Master and Apprentice or a Slave to Technology? A Randomized Controlled Trial of Minimal Access Surgery Simulation-Based Training Techniques.

Introduction: This study set out to assess the efficacy of three different approaches to simulation-based minimal access surgery (MAS) training using a three-dimensional printed neonatal thoracoscopic simulator and a virtual simulator. Materials and Methods: Randomized controlled trial of medical students (N = 32), as novices to MAS. The participants performed two construct validated tasks on a thoracoscopic simulator and were then randomly allocated into four intervention groups: (1) three consultant-led sessions on a thoracoscopic simulator; (2) three self-directed learning sessions on the same simulator; (3) self-directed "virtual training" on the "SimuSurg" application; and (4) control. Postintervention participants repeated both tasks. Videos of all task attempts were de-identified and marked by a blinded consultant pediatric surgeon. Results: There were no statistically significant differences in baseline objective structured assessment of technical skills (OSATS) scores or demographics in any group. For the "ring transfer" task, Groups 1 and 2 showed significant improvement after intervention, with no significant change in Groups 3 or 4. There was no significant difference between Groups 1 or 2 in postintervention scores. For the "needle pass" task, no group demonstrated a statistically significant improvement after intervention. Conclusion: Practice on a physical simulator either consultant-led or self-directed led to improved scores for MAS novices compared with a virtual simulator or no intervention for a simple "ring transfer" task. This suggests that time on the physical simulator was the most important factor and implies that trainees could usefully practice simple tasks at their convenience rather than require consultant supervision. This improvement is not seen in more challenging tasks such as the "needle pass."

Development of an instrumented thoracoscopic surgical trainer for objective evaluation of esophageal atresia/tracheoesophageal fistula repair.

Operative repair of complex conditions such as esophageal atresia and tracheoesophageal fistula (EA/TEF) is technically demanding, but few training opportunities exist outside the operating theater for surgeons to attain these skills. Learning them during surgery on actual neonates where the stakes are high, margins for error narrow, and where outcomes are influenced by technical expertise, is problematic. There is an increasing demand for high-fidelity simulation that can objectively measure performance. We developed such a simulator to measure force and motion reliably, allowing quantitative feedback of technical skill. A 3D-printed simulator for thoracoscopic repair of EA/TEF was instrumented with motion and force tracking components. A 3D mouse, inertial measurement unit (IMU), and optical sensor that captured force and motion data in four degrees of freedom (DOF) were calibrated and verified for accuracy. The 3D mouse had low average relative errors of 2.81%, 3.15%, and 6.15% for 0 mm, 10 mm offset in Y, and 10 mm offset in X, respectively. This increased to - 23.5% at an offset of 42 mm. The optical sensors and IMU displayed high precision and accuracy with low SDs and average relative errors, respectively. These parameters can be a useful measurement of performance for thoracoscopic EA/TEF simulation prior to surgery. Graphical abstract Inclusion of sensors into a high-fidelity simulator design can produce quantitative feedback which can be used to objectively asses performance of a technically difficult procedure. As a result, more surgical training can be done prior to operating on actual patients in the operating theater.

Leptin promotes glioblastoma.

The hormone leptin has a variety of functions. Originally known for its role in satiety and weight loss, leptin more recently has been shown to augment tumor growth in a variety of cancers. Within gliomas, there is a correlation between tumor grade and tumor expression of leptin and its receptor. This suggests that autocrine signaling within the tumor microenvironment may promote the growth of high-grade gliomas. Leptin does this through stimulation of cellular pathways that are also advantageous for tumor growth and recurrence: antiapoptosis, proliferation, angiogenesis, and migration. Conversely, a loss of leptin expression attenuates tumor growth. In animal models of colon cancer and melanoma, a decline in the expression and secretion of leptin resulted in a reduction of tumor growth. In these models, positive mental stimulation through environmental enrichment decreased leptin secretion and improved tumor outcome. This review explores the link between leptin and glioblastoma.