Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training thro...Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values need to be determined using real tissue samples.The system has yet to be validated by cross-comparing real and VR haptics with surgeons.展开更多
BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is b...BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.展开更多
Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms un...Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.Methods:A prospective,educational cohort study of a novice training program consisting of directed,self-regulated learning with distributed practice(5x3 procedures)in a virtual reality temporal bone simulator.The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos.Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants.Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’self-assessment scores.Results:Six major themes were identified in the interviews:goal-directed behaviour,use of learning supports for scaffolding of the training,cognitive engagement,motivation from self-assessment,selfassessment bias,and feedback on self-assessment(validation).Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure.They scaffolded their learning through the available learning supports.Finally,structured self-assessment was reported to increase the participants’cognitive engagement,which was further supported by a quantitative increase in cognitive load.Conclusions:Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.展开更多
Laparoscopic skills training has always been crucial for novice surgeons. Readily accessible equipment, aswell as structured training curriculum should be provided to guarantee adequate practice hours and skillprofici...Laparoscopic skills training has always been crucial for novice surgeons. Readily accessible equipment, aswell as structured training curriculum should be provided to guarantee adequate practice hours and skillproficiency. Dry-lab training is typically adopted before animal model surgery, usually comprising ofpurpose-built bulky simulators that is neither accessible nor portable. In this technical note, we designed ahome-made simulator, using two 4 L water jugs as operating space that are communicated inside, plus anobservation hole taped in between to mimic the triangular working space of laparoscopic surgery. Imagingwas achieved via smartphone camera, which was wirelessly connected to a laptop and a projector for realtime display on multiple screens, using built-in multi-screen collaboration software. A self-regulated andproficiency-based training curriculum was adopted. This dry-lab simulator is low-cost, highly portable andeasily replicable for basic laparoscopic skills training for the beginners to intermediate surgeons, whichmay serve as a good way for the standardized residency and specialist training program.展开更多
Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity ...Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with highincome countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.展开更多
Objective This study aimed to investigate the clinical efficacy of laparoscopic training using origami,a traditional Japanese papercraft,using laparoscopic forceps to create origami cranes.Methods In this retrospectiv...Objective This study aimed to investigate the clinical efficacy of laparoscopic training using origami,a traditional Japanese papercraft,using laparoscopic forceps to create origami cranes.Methods In this retrospective study,4 surgeons were randomly divided into 2 groups:The training group,consisting of surgeons 1 and 2,and the non-training group,consisting of surgeons 3 and 4.Over the course of a one-year study period,the training group regularly underwent laparoscopic surgery training with a dry box,wherein they folded a total of 1000 origami cranes using laparoscopic instruments.The non-training group periodically underwent common laparoscopic surgery training of techniques such as suturing and ligation.Each surgeon regularly performed the transabdominal preperitoneal approach for inguinal hernias.Each training was conducted concurrently with the surgeries.The procedure time(peritoneum detachment,mesh placement,and closure of the peritoneum),total operation time(time from peritoneum detachment to closure of the peritoneum),and surgical outcomes were examined.Results The training group showed greater improvement in the total operation time and more stable performance than the non-training group.Additionally,the time taken for peritoneum detachment was significantly shorter in the training group.Conclusion Laparoscopic training using origami has the potential to enhance laparoscopic surgical skills and improve surgical outcomes.展开更多
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. ...Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.展开更多
<div style="text-align:justify;"> <strong>Background and Aim:</strong><span "=""> The only way to survive a sudden cardiac arrest is when the CPR is performed immediate...<div style="text-align:justify;"> <strong>Background and Aim:</strong><span "=""> The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre</span>- and post-simulation-based BLS training (BLS) and the outcome was<span "=""> measured on the basis of patient survival after the cardiac arrest. <b>Study Design</b><strong>:</strong> This pre- and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. <b>Results: </b>296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff—providers) were graded for the response by pre- and post-training testing. In the course of pre</span>-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC (p<span "=""> </span><<span "=""> </span>0.05<span "="">). <b>Conclusion: </b>A simulation-based CPR and BLS training curriculum greatly improves patient outcome by reducing mortality and morbidity with improved subjectivity, self-efficiency along with the objective assessment of the performance scores during acute cardiac arrest in Emergency Cardiovascular Care (ECC).</span> </div>展开更多
Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysi...Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.展开更多
The use of virtual simulation-based training continues to expand, as organizations explore alternative methods to reduce the cost of training. While virtual simulation has been empirically validated to be effective in...The use of virtual simulation-based training continues to expand, as organizations explore alternative methods to reduce the cost of training. While virtual simulation has been empirically validated to be effective in the transfer of skills to the live environment, what is still unknown is what effect, if any, that an individual’s sense of presence in the simulation has on their performance. In this paper, we examine the relationship between presence and performance while performing a psychomotor task in a virtual environment. The independent variables were visual display and expertise level. The dependent variables were presence and performance. We found evidence of a moderate relationship between the degree of presence experienced in the simulation and an individual’s performance over three training trials. Results of this study may inspire future research to investigate whether higher presence in virtual simulation results in higher performance.展开更多
Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic ta...Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic tasks require subjects to reach,grasp and transport a ring through a rollercoaster obstacle using a pair of laparoscopic graspers.The task was performed either bimanually(using both hands)or unimanually(using their preferred hands)in a dyad team.Results:Twelve participants completed all the tasks.The dyad teams recorded significantly greater number of anticipatory movements than individuals who performed the task bimanually(p<0.05).However,there is no significant difference in the task completion time(p=0.701)and the number of errors(p=0.860)recorded between the dyad and the bimanual group.Conclusion:Compared to a single operator,dyad operators performed the task with greater number of anticipatory movements.The increased movement synchronization can help benefit surgical education and team training.展开更多
Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which...Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.展开更多
腹腔镜手术自动化是智能外科的重要组成部分,其前提是腔镜视野下手术器械与脏器实时精准分割。受术中血液污染、烟雾干扰等复杂因素影响,器械与脏器实时精准分割面临巨大挑战,现有图像分割方法均表现不佳。因此提出一种基于注意力感知...腹腔镜手术自动化是智能外科的重要组成部分,其前提是腔镜视野下手术器械与脏器实时精准分割。受术中血液污染、烟雾干扰等复杂因素影响,器械与脏器实时精准分割面临巨大挑战,现有图像分割方法均表现不佳。因此提出一种基于注意力感知与空间通道的快速分割网络(ASC-Net),以实现腹腔镜图像中器械和脏器快速精准分割。在UNet架构下,设计了注意力感知与空间通道模块,通过跳跃连接将二者嵌入编码与解码模块间,使网络重点关注图像中相似目标间深层语义信息差异,同时多维度学习各目标的多尺度特征。此外,采用预训练微调策略,减小网络计算量。实验结果表明:在EndoVis2018数据集上的平均骰子系数(mDice)、平均重叠度(mIoU)、平均推理时间(mIT)分别为90.64%,86.40%和16.73 ms (60帧/秒),相比于现有最先进方法,mDice与mIoU提升了26%与39%,且mIT降低了56%;在AutoLaparo数据集上的mDice,mIoU和mIT分别为93.72%,89.43%和16.41ms(61帧/秒),同样优于对比方法。该方法在保证分割速度的同时有效提升了分割精度,实现了腹腔镜图像中手术器械和脏器的快速精准分割,将助力腹腔镜手术自动化快速发展。展开更多
文摘Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values need to be determined using real tissue samples.The system has yet to be validated by cross-comparing real and VR haptics with surgeons.
文摘BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.
文摘Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.Methods:A prospective,educational cohort study of a novice training program consisting of directed,self-regulated learning with distributed practice(5x3 procedures)in a virtual reality temporal bone simulator.The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos.Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants.Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’self-assessment scores.Results:Six major themes were identified in the interviews:goal-directed behaviour,use of learning supports for scaffolding of the training,cognitive engagement,motivation from self-assessment,selfassessment bias,and feedback on self-assessment(validation).Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure.They scaffolded their learning through the available learning supports.Finally,structured self-assessment was reported to increase the participants’cognitive engagement,which was further supported by a quantitative increase in cognitive load.Conclusions:Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.
基金This study is supported by the 2021 Changhai Hospital Educational Sponsorship Fund(CHPY2021B24,General Program,YC).
文摘Laparoscopic skills training has always been crucial for novice surgeons. Readily accessible equipment, aswell as structured training curriculum should be provided to guarantee adequate practice hours and skillproficiency. Dry-lab training is typically adopted before animal model surgery, usually comprising ofpurpose-built bulky simulators that is neither accessible nor portable. In this technical note, we designed ahome-made simulator, using two 4 L water jugs as operating space that are communicated inside, plus anobservation hole taped in between to mimic the triangular working space of laparoscopic surgery. Imagingwas achieved via smartphone camera, which was wirelessly connected to a laptop and a projector for realtime display on multiple screens, using built-in multi-screen collaboration software. A self-regulated andproficiency-based training curriculum was adopted. This dry-lab simulator is low-cost, highly portable andeasily replicable for basic laparoscopic skills training for the beginners to intermediate surgeons, whichmay serve as a good way for the standardized residency and specialist training program.
文摘Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with highincome countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.
