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Surgical simulator training reduces operative times in resident surgeons learning phacoemulsification cataract surgery.

ABSTRACT: Purpose:To compare the surgical duration for routine phacoemulsification surgeries in residents with and without virtual simulator training. Methods:Retrospective cohort study of operative times of routine phacoemulsification cataract surgeries performed by 29 different third-year residents rotating at one academic institution. One group underwent mandatory virtual cataract surgery simulator training (SIM) in their second year of residency before starting surgeries while the other group did not undergo any simulator training (NOSIM). Outcomes measured were comparative surgical times and vitreous loss rates between groups in their third year of residency. Results:722 surgeries were included. Surgeries in the SIM group were on average 6.7 min (min) shorter compared to the NOSIM group (P = 0.0001). Although both groups required less time for surgery over the course of the academic year, regression analysis showed that NOSIM group residents overall required 17% longer time for an uncomplicated clear corneal phacoemulsification surgery (incidence rate ratio 1.17; p = 0.0001). In the final month of their residency residents in the SIM group (32.2 ± 3 min) were 9 min faster than NOSIM peers (41.2 ± 3 min mean ± SE; p = 0.02). Vitreous loss rates were 1.4% in the SIM group and 3.6% in the NOSIM group (p = 0.06). Conclusion and Importance:Early and continuous implementation of mandatory virtual simulator surgical training before starting intraocular surgeries significantly decreases operative times in third year residents learning phacoemulsification compared to non-simulator trained peers.

SUBMITTER: Lopez-Beauchamp C

PROVIDER: S-EPMC6926105 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Surgical simulator training reduces operative times in resident surgeons learning phacoemulsification cataract surgery.

Lopez-Beauchamp Cristina C Singh Gemini A GA Shin Soo Y SY Magone M Teresa MT

American journal of ophthalmology case reports 20191209

<h4>Purpose</h4>To compare the surgical duration for routine phacoemulsification surgeries in residents with and without virtual simulator training.<h4>Methods</h4>Retrospective cohort study of operative times of routine phacoemulsification cataract surgeries performed by 29 different third-year residents rotating at one academic institution. One group underwent mandatory virtual cataract surgery simulator training (SIM) in their second year of residency before starting surgeries while the other ...[more]

PMID: 31890989

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Project description:OBJECTIVES:To investigate differences in surgical time, the distance the surgical instrument travelled and number of movements required to complete manual phacoemulsification cataract surgery versus femtosecond laser cataract surgery. DESIGN:Non-randomised comparative case series. SETTING:Single surgery site, Moorfields Eye Hospital, UK. PARTICIPANTS:40 cataract surgeries of 40 patients. INTERVENTIONS:Laser-assisted and manual phacoemulsification cataract surgery. Laser-assisted surgery cases were performed using the AMO Catalys platform. PRIMARY AND SECONDARY OUTCOME MEASURES:Computer vision tracking software PhacoTracking were applied to the recordings to establish the distance the instrument travelled, total number of movements (the number of times an instrument stops and starts moving) and time taken for surgery steps including phacoemulsification, irrigation-aspiration (IA) and overall surgery time. The time taken for laser docking and delivery was not included in the analyses. RESULTS:Data on 19 laser-assisted and 19 manual phacoemulsification surgeries were analysed (two cases were excluded due to insufficient video-recording quality). There were no differences in the number of instrument moves, the distance the instrument travelled or time taken to complete the phacoemulsification stage. However for IA, the number of instrument moves (manual: mean 20 (SD 15) vs laser: mean 38 (SD 22), P=0.008) and time taken (manual: mean 75?s (SD 24) vs laser: mean 108?s (SD 36), P=0.003) were significantly greater for laser cases. For laser versus manual cases overall, there was no difference in number of moves or the distance the instrument travelled, but laser cases took longer (mean 88?s, P=0.049). CONCLUSIONS:Laser cataract surgery cases took longer to complete without accounting for the time taken to complete the laser procedure itself. This appears to be in part due to IA requiring more instrument manoeuvres and taking longer to complete. Data from a large randomised series would better elucidate this relationship.

Project description:BackgroundMinimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. There is a growing body of evidence supporting its use at the time of phacoemulsification to help lower IOP. However, it is still not clear how much of the IOP lowering effect can be attributed to the iStent, the crystalline lens extraction or both when inserted concurrently at the time of phacoemulsification. This has been an important issue in understanding its potential role in the glaucoma management paradigm.PurposeTo conduct a systematic review and meta-analysis comparing the IOP lowering effect of iStent insertion at the time of phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataracts.MethodsA systematic review was conducted utilizing various databases. Studies examining the IOP lowering effect of iStent insertion in combination with phacoemulsification, as well as studies examining the IOP lowering effect of phacoemulsification alone were included. Thirty-seven studies, reporting on 2495 patients, met the inclusion criteria. The percentage reduction in IOP (IOPR%) and mean reduction in topical glaucoma medications after surgery were determined. The standardized mean difference (SMD) was computed as a measure of the treatment effect for continuous outcomes taking into account heterogeneity. Fixed-effect and random-effect models were applied.ResultsA 4% IOP reduction (IOPR%) from baseline occurred following phacoemulsification as a solo procedure compared to 9% following an iStent implant with phacoemulsification, and 27% following 2 iStents implants with phacoemulsification. Compared with cataract extraction alone, iStent with phacoemulsification resulted in significant reduction in the post-operative IOP (IOPR%) (SMD = -0.46, 95% CI: [-0.87, -0.06]). A weighted mean reduction in the number of glaucoma medications per patient was 1.01 following phacoemulsification alone compared to 1.33 after one iStent implant with phacoemulsification, and 1.1 after 2 iStent implants with phacoemulsification. Compared to cataract extraction alone, iStent with cataract extraction showed a significant decrease in the number of glaucoma medications (SMD = -0.65, 95% CI: [-1.18, -0.12]). Funnel plots suggested the absence of publication bias.ConclusionBoth iStent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant decrease in IOP and topical glaucoma medications. In terms of both reductions, iStent with phacoemulsification significantly outperforms phacoemulsification alone.

Dataset Information

Surgical simulator training reduces operative times in resident surgeons learning phacoemulsification cataract surgery.

Publications

Surgical simulator training reduces operative times in resident surgeons learning phacoemulsification cataract surgery.

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