Adapting Motor Imagery Training Protocols to Surgical Education: A Systematic Review and Meta-Analysis.

Objective. Motor imagery (MI) is widely used to improve technical skills in sports and has been proven to be effective in neurorehabilitation and surgical education. This review aims to identify the key characteristics of MI protocols for implementation into surgical curricula. Design. This study is a systematic review and meta-analysis. PubMed, MEDLINE, Embase and PsycINFO databases were systematically searched. The primary outcome was the impact of MI training on measured outcomes, and secondary outcomes were study population, MI intervention characteristics, study primary outcome measure and subject rating of MI ability (systematic review registration: PROSPERO CRD42019121895). Results. 456 records were screened, 60 full texts randomising 2251 participants were reviewed and 39 studies were included in meta-analysis. MI was associated with improved outcome in 35/60 studies, and pooled analysis also showed improved outcome on all studies with a standardised mean difference of .39 (95% CI: .12, .67, P = .005). In studies where MI groups showed improved outcomes, the median duration of training was 24 days (mode 42 days), and the median duration of each individual MI session was 30 minutes (range <1 minute-120 minutes). Conclusions. MI training protocols for use in surgical education could have the following characteristics: MI training delivered in parallel to existing surgical training, in a flexible format; inclusion of a brief period of relaxation, followed by several sets of repetitions of MI and a refocusing period. This is a step towards the development of a surgical MI training programme, as a low-cost, low-risk tool to enhance practical skills.

A systematic review of transurethral resection of ejaculatory ducts for the management of ejaculatory duct obstruction.

OBJECTIVE: Ejaculatory duct obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the ejaculatory ducts (TURED) as a treatment option. A systematic review was therefore conducted to assess its efficacy and identify patient subgroups that benefit from the procedure. MATERIAL AND METHODS: A database search of PubMed, Embase, and Scopus (up to January 2019) and the World Health Organization trial registry was performed to identify all studies assessing infertile men with EDO undergoing TURED. The primary outcome measures included semen parameters and natural pregnancies. The secondary outcomes included complications, symptomatic improvement, and a change from in vitro fertilization to intrauterine insemination. RESULTS: Of 3,277 articles screened, 29 studies with 634 patients were included in the study. Although outcomes varied considerably among studies, a general increase in all semen parameters postoperatively was observed. Semen volume (n=23 studies) improved in a median of 83.0% of patients (interquartile range [IQR]: 37.5). Sperm motility and concentration (n=10 and n=21 studies) improved in a median of 63.0% (IQR: 15.0) and 62.5% (IQR: 16.5) of patients, respectively. The natural pregnancy rate across the studies was a median of 25.0% (IQR: 15.7). Improvements in both the outcomes were greater in patients with congenital etiologies and partial EDO. Differences in surgical technique did not appear to affect outcomes. CONCLUSION: TURED is associated with improvements in semen parameters and offers a chance of restoring fertility in previously subfertile men. Although results are promising, the current evidence remains limited owing to predominantly retrospective studies with small sample sizes.