文摘Objective This study aimed to investigate the clinical efficacy of laparoscopic training using origami,a traditional Japanese papercraft,using laparoscopic forceps to create origami cranes.Methods In this retrospective study,4 surgeons were randomly divided into 2 groups:The training group,consisting of surgeons 1 and 2,and the non-training group,consisting of surgeons 3 and 4.Over the course of a one-year study period,the training group regularly underwent laparoscopic surgery training with a dry box,wherein they folded a total of 1000 origami cranes using laparoscopic instruments.The non-training group periodically underwent common laparoscopic surgery training of techniques such as suturing and ligation.Each surgeon regularly performed the transabdominal preperitoneal approach for inguinal hernias.Each training was conducted concurrently with the surgeries.The procedure time(peritoneum detachment,mesh placement,and closure of the peritoneum),total operation time(time from peritoneum detachment to closure of the peritoneum),and surgical outcomes were examined.Results The training group showed greater improvement in the total operation time and more stable performance than the non-training group.Additionally,the time taken for peritoneum detachment was significantly shorter in the training group.Conclusion Laparoscopic training using origami has the potential to enhance laparoscopic surgical skills and improve surgical outcomes.
文摘Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
文摘<div style="text-align:justify;"> <strong>Background and Aim:</strong><span "=""> The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre</span>- and post-simulation-based BLS training (BLS) and the outcome was<span "=""> measured on the basis of patient survival after the cardiac arrest. <b>Study Design</b><strong>:</strong> This pre- and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. <b>Results: </b>296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff—providers) were graded for the response by pre- and post-training testing. In the course of pre</span>-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC (p<span "=""> </span><<span "=""> </span>0.05<span "="">). <b>Conclusion: </b>A simulation-based CPR and BLS training curriculum greatly improves patient outcome by reducing mortality and morbidity with improved subjectivity, self-efficiency along with the objective assessment of the performance scores during acute cardiac arrest in Emergency Cardiovascular Care (ECC).</span> </div>
文摘Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.
文摘The use of virtual simulation-based training continues to expand, as organizations explore alternative methods to reduce the cost of training. While virtual simulation has been empirically validated to be effective in the transfer of skills to the live environment, what is still unknown is what effect, if any, that an individual’s sense of presence in the simulation has on their performance. In this paper, we examine the relationship between presence and performance while performing a psychomotor task in a virtual environment. The independent variables were visual display and expertise level. The dependent variables were presence and performance. We found evidence of a moderate relationship between the degree of presence experienced in the simulation and an individual’s performance over three training trials. Results of this study may inspire future research to investigate whether higher presence in virtual simulation results in higher performance.
基金The author appreciates the support from Francesca Seal for assisting with data collection and David Pinzon for technical assistance throughout the project.This work was funded by the Wynne Rigal Summer Research Award to Bo Bao,Faculty of Medicine and Dentistry,University of Alberta and the Royal Alexandra Hospital Foundation(Grant no.Res00066823)MIS Research Funds to Dr.Bin Zheng.
文摘Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic tasks require subjects to reach,grasp and transport a ring through a rollercoaster obstacle using a pair of laparoscopic graspers.The task was performed either bimanually(using both hands)or unimanually(using their preferred hands)in a dyad team.Results:Twelve participants completed all the tasks.The dyad teams recorded significantly greater number of anticipatory movements than individuals who performed the task bimanually(p<0.05).However,there is no significant difference in the task completion time(p=0.701)and the number of errors(p=0.860)recorded between the dyad and the bimanual group.Conclusion:Compared to a single operator,dyad operators performed the task with greater number of anticipatory movements.The increased movement synchronization can help benefit surgical education and team training.
文摘Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.
文摘腹腔镜手术自动化是智能外科的重要组成部分,其前提是腔镜视野下手术器械与脏器实时精准分割。受术中血液污染、烟雾干扰等复杂因素影响,器械与脏器实时精准分割面临巨大挑战,现有图像分割方法均表现不佳。因此提出一种基于注意力感知与空间通道的快速分割网络(ASC-Net),以实现腹腔镜图像中器械和脏器快速精准分割。在UNet架构下,设计了注意力感知与空间通道模块,通过跳跃连接将二者嵌入编码与解码模块间,使网络重点关注图像中相似目标间深层语义信息差异,同时多维度学习各目标的多尺度特征。此外,采用预训练微调策略,减小网络计算量。实验结果表明:在EndoVis2018数据集上的平均骰子系数(mDice)、平均重叠度(mIoU)、平均推理时间(mIT)分别为90.64%,86.40%和16.73 ms (60帧/秒),相比于现有最先进方法,mDice与mIoU提升了26%与39%,且mIT降低了56%;在AutoLaparo数据集上的mDice,mIoU和mIT分别为93.72%,89.43%和16.41ms(61帧/秒),同样优于对比方法。该方法在保证分割速度的同时有效提升了分割精度,实现了腹腔镜图像中手术器械和脏器的快速精准分割,将助力腹腔镜手术自动化快速发展。