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1.
J Am Acad Orthop Surg ; 32(16): e816-e825, 2024 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-39093460

RESUMO

BACKGROUND: Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. METHODS: A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. RESULTS: Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). DISCUSSION: Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. CONCLUSION: This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. LEVEL OF EVIDENCE: III.


Assuntos
Competência Clínica , Hallux Valgus , Procedimentos Cirúrgicos Minimamente Invasivos , Treinamento por Simulação , Hallux Valgus/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Treinamento por Simulação/métodos , Curva de Aprendizado , Cadáver , Modelos Anatômicos , Duração da Cirurgia
2.
Rev Col Bras Cir ; 51: e20243574, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38808819

RESUMO

INTRODUCTION: the simulation in minimally invasive surgery is fundamental for surgeon in training to learning and training skills, especially in pediatrics, due to the particularities, reduced spaces, specific and rare procedures. The aim of this study was to propose an adapted series of exercises and to simply evaluate the performance of pediatric surgery residents in the initial implementation of a training program. METHOD: seven basic skills exercises in video surgery, based on series and programs already published and using low-cost materials, were performed by six residents in 2 moments, with an interval of 15 days and evaluated by simple instrument. RESULTS: there was no difficulty with models. Considering the individual averages of the seven exercises together in the two moments, five of the six residents increased the score in the second moment. The average score per exercise increased in five of the seven tasks. Despite the small number of participants and repetition, it has already been possible to observe a trend of better performance with decreased time of all residents after a single repetition. All considered the exercises capable of training essential skills of the specialty, with simple and inexpensive materials. CONCLUSION: given the challenges of simulated training in pediatric video surgery, it is known the benefit of a continuous program, with exercises that can simulate real situations. A pre-established schedule, more participants and repetitions, supervision of experienced surgeons and validated instruments are fundamental to evaluate surgeons in training and show statistical benefits of simulated exercises in this series.


Assuntos
Internato e Residência , Procedimentos Cirúrgicos Minimamente Invasivos , Pediatria , Treinamento por Simulação , Internato e Residência/métodos , Pediatria/educação , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Treinamento por Simulação/métodos , Humanos
3.
J Robot Surg ; 18(1): 234, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38819615

RESUMO

When combined with healthcare pressures, the exponential growth of robotic-assisted surgery (RAS) has impacted UK-based training outcomes, including the learning curve to competency. Aim: To ascertain the current provision of RAS and investigate differences in access to minimal access surgical (MAS) facilities and training across the UK. A two-armed electronic survey was conducted. The first arm questioned clinical leads regarding robotic practice and future training provisions. The second investigated trainee and trainers' perceptions of MAS training and facilities. 64% (52/81) of responding trusts utilise a robotic system. The majority (68% [55/81]) have plans to expand or acquire a system within 3 years. 171 responses from 112 UK and Republic of Ireland hospitals were collected for Arm 2. Laparoscopic categories queried whether trainees had access to a formal curriculum, training days and sim-boxes. Most consultants (51.9%) and trainees (51.6%) reported that there was no formal local training curriculum for robotic surgery. Combined responses demonstrated 42.1% (n = 195/463) said "yes", 39.5% (n = 183) "no" and 18.4% (n = 85) "don't know". For combined robotic categories (simulation, training days and operative lists) 28.3% (n = 134/473) responded "yes", 51.6% (n = 244) said "no" and 20.1% (n = 95) said "don't know". This study provides insight into the current provision of robotic-assisted surgery at UK trusts and highlights the need to facilitate regular clinical training and equitable access to MAS simulation within a formal curriculum. This may aid regulation of training in parallel with the expansion of robotic practice and avoid a significant skill acquisition gap and risks to patient safety.


