The effect of repeated full immersion simulation training in ureterorenoscopy on mental workload of novice operators.

BACKGROUND: Difficult surgical procedures may result in a higher mental workload, leading to increased fatigue and subsequent errors. This study was aimed to investigate the effect of repeated simulation training in ureterorenoscopy in a high-fidelity setting on the performance and mental workload of novice operators. METHODS: Medical students voluntarily participated in the present simulation study. After a didactic and video-based lecture, they underwent simulation training involving a renal stone case, including a rigid cystoscope component (task 1, performing a WHO checklist, assembling a scope, and insertion of a guide-wire and an access sheath after examining the bladder) and a flexible ureterorenoscope component (task 2, retrieving a stone located in the upper calyx using a basket after inspecting the upper, middle, and lower calyx). Training was performed in a mock operating theater. Technical skills were assessed by one author (an experienced urologist) onsite using an Objective Structured Assessment of Technical Skills (OSATS) score at each training session. The mental workload was subjectively evaluated by the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire after each training session. RESULTS: Seventeen students completed a minimum of 6 training sessions (male: female = 10: 7, median age of 22) over a median of 21 days (range, 10-32). In both tasks 1 and 2, the OSATS score improved over the 6 sessions with evidence of plateauing (MANOVA model, task 1: p < 0.0001, task 2: p < 0.0001). In contrast, the NASA-TLX score persistently decreased without plateauing (task 1: p = 0.0005, task 2: p = 0.0028). CONCLUSIONS: Under repeated simulation training in ureterorenoscopy in a high-fidelity setting, participants showed a continual decrease of the mental workload, while the improvement of technical skills reached a plateau over the 6 sessions. Our study showed the important benefit of simulation training to reduce the mental workload by repeated scenario training before actual clinical practice.

Validity assessment of a simulation module for robot-assisted thoracic lobectomy.

BACKGROUND: Training for robot-assisted thoracic lobectomy remains an issue, prompting the development of virtual reality simulators. Our aim was to assess the construct and face validity of a new thoracic lobectomy module on the RobotiX Mentor, a robotic surgery simulator. We also aimed to determine the acceptability and feasibility of implementation into training. METHODS: This prospective, observational, and comparative study recruited novice (n = 16), intermediate (n = 9), and expert (n = 5) participants from King's College London, the 25th European Conference on General Thoracic Surgery, and the Society of Robotic Surgery conference 2018. Each participant completed two familiarization tasks followed by the Guided Robotic Lobectomy module and an evaluation questionnaire. Outcome measures were compared using Mann-Whitney U tests. RESULTS: Construct validity was demonstrated in 12/21 performance evaluation metrics. Significant differences between groups were found in all metrics including: time taken to complete module, vascular injury, respect for tissue, number of stapler firings, time instruments out of view, number of instrument collisions, and number of movements. Participants deemed aspects of the simulator (mean 3/5) and module (3/5) as realistic and rated the simulator as both acceptable (3.8/5) and feasible (3.8/5) for robotic surgical training. CONCLUSIONS: Face validity, acceptability, and feasibility were established for the thoracic lobectomy module of the RobotiX Mentor simulator. Moderate evidence of construct validity was also demonstrated. With further work, this simulation module could help to reduce the initial part of the learning curve for trainees and decrease the risk of errors during live training.

To investigate the correlation between the visual prostate symptom score, the international prostate symptom score, and uroflowmetry parameters in adult Thai males of different educational levels.

