128: The use of a low fidelity fetal surgery simulator decreases the learning curve required for fetoscopic spin bifida surgery and allows rapid integration of new techniques and equipment

Background Hallux valgus is one of the most common orthopaedic deformities of the foot, affecting as much as 23% of the population age 18 to 65. In addition to its high prevalence, it has a complex multifactorial pathogenesis. Surgical correction options have variable rates of success and new techniques are being developed. The modified Lapidus procedure attempts to correct in 3 planes of deformity, which may create a steeper learning curve for those newly adopting the technique. Methods A retrospective review was performed on patients who underwent hallux valgus reconstruction with a modified Lapidus procedure between March 2018 and July 2020. Exclusion criteria included revision surgery, 6 or more concurrent procedures, or a flexor digitorum longus tendon transfer for adult acquired flatfoot correction. Results There were a total of 81 modified Lapidus procedures for hallux valgus within the study time frame and 68 were included in the study. Over a period of 2 years there was a significant decrease in overall surgery duration from 78.93 minutes at month 0 to 61.80 minutes at 24 months ( P = .036). The average preoperative/postoperative intermetatarsal angles were 15.08° and 4.91°, respectively. There was an average decrease of 10.17°. The rate of nonunion was 4.41% (3/68), and the rate of recurrence at 6 months was 5.88% (4/68). There was not a significant difference in the rate of recurrence ( P = .394) or the rate of nonunion ( P = .817) as the surgeon increased in experience. Conclusion Although there is a significant learning curve for the modified Lapidus procedure, it is largely overcome by the 23rd case. Additionally, experience with the technique does not appear to affect the patient outcomes of nonunion or recurrence. Levels of Evidence Level IV: Retrospective

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Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Ginekologia Polska ◽

10.5603/gp.2020.0028 ◽

2020 ◽

Vol 91 (3) ◽

pp. 123-131 ◽

Cited By ~ 1

Author(s):

Ewa I. Horzelska ◽

Mateusz Zamlynski ◽

Tomasz Horzelski ◽

Jacek Zamlynski ◽

Agnieszka Pastuszka ◽

...

Keyword(s):

Learning Curve ◽

Fetal Surgery

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Advanced Nasal Operations

Mechanical Engineering ◽

10.1115/1.2001-feb-4 ◽

2001 ◽

Vol 123 (02) ◽

pp. 56-58

Author(s):

Jack Raplee

Keyword(s):

Air Force ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Northern Europe ◽

Surveillance Systems ◽

New Techniques ◽

Tissue Manipulation ◽

Military Applications ◽

Surgery Simulator ◽

Nose And Throat

Lockheed Martin Naval Electronics and Surveillance Systems in Akron, Ohio, had shipped Sweden’s Air Force two full mission simulators as well as five multi-mission simulators by the end of 1999. A change of the simulator’s database for precision rather than speed and for tissue manipulation instead of aircraft tactics resulted in the development of Lockheed Martin’s endoscopic sinus surgery simulator. The virtual terrain thus became smaller—the human sinus instead of Northern Europe. Using an endoscopic sinus surgery simulator, doctors can practice a variety of complex nasal procedures and reduce the risk to patients. Using simulation technology originally designed for military applications, the simulator features a dummy named Martin and can simulate a broad range of situations, including the effects of medication on a patient. The simulator is designed to train nasal surgeons and ear, nose, and throat residents to evaluate new techniques, handle instruments more efficiently, and familiarize themselves with anatomy.

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Validation of a high-fidelity training model for fetoscopic spina bifida surgery

Scientific Reports ◽

10.1038/s41598-021-85607-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Luc Joyeux ◽

Allan Javaux ◽

Mary P. Eastwood ◽

Felix R. De Bie ◽

Gert Van den Bergh ◽

...

Keyword(s):

Spina Bifida ◽

Learning Curve ◽

Abdominal Cavity ◽

Splitting Method ◽

Fetal Surgery ◽

Operation Time ◽

Training Model ◽

High Fidelity ◽

Technical Performance ◽

Repair Operation

AbstractOpen fetal surgery for spina bifida (SB) is safe and effective yet invasive. The growing interest in fetoscopic SB repair (fSB-repair) prompts the need for appropriate training. We aimed to develop and validate a high-fidelity training model for fSB-repair. fSB-repair was simulated in the abdominal cavity and on the stomach of adult rabbits. Laparoscopic fetal surgeons served either as novices (n = 2) or experts (n = 3) based on their experience. Technical performance was evaluated using competency Cumulative Sum (CUSUM) analysis and the group splitting method. Main outcome measure for CUSUM competency was a composite binary outcome for surgical success, i.e. watertight repair, operation time ≤ 180 min and Objective-Structured-Assessment-of-Technical-Skills (OSATS) score ≥ 18/25. Construct validity was first confirmed since competency levels of novices and experts during their six first cases using both methods were significantly different. Criterion validity was also established as 33 consecutive procedures were needed for novices to reach competency using learning curve CUSUM, which is a number comparable to that of clinical fSB-repair. Finally, we surveyed expert fetal surgeons worldwide to assess face and content validity. Respondents (26/49; 53%) confirmed it with ≥ 71% of scores for overall realism ≥ 4/7 and usefulness ≥ 3/5. We propose to use our high-fidelity model to determine and shorten the learning curve of laparoscopic fetal surgeons and retain operative skills.

