Reliability testing of a modified MISTELS score using a low-cost trainer box

Construction and Validation of a Low-Cost Laparoscopic Simulator for Surgical Education

A global assessment tool for evaluation of intraoperative laparoscopic skills

“iTrainers” – Novel and Inexpensive Alternatives to Traditional Laparoscopic Box Trainers

A Randomized Controlled Study to Evaluate the Impact of Instrument and Laparoscope Length on Performance and Learning Curve in Single-Incision Laparoscopic Surgery.

Virtual Laparoscopic Skills Training Guide for FLS (Fundamentals of Laparoscopic Surgery)

The aim of the study was to assess whether an inexpensive tablet-based box trainer (TBT) is at least equally effective compared with a standard box trainer (SBT) to learn basic laparoscopic skills (BLS). BLS training outside the operating room has been shown to be beneficial for surgical residency. However, simulation trainers are expensive and are not consistently available in all training centers. Therefore, TBT and other homemade box trainers were developed. Medical students were randomized to either a TBT or an SBT and trained 4 fundamentals of laparoscopic surgery (FLS) tasks for 1 hour twice a week for 4 weeks. A baseline test before the training period and a posttraining test were performed. All students then completed a questionnaire to assess their assigned box trainer. The primary outcome measure was the improvement in total test scores. Improvement in the scores for the 4 individual FLS tasks was chosen as a secondary outcome measure. Thirty-two medical students were recruited. Baseline test scores did not differ significantly between the groups. BLS improved significantly in both groups for the total score and for all 4 tasks separately. Participants in the TBT group showed a greater improvement of total scores than those in the SBT group, although this did not reach statistical significance; noninferiority of the TBT compared with the SBT concerning the improvement of total scores could be demonstrated. Regarding the individual FLS tasks, noninferiority of the TBT could be shown for the pattern cutting and the suturing with intracorporeal knot-tying task. The acceptance of the TBT by the trainees was very good. Learning BLS on a homemade TBT is at least equally effective as on an SBT, with the advantage of being very cost saving. Therefore, this readily available box trainer may be used as an effective, flexible training device outside the operating room to improve accessibility to simulation training.

Background:Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program.Materials and Methods:Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study.Results:Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints.Conclusion:The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.

This study examined how hand dominance could influence postural sway during laparoscopic skills practice. Ten inexperienced medical trainees performed a peg transfer task using the Fundamentals of Laparoscopic Surgery (FLS) training box and the virtual reality (VR) trainer. Surface electromyographic recordings of upper and lower limb muscles were taken, while the postural sway was measured by a pressure mapping system. Skills performance using the non-dominant hand required more muscle effort and increased more postural sway. Compared with the FLS training box, training with VR decreased the use of muscle effort and could reduce the influence of hand dominance on the overall postural sway during laparoscopic surgical skills practice.

The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training. For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure. None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points. The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.

The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities. To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS. The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted. 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p<0.001). The cost of the program represented a saving of 67.89%. The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.

Spleen-sparing excision of giant splenic hydatid cyst

Radiographic evaluation of lumbar intervertebral disc height index: An intra and inter-rater agreement and reliability study

Background: Generalised joint hypermobility (GJH) is a common connective tissue disorder associated with a range of musculoskeletal complaints. An effective screening tool to assess GJH may influence our understanding and choice of management. Diagnosis is clinical, using tools such as the Beighton Hypermobility Score and the Contompasis Scoring System. The comparable reliability of these tools has not been previously reported. The aim of the present study was to compare the intra- and inter-rater reliability of the Beighton Score to the Contompasis Score to assess GJH. Methods: This was a randomised observational study assessing 36 pain-free participants: 27 females and nine males, with a mean age of 22.7 years ± 3.71 (range 18 to 32 years). Participants were assessed by two researchers over two sessions to allow for intra- and inter-rater analysis. Intraclass correlation coefficient (ICC) and weighted Kappa statistics were used to calculate the level of agreement. Results: The intra- (ICC=0.71–0.82) and inter-rater (ICC=0.72–0.80) reliability of the Beighton Score is substantial to almost perfect. The Contompasis Score displayed substantial to almost perfect intra-rater (ICC=0.73–0.82) reliability and moderate to substantial inter-rater (ICC=0.58–0.62) reliability. Conclusions: It is hypothesised that in clinical practice the Beighton Score is more appropriate due to greater inter-rater reliability, whereas in a research setting with experienced practitioners, the Contompasis Score would be more appropriate, due to almost perfect intra-rater reliability. Implications: The present study provides an indication of the measurement capabilities of the Beighton and Contompasis Scores, as well as providing a platform for further research.

To investigate the feasibility of quantitative analysis of muscle stiffness by Acoustic Radiation Force Impulse (ARFI) imaging, to obtain the reference values at relaxing and contraction position of gastrocnemius medialis (GCM) and to evaluate the inter-observer and intra-observer reliabilities of shear wave velocities measurements in healthy skeletal muscles. The stiffness of the left GCM muscle of 15 healthy volunteers was measured by ARFI elastography in transverse scan while the ankle was in the relaxed position and in 30 degrees of plantar flexion with the submaximal isometric contraction. All subjects were examined by two experienced physiatrists with four years of experience. Reliability of ARFI measurements was assessed by means of the intraclass correlation coefficient (ICC). Interobserver and intra-observer reliabilities were statistically analyzed. The mean shear wave velocity (SWV) of GCM at plantar flexion position with submaximal isometric contraction was significantly higher than that at relaxed position (first physiatrists: plantar flexion with submaximal isometric contraction 2.41±1.09 m/s, relaxed 0.84±0.28 m/s, second physiatrist: plantar flexion with submaximal isometric contraction 2.49±0.94m/s, relaxed 0.83±0.21), p<0.05. The inter-observer reliability was excellent for ankle-plantar flexion with submaximal isometric contraction (ICC=0.968), and good for relaxed position (ICC=0.891) respectively. The intra-observer reliability for ankle-plantar flexion with submaximal isometric contraction were excellent (ICC: first physiatrist 0.98 and second physiatrist 0.96) and that for relaxed position (ICC: first physiatrist 0.98 and second physiatrist 0.90) were also excellent. There was no significant correlation between SWV and body mass index. ARFI elastography is a reliable imaging modality for quantifying the stiffness of contracting muscles. Additionally, the characterization of pathological soft tissues by ARFI elastography would be a promising clinical practice for patients with musculoskeletal issues.

Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain–behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.