Twelve cases of uncomplicated laparoscopic cholecystectomy (LC) were selected. Edited video segments focused on essential intra-operative anatomical structure identification and critical surgical steps. Evaluation of these videos was constructed on a scoring system based on pre and post-teach tests. The mean value of the pre-teach score was 33.2 ± 18.0 points and in the post-teach test the mean value was 66.7 ± 9.7 points. A statistically significant difference was seen when comparing pre and post-teach results (p<.00001). The widespread and the systematic use of video assisted learning may be a useful and economic tool in adjunct to the surgical training techniques practiced until now throughout the surgical community.

Efficiency of chemically preserved dog's cadavers in surgical techniques training

Surgical skill is developed through repetitive exercise. Hence, several institutions are adopting simulators and other training models in undergraduate programs and medical and veterinary residence program, enabling repetition of individualized exercises. In this study, we used the modified Larssen solution, in order to evaluate the preservation of organoleptic characteristics of carcasses and their viscera, used in surgical technique teaching, comparing the preservation of bodies with and without heparin administration, and to evaluate the model´s efficiency for surgical training. Veterinary medicine residents and fifth year graduation students participated in the training at the Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP). At the end of each training session, the participants completed a questionnaire that aimed to assess empirically the consistency, color, odor and texture of the covered bodies, and compared the methods of preservation and the training efficiency. After analyzing the results, it was found that there was no significant difference between the two groups with respect to heparin use and that the model is effective for the training of surgical techniques. It was concluded that the use of modified Larssen solution allowed greater durability of dog cadavers, with no difference with prior heparinization during preparation of, and for surgical training with the chemically preserved dog´s cadavers. This tool proved to be effective for surgical training of veterinary doctors.

Programa de aprendizaje con modelos animales para corrección videoasistida de cardiopatías congénitas en edad pediátrica: primeros pasos en España

Minimally invasive cardiac surgery has grown in popularity in the adult population over the past 10 years. This growth has been driven by a desire to achieve many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma in the cardiac surgical area. However, its application in the field of congenital heart disease in paediatric patients is still limited. Alternative minimally invasive approaches have been used in these cases in recent years, but currently, the step forward to a video-assisted repair is still far away. The small size of these paediatric patients is the main limiting factor.As the use of animal models for training in surgical techniques is well-established, this article presents the initial experience in Spain of an animal model training program for video-assisted repair in congenital heart defects in paediatric patients. A discussion is presented on the preliminary results, benefits, and disadvantages of video-assisted repair in this complex scenario. This kind of training, in close partnership with paediatric surgeons with expertise in thoracoscopic techniques, is a key point for acquiring novel surgical skills for those surgeons dedicated to congenital heart defects.

Training the next generation of surgeons in robotic surgery.

ContextRobotic surgery has been used with rapidly increasing frequency within urology and across many other surgical specialties. A standardized curriculum for the training and credentialing of robotic surgeons has unfortunately trailed far behind the adoption of this surgical technology.ObjectiveTo review the current available surgical skills training models, assessments, and curricula for the purpose of training resident, fellow, and practicing surgeons in an effort to promote surgical skill proficiency and mastery and to minimize the risk of patient harm.Evidence acquisitionWe performed a thorough review of available literature through a PubMed database search in February 2015.Evidence synthesisIn this article, we compiled and scrutinized the available relevant literature regarding past and present robotic surgical training techniques and credentialing criteria. This review details the basic surgical skills (both technical and nontechnical) that are necessary for individuals and teams to be successful in the operative setting. We go on to discuss the role of current robotic surgical training techniques including dry lab and virtual simulators. Finally, we offer current validated training curricula, the Global Evaluative Assessment of Robotic Skills and Fundamentals of Robotic Surgery models, which have laid the groundwork for a future standardized model that could be applied on a national and international level and across several surgical subspecialties. The ultimate goal of the review is to provide a foundation from which a future standardized training and credentialing curriculum could be based.ConclusionThere is currently a great need for a standardized curriculum to be developed and employed for the use of training and credentialing future and current robotic surgeons.