Assuntos
Procedimentos Cirúrgicos Robóticos , Reino Unido , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Currículo , Competência Clínica , Inquéritos e Questionários , Curva de Aprendizado , Irlanda , Laparoscopia/educação
4.
World J Surg ; 48(7): 1602-1608, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38814054

RESUMO

BACKGROUND: Access to minimally invasive surgery (MIS) is limited in Sub-Saharan African countries. In 2019, the Mount Sinai Department of Surgery in New York collaborated with local Ugandans to construct the Kyabirwa Surgical Center (KSC), an independent, replicable, self-sustaining ambulatory surgical center in Uganda. We developed a focused MIS training program using a combination of in-person training and supervised telementoring. We present the results of our initial MIS telementoring experience. METHODS: We worked jointly with Ugandan staff to construct the KSC in the rural province of Jinja. A solar-powered backup battery system ensured continuous power availability. Underground fiber optic cables were installed to provide stable high-speed Internet. The local Ugandan general surgeon (JOD) underwent a mini-fellowship in MIS and then trained extensively using the Fundamentals of Laparoscopic Surgery program. After a weeklong in-person session to train the Ugandan OR team, JOD performed laparoscopic cases with telementoring, which was conducted remotely by surgeons in New York via audiovisual feeds from the KSC OR. RESULTS: From October 2021 to February 2024, JOD performed 61 telementored laparoscopic operations at KSC including 37 appendectomies and 24 cholecystectomies. Feedback was provided regarding patient positioning, port placement, surgical technique, instrument use, and critical steps of the operation. There were no intra-operative complications. Postoperatively, field medical workers visited patients at home to collect follow-up information. Two superficial wound infections (3.3%) were reported in the short-term follow-up. CONCLUSION: Telementoring can be safely implemented to assist surgeons in previously underserved areas to provide advanced laparoscopic surgical care to the local patient population.


Assuntos
Tutoria , Procedimentos Cirúrgicos Minimamente Invasivos , Telemedicina , Uganda , Humanos , Tutoria/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Serviços de Saúde Rural , Cooperação Internacional , Laparoscopia/educação , Feminino , Masculino , Adulto
5.
J Cardiothorac Surg ; 19(1): 293, 2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38760859

RESUMO

BACKGROUND: Simulated self-practice using simulation models could improve fine motor skills and self confidence in surgical trainees. AIMS: The purpose of this study is to evaluate on self-reported confidence level in cardiothoracic surgical trainees by using surgical simulation models. METHODS: We conducted a cross-sectional study on all surgeons (n=10) involved in MIS simulation training. All surgeons are required to perform on three minimally invasive surgery (MIS) procedures (Mitral Valve Repair, Mitral Valve Replacement and Aortic Valve Replacement). A questionnaire was designed based on two existing scales related to self-confidence, the surgical self-efficacy scale [SSES] and the perceived competency scale [PCS]. We assessed their self-confidence (before and after training) in the use of simulation in MIS procedures using rating scales 1-5. The mean score was calculated for each domain and used as the predictor variable. We also developed six questions (PCS) using Objective Structured Assessment of Technical Skills (OSAT) related to each domain and asked participants how confident they were after performing each MICS procedure. RESULTS: The mean score was 4.7 for all assessed domains, except "knowledge" (3.8). Surgeons who had performed one or more MIS procedures had higher scores (P<0.05). There was no correlation between the number of MIS procedures performed and self-confidence scores. CONCLUSIONS: The results indicate that the cardiac surgery training based on MIS simulation improves trainees and consultants in terms of the level of self-confidence. Although surgeons generally have high levels of self-confidence after simulation training in MIS cardiac procedures, there is still room for improvement with respect to technical skills related to the procedure itself and its results.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Competência Clínica , Autorrelato , Treinamento por Simulação , Humanos , Estudos Transversais , Treinamento por Simulação/métodos , Masculino , Procedimentos Cirúrgicos Cardíacos/educação , Feminino , Cirurgia Torácica/educação , Autoeficácia , Adulto , Inquéritos e Questionários , Cirurgiões/educação , Procedimentos Cirúrgicos Minimamente Invasivos/educação
6.
BMC Musculoskelet Disord ; 25(1): 373, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38730376

RESUMO

INTRODUCTION: An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair. METHODS: From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes. RESULTS: Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly. CONCLUSION: Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.


