Surgeons' requirements for a surgical support system to improve laparoscopic access.
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ABSTRACT:
SUBMITTER: Spiller M
PROVIDER: S-EPMC9297603 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Outcomes of surgical trials hinge on surgeon selection and their underlying expertise. Assessment of expertise is paramount. We investigated whether surgeons' performance measured by the fundamentals of laparoscopic surgery (FLS) assessment program could predict their performance in a surgical trial. METHODS:As part of a prospective multi-institutional study of minimally invasive inguinal lymphadenectomy (MILND) for melanoma, surgical oncologists with no prior MILND experience underwent pre-trial FLS assessment. Surgeons completed MILND training, began enrolling patients, and submitted videos of each MILND case performed. Videos were scored with the global operative assessment of laparoscopic skills (GOALS) tool. Associations between baseline FLS scores and participant's trial performance metrics were assessed. RESULTS:Twelve surgeons enrolled patients; their median total baseline FLS score was 332 (range 275-380, max possible 500, passing >270). Participants enrolled 87 patients in the study (median 6 per surgeon, range 1-24), of which 72 (83%) videos were adequate for scoring. Baseline GOALS score was 17.1 (range 9.6-21.2, max possible score 30). Inter-rater reliability was excellent (ICC = 0.85). FLS scores correlated with improved GOALS scores (r = 0.57, p = 0.05) and with decreased operative time (r = -0.6, p = 0.02). No associations were found with the degree of patient recruitment (r = 0.02, p = 0.7), lymph node count (r = 0.01, p = 0.07), conversion rate (r = -0.06, p = 0.38) or major complications(r = -0.14, p = 0.6). CONCLUSIONS:FLS skill assessment of surgeons prior to their enrollment in a surgical trial is feasible. Although better FLS scores predicted improved operative performance and operative time, other trial outcome measures showed no difference. Our findings have implications for the documentation of laparoscopic expertise of surgeons in practice and may allow more appropriate selection of surgeons to participate in clinical trials.
| S-EPMC6201269 | biostudies-literature
Project description:The design of medical devices is a complex and crucial process to ensure patient safety. It has been shown that improperly designed devices lead to errors and associated accidents and costs. A key element for a successful design is incorporating the views of the primary and secondary stakeholders early in the development process. They provide insights into current practice and point out specific issues with the current processes and equipment in use. This work presents how information from a user-study conducted in the early stages of the RAFS (Robot Assisted Fracture Surgery) project informed the subsequent development and testing of the system. The user needs were captured using qualitative methods and converted to operational, functional, and non-functional requirements based on the methods derived from product design and development. This work presents how the requirements inform a new workflow for intra-articular joint fracture reduction using a robotic system. It is also shown how the various elements of the system are developed to explicitly address one or more of the requirements identified, and how intermediate verification tests are conducted to ensure conformity. Finally, a validation test in the form of a cadaveric trial confirms the ability of the designed system to satisfy the aims set by the original research question and the needs of the users.
| S-EPMC6153987 | biostudies-literature
Project description:BackgroundTo prepare for surgery, surgeons often recur to surgical videos, with YouTube being reported as the preferred source. This study aimed to compare the evaluation of three surgical trainees and three senior surgeons of the 25 most viewed laparoscopic appendectomy videos listed on YouTube. Additionally, we assessed the video conformity to the published guidelines on how to report laparoscopic surgery videos (LAP-VEGaS).MethodsBased on the number of visualization, the 25 most viewed videos on laparoscopic appendectomy uploaded on YouTube between 2010 and 2018 were selected. Videos were evaluated on the surgical technical performance (GOALS score), critical view of safety (CVS), and overall video quality and utility.ResultsVideo image quality was poor for nine (36%) videos, good for nine (36%), and in high definition for seven (28%). Educational content (e.g., audio or written commentary) was rarely present. With the exception of the overall level of difficulty, poor consistency was observed for the GOALS domains between senior surgeons and trainees. Fifteen videos (60%) demonstrated a satisfactory CVS score (≥ 5). Concerning the overall video quality, agreement among senior surgeons was higher (Cronbach's alpha 0.897) than among trainees (Cronbach's alpha 0.731). The mean overall videos utility (Likert scale, 1 to 5) was 1.92 (SD 0.88) for senior examiners, and 3.24 (SD 1.02) for trainee examiners. The conformity to the LAP-VEGaS guidelines was weak, with a median value of 8.1% (range 5.4-18.9%).ConclusionLaparoscopic videos represent a useful and appropriate educational tool but they are not sufficiently reviewed to obtained standard quality. A global effort should be made to improve the educational value of the uploaded surgical videos, starting from the application of the nowadays-available LAP-VEGaS guidelines.
