Can effective pedagogy be ensured in minimally invasive surgery e-learning?

INTRODUCTION: Effectiveness of e-learning diminishes without the support of a pedagogical model to guide its use. In minimally invasive surgery (MIS), this has been reported as a limitation when technology is used to deliver contents without a sound pedagogical background. MATERIAL AND METHODS: We describe how a generic pedagogical model, the 3D pedagogy framework, can be used for setting learning outcomes and activities in e-learning platforms focused on MIS cognitive skills. A demonstrator course on Nissen fundoplication was developed following the model step-by-step in the MISTELA learning platform. Course design was informed by Kolb's Experiential learning model. Content validation was performed by 13 MIS experts. RESULTS: Ten experts agreed on the suitability of content structuring done according to the pedagogical model. All experts agreed that the course provides means to assess the intended learning outcomes. CONCLUSIONS: This work showcases how a general-purpose e-learning framework can be accommodated to the needs of MIS training without limiting the course designers' pedagogical approach. Key advances for its success include: (1) proving the validity of the model in the wider scope of MIS skills and (2) raising awareness amongst stakeholders on the need of developing training plans with explicit, rather than assumed, pedagogical foundations. Abbreviations: MIS: minimally invasive surgery; TEL: technology enhanced learning.

Improving Cell Viability and Velocity in µ-Extrusion Bioprinting with a Novel Pre-Incubator Bioprinter and a Standard FDM 3D Printing Nozzle.

Bioprinting is a promising emerging technology. It has been widely studied by the scientific community for the possibility to create transplantable artificial tissues, with minimal risk to the patient. Although the biomaterials and cells to be used are being carefully studied, there is still a long way to go before a bioprinter can easily and quickly produce printings without harmful effects on the cells. In this sense, we have developed a new µ-extrusion bioprinter formed by an Atom Proton 3D printer, an atmospheric enclosure and a new extrusion-head capable to increment usual printing velocity. Hence, this work has two main objectives. First, to experimentally study the accuracy and precision. Secondly, to study the influence of flow rates on cellular viability using this novel µ-extrusion bioprinter in combination with a standard FDM 3D printing nozzle. Our results show an X, Y and Z axis movement accuracy under 17 µm with a precision around 12 µm while the extruder values are under 5 and 7 µm, respectively. Additionally, the cell viability obtained from different volumetric flow tests varies from 70 to 90%. So, the proposed bioprinter and nozzle can control the atmospheric conditions and increase the volumetric flow speeding up the bioprinting process without compromising the cell viability.

Ergonomics problems due to the use and design of dissector and needle holder: a survey in minimally invasive surgery.

BACKGROUND: This study analyzes the problems and consequences associated with prolonged use of laparoscopic instruments (dissector and needle holder) and equipments. METHODS: A total of 390 questionnaires were sent to the laparoscopic surgeons of the Spanish Health System. Questions were structured on the basis of 4 categories: demographics, assessment of laparoscopic dissector, assessment of needle holder, and other informations. RESULTS: A response rate of 30.26% was obtained. Among them, handle shape of laparoscopic instruments was identified as the main element that needed to be improved. Furthermore, the type of instrument, electrocautery pedals and height of the operating table were identified as major causes of forced positions during the use of both surgical instruments. CONCLUSIONS: As far as we know, this is the largest Spanish survey conducted on this topic. From this survey, some ergonomic drawbacks have been identified in: (a) the instruments' design, (b) the operating tables, and (c) the posture of the surgeons.

Effects of pneumoperitoneum and body position on the morphology of abdominal vascular structures analyzed in MRI.

PURPOSE: To analyze the complications of laparoscopy in different vascular structures using magnetic resonance imaging (MRI). MRI has become a key tool in laparoscopic surgery. During these procedures, pneumoperitoneum creation and placing the patient in the surgical position provoke different changes in the splachnic circulation. MATERIALS AND METHODS: Ten pigs were included in the study. MRI studies of the abdominal area were carried out in four different situations of abdominal pressure and body position. RESULTS: Changes in the area of the lumen of the portal vein and the abdominal aorta were analyzed in all situations. A significant reduction in the area of the abdominal aorta was observed after the pneumoperitoneum in supine and anti-Trendelemburg position. The lumen of the portal vein was significantly reduced in all analyzed situations except when placing the patient in anti-Trendelemburg without pneumoperitoneum, in which case the area was increased. CONCLUSION: The creation of pneumoperitoneum provokes morphological changes in the lumen of different abdominal vessels as a consequence of the increase of pressure. Furthermore, the combination of pneumoperitoneum together with the anti-Trendelemburg position results in a more significant reduction of the lumen of the portal vein and the abdominal aorta.

Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery.

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor-trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

Video-based assistance system for training in minimally invasive surgery.

In this paper, the development of an assisting system for laparoscopic surgical training is presented. With this system, we expect to facilitate the training process at the first stages of training in laparoscopic surgery and to contribute to an objective evaluation of surgical skills. To achieve this, we propose the insertion of multimedia contents and outlines of work adapted to the level of experience of trainees and the detection of the movements of the laparoscopic instrument into the monitored image. A module to track the instrument is implemented focusing on the tip of the laparoscopic tool. This tracking method does not need the presence of artificial marks or special colours to distinguish the instruments. Similarly, the system has another method based on visual tracking to localize support multimedia content in a stable position of the field of vision. Therefore, this position of the support content is adapted to the movements of the camera or the working area. Experimental results are presented to show the feasibility of the proposed system for assisting in laparoscopic surgical training.