Assuntos
Tendão do Calcâneo , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/lesões , Masculino , Feminino , Adulto , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Pessoa de Meia-Idade , Traumatismos dos Tendões/cirurgia , Ruptura/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Instrumentos Cirúrgicos , Agulhas , Duração da Cirurgia
7.
Sci Rep ; 14(1): 12502, 2024 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822017

RESUMO

Minimally invasive abdominal surgery (MAS) can exert a physical cost. Surgical trainees spend years assisting minimally-invasive surgeries, increasing the risk of workplace injury. This prospective questionnaire-based cohort study was conducted amongst general surgery residents in Singapore. Residents assisting major MAS surgery were invited to complete anonymous online survey forms after surgery. The Phase 1 survey assessed physical discomfort scores and risk factors. Intraoperative measures to improve ergonomics were administered and evaluated in Phase 2. During Phase 1 (October 2021 to April 2022), physical discomfort was reported in at least one body part in 82.6% (n = 38) of respondents. Over a third of respondents reported severe discomfort in at least one body part (n = 17, 37.0%). Extremes of height, training seniority, longer surgical duration and operative complexity were significant risk factors for greater physical discomfort. In Phase 2 (October 2022 to February 2023), the overall rate of physical symptoms and severe discomfort improved to 81.3% (n = 52) and 34.4% (n = 22) respectively. The ergonomic measure most found useful was having separate television monitors for the primary surgeon and assistants, followed by intraoperative feedback on television monitor angle or position. Close to 20% of survey respondents felt that surgeon education was likely to improve physical discomfort.


Assuntos
Abdome , Ergonomia , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Feminino , Masculino , Adulto , Estudos Prospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Abdome/cirurgia , Inquéritos e Questionários , Internato e Residência , Cirurgiões/educação , Singapura , Fatores de Risco
8.
Int J Comput Assist Radiol Surg ; 19(6): 1085-1091, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38570373

RESUMO

PURPOSE: Automated endoscopy video analysis is essential for assisting surgeons during medical procedures, but it faces challenges due to complex surgical scenes and limited annotated data. Large-scale pretraining has shown great success in natural language processing and computer vision communities in recent years. These approaches reduce the need for annotated data, which is of great interest in the medical domain. In this work, we investigate endoscopy domain-specific self-supervised pretraining on large collections of data. METHODS: To this end, we first collect Endo700k, the largest publicly available corpus of endoscopic images, extracted from nine public Minimally Invasive Surgery (MIS) datasets. Endo700k comprises more than 700,000 images. Next, we introduce EndoViT, an endoscopy-pretrained Vision Transformer (ViT), and evaluate it on a diverse set of surgical downstream tasks. RESULTS: Our findings indicate that domain-specific pretraining with EndoViT yields notable advantages in complex downstream tasks. In the case of action triplet recognition, our approach outperforms ImageNet pretraining. In semantic segmentation, we surpass the state-of-the-art (SOTA) performance. These results demonstrate the effectiveness of our domain-specific pretraining approach in addressing the challenges of automated endoscopy video analysis. CONCLUSION: Our study contributes to the field of medical computer vision by showcasing the benefits of domain-specific large-scale self-supervised pretraining for vision transformers. We release both our code and pretrained models to facilitate further research in this direction: https://github.com/DominikBatic/EndoViT .


Assuntos
Endoscopia , Humanos , Endoscopia/métodos , Endoscopia/educação , Processamento de Imagem Assistida por Computador/métodos , Gravação em Vídeo , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
9.
Innovations (Phila) ; 19(2): 175-183, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38577864

RESUMO

OBJECTIVE: We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator. METHODS: An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program. RESULTS: Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%. CONCLUSIONS: A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.


Assuntos
Anastomose Cirúrgica , Competência Clínica , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Anastomose Cirúrgica/educação , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/educação , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Treinamento por Simulação/métodos , Vasos Coronários/cirurgia , Estudo de Prova de Conceito
10.
Surg Endosc ; 38(5): 2344-2349, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38632119

RESUMO

BACKGROUND: Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. METHODS: Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). RESULTS: From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). CONCLUSIONS: ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.


