Effects of Real Time Feedback on Novice's Laparoscopic Learning Curve.

Objective: Analyze the learning curve of medical students when they are trained with a laparoscopic box trainer and are presented with different modes of real-time feedback on their performance in the laparoscopic suturing procedure.

Design: A prospective randomized controlled trial (RTC) was performed. Three groups were proposed: control, visual, and haptic.

Objective Evaluation of Laparoscopic Experience Based on Muscle Electromyography and Accelerometry Performing Circular Pattern Cutting Tasks: A Pilot Study.

The aim of this work is to present a new physical laparoscopy simulator with an electromyography (EMG)/accelerometry-based muscle activity recording system, , and perform objective evaluation of laparoscopic skills based on the quantification of muscle activity of participants with different levels of laparoscopic experience. . EMG and ACC signals were obtained from 14 participants (6 experts, 8 medical students) performing circular pattern cutting tasks using a laparoscopic box trainer with the Trigno (Delsys Inc, Natick, MA) portable wireless system of 16 wireless sensors.

Objective psychomotor laparoscopic skills evaluation using a low-cost wearable device based on accelerometry: construct and concurrent validity study.

Background: Motion analysis of surgical maneuvers provides useful quantitative information for the objective evaluation of the surgeons. However, surgical simulation laboratories for laparoscopic training do not usually integrate devices that help quantify the level of skills of the surgeons due to their limited resources and the high costs of new technologies. The purpose of this study is to present the construct and concurrent validity of a low-cost motion tracking system, based on a wireless triaxial accelerometer, employed to objectively evaluate psychomotor skills of surgeons during laparoscopic training.

Face, content, and construct validity of the virtual immersive operating room simulator for training laparoscopic procedures.

Background: The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience.

Methods: The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure.

Development of a 3D Motion Tracking System for the Analysis of Skills in Microsurgery.

Microsurgical skills of trainee surgeons have been subjectively evaluated due to the lack of technological tools. The objective of this investigation is to present the construct validity of the mitracks3D, which is a system designed to help in the objective evaluation of microsurgery trainees. To achieve this, a stereoscopic vision system records the 3D motion of two tweezers manipulated by surgeons during microsurgery training.

Integration of Comprehensive Metrics into the PsT1 Neuroendoscopic Training System.

Objective: Metric-based surgical training can be used to quantify the level and progression of neurosurgical performance to optimize and monitor training progress. Here we applied innovative metrics to a physical neurosurgery trainer to explore whether these metrics differentiate between different levels of experience across different tasks.

Methods: Twenty-four participants (9 experts, 15 novices) performed 4 tasks (dissection, spatial adaptation, depth adaptation, and the A-B-A task) using the PsT1 training system.

Design of a Dynamic Force Measurement System for Training and Evaluation of Suture Surgical Skills.

The aim of this study is to present the SurgeForce system, a tissue handling training device for analysis of dynamic force applied to the tissue and objective assessment of basic surgical skills during the suture process. The SurgeForce system consists of a mechanical base formed by two platforms joint with three stainless steel springs and a three axial digital accelerometer attached to the upper platform, which detects the dynamic force caused by a surgeon when performing a suture task over a synthetic tissue pad. Accelerometer data is sent to a control unit where preprocessing to transform the raw data into a force signal is done, and then, the force signal is sent to a computer application, which register the force exerted over the synthetic tissue pad.

Construct validity of the SurgForce system for objective assessment of laparoscopic suturing skills.

Background: Laparoscopic surgery requires a new set of skill to be learned by the surgeons, of which the most relevant is tissue manipulation. Excessive forces applied to the tissue can cause rupture during manipulation or ischemia when confronting both sides of the tissue. The aim of this study is to establish the construct validity of the SurgForce system for objective assessment of advanced laparoscopic skills, based on the force signal generated during suture tasks, and the development of force parameters for evaluating tissue handling interaction.

Objective classification of psychomotor laparoscopic skills of surgeons based on three different approaches.

Background: The determination of surgeons' psychomotor skills in minimally invasive surgery techniques is one of the major concerns of the programs of surgical training in several hospitals. Therefore, it is important to assess and classify objectively the level of experience of surgeons and residents during their training process. The aim of this study was to investigate three classification methods for establishing automatically the level of surgical competence of the surgeons based on their psychomotor laparoscopic skills.

Development and Preliminary Validation of a Rabbit Model of Duodenal Atresia for Training in Pediatric Surgical Skills.

Duodenal atresia is a congenital defect that requires advanced surgical skills. The objective of this study is to present an anatomical defect of duodenal atresia using a rabbit model and evaluate the preliminary experience for the training of surgical skills with pediatric surgeons. Adult white New Zealand male rabbits weighing 3.

