Touch Surgery: Analysis and Assessment of Validity of a Hand Surgery Simulation “App”

Background: Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. Methods: Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants’ score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. Results: All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. Conclusions: The study confirms app validity and usefulness by demonstrating that every cohort’s simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app’s veracity and utility increased with lower levels of training experience.

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Developing a 3D composite training model for cranial remodeling

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18773 ◽

2019 ◽

Vol 24 (6) ◽

pp. 632-641 ◽

Cited By ~ 1

Author(s):

Du Cheng ◽

Melissa Yuan ◽

Imali Perera ◽

Ashley O’Connor ◽

Alexander I. Evins ◽

...

Keyword(s):

Soft Tissues ◽

Surgical Simulation ◽

Cranial Vault ◽

Neurosurgical Procedures ◽

Training Experience ◽

Training Tool ◽

Complex Anatomy ◽

3D Printed ◽

Multiple Materials ◽

The Impact

OBJECTIVECraniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement (FOA), and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The infrequent exposure to complex neurosurgical procedures such as these during residency limits extraoperative training. Lack of cadaveric teaching tools given the pediatric nature of synostosis compounds this challenge. The authors sought to create lifelike 3D printed models based on actual cases of craniosynostosis in infants and incorporate them into a practical course for endoscopic and open correction. The authors hypothesized that this training tool would increase extraoperative facility and familiarity with cranial vault reconstruction to better prepare surgeons for in vivo procedures.METHODSThe authors utilized representative craniosynostosis patient scans to create 3D printed models of the calvaria, soft tissues, and cranial contents. Two annual courses implementing these models were held, and surveys were completed by participants (n = 18, 5 attending physicians, 4 fellows, 9 residents) on the day of the course. These participants were surveyed during the course and 1 year later to assess the impact of this training tool. A comparable cohort of trainees who did not participate in the course (n = 11) was also surveyed at the time of the 1-year follow-up to assess their preparation and confidence with performing craniosynostosis surgeries.RESULTSAn iterative process using multiple materials and the various printing parameters was used to create representative models. Participants performed all major surgical steps, and we quantified the fidelity and utility of the model through surveys. All attendees reported that the model was a valuable training tool for open reconstruction (n = 18/18 [100%]) and endoscopic suturectomy (n = 17/18 [94%]). In the first year, 83% of course participants (n = 14/17) agreed or strongly agreed that the skin and bone materials were realistic and appropriately detailed; the second year, 100% (n = 16/16) agreed or strongly agreed that the skin material was realistic and appropriately detailed, and 88% (n = 14/16) agreed or strongly agreed that the bone material was realistic and appropriately detailed. All participants responded that they would use the models for their own personal training and the training of residents and fellows in their programs.CONCLUSIONSThe authors have developed realistic 3D printed models of craniosynostosis including soft tissues that allow for surgical practice simulation. The use of these models in surgical simulation provides a level of preparedness that exceeds what currently exists through traditional resident training experience. Employing practical modules using such models as part of a standardized resident curriculum is a logical evolution in neurosurgical education and training.

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Endoscopic Carpal Tunnel Release

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0098 ◽

2019 ◽

pp. 989-994

Author(s):

Antony Hazel ◽

Neil F. Jones

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Anatomical Landmarks ◽

Transverse Carpal Ligament ◽

Palmar Arch ◽

Endoscopic Carpal Tunnel Release ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery ◽

Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

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Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema

Physical Therapy ◽

10.1093/ptj/82.10.1009 ◽

2002 ◽

Vol 82 (10) ◽

pp. 1009-1016 ◽

Cited By ~ 15

Author(s):

Julie E Donachy ◽

Emily L Christian

Keyword(s):

Physical Therapy ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Tourniquet Time ◽

Compression Bandaging ◽

Right Hand ◽

Tunnel Syndrome ◽

Chronic Lymphedema

Abstract Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.

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Hybrid Surgical Simulator: A Temporal Bone Simulator Validation Study of the Stryker Surgical Simulator (S3)

Military Medicine ◽

10.1093/milmed/usaa178 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2026-e2031

Author(s):

Charles Meyer ◽

Francine Noda ◽

Craig R Folsom

Keyword(s):