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Stellar Evolution

Transactions of the International Astronomical Union ◽

10.1017/s0251107x00022343 ◽

1962 ◽

Vol 11 (02) ◽

pp. 137-143

Author(s):

M. Schwarzschild

Keyword(s):

Solar System ◽

Stellar Evolution ◽

Space Craft ◽

New Techniques ◽

Substantial Body ◽

Individual Stars ◽

The Past ◽

Evolution Of Galaxies ◽

History Of ◽

Fast Flow

It is perhaps one of the most important characteristics of the past decade in astronomy that the evolution of some major classes of astronomical objects has become accessible to detailed research. The theory of the evolution of individual stars has developed into a substantial body of quantitative investigations. The evolution of galaxies, particularly of our own, has clearly become a subject for serious research. Even the history of the solar system, this close-by intriguing puzzle, may soon make the transition from being a subject of speculation to being a subject of detailed study in view of the fast flow of new data obtained with new techniques, including space-craft.

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Microstructural characterization of CoPtCr/Cr thin film disks by cross-section TEM and elongated probe micro-diffraction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100088129 ◽

1991 ◽

Vol 49 ◽

pp. 762-763

Author(s):

M.A. Parker ◽

K.E. Johnson ◽

C. Hwang ◽

A. Bermea

Keyword(s):

Magnetic Recording ◽

Electron Probe ◽

Microstructural Characterization ◽

Crystallographic Structure ◽

Recording Media ◽

Layer By Layer ◽

Cross Sectional ◽

New Techniques ◽

Polished Side

We have reported the dependence of the magnetic and recording properties of CoPtCr recording media on the thickness of the Cr underlayer. It was inferred from XRD data that grain-to-grain epitaxy of the Cr with the CoPtCr was responsible for the interaction observed between these layers. However, no cross-sectional TEM (XTEM) work was performed to confirm this inference. In this paper, we report the application of new techniques for preparing XTEM specimens from actual magnetic recording disks, and for layer-by-layer micro-diffraction with an electron probe elongated parallel to the surface of the deposited structure which elucidate the effect of the crystallographic structure of the Cr on that of the CoPtCr.XTEM specimens were prepared from magnetic recording disks by modifying a technique used to prepare semiconductor specimens. After 3mm disks were prepared per the standard XTEM procedure, these disks were then lapped using a tripod polishing device. A grid with a single 1mmx2mm hole was then glued with M-bond 610 to the polished side of the disk.

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Computer averaging of lattice images of poly-4-methyl-pentene-1 (P4mp1): Noise created artifacts

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100126731 ◽

1987 ◽

Vol 45 ◽

pp. 388-389

Author(s):

P. Pradère ◽

J.F. Revol ◽

R. St. John Manley

Keyword(s):

Low Dose ◽

Polymer Concentration ◽

Processing System ◽

Limiting Factor ◽

Dilute Solution ◽

New Techniques ◽

Dose Unit ◽

Lattice Images ◽

Dose Imaging ◽

Imaging Conditions

Although radiation damage is the limiting factor in HREM of polymers, new techniques based on low dose imaging at low magnification have permitted lattice images to be obtained from very radiation sensitive polymers such as polyethylene (PE). This paper describes the computer averaging of P4MP1 lattice images. P4MP1 is even more sensitive than PE (total end point dose of 27 C m-2 as compared to 100 C m-2 for PE at 120 kV). It does, however, have the advantage of forming flat crystals from dilute solution and no change in d-spacings is observed during irradiation.Crystals of P4MP1 were grown at 60°C in xylene (polymer concentration 0.05%). Electron microscopy was performed with a Philips EM 400 T microscope equipped with a Low Dose Unit and operated at 120 kV. Imaging conditions were the same as already described elsewhere. Enlarged micrographs were digitized and processed with the Spider image processing system.

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Serial thin sectioning for pre- and post-embedding immunohistochemistry: Achieving consistent and reliable results for a 3-D reconstruction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010014748x ◽

1993 ◽

Vol 51 ◽

pp. 328-329

Author(s):

Antonia M. Milroy

Keyword(s):

Nervous System ◽

Computer Assisted ◽

Serial Sectioning ◽

Electron Microscopic ◽

High Quality ◽

New Techniques ◽

3 Dimensional ◽

Multiple User ◽

Thin Sectioning ◽

Subcellular Level

In recent years many new techniques and instruments for 3-Dimensional visualization of electron microscopic images have become available. Higher accelerating voltage through thicker sections, photographed at a tilt for stereo viewing, or the use of confocal microscopy, help to analyze biological material without the necessity of serial sectioning. However, when determining the presence of neurotransmitter receptors or biochemical substances present within the nervous system, the need for good serial sectioning (Fig. 1+2) remains. The advent of computer assisted reconstruction and the possibility of feeding information from the specimen viewing chamber directly into a computer via a camera mounted on the electron microscope column, facilitates serial analysis. Detailed information observed at the subcellular level is more precise and extensive and the complexities of interactions within the nervous system can be further elucidated.We emphasize that serial ultra thin sectioning can be performed routinely and consistently in multiple user electron microscopy laboratories. Initial tissue fixation and embedding must be of high quality.

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A Voice From the Clinic: New Techniques for the Treatment of Recurrent Respiratory Papilloma

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd10.2.4 ◽

2000 ◽

Vol 10 (2) ◽

pp. 4-5

Author(s):

Robin A. Samlan ◽

Paul W. Flint ◽

Celia Bassich-Zeren

Keyword(s):

New Techniques

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