| S-EPMC6507219 | biostudies-literature
Project description:The development of operative skills during general surgery residency depends largely on the resident surgeons' (residents) ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skills and comfort level of residents from both the residents' and attending surgeons' (attendings') perspectives.We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both residents and attendings completed a survey in which they rated the residents' operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Residents' and attendings' evaluations of residents' performance were compared using 2-sided t tests.The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution.All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1 and August 31, 2013. Data were collected for 28 of the institution's 54 trainees.Attendings rated residents higher than what residents rated themselves on a 5-point Likert-type scale regarding depth perception (3.86 vs. 3.38, p < 0.005), bimanual dexterity (3.75 vs. 3.36, p = 0.005), efficiency (3.58 vs. 3.18, p < 0.005), tissue handling (3.69 vs. 3.23, p < 0.005), and comfort while performing a case (3.86 vs. 3.38, p < 0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p = 0.85), the level of difficulty of the case (2.98 vs. 2.85, p = 0.443), and the degree of teaching done by the attending during the case (3.61 vs. 3.54, p = 0.701).A gap exists between residents' and attendings' perception of residents' laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess and be in general agreement with attendings on their level of laparoscopic skills and comfort level while performing a case.
| S-EPMC4662891 | biostudies-literature
Project description:BACKGROUND:Both laparoscopic surgery and computer games make similar demands on eye-hand coordination and visuospatial cognitive ability. A possible connection between both areas could be used for the recruitment and training of future surgery residents. AIM:The goal of this study was to investigate whether gaming skills are associated with better laparoscopic performance in medical students. METHODS:135 medical students (55 males, 80 females) participated in an experimental study. Students completed three laparoscopic tasks (rope pass, paper cut, and peg transfer) and played two custom-designed video games (2D and 3D game) that had been previously validated in a group of casual and professional gamers. RESULTS:There was a small significant correlation between performance on the rope pass task and the 3D game, Kendall's ?(111) = -.151, P = .019. There was also a small significant correlation between the paper cut task and points in the 2D game, Kendall's ?(102) = -.180, P = .008. Overall laparoscopic performance was also significantly correlated with both the 3D game, Kendall's ?(112) = -.134, P = .036, and points in the 2D game, Kendall's ?(113) = -.163, P = .011. However, there was no significant correlation between the peg transfer task and both games (2D and 3D game), P = n.s.. CONCLUSION:This study provides further evidence that gaming skills may be an advantage when learning laparoscopic surgery.
| S-EPMC7449406 | biostudies-literature
Project description:BackgroundDeep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated. Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia.MethodsIn this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1-2 twitches) or a moderate neuromuscular block (train-of-four 1-2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor1 to optimal5.ResultsDeep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block: mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively (P=0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different.ConclusionsDuring sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery.Clinical trial registrationNL7844 (www.trialregister.nl).
| S-EPMC7572301 | biostudies-literature
Project description:Laparoscopic Gastric Plication (LGP) is a relatively new bariatric surgery procedure unique by not removing any part of the stomach. To bring new insights into the underlying molecular mechanism, we here present the first hypothesis-free analysis of the impact of LGP on the inflammatory and metabolic state as reflected by the serum proteome. A label-free quantitative shotgun proteomics approach was used to compare the serum proteome of 16 obese individuals before surgery with the serum of same individuals 1 to 2 months (timepoint T1) and 4 to 5 months (timepoint T2) post-surgery.