Temporal Bone ◽

Content Validity ◽

Haptic Feedback ◽

Surgical Simulation ◽

Subjective Evaluation ◽

Face Validity ◽

Task Completion ◽

Surgical Simulator ◽

Surgical Performance ◽

Training Tool

ABSTRACT Introduction The Stryker Surgical Simulator is a hybrid, temporal bone simulator that uses both tactile and haptic feedback combined with a computer interface. We sought to validate this simulator as an otolaryngology resident training tool for performing tympanomastoidectomy. Materials and Methods 15 residents and staff performed five basic cortical mastoidectomies. Staff surgeons comprised the “expert” cohort and resident surgeons comprised the “trainee” cohort. Subjective evaluation of the face validity and content validity was assessed via pre- and postquestionnaires. Objective evaluation of content validity was assessed through grading of each temporal bone dissection specimen, comparing time to task completion, and calculating the rate of injury to critical structures. Study approved by the Institutional Review Board (2013.0001). Results Post hoc questionnaires showed that both staff and residents subjectively rated the simulator favorably on face validity, content validity, and all global assessment categories, though there were no significant distinctions between groups (P > 0.05). The resident group had a significantly longer drilling time compared with the staff group throughout the series of tympanomastoidectomies (P = 0.008), and both groups showed a decrease in time to task completion with repetitive drilling. However, there were no significant differences in surgical performance as evaluated by a blinded senior neurotologist (P = 0.52). There were also no critical injuries recorded by the simulator in any of the 75 trials, preventing any evaluation on this measure. Conclusions Despite favorable subjective evaluations by both staff and residents, objective discrimination between experienced and novice participants was not achieved. This was likely in part due to inherent design flaws of the simulator. This emphasizes the potential shortcomings of surgical simulation models for highly technical procedures and points to the importance of intensive study and validation prior to incorporation of commercial training models into surgical training programs.

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Revision Surgery after Carpal Tunnel Release –Analysis of the Pathology in 200 Cases during a 2 Year Period

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.09.022 ◽

2006 ◽

Vol 31 (1) ◽

pp. 68-71 ◽

Cited By ~ 90

Author(s):

N. STÜTZ ◽

A. GOHRITZ ◽

J. VAN SCHOONHOVEN ◽

U. LANZ

Keyword(s):

Carpal Tunnel ◽

Revision Surgery ◽

Carpal Tunnel Release ◽

Operative Procedure ◽

Hand Surgery ◽

Scar Tissue ◽

Technical Errors ◽

Number Of Patients ◽

Release Analysis ◽

Specific Reason

Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.

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Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409354015 ◽

2009 ◽

Vol 35 (3) ◽

pp. 228-231 ◽

Cited By ~ 10

Author(s):

S. M. Koh ◽

F. Moate ◽

D. Grinsell

Keyword(s):

Carpal Tunnel Syndrome ◽

Range Of Motion ◽

Grip Strength ◽

Complex Regional Pain Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Pain Syndrome ◽

Hand Surgery ◽

Pain Scores ◽

Tunnel Syndrome

This study highlights the benefits of carpal tunnel release (CTR) in four patients presenting with complex regional pain syndrome (CRPS) after hand surgery who also had carpal tunnel syndrome (CTS) diagnosed clinically and by nerve conduction studies. Three of the patients underwent pre- and postoperative volumetric, circumference, grip strength and range of motion measurements. The Disabilities of the Arm, Shoulder and Hand (DASH) functional outcome measure and pain scores were also used. There was almost complete resolution of CRPS symptoms in all four patients, with notable reductions in oedema and improvements in grip strength and range of motion. There were also improvements in DASH outcome scores and pain scores after CTR.

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Litigation Following Carpal Tunnel Release

Hand ◽

10.1177/1558944718760032 ◽

2018 ◽

Vol 14 (4) ◽

pp. 466-470 ◽

Cited By ~ 3

Author(s):

Nishant Ganesh Kumar ◽

Nicholas Hricz ◽

Brian C. Drolet

Keyword(s):

Median Nerve ◽

Nerve Injury ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

The United States ◽

Fellowship Training ◽

Malpractice Claims ◽

Predominantly Female ◽

Median Nerve Injury

Background: Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon. This study aimed to understand the patient, procedure, and surgeon factors involved in CTR malpractice litigation. Methods: The Westlaw legal database was queried for all recorded CTR malpractice cases resulting in jury verdicts and settlements. Only cases directly related to injury after CTR were included in this study. Cases were reviewed to determine plaintiff demographics, defendant training, liability, injury, outcomes, and monetary awards. Results: Ninety-two unique cases were identified. Plaintiffs were predominantly female (n = 65, 71%). Most surgeons were orthopedic-trained (n = 37, 52%). Only 27% of defendants (n = 19) were hand fellowship-trained. Only 19% of cases resulting in a monetary award were against surgeons who had hand fellowship training. The majority of cases (n = 61, 66%) were found in favor of the defendant. Monetary awards averaged $305 923 (range = $12 000-1 338 147), while settlements averaged $266 250. Alleged liability was most for surgeon negligence (n = 69, 75%) with a third of cases resulting in monetary awards. Median nerve injury was claimed in 41 cases (45%), with 17 (41%) resulting in monetary awards. Conclusion: Although CTR is generally safe and effective, some patients will experience complications. Median nerve injury was the most common reason for successful litigation in this study. Adequate training and experience in hand surgery may lower the risk of injuries resulting in successful malpractice suits.

