Autonomous Non-Technical Surgical Skill Assessment and Workload Analysis in Laparoscopic Cholecystectomy Training

Mental Imagery as a Formal Educational Adjunct for Surgical Skills Development in Medical Students: A Scoping Review.

POSNA Leadership Program (PLP): Developing surgeon leaders for patients, organizations, and our society

Sleep deficiency can adversely affect the performance of resident physicians, resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons, is less clear. Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under 2 conditions, post-call (defined as > 2 hours of nighttime clinical duties) and non-post-call. Each surgeon contributed up to 5 surgical procedures post-call and non-post-call, yielding 362 cases total (150 post-call and 210 non-post-call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less post-call (4.98 ± 1.41) vs non-post-call (6.68 ± 0.88, P < .01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons ratings demonstrated poorer performance while post-call for situational awareness, decision-making, and communication/teamwork. Fewer hours of sleep also were related to lower ratings for situational awareness and decision-making. Decreased self-reported alertness was observed to be associated with increased procedure time. Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased, suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on nontechnical surgical skills were adversely affected by sleep deficiency. Quan SF, Landrigan CP, Barger LK, etal. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med. 2023;19(4):673-683.

Postgraduate medical training has evolved considerably from an emphasis on hands-on, autonomous learning to a paradigm where simulation technologies are used to introduce and augment certain skill sets. This review is intended to provide an update on surgical simulators and tools for urological trainee education. We provide an overview of simulation platforms for robotics, endoscopy, and laparoscopic practice and training. In general, these simulators provide face, content, and construct validity. Various educational and evaluation tools have been adopted. Simulation platforms have been developed for technical and non-technical surgical skills, educational bootcamps, and tools for evaluation and feedback. While trainees find the opportunity to practice their skills beneficial, there may be difficulty with access due to cost and availability. Additionally, there is a need for more objective metrics demonstrating improvement in skill or patient outcome.

Fault detection method for energy measurement systems equipped with a Rogowski coil using the coil's response to a unit voltage jump and a fully convolutional neural network

In the paper, experimental verification of vision feedback in position control of surgical tools for minimal invasive surgery (MIS) (Dutkiewicz et al., 2004) is presented. The laparoscope positioning is based on computer recognition of surgical tools on the image from a laparoscopic camera. Experimental results, obtained from special laboratory test bed based on the Staubli robot equipped with laparoscopic camera are presented.

ABSTARCTReal-time tool tracking in minimally invasive-surgery (MIS) has numerous applications for computer-assisted interventions (CAIs). Visual tracking approaches are a promising solution to real-time surgical tool tracking, however, many approaches may fail to complete tracking when the tracker suffers from issues such as motion blur, adverse lighting, specular reflections, shadows, and occlusions. We propose an automatic real-time method for two-dimensional tool detection and tracking based on a spatial transformer network (STN) and spatio-temporal context (STC). Our method exploits both the ability of a convolutional neural network (CNN) with an in-house trained STN and STC to accurately locate the tool at high speed. Then we compared our method experimentally with other four general of CAIs’ visual tracking methods using eight existing online and in-house datasets, covering both in vivo abdominal, cardiac and retinal clinical cases in which different surgical instruments were employed. The experiments demonstrate that our method achieved great performance with respect to the accuracy and the speed. It can track a surgical tool without labels in real time in the most challenging of cases, with an accuracy that is equal to and sometimes surpasses most state-of-the-art tracking algorithms. Further improvements to our method will focus on conditions of occlusion and multi-instruments.

Background: Laparoscopic cholecystectomy (LC) is very commonly performed for removal of gallstones. In routine, ultrasonic devices are used for laparoscopy involving the deeper operating fields, while electrosurgical devices are preferred for LC. However, nowadays both of these devices are used for LC. The objective of this study was to compare the surgical outcomes of ultrasonic dissector over conventional electrocautery in patients planned for LC. Material and Methods: This non-randomized clinical trial was conducted in general surgery unit, Jinnah hospital Lahore. The study duration was 15th January 2015 to 31st December 2016. In group A (n=100), patients were operated through three-port standard laparoscopic cholecystectomy and conventional electrosurgical cautery was used for dissection. While in group B (n=50), patients were operated through single incision laparoscopic surgery (SILS) and Harmonic dissector was used for sealing of cystic artery and cystic duct. SPSS version 23 was used for data analysis. Complications between electrocautery and ultrasonic dissector were compared using chi-square test/Fischer exact test and operative time was compared using student’s t-test with p-value ≤ 0.05 considered as statistically significant.Results: Out of 150 patients planned for laparoscopic cholecystectomy, 33 (22%) were males and 117 (78%) females. The mean age was 40±6.45 years with an age range of 12-80 years. In group A, intraoperative gall bladder perforation was found in 5 patients whereas in group B, there was only one patient with perforation. A total of 4 cases were converted to open cholecystectomy in group A due to difficult dissection in Calot’s triangle as compared to 1 case in group B. In group A, 3 cases had postoperative bile leakage in the drain. In two patients it settled over a period of 3 days. About 03 cases had wound infection in group A and 1 in group B. Mean operative time in group A was 42.2±8.93 minutes versus 35.7±4.85 minutes in group B (p-value 0.001).Conclusion: In this study, the rate of post-operative complications was similar between the two groups, but operative time was significantly shorter in the group B. Harmonic dissector enabled easy dissection of tissues with good hemostasis and less trafficking of instrument, avoiding use of clips and sutures during minimal invasive surgery.