Validation of the VBLaST pattern cutting task: a learning curve study.

Background: Mastery of laparoscopic skills is essential in surgical practice and requires considerable time and effort to achieve. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC) is a virtual simulator that was developed as a computerized version of the pattern cutting (PC) task in the Fundamentals of Laparoscopic Surgery (FLS) system. To establish convergent validity for the VBLaST-PC, we assessed trainees' learning curves using the cumulative summation (CUSUM) method and compared them with those on the FLS.

OR fire virtual training simulator: design and face validity.

Background: The Virtual Electrosurgical Skill Trainer is a tool for training surgeons the safe operation of electrosurgery tools in both open and minimally invasive surgery. This training includes a dedicated team-training module that focuses on operating room (OR) fire prevention and response. The module was developed to allow trainees, practicing surgeons, anesthesiologist, and nurses to interact with a virtual OR environment, which includes anesthesia apparatus, electrosurgical equipment, a virtual patient, and a fire extinguisher.

Achieving Interface and Environment Fidelity in the Virtual Basic Laparoscopic Surgical Trainer.

Virtual reality trainers are educational tools with great potential for laparoscopic surgery. They can provide basic skills training in a controlled environment and free of risks for patients. They can also offer objective performance assessment without the need for proctors.

Face and content validation of a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™).

Background: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical paradigm, where peritoneal access is achieved through one of the natural orifices of the body. It is being reported as a safe and feasible surgical technique with significantly reduced external scarring. Virtual Translumenal Endoscopic Surgical Trainer (VTEST™) is the first virtual reality simulator for the NOTES.

Use of stochastic resonance methods for improving laparoscopic surgery performance.

Background: Vibrotactile feedback (VIB) has been utilized in previous research as sensory augmentation to improve performance during minimally invasive surgical tasks. Stochastic resonance (SR), introduced into the human control system as white noise at a subthreshold level, has shown promise to improve the sensitivity of tactile receptors resulting in performance enhancement for sensorimotor tasks. The purpose of this study was to determine whether SR could improve performance (accuracy, speed) in a simulated laparoscopic palpation task.

Haptic Communication in Collaborative Virtual Environments.

Objective: To understand the interaction between haptic and verbal communication, we quantified the relative effect of verbal, haptic, and haptic-plus-verbal feedback in a collaborative virtual pointing task.

Background: Collaborative virtual environments (CVEs) provide a medium for interaction among remote participants. Better understanding of the role of haptic feedback as a supplement to verbalization can improve the design of CVEs.

The effect of stress on learning in surgical skill acquisition.

Background: An excessive level of stress and anxiety in medical education can have a negative impact on learning. In particular, the interaction between attending surgeons and trainees in the operating room could induce stress on trainees that is counterproductive, especially if the teaching style or feedback is unduly harsh or critical.

Aim: To characterize the effects of stress resulting from attending-trainee interaction during surgical skill acquisition.

A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training.

Background: Distractions during surgical procedures have been linked to medical error and team inefficiency. This systematic review identifies the most common and most significant forms of distraction in order to devise guidelines for mitigating the effects of distractions in the OR.

Methods: In January 2015, a PubMed and Google Scholar search yielded 963 articles, of which 17 (2 %) either directly observed the occurrence of distractions in operating rooms or conducted a laboratory experiment to determine the effect of distraction on surgical performance.

Face and construct validation of a next generation virtual reality (Gen2-VR) surgical simulator.

Introduction: Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR) system to train surgeons in these environments.

Identifying Opportunities for Virtual Reality Simulation in Surgical Education: A Review of the Proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR Surgery.

Objectives: To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation.

Background Data: Simulation is an increasingly important part of surgical training. VR is a developing platform for using simulation to teach technical skills, behavioral skills, and entire procedures to trainees and practicing surgeons worldwide.

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES.

Background: NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery.

Effects of sleep hours and fatigue on performance in laparoscopic surgery simulators.

Background: Studies on a virtual reality simulator have demonstrated that sleep-deprived residents make more errors. Work-hour restrictions were implemented, among other reasons, to ensure enough sleep time for residents. The objective of this study was to assess the effects of sleep time, perceived fatigue, and experience on surgical performance.

Prevention of surgical skill decay.

The U.S. military medical community spends a great deal of time and resources training its personnel to provide them with the knowledge and skills necessary to perform life-saving tasks, both on the battlefield and at home.