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The SMART Trocar: Force, Deviation, and Impedance Sensing Trocar for Enhanced Laparoscopic Surgery

2019 Design of Medical Devices Conference ◽

10.1115/dmd2019-3244 ◽

2019 ◽

Author(s):

Jonathan Schrope ◽

Bjorn Olmanson ◽

Caleb Fick ◽

Cameron Motameni ◽

Tayvin Viratyosin ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Abdominal Wall ◽

Surgical Simulation ◽

Impedance Measurement ◽

Organ Damage ◽

Applied Force ◽

Impedance Sensing ◽

Training Tool ◽

Trocar Placement ◽

Electrical Impedance Measurement

Intra-abdominal organ and vascular injuries during laparoscopic trocar placement remain a significant cause for surgical complications during laparoscopic procedures. These complications can arise if the surgeon deviates from the proper placement axis, requiring additional applied force to obliquely traverse the abdominal wall. This increase in force application increases the risk of internal vessel and organ damage immediately after entrance to the peritoneal cavity. To mitigate this risk, our group designed a trocar that provides real-time feedback of deviation from the proper insertion axis, applied force, and position of the trocar tip within the tissue. This was performed using an accelerometer, load cell, and electrical impedance measurement. Our device was tested in a surgical simulation laboratory by medical students using a porcine abdominal wall model. Results establish our device as an effective training tool for educating surgeons on trocar placement in laparoscopic surgery.

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Development and Validation of a Novel Surgical Simulation for Parotidectomy and Facial Nerve Dissection

Otolaryngology ◽

10.1177/0194599820913587 ◽

2020 ◽

Vol 163 (2) ◽

pp. 344-347

Author(s):

Fanny Gabrysz-Forget ◽

Samuel Rubin ◽

Dmitry Nepomnayshy ◽

Robert Dolan ◽

Bharat Yarlagadda

Keyword(s):

Facial Nerve ◽

Surgical Simulation ◽

Copper Wire ◽

Low Cost ◽

Face Validity ◽

Training Tool ◽

Parotid Surgery ◽

The Face ◽

Development And Validation ◽

Novel Model

We present the development and validation of a low-cost novel model for training of parotid surgery. The model consists of a 3-dimensionally printed skeleton, silicone-based soft tissue, and facial nerve replicated with copper wire, circuited to indicate contact with instruments. The face validity of the simulator was evaluated with a 21-item 5-point Likert survey. Content validity was evaluated through a survey completed by the trainees after their first live parotidectomy following the simulation. Twelve residents and 6 faculty completed the simulated procedure of superficial parotidectomy after watching a video demonstration. Completion of 16 surgical steps evaluated by this model was graded for each participant. The mean ± SD total assessment score for faculty was 15.83 ± 0.41, as compared with 13.33 ± 2.06 for residents ( P = .0081). The simulator as a training tool was well received by both faculty and residents (5 vs 4, P = .0206). Participants strongly agreed that junior residents would benefits from use of the model.

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Prospective Evaluation of Opioid Consumption Following Hand Surgery Performed Wide Awake Versus With Sedation

Hand ◽

10.1177/1558944716677536 ◽

2016 ◽

Vol 12 (6) ◽

pp. 606-609 ◽

Cited By ~ 11

Author(s):

Andrew Miller ◽

Nayoung Kim ◽

Asif M. Ilyas

Keyword(s):

Carpal Tunnel Release ◽

Hand Surgery ◽

Opioid Consumption ◽

Anesthesia Care ◽

Prospective Evaluation ◽

Opioid Use ◽

Monitored Anesthesia Care ◽

Open Carpal Tunnel Release ◽

Wide Awake ◽

No Tourniquet

Background: We prospectively evaluated opioid consumption postoperatively following trigger finger release (TFR) and open carpal tunnel release (CTR), and hypothesized that cases performed wide awake with local anesthesia and no tourniquet (WALANT) would result in increased opioid consumption compared with cases performed under monitored anesthesia care (MAC). Methods: Postoperative opioid consumption following CTR and TFR was prospectively collected over 6 months. The primary end points of the study were: (1) total opioid consumption; and (2) the number of days an opioid was used for both groups. Results: Mean opioid use and number of days the opioid was used for all MAC cases were 3.95 pills and 1.8 days, respectively. The results for WALANT were 3.85 pills and 1.6 days. Conclusions: These results suggest that effective pain control postoperatively may be independent of anesthesia type for soft tissue procedures of the hand. Specifically, average opioid consumption and days of utilization were similar in both the MAC and WALANT groups. Average postoperative opioid consumption was approximately only 4 opioid pills. Consideration should be given to prescribing fewer opioids for surgeries such as CTR and TFR.

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