Assuntos
Hérnia Inguinal , Herniorrafia , Internato e Residência , Humanos , Hérnia Inguinal/cirurgia , Herniorrafia/educação , Herniorrafia/tendências , Herniorrafia/estatística & dados numéricos , Herniorrafia/métodos , Internato e Residência/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Cirurgia Geral/educação , Cirurgia Geral/tendências , Acreditação , Educação de Pós-Graduação em Medicina/tendências , Educação de Pós-Graduação em Medicina/métodos , Competência Clínica , Laparoscopia/educação , Laparoscopia/tendências , Laparoscopia/estatística & dados numéricos , Estados Unidos , Estudos Retrospectivos
11.
Vet Clin North Am Small Anim Pract ; 54(4): 603-613, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38485606

RESUMO

Veterinary minimally invasive surgery (MIS) training options are becoming more available. This article reviews new developments in this area and the current evidence for manual skills and cognitive training of MIS.


Assuntos
Competência Clínica , Educação em Veterinária , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Animais , Educação em Veterinária/métodos , Cirurgia Veterinária/educação , Cirurgia Veterinária/métodos
12.
J Minim Invasive Gynecol ; 31(6): 518-524, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38527702

RESUMO

STUDY OBJECTIVE: Fellowship program directors (FPDs) play an important role in the development of fellows and learners, but little is known about their demographics. This cross-sectional study aims to examine the characteristics of minimally invasive gynecologic surgery (MIGS) FPDs. DESIGN: A retrospective cross-sectional study. SETTING: Data obtained from publicly available information on official websites of the program directors studied. SUBJECTS: MIGS fellowship program directors. INTERVENTIONS: All US-based MIGS programs affiliated with the AAGL in 2023 were included. Information about FPD gender, medical school attended and graduation year, residency program attended and graduation year, any additional graduate degrees earned, fellowship programs completed, and the year of their appointment as FPD was collected through publicly available sources. Scholarly activity was measured by peer-reviewed articles and the Hirsch index. MEASUREMENTS AND MAIN RESULTS: Of the 54 FPDs, 28 (51.85%) were female and 26 (48.15%) were male. Male FPDs were significantly older (54.6 ± 8.7 years) than female FPDs (46.2 ± 5.0 years), p <.05. Average age at appointment was 43.1 ± 6.7 years, with female FPDs being appointed at significantly younger ages (39.4 ± 5.1 years) compared to male FPDs (44.5 ± 6.8 years), p <.05. Male FPDs had statistically significant higher Hirsch indices (14 ± 11.4) compared to female FPDs (8 ± 5.8), p <.05. Of the FPDs who completed a fellowship, 27 (50%) did so in MIGS, eight (14.81%) in Gynecologic-Oncology, 6 (11.11%) in Urogynecology, and 4 (7.41%) in Reproductive Endocrinology/Infertility. CONCLUSIONS: MIGS fellowships have a uniquely equal representation of male and female FPDs, as surgical subspecialties historically tend to be male dominant. Notably, there is diversity in the type of fellowship pursued by MIGS FPDs, with nearly half of FPDs completing a fellowship outside of MIGS. The reasons for differences in scholarly contributions, indicated by Hirsch index, of male versus female FPDs is unclear.


Assuntos
Bolsas de Estudo , Procedimentos Cirúrgicos em Ginecologia , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Feminino , Bolsas de Estudo/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/educação , Masculino , Estudos Retrospectivos , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Estados Unidos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Internato e Residência , Ginecologia/educação
13.
Med Biol Eng Comput ; 62(6): 1887-1897, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38403863