Orthogonal cameras system for tracking of laparoscopic instruments in training environments.

Introduction: Motion analysis is a valuable tool for assessment of psychomotor skills in laparoscopy. Nonetheless, it requires technologies for tracking the activity of the laparoscopic instruments during training. This paper presents a sensor-free system to track the movements of laparoscopic instruments based on an orthogonal camera system and video image processing.

Development of a Laparoscopic Box Trainer Based on Open Source Hardware and Artificial Intelligence for Objective Assessment of Surgical Psychomotor Skills.

Background: A trainer for online laparoscopic surgical skills assessment based on the performance of experts and nonexperts is presented. The system uses computer vision, augmented reality, and artificial intelligence algorithms, implemented into a Raspberry Pi board with Python programming language.

Methods: Two training tasks were evaluated by the laparoscopic system: transferring and pattern cutting.

Interpretation of motion analysis of laparoscopic instruments based on principal component analysis in box trainer settings.

Background: Motion analysis parameters (MAPs) have been extensively validated for assessment of minimally invasive surgical skills. However, there are discrepancies on how specific MAPs, tasks, and skills match with each other, reflecting that motion analysis cannot be generalized independently of the learning outcomes of a task. Additionally, there is a lack of knowledge on the meaning of motion analysis in terms of surgical skills, making difficult the provision of meaningful, didactic feedback.

Pediatric inguinal hernia repair with a single-incision approach using an Endo Close™ suturing device.

Background: Diverse techniques have been described for pediatric inguinal hernia repair, based on extraperitoneal [1-4] and intraperitoneal [5-8] methodologies. In this video, we describe a novel technique to repair pediatric inguinal hernia using an Endo Close™ suturing device by percutaneous puncture with a single incision.

Methods: With a transumbilical approach, a 5-mm trocar is inserted for a 30° laparoscope.

A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.

Background: Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking.

Construct validity of a video-tracking system based on orthogonal cameras approach for objective assessment of laparoscopic skills.

Purpose: This study was aimed to establish the construct validity of a video-tracking system based on orthogonal cameras approach for assessment of laparoscopic psychomotor skills in training environments.

Methods: The camera-tracking system consists of two webcams placed in orthogonal configuration at a distance of 13.5 cm.

Construction and validation of a low-cost surgical trainer based on iPhone technology for training laparoscopic skills.

In this article, we describe the construction and validation of a laparoscopic trainer using an iPhone 5 and a plastic document holder case. The abdominal cavity was simulated with a clear plastic document holder case. On 1 side of the case, 2 holes for entry of laparoscopic instruments were drilled.

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.

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons.

Background: The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons' psychomotor skills.

Methods: Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system.

Adapting to the 30-degree visual perspective by emulating the angled laparoscope: a simple and low-cost solution for basic surgical training.

Introduction: The ability to handle and adapt to the visual perspectives generated by angled laparoscopes is crucial for skilled laparoscopic surgery. However, the control of the visual work space depends on the ability of the operator of the camera, who is often not the most experienced member of the surgical team. Here, we present a simple, low-cost option for surgical training that challenges the learner with static and dynamic visual perspectives at 30 degrees using a system that emulates the angled laparoscope.

Synchronous electrical stimulation of laryngeal muscles: an alternative for enhancing recovery of unilateral recurrent laryngeal nerve paralysis.

Background: Although electrical stimulation of the larynx has been widely studied for treating voice disorders, its effectiveness has not been assessed under safety and comfortable conditions. This article describes design, theoretical issues, and preliminary evaluation of an innovative system for transdermal electrical stimulation of the larynx. The proposed design includes synchronization of electrical stimuli with laryngeal neuromuscular activity.

Optimizing the positional relationships between instruments used in laparoscopic simulation using a simple trigonometric method.

Background: Various methods for evaluating laparoscopic skill have been reported, but without detailed information on the configuration used they are difficult to reproduce. Here we present a method based on the trigonometric relationships between the instruments used in a laparoscopic training platform in order to provide a tool to aid in the reproducible assessment of surgical laparoscopic technique.

Materials And Methods: The positions of the instruments were represented using triangles.

Analysis of subtle movements related to neurodegenerative diseases using wearable inertial sensors: a study in healthy subjects.

Evaluation of movement disorders is a useful tool for the diagnostic and monitoring of diseases related with damage of the motor control systems, such as Parkinson's disease. The evaluation of well characterized movement disorders has been proposed using different techniques each one with their advantages and limitations. This document propose the use a system based on inertial sensors and wireless technology for the measurement and evaluation of three of the most common movement disorders related with Parkinson's disease.