Image Guided Interpedicular Screw Placement Simulation System for Training and Skill Evaluation. Proof of Concept.

Background: The SpineST-01 system is an image-guided vertebrae cannulation training system. During task execution, the computer calculates performance-based metrics displaying different visual perspectives (lateral view, axial view, anteroposterior view) with the position of the instrument inside the vertebra. Finally, a report with the metrics is generated as performance feedback.

Novices' learning curve in single-port surgery using three surgical training programs.

Background: The objective of this study was to evaluate the novices' learning curves and proficiency level reached in laparoendoscopic single-site (LESS) surgery using three surgical training programs.

Material And Methods: Participants were randomly divided into three groups, who trained in a specific practice regimen for 12 days using a laparoscopic box simulator and three tasks. Group A trained in three stages using conventional laparoscopic surgery (CLS) with straight instruments, and LESS with straight and articulating instruments for four days each.

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.

Steerable Surgical Instrument for Conventional and Single-Site Minimally Invasive Surgery.

This article aims to present an innovative design of a steerable surgical instrument for conventional and single-site minimally invasive surgery (MIS), which improves the dexterity and maneuverability of the surgeon while offering a solution to the limitations of current tools. The steerable MIS instrument consists of a deflection structure with a curved sliding joints design that articulates the distal tip in two additional degrees of freedom (DoFs), relative to the instrument shaft, using transmission by cables. A passive ball-joint mechanism articulates the handle relative to the instrument shaft, improves wrist posture, and prevents collision of instrument handles during single-site MIS procedures.

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.

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.

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.

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.

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.

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.

Is the digitization of laparoscopic movement using accessible alternative technologies possible?

It is widely documented that laparoscopic surgeons require training, and an objective evaluation of the training that they receive. The most advanced evaluation systems integrate the digitization of the movement of laparoscopic tools. A great number of these systems, however, do not permit the use of real tools and their high cost limits their academic impact.

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.

Initial clinical experience using a novel laparoscopy assistant.

This article presents the first clinical and experimental experiences of the PMASS (Postural Mechatronic Assistance Solo Surgery) from a prospective study carried on on thirteen laparoscopic procedures. Also, their advantages and disadvantages are identified. The PMASS is a system with three articulations; two articulations are passive and one is active; this handles the optic in real time, reducing the latency time by spatial relocation.

Postural mechatronic assistant for laparoscopic solo surgery (PMASS).

Background And Purpose: Laparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of the visual perspective.

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.

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.

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.

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.