RESUMO

Mixed-reality surgical simulators are seen more objective than conventional training. The simulators' utility in training must be established through validation studies. Establish face-, content-, and construct-validity of a novel mixed-reality surgical simulator developed by McGill University, CAE-Healthcare, and DePuy Synthes. This study, approved by a Research Ethics Board, examined a simulated L4-L5 oblique lateral lumbar interbody fusion (OLLIF) scenario. A 5-point Likert scale questionnaire was used. Chi-square test verified validity consensus. Construct validity investigated 276 surgical performance metrics across three groups, using ANOVA, Welch-ANOVA, or Kruskal-Wallis tests. A post-hoc Dunn's test with a Bonferroni correction was used for further analysis on significant metrics. Musculoskeletal Biomechanics Research Lab, McGill University, Montreal, Canada. DePuy Synthes, Johnson & Johnson Family of Companies, research lab. Thirty-four participants were recruited: spine surgeons, fellows, neurosurgical, and orthopedic residents. Only seven surgeons out of the 34 were recruited in a side-by-side cadaver trial, where participants completed an OLLIF surgery first on a cadaver and then immediately on the simulator. Participants were separated a priori into three groups: post-, senior-, and junior-residents. Post-residents rated validity, median > 3, for 13/20 face-validity and 9/25 content-validity statements. Seven face-validity and 12 content-validity statements were rated neutral. Chi-square test indicated agreeability between group responses. Construct validity found eight metrics with significant differences (p < 0.05) between the three groups. Validity was established. Most face-validity statements were positively rated, with few neutrally rated pertaining to the simulation's graphics. Although fewer content-validity statements were validated, most were rated neutral (only four were negatively rated). The findings underscored the importance of using realistic physics-based forces in surgical simulations. Construct validity demonstrated the simulator's capacity to differentiate surgical expertise.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Fusão Vertebral/métodos , Reprodutibilidade dos Testes , Realidade Virtual , Feminino , Masculino , Inquéritos e Questionários , Simulação por Computador , Coluna Vertebral/cirurgia , Adulto , Realidade Aumentada
15.
Surg Endosc ; 38(2): 1029-1044, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38087109

RESUMO

BACKGROUND: Minimally invasive surgery (MIS) requires intense education and training with structured supervision and feedback. However, a standardized training structure is lacking in Germany. This nationwide survey aimed to assess the current state of minimally invasive surgery (MIS) training and factors impacting surgeons' satisfaction. METHODS: Between July and October 2021, an online survey was conducted among general, abdominal, and thoracic surgeons in Germany. The survey collected data on department size, individual operative experience, availability of MIS training equipment and curricula, and individual satisfaction with training. A linear regression analysis was conducted to investigate factors influencing the surgeons' satisfaction with the MIS training. RESULTS: A total of 1008 surgeons participated in the survey, including residents (26.1%), fellows (14.6%), attendings (43.8%), and heads of departments (15.2%). Of the respondents, 57.4% reported having access to MIS training equipment, 29.8% and 26% had a curriculum for skills lab MIS training and intraoperative MIS training, respectively. In multivariate linear regression analysis, strongest predictors for surgeons' satisfaction with skills lab MIS training and intraoperative training were the availability of respective training curricula (skills lab: ß 12.572; p < 0.001 & intraoperative: ß 16.541; p < 0.001), and equipment (ß 5.246; p = 0.012 & ß 4.295; p = 0.037), and experience as a first surgeon in laparoscopy (ß 12.572; p < 0.001 & ß 3.748; p = 0.007). Additionally, trainees and teachers differed in their satisfaction factors. CONCLUSION: Germany lacks standardized training curricula and sufficient access to MIS training equipment. Trainees and teachers have distinct factors influencing their satisfaction with MIS training. Standardized curricula, equipment accessibility, and surgical experience are crucial for improving surgeons' satisfaction with training.


Assuntos
Laparoscopia , Cirurgiões , Humanos , Cirurgiões/educação , Inquéritos e Questionários , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Laparoscopia/educação , Satisfação Pessoal , Competência Clínica
16.
Int J Med Inform ; 180: 105269, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37907015

RESUMO

INTRODUCTION: Technology Enhanced Learning (TEL) can provide the tools to safely master minimally invasive surgery (MIS) skills in patient-free environments and receive immediate objective feedback without the constant presence of an instructor. However, TEL-based systems tend to work isolated from one another, focus on different skills, and fail to provide contents without a sound pedagogical background. OBJECTIVE: The objective of this descriptive study is to present in detail EASIER, an innovative TEL platform for surgical and interventional training, as well as the results of its validation. METHODS: EASIER provides a Learning Management System (LMS) for institutions and content creators that can connect and integrate TEL "external assets" (virtual reality simulators, augmented box trainers, augmented videos, etc.) addressing different skills. The platform integrates all skills under an Assessment Module that measures skills' progress in different courses. Finally, it provides content creators with a pedagogical model to scaffold contents while retaining flexibility to approach course design with different training philosophies in mind. Three courses were developed and hosted in the platform to validate it with end-users in terms of usability, performance, learning results in the courses and student self-perception on learning. RESULTS: In total 111 volunteers completed the validation. The study was limited due to the COVID-19 pandemic, which limited access to external assets (virtual reality simulators). Nevertheless, usability was rated with 73.1 in the System Usability Scale. Most positive aspects on performance were easiness to access the platform, easiness to change the configuration and not requiring additional plug-ins to use the platform. The platform was rated above average in the six scales of the User Experience Questionnaire. Overall, student results improved significantly across the three courses (p < 0.05). CONCLUSIONS: This study provides, within its limitations, evidence on the usefulness of the EASIER platform for distance learning of MIS skills. Results show the potential impact of the platform and are an encouraging boost for the future, especially in the aftermath of the COVID-19 pandemic.