2019-06-06 | PXD010528 | Pride
Project description:BACKGROUND:Given the rarity of pediatric surgical disease, it is important to consider available large-scale data resources as a means to better study and understand relevant disease-processes and their treatments. The Military Health System Data Repository (MDR) includes claims-based information for >?3 million pediatric patients who are dependents of members and retirees of the United States Armed Services, but has not been externally validated. We hypothesized that demographics and selected outcome metrics would be similar between MDR and the previously validated American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) for several common pediatric surgical operations. METHODS:We selected five commonly performed pediatric surgical operations: appendectomy, pyeloplasty, pyloromyotomy, spinal arthrodesis for scoliosis, and facial reconstruction for cleft palate. Among children who underwent these operations, we compared demographics (age, sex, and race) and clinical outcomes (length of hospital stay [LOS] and mortality) in the MDR and NSQIP-P, including all available overlapping years (2012-2014). RESULTS:Age, sex, and race were generally similar between the NSQIP-P and MDR. Specifically, these demographics were generally similar between the resources for appendectomy (NSQIP-P, n?=?20,602 vs. MDR, n?=?4363; median age 11 vs. 12?years; female 40% vs. 41%; white 75% vs. 84%), pyeloplasty (NSQIP-P, n?=?786 vs. MDR, n?=?112; median age 0.9 vs. 2?years; female 28% vs. 28%; white 71% vs. 80%), pyloromyotomy, (NSQIP-P, n?=?3827 vs. MDR, n?=?227; median age 34 vs. <?1?year, female 17% vs. 16%; white 76% vs. 89%), scoliosis surgery (NSQIP-P, n?=?5743 vs. MDR, n?=?95; median age 14.2 vs. 14?years; female 75% vs. 67%; white 72% vs. 75%), and cleft lip/palate repair (NSQIP-P, n?=?6202 vs. MDR, n?=?749; median age, 1 vs. 1?year; female 42% vs. 45%; white 69% vs. 84%). Length of stay and 30-day mortality were similar between resources. LOS and 30-day mortality were also similar between datasets. CONCLUSION:For the selected common pediatric surgical operations, patients included in the MDR were comparable to those included in the validated NSQIP-P. The MDR may comprise a valuable clinical outcomes research resource, especially for studying infrequent diseases with follow-up beyond the 30-day peri-operative period.
| S-EPMC6839070 | biostudies-literature
Project description:ObjectiveTo study the patterns of usage and perception among U.S. oculoplastic surgeons regarding surgical loupes.MethodsAn anonymous 20-question survey was emailed out to the American Society of Ophthalmic Plastic and Reconstructive Surgery listserv. Data were compiled in Google Forms. SPSS was used for statistical analyses. This study was approved by the institutional review board.ResultsOf the 609 members contacted, 239 (39%) completed the survey; 95% of respondents owned loupes and 78% regularly used them. No association was observed between frequency of loupe usage and sex or years in practice. The most common magnification and brand were 2.5× and Designs for Vision, respectively. The most common problems associated with loupes were limited vision (33%) and lack of comfort (24%), with 11% citing neck and cervical spinal disorders. The most common benefits were magnification (93%) and increased visual accuracy (68%). Of the respondents, 56% believed improved patient care to be a benefit and 76% believed that loupes enhance surgical outcome. With regard to training, 67% supported incorporating loupes into residency, 35% believed in mandating loupe purchase, and 25% wanted residencies to provide loupes at no cost. Respondent support for the use of loupes in practice and training was directly correlated with how frequently they used loupes.ConclusionsThe vast majority of respondents owned loupes. Although most loupe owners used loupes regularly, a sizable proportion operated with limited vision and lack of comfort. Overall, just over half of respondents believed that loupes improve patient care and should be integrated into residency.
| S-EPMC7605496 | biostudies-literature
Project description:The aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons.Total 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion.The 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case.Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications.
| S-EPMC4422989 | biostudies-other