BACKGROUND: To evaluate the correlation between the International Prostate Symptom Score (IPSS), Visual Prostate Symptom Score (VPSS), and uroflowmetry parameters in Thai males and to examine the possibility in establishing a severity cut-off point for VPSS. METHODS: Between 1st February and 31st May 2016 a total of 200 men were enrolled onto the study and divided into high and low educated groups. All of them were requested to complete paperwork including their personal data, and then to complete a VPSS and IPSS questionnaire. Uroflowmetry, residual urine and prostate size were measured. The relationship between the answers to the VPSS and IPSS together with the other objective parameters was assessed using Spearman's rank test. RESULTS: The mean age of the patients was 61.2 years. 69.9% of subjects were highly educated. There was a statistically significant correlation between VPSS and IPSS in total, and any individual scores except frequency score. There was weak correlation between the VPSS and the uroflowmetry parameters and prostate size. The low educated group had a statistically significant lower completion rate of both the VPSS (41.6% vs. 79.8%) and IPSS (61.2% vs. 81.2%) without assistance than the higher educated group and most of the lower educated group felt that the IPSS was easier to understand than the VPSS (51.2% vs. 48.8%, P < 0.001). A VPSS severity score ≤6 or ≥14 had a very high specificity that predicted the patients would have mild or severe symptoms (94.7% and 98.6%) while a VPSS between 7 and 13 had a high sensitivity (90.8%) but a low specificity (16.9%) when it came to the prediction of moderate symptoms. CONCLUSION: VPSS showed a significant correlation to the IPSS and uroflowmetry parameters. A VPSS score ≤6, 7 to 13 and ≥14 may indicate mild, moderate, and severe symptoms respectively.

The Validation of a Novel Robot-Assisted Radical Prostatectomy Virtual Reality Module.

OBJECTIVE: To perform the first validation of a full procedural virtual reality robotic training module and analysis of novice surgeon's learning curves. DESIGN: Participants completed the bladder neck dissection task and urethrovesical anastomosis task (UVA) as part of the prostatectomy module. Surgeons completed feedback questionnaires assessing the realism, content, acceptability and feasibility of the module. Novice surgeons completed a 5.5-hour training programme using both tasks. SETTING: King's College London, London. PARTICIPANTS: 13 novice, 24 intermediate and 8 expert surgeons completed the validation study. RESULTS: Realism was scored highly for BDN (mean 3.4/5) and UVA (3.74/5), as was importance of BDN (4.32/5) and UVA (4.6/5) for training. It was rated as a feasible (3.95/5) and acceptable (4/5) tool for training. Experts performed significantly better than novice group in 6 metrics in the UVA including time (p = 0.0005), distance by camera (p = 0.0010) and instrument collisions (p = 0.0033), as well as task-specific metrics such as number of unnecessary needle piercing points (p = 0.0463). In novice surgeons, a significant improvement in performance after training was seen in many metrics for both tasks. For bladder neck dissection task, this included time (p < 0.0001), instrument collisions (p = 0.0013) and total time instruments are out of view (p = 0.0251). For UVA, this included time (p = 0.0135), instrument collisions (p = 0.0066) and task-specific metrics such as injury to the urethra (p = 0.0032) and bladder (p = 0.0189). CONCLUSIONS: Surgeons found this full procedural VR training module to be a realistic, feasible and acceptable component for a robotic surgical training programme. Construct validity was proven between expert and novice surgeons. Novice surgeons have shown a significant learning curve over 5.5 hours of training, suggesting this module could be used in a surgical curriculum for acquisition of technical skills. Further implementation of this module into the curriculum and continued analysis would be beneficial to gauge how it can be fully utilised.

Torsion of an Accessory Hepatic Lobe with Embedded Gallbladder: In an 11-Month-Old Boy.

An accessory lobe of the liver is a rare entity in clinical practice which is diagnosed incidentally. Infrequently, it may present as torsion with a clinical picture of an acute abdomen, a palpable mass, and may be associated with liver function abnormalities. Many of these patients have a history of previous surgery for congenital abdominal wall defects such as omphalocele. We present an extremely rare case of torsion of an accessory hepatic lobe in an 11-month-old male patient who presented in a state of shock. The infant underwent laparotomy and excision of the accessory lobe. Here, we aim to emphasize the importance of prompt management and early resection which is the cornerstone of a favorable outcome.