Assuntos
Educação a Distância , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Competência Clínica , COVID-19 , Aprendizagem , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Pandemias
17.
Surg Endosc ; 37(12): 9393-9398, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37658200

RESUMO

BACKGROUND: Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs. METHODS: De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated. RESULTS: MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01]. CONCLUSIONS: Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.


Assuntos
Neoplasias Colorretais , Internato e Residência , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Bolsas de Estudo , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Laparoscopia/educação , Hérnia , Educação de Pós-Graduação em Medicina , Competência Clínica
18.
Surg Endosc ; 37(10): 7784-7789, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37587239

RESUMO

INTRODUCTION: Previous reports show that over 85% of general surgery residents choose to pursue fellowship training after completing residency. There continues to be an increase interest among general surgery residents in minimally invasive surgery (MIS) fellowship. Moreover, demographic disparities, particularly gender disparities continue to persist among surgical sub-specialties. In this study, we evaluated the gender disparities and practice patterns among graduating MIS fellows. METHODS AND PROCEDURES: MIS fellows were surveyed, and 169 results were received from fellows who completed training in the years: 2010, 2015-2019. Surveys collected were used to create a descriptive analysis of the demographics, practice patterns and job finding measures. Loglinear regression model was performed to assess gender trend variation over training years. RESULTS: Fellows self-reported gender showed 65% male, 30% female, and 5% prefer not to say. The cohort of participants was described as 45.3% white, 5.3% African American, and 6.5% Hispanic or Latino. Further, results showed 87.1% of fellows work in MIS surgery with 91.8% reporting their fellowship experience facilitated their ability to find a job. Most alumni pursue a comprehensive MIS practice. Moreover, the proportion of female fellows increased from 29 to 41%, but this increase over time was not significant using loglinear regressions [p-value = 0.0810, Relative risk = 1.1994 (95% CI 0.9778, 1.4711)]. CONCLUSION: Overall, there is good evidence to support that fellowship training facilitates future career advancements. Further, MIS fellows have differential practice patterns. Finally, females remain underrepresented among the MIS fellows which should call for leadership action to bridge these gaps.


Assuntos
Educação de Pós-Graduação em Medicina , Internato e Residência , Humanos , Masculino , Feminino , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo , Competência Clínica , Inquéritos e Questionários , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Demografia
20.
Surg Today ; 53(8): 984-991, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36897420

RESUMO

PURPOSE: Subsequent to the publication of "Guidelines for cadaver dissection in education and research of clinical medicine" in 2012, cadaver surgical training (CST) was implemented in various surgical fields across Japan. This article summarizes the recent progress made in the implementation of CST using donated cadavers, and its associated research, focusing on the field of surgery, and discusses its future direction. METHODS: All reports from 2012 to 2021 registered with the CST Promotion Committee of the Japan Surgical Society were analyzed. There were 292 (24.9%) programs in the field of surgery, including acute care surgery, out of a total of 1173 programs overall. Data were classified by the purpose of implementations and fields of surgery, with subclassification by organ, costs and participation fees. RESULTS: CST and its research were introduced in 27 (33.3%) of a total 81 universities. The total number of participants was 5564 and the major (80%) purpose of the program was to advance surgical techniques. When classified by objectives, 65, 59 and 11% were for mastering operations for malignant disease, minimally invasive surgery, and transplantation surgery, respectively. CONCLUSION: CST in the field of surgery is increasing progressively in Japan, but still with disproportionate dissemination. Further efforts are needed to achieve full adoption.


Assuntos
Dissecação , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Japão , Cadáver , Procedimentos Cirúrgicos Minimamente Invasivos/educação
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