Millimetric laparoscopic surgery training on a physical trainer using rats.

PURPOSE: To demonstrate the possibility of laparoscopic technique training and refinement at the millimetric level. MATERIAL AND METHODS: A physical trainer and Winstar rats were used. RESULTS: The training system is visually similar to pneumoperitoneum. The laparoscopic technique is perfected in a visual space illuminated by white light, with two-dimensional feedback and at a geometric level that allows for refinement of the technique. CONCLUSIONS: It is possible to refine the technique at this geometric level at a low cost and without requiring laparoscopic equipment. In addition, optics tests indicate the possibility in the short term of refining the laparoscopic technique to the microanastomotic level.

Novel laparoscopic home trainer.

BACKGROUND: Minimum-invasion surgery is performed by means of 2-dimensional visual feedback and without haptic sensitivity. This demands that specialty surgeons adapt to and develop new psychomotor abilities. These abilities can only be learned, developed, and maintained through training. Training technology has been divided into virtual trainers and physical trainers. The former, due to their high cost, have not had the expected academic impact, whereas the latter, although an excellent low-cost alternative, do not offer the visual handling options for refining the required psychomotor abilities. The purpose of this article is to describe the design of a box trainer which can establish a closer relationship with the visual and functional perspectives of optics during surgery, thus establishing better learning protocols. METHODS: A laparoscopic surgery trainer was designed and built based on the shape of the abdominal cavity formed during such surgery. The visual feedback is achieved with a color mini-camera whose position and orientation are controlled by means of a magnetic system with 0 and 45-degree optics options. RESULTS: A trainer which allows for changes in visual perspective, for developing abilities and skills, with optics other than those of 0 degrees within a geometric space similar to that of the pneumoperitoneum has been designed. CONCLUSIONS: A training system which provides illumination and visual perspective conditions similar to those of real surgery using 0 and 45-degree optics has been designed. The training system is portable and easy to connect for training purposes. Its ports allow for various options that help to improve skills and propose new approaches.

PsT1: A Low-Cost Optical Simulator for Psychomotor Skills Training in Neuroendoscopy.

BACKGROUND: Well-developed psychomotor skills are important for competence in minimally invasive surgery. Neuroendoscopy is no exception, and adaptation to different visual perspectives and careful handling of the surgical instruments are mandatory. Few training systems, however, focus on developing psychomotor skills for neuroendoscopy. Here, we introduce a new training system called PsT1 that provides visual feedback via the use of simple optics that emulate the endoscope at 0° and 30°. Time and error metrics are generated automatically with integrated software to ensure objective assessment. METHODS: Neuroendoscopic optics were emulated with a low-cost, commercially available universal serial bus 2.0 camera and a light-emitting diode light source. Visual feedback of 30° was obtained by displacing the optical axis of the universal serial bus camera by 30°, and metrics (time, precision, and errors) were generated automatically by the software. Three evaluation modules were developed (spatial adaptation, depth adaptation, and dissection), and 35 expert and nonexpert neurosurgeons performed an initial evaluation of the system. RESULTS: A total of 81% and 90% of surgeons agreed that the visuals were satisfactory and movement and control were accurately replicated, respectively. The advantages and disadvantages of the system were compared. CONCLUSIONS: Here, we present a novel, low-cost, and easy-to-implement training system for developing basic neuroendoscopic psychomotor skills. The use of objective metrics, surgical instruments, and emulation of the neuroendoscope at 0° and 30° are competitive advantages of the current system.

Mechatronic assistant system for dental drill handling.

BACKGROUND: Holding a dental tool for many hours of work is reflected in fatigue and manual tremor, which causes bad handling of rotatory instruments and consequently injuries within the buccal cavity. At present there exists no system to help the medical dentist in the support and handling of the dental drill. We propose the use of a mechatronic system to help the odontologist in handling the dental drill. METHODS: The mechatronic system consists of an articulated arm with force sensors and actuators that are activated electronically. The mechanism was developed so that the handpiece is held simultaneously by the mechatronic arm and the hand of the dentist. Expert dentists and odontology students were asked to execute tasks to assess positioning accuracy and system resolution. Students performed positioning tasks to evaluate adaptation to the system. The subjects drew the contour of a circle with and without the mechatronic assistant to assess positioning accuracy. Similarly, they made cavities on acrylic typodonts to evaluate resolution and accuracy. Adaptation to the system was evaluated by inserting the drill burr into cavities previously made. RESULTS: The mechatronic system provides support and stability while handling the dental drill. The threshold of force required to move the mechanism prevents involuntary movements affecting the quality of work made on cavities. Positioning accuracy was improved by 53% (p < 0.017) using the system. Similarly, resolution of drilling was improved by 76% (p < 0.001). CONCLUSION: We have developed the first mechatronic system to assist dentists in handling the dental drill. The arm allows the dentist to manipulate the tool with smooth and precise movements during the preparation of dental cavities with the application of force. The mechatronic system minimizes manual tremor due to fatigue and reduces the risk of iatrogenic dental injuries.

Laparoscopic Learning Evaluation over the Internet.

Learning and refining laparoscopic surgical technique requires a continuous training process. For this learning process to have value, it must include objective evaluations and the interaction of expert surgeons. These surgeons, however, are normally located at third-level hospitals, so it is difficult for them to be available for this important process. In order to bring together learning and evaluation, we developed an Internet-based evaluation system for laparoscopic surgical technique. The system applies the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) evaluation methodology, and is remotely supervised by surgeons who specialize in laparoscopy.

Laparoscopic Nissen solo surgery using PMAT (first experience).

This article describes the use of a Postural Mechatronic Assistant Trainer (PMAT) in pediatric Nissen surgery. This mechatronic system enables users to establish the logistical considerations for solo surgery and determine the advantages this new tool offers for the autonomous handling of optics.