Can tonic accommodation predict surgical performance?

Abstract Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract

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The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials

Brain Sciences ◽

10.3390/brainsci11060707 ◽

2021 ◽

Vol 11 (6) ◽

pp. 707

Author(s):

Chao-Ming Hung ◽

Bing-Yan Zeng ◽

Bing-Syuan Zeng ◽

Cheuk-Kwan Sun ◽

Yu-Shian Cheng ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Skill Acquisition ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Meta Analysis ◽

Controlled Trials ◽

Surgical Skill ◽

Sham Control ◽

Surgical Performance ◽

Randomized Controlled

The application of transcranial direct current stimulation (tDCS) to targeted cortices has been found to improve in skill acquisition; however, these beneficial effects remained unclear in fine and complicated skill. The aim of the current meta-analysis was to investigate the association between tDCS application and the efficacy of surgical performance during surgical skill training. We included randomized controlled trials (RCTs) investigating the efficacy of tDCS in enhancing surgical skill acquisition. This meta-analysis was conducted under a random-effect model. Six RCTs with 198 participants were included. The main result revealed that tDCS was associated with significantly better improvement in surgical performance than the sham control (Hedges’ g = 0.659, 95% confidence intervals (95%CIs) = 0.383 to 0.935, p < 0.001). The subgroups of tDCS over the bilateral prefrontal cortex (Hedges’ g = 0.900, 95%CIs = 0.419 to 1.382, p < 0.001) and the primary motor cortex (Hedges’ g = 0.599, 95%CIs = 0.245 to 0.953, p = 0.001) were both associated with significantly better improvements in surgical performance. The tDCS application was not associated with significant differences in error scores or rates of local discomfort compared with a sham control. This meta-analysis supported the rationale for the tDCS application in surgical training programs to improve surgical skill acquisition.

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Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00487-6 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Gianluca Sampieri ◽

Amirpouyan Namavarian ◽

Marc Levin ◽

Justine Philteos ◽

Jong Wook Lee ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Patient Outcomes ◽

Noise Level ◽

Neck Surgery ◽

Operating Rooms ◽

Head And Neck Surgery ◽

Noise Levels ◽

Surgical Performance ◽

The Mean

Abstract Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

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Objective Measures of Surgeon Nontechnical Skills in Surgery: A Scoping Review

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720821995319 ◽

2021 ◽

pp. 001872082199531

Author(s):

Jackie S. Cha ◽

Denny Yu

Keyword(s):

Situation Awareness ◽

Cognitive Skills ◽

Behavioral Science ◽

Assessment Tools ◽

Objective Measures ◽

Communication Model ◽

Eligibility Criteria ◽

Surgical Performance ◽

Nontechnical Skills ◽

Objective Metrics

Objective The purpose of this study was to identify, synthesize, and discuss objective behavioral or physiological metrics of surgeons’ nontechnical skills (NTS) in the literature. Background NTS, or interpersonal or cognitive skills, have been identified to contribute to safe and efficient surgical performance; however, current assessments are subjective, checklist-based tools. Intraoperative skill evaluation, such as technical skills, has been previously utilized as an objective measure to address such limitations. Methods Five databases in engineering, behavioral science, and medicine were searched following PRISMA reporting guidelines. Eligibility criteria included studies with NTS objective measurements, surgeons, and took place within simulated or live operations. Results Twenty-three articles were included in this review. Objective metrics included communication metrics and measures from physiological responses such as changes in brain activation and motion of the eye. Frequencies of content-coded communication in surgery were utilized in 16 studies and were associated with not only the communication construct but also cognitive constructs of situation awareness and decision making. This indicates the underlying importance of communication in evaluating the NTS constructs. To synthesize the scoped literature, a framework based on the one-way communication model was used to map the objective measures to NTS constructs. Conclusion Objective NTS measurement of surgeons is still preliminary, and future work on leveraging objective metrics in parallel with current assessment tools is needed. Application Findings from this work identify objective NTS metrics for measurement applications in a surgical environment.

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Augmented Reality with HoloLens® in Parotid Tumor Surgery: A Prospective Feasibility Study

ORL ◽

10.1159/000514640 ◽

2021 ◽

pp. 1-10

Author(s):

Claudia Scherl ◽

Johanna Stratemeier ◽

Nicole Rotter ◽

Jürgen Hesser ◽

Stefan O. Schönberg ◽

...