Characterizing the learning curve of the VBLaST-PT(©) (Virtual Basic Laparoscopic Skill Trainer).

Background: Mastering laparoscopic surgical skills requires considerable time and effort. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PT(©)) is being developed as a computerized version of the peg transfer task of the Fundamentals of Laparoscopic Surgery (FLS) system using virtual reality technology. We assessed the learning curve of trainees on the VBLaST-PT(©) using the cumulative summation (CUSUM) method and compared them with those on the FLS to establish convergent validity for the VBLaST-PT(©).

Development and validation of VBLaST-PT© : a virtual peg transfer simulator.

Peg transfer is one of the five tasks in the Fundamentals of Laparoscopic Surgery (FLS), which is now established as a standard for training minimally invasive surgery. In this paper we report development and preliminary validation of Virtual Basic Laparoscopic Skill Trainer-peg transfer (VBLaST-PT© simulator. Face validation of the VBLaST-PT© with 34 subjects revealed high scores for all aspects of simulation.

Effect of automatic image realignment on visuomotor coordination in simulated laparoscopic surgery.

During laparoscopic surgery, the surgeon's hand-eye coordination is often disrupted by the incongruent mapping between the orientation of the endoscopic view and the actual operative field. Two experiments were conducted to examine the effect of automatic image realignment on the performance of laparoscopic surgery. The first experiment investigated how visual-motor misalignment impacted laparoscopic surgery performance.

Ergonomic considerations in natural orifice translumenal endoscopic surgery (NOTES): a case study.

Surgical technique evolved from traditional open surgery to laparoscopic surgery, offering patients reduced pain and quick recovery. Recently, a new approach called natural orifice translumenal endoscopic surgery (NOTES) has emerged. In NOTES, procedures may be transvaginal, transgastric, or transrectal or transesophageal.

Evaluation of techniques to model bend loss in multimode fibers for endoscopic application.

Bend loss from optical fibers can have positive applications, which need to be characterized and related to fiber curvature in a systematic approach to be useful. One potential application for optical fibers is a shape sensor for tracking flexible bodies in remote access environments, such as in endoscopy or boroscopy. We conducted a review of bend-loss characterization and evaluated several methods for characterizing bend loss in multimode optical fibers for an endoscopic shape-tracking application.

Differences in day and night shift clinical performance in anesthesiology.

Objective: This study examined whether anesthesia residents (physicians in training) performed clinical duties in the operating room differently during the day versus at night.

Background: Fatigue from sleep deprivation and working through the night is common for physicians, particularly during residency training.

Methods: Using a repeated-measures design, we studied 13 pairs of day-night matched anesthesia cases.

Innovative dynamic minimally invasive training environment (DynaMITE).

Existing laparoscopic box trainers consist only of static tasks and do not adequately prepare surgeons to navigate the dynamic surgical environment. This paper describes an innovative design using controlled motorized target movements to enhance the training of dynamic motor skills. The prototype was tested using 15 subjects with different surgical experience levels.

Can surgeons think and operate with haptics at the same time?

Much effort has been devoted to incorporating haptic feedback into surgical simulators. However, the benefits of haptics for novice trainees in the early stages of learning are not clear. Presumably, novices have less spare attentional resources to attend to haptic cues while learning basic laparoscopic skills.

Lowering communication barriers in operating room technology.

Objectives: This paper examines the effects of new technology on team communication and information flow in a complex work environment, and offers design suggestions for improved team performance.

Background: Case study of a robot-assisted cholecystectomy procedure revealed teamwork disruption and an increase in the complexity of information flow and communication in the operating room as a result of the novel technology. A controlled experiment using a between-subjects design was conducted to test the hypothesis that providing critical information in a timely and accessible manner would increase communication efficiency and reduce errors in task performance.

Effects of vision and friction on haptic perception.

Objective: Two experiments were conducted to examine the effects of vision and masking friction on contact perception and compliance differentiation thresholds in a simulated tissue-probing task.

Background: In minimally invasive surgery, the surgeon receives limited haptic feedback because of the current design of the instrumentation and relies on visual feedback to judge the amount of force applied to the tissues. It is suggested that friction forces inherent in the instruments contribute to errors in surgeons' haptic perception.

Effects of cognitive distraction on performance of laparoscopic surgical tasks.

Hypothesis: To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator.

Design: Within-subjects design.

Setting: A surgical skills laboratory.