EASIER: A new model for online learning of minimally invasive surgery skills.

Introduction: Technology Enhanced Learning (TEL) can provide the tools to safely master minimally invasive surgery (MIS) skills in patient-free environments and receive immediate objective feedback without the constant presence of an instructor. However, TEL-based systems tend to work isolated from one another, focus on different skills, and fail to provide contents without a sound pedagogical background.

Objective: The objective of this descriptive study is to present in detail EASIER, an innovative TEL platform for surgical and interventional training, as well as the results of its validation.

Can effective pedagogy be ensured in minimally invasive surgery e-learning?

Introduction: Effectiveness of e-learning diminishes without the support of a pedagogical model to guide its use. In minimally invasive surgery (MIS), this has been reported as a limitation when technology is used to deliver contents without a sound pedagogical background.

Material And Methods: We describe how a generic pedagogical model, the 3D pedagogy framework, can be used for setting learning outcomes and activities in e-learning platforms focused on MIS cognitive skills.

Self-assessment in laparoscopic surgical skills training: Is it reliable?

Background: The concept of self-assessment has been widely acclaimed for its role in the professional development cycle and self-regulation. In the field of medical education, self-assessment has been most used to evaluate the cognitive knowledge of students. The complexity of training and evaluation in laparoscopic surgery has previously acted as a barrier in determining the benefits self-assessment has to offer in comparison with other fields of medical education.

Supervised classification of psychomotor competence in minimally invasive surgery based on instruments motion analysis.

Background: Objective assessment of psychomotor skills has become an important challenge in the training of minimally invasive surgical (MIS) techniques. Currently, no gold standard defining surgical competence exists for classifying residents according to their surgical skills. Supervised classification has been proposed as a means for objectively establishing competence thresholds in psychomotor skills evaluation.

Multimodal phantom of liver tissue.

Medical imaging plays an important role in patients' care and is continuously being used in managing health and disease. To obtain the maximum benefit from this rapidly developing technology, further research is needed. Ideally, this research should be done in a patient-safe and environment-friendly manner; for example, on phantoms.

Perceiving haptic feedback in virtual reality simulators.

Background: To improve patient safety, training of psychomotor laparoscopic skills is often done on virtual reality (VR) simulators outside the operating room. Haptic sensations have been found to influence psychomotor performance in laparoscopy. The emulation of haptic feedback is thus an important aspect of VR simulation.

Limitations of haptic feedback devices on construct validity of the LapSim® virtual reality simulator.

Background: Surgeons performing laparoscopy need a high degree of psychomotor skills, which can be trained and assessed on virtual reality (VR) simulators. VR simulators simulate the surgical environment and assess psychomotor skills according to predefined parameters. This study aimed to validate a proficiency-based training setup that consisted of two tasks with predefined threshold values and handles with haptic feedback on the LapSim(®) VR simulator.

A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance.

Background: A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To assure high quality of skills, it is important to be able to measure and assess these skills. For that, it is necessary to determine aspects that indicate the difference between performances at various levels of proficiency.

EVA: laparoscopic instrument tracking based on Endoscopic Video Analysis for psychomotor skills assessment.

Introduction: The EVA (Endoscopic Video Analysis) tracking system is a new system for extracting motions of laparoscopic instruments based on nonobtrusive video tracking. The feasibility of using EVA in laparoscopic settings has been tested in a box trainer setup.

Methods: EVA makes use of an algorithm that employs information of the laparoscopic instrument's shaft edges in the image, the instrument's insertion point, and the camera's optical center to track the three-dimensional position of the instrument tip.

Relevance of motion-related assessment metrics in laparoscopic surgery.

Introduction: Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills and their correlation with the different abilities sought to measure.

Assessment of joystick and wrist control in hand-held articulated laparoscopic prototypes.

Background: Various steerable instruments with flexible distal tip have been developed for laparoscopic surgery. The problem of steering such instruments, however, remains a challenge, because no study investigated which control method is the most suitable. This study was designed to examine whether thumb (joystick) or wrist control method is designated for prototypes of steerable instruments by means of motion analysis.

Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery.

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor-trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy.

Intracorporeal suturing: economy of instrument movements using a box trainer model.

Study Objective: To determine whether economy of instrument movement can differentiate between skills levels during intracorporeal suturing using a box trainer model.

Design: Prospective cohort study (Canadian Task Force classification II-2).

Setting: Skills laboratory of a university teaching hospital.

Virtual reality in laparoscopic skills training: is haptic feedback replaceable?

With the emphasis on laparoscopic skills training outside of the operating room (OR), simulators are constantly being developed and improved. Virtual reality (VR) trainers have been looking for solutions to compensate their lack of haptic feedback. A possible solution is the addition of kinematic interaction between laparoscopic instruments and objects.

How to objectively classify residents based on their psychomotor laparoscopic skills?

In minimally invasive surgery (MIS), a surgeon needs to acquire a certain level of basic psychomotor MIS skills to perform surgery safely. Evaluation of those skills is a major impediment. Although various assessment methods have been introduced, none of them came as a superior.

Objective classification of residents based on their psychomotor laparoscopic skills.

Background: From the clinical point of view, it is important to recognize residents' level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g.

Force feedback and basic laparoscopic skills.

Background: Not much is known about the exact role of force feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force application tasks.

Methods: A group of 19 gynecologic residents, randomly divided into two groups, performed three laparoscopic tasks in both the box trainer and the virtual reality (VR) trainer.

Retracting and seeking movements during laparoscopic goal-oriented movements. Is the shortest path length optimal?

Aims: Minimally invasive surgery (MIS) requires a high degree of eye-hand coordination from the surgeon. To facilitate the learning process, objective assessment systems based on analysis of the instruments' motion are being developed. To investigate the influence of performance on motion characteristics, we examined goal-oriented movements in a box trainer.