Keyword(s):

Augmented Reality ◽

Tumor Surgery ◽

Parotid Tumor ◽

Hand Gestures ◽

Surgical Performance ◽

3D Images ◽

Additional Information ◽

Parotid Surgery ◽

Surgical Field ◽

Improve Planning

Introduction: Augmented reality can improve planning and execution of surgical procedures. Head-mounted devices such as the HoloLens® (Microsoft, Redmond, WA, USA) are particularly suitable to achieve these aims because they are controlled by hand gestures and enable contactless handling in a sterile environment. Objectives: So far, these systems have not yet found their way into the operating room for surgery of the parotid gland. This study explored the feasibility and accuracy of augmented reality-assisted parotid surgery. Methods: 2D MRI holographic images were created, and 3D holograms were reconstructed from MRI DICOM files and made visible via the HoloLens. 2D MRI slices were scrolled through, 3D images were rotated, and 3D structures were shown and hidden only using hand gestures. The 3D model and the patient were aligned manually. Results: The use of augmented reality with the HoloLens in parotic surgery was feasible. Gestures were recognized correctly. Mean accuracy of superimposition of the holographic model and patient’s anatomy was 1.3 cm. Highly significant differences were seen in position error of registration between central and peripheral structures (p = 0.0059), with a least deviation of 10.9 mm (centrally) and highest deviation for the peripheral parts (19.6-mm deviation). Conclusion: This pilot study offers a first proof of concept of the clinical feasibility of the HoloLens for parotid tumor surgery. Workflow is not affected, but additional information is provided. The surgical performance could become safer through the navigation-like application of reality-fused 3D holograms, and it improves ergonomics without compromising sterility. Superimposition of the 3D holograms with the surgical field was possible, but further invention is necessary to improve the accuracy.

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A data-driven performance dashboard for surgical dissection

Scientific Reports ◽

10.1038/s41598-021-94487-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amir Baghdadi ◽

Sanju Lama ◽

Rahul Singh ◽

Hamidreza Hoshyarmanesh ◽

Mohammadsaleh Razmi ◽

...

Keyword(s):

Performance Monitoring ◽

Economic Consequences ◽

Skill Assessment ◽

Geospatial Information ◽

Surgical Performance ◽

Intelligence Models ◽

Artificial Intelligence Models ◽

Surgical Data ◽

Expert Surgeon ◽

The Rich

AbstractSurgical error and resulting complication have significant patient and economic consequences. Inappropriate exertion of tool-tissue force is a common variable for such error, that can be objectively monitored by sensorized tools. The rich digital output establishes a powerful skill assessment and sharing platform for surgical performance and training. Here we present SmartForceps data app incorporating an Expert Room environment for tracking and analysing the objective performance and surgical finesse through multiple interfaces specific for surgeons and data scientists. The app is enriched by incoming geospatial information, data distribution for engineered features, performance dashboard compared to expert surgeon, and interactive skill prediction and task recognition tools to develop artificial intelligence models. The study launches the concept of democratizing surgical data through a connectivity interface between surgeons with a broad and deep capability of geographic reach through mobile devices with highly interactive infographics and tools for performance monitoring, comparison, and improvement.

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The art of robotic colonic resection: a review of progress in the past 5 years

Updates in Surgery ◽

10.1007/s13304-020-00969-2 ◽

2021 ◽

Author(s):

Hongyi Liu ◽

Maolin Xu ◽

Rong Liu ◽

Baoqing Jia ◽

Zhiming Zhao

Keyword(s):

Robotic Surgery ◽

Hospital Stay ◽

Intraoperative Complications ◽

Intestinal Anastomosis ◽

Length Of Hospital Stay ◽

Colonic Resection ◽

Surgical Performance ◽

Conversion To Open Surgery ◽

Minimal Invasiveness ◽

The Past

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

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RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING

British Journal of Surgery ◽

10.1093/bjs/znab160.042 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

J A Sánchez-Margallo ◽

J Castillo Rabazo ◽

D Durán Rey ◽

I López-Agudelo ◽

M R González-Portillo ◽

...

Keyword(s):

Heart Rate ◽

Objective Evaluation ◽

Laparoscopic Training ◽

Evaluation Tool ◽

Surgical Performance ◽

Hand Motion ◽

Task Load ◽

Tissue Manipulation ◽

Level Of Experience

Abstract INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.

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