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1.
Objective Psychomotor Skills Assessment of Experienced, Junior,
and Novice Laparoscopists with Virtual Reality 总被引:22,自引:1,他引:21
Anthony G. Gallagher Ph.D. Karen Richie B.Sc. Neil McClure M.D. Jim McGuigan 《World journal of surgery》2001,25(11):1478-1483
Objective assessment of psychomotor
skills in surgery is now a priority; however, this assessment is
difficult to achieve because of measurement difficulties associated
with the reliability and validity of assessing surgical skills in vivo
and in the laboratory. In this study virtual reality (VR) was used to
overcome these problems in the objective psychomotor assessment of
senior, junior, and novice laparoscopists. Twelve experienced
laparoscopic surgeons (performed >50 Minimal Access Surgery (MAS)
procedures), 12 inexperienced laparoscopic surgeons (<10 MAS
procedures), and 12 laparoscopic novices (no MAS procedures)
participated in the study. Each subject completed all six tasks of the
Minimally Invasive Surgical Trainer; Virtual Reality (MIST VR). In
comparison to the other groups, experienced laparoscopic surgeons
performed the tasks significantly (p < 0.01) faster,
had a lower error rate, were more economic in their movement of
surgical instruments and in the use of diathermy. As a group they also
showed greater consistency in their performance. MIST VR distinguished
between the three groups of laparoscopists. VR provides a useful
objective assessment tool for evaluating psychomotor skills for
laparoscopic surgery. 相似文献
2.
Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures 总被引:6,自引:0,他引:6
Gallagher AG Smith CD Bowers SP Seymour NE Pearson A McNatt S Hananel D Satava RM 《Journal of the American College of Surgeons》2003,197(3):479-488
BACKGROUND: Minimally invasive surgery (MIS) has introduced a new and unique set of psychomotor skills for a surgeon to acquire and master. Although assessment technologies have been proposed, precise and objective psychomotor skills assessment of surgeons performing laparoscopic procedures has not been detailed. STUDY DESIGN: Two hundred ten surgeons attending the 2001 annual meeting of the American College of Surgeons in New Orleans who reported having completed more than 50 laparoscopic procedures participated. Subjects were required to complete one box-trainer laparoscopic cutting task and a similar virtual reality task. These tasks were specifically designed to test only psychomotor and not cognitive skills. Both tasks were completed twice. Performance of tasks was assessed and analyzed. Demographic and laparoscopic experience data were also collected. RESULTS: Complete data were available on 195 surgeons. In this group, surgeons performed the box-trainer task better with their dominant hand (p < 0.0001) and there was a strong and statistically significant correlation between trials (r = 0.47 - 0.64, p < 0.0001). After transforming raw data to z-scores (mean = 0 and SD = 1) it was shown that between 2% and 12% of surgeons performed more than two standard deviations from the mean. Some surgeons' performance was 20 standard deviations from the mean. Minimally Invasive Surgical Trainer Virtual Reality metrics demonstrated high measurement consistency as assessed by coefficient alpha (alpha = 0.849). CONCLUSIONS: Objective assessment of laparoscopic psychomotor skills is now possible. Surgeons who had performed more than 50 laparoscopic procedures showed considerable variability in their performance on a simple laparoscopic and virtual reality task. Approximately 10% of surgeons tested performed the task significantly worse than the group's average performance. Studies such as this may form the methodology for establishing criteria levels and performance objectives in objective assessment of the technical skills component of determining surgical competence. 相似文献
3.
Background: Increasing constraints on the time and resources needed to train surgeons have led to a new emphasis on finding innovative ways to teach surgical skills outside the operating room. Virtual reality training has been proposed as a method to both instruct surgical students and evaluate the psychomotor components of minimally invasive surgery ex vivo. Methods: The performance of 100 laparoscopic novices was compared to that of 12 experienced (>50 minimally invasive procedures) and 12 inexperienced (<10 minimally invasive procedures) laparoscopic surgeons. The values of the experienced surgeons performance were used as benchmark comparators (or criterion measures). Each subject completed six tasks on the Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR) three times. The outcome measures were time to complete the task, number of errors, economy of instrument movement, and economy of diathermy. Results: After three trials, the mean performance of the medical students approached that of the experienced surgeons. However, 7–27% of the scores of the students fell more than two SD below the mean scores of the experienced surgeons (the criterion level). Conclusions: The MIST-VR system is capable of evaluating the psychomotor skills necessary in laparoscopic surgery and discriminating between experts and novices. Furthermore, although some novices improved their skills quickly, a subset had difficulty acquiring the psychomotor skills. The MIST-VR may be useful in identifying that subset of novices. 相似文献
4.
Justin Bric Michael Connolly Andrew Kastenmeier Matthew Goldblatt Jon C. Gould 《Surgical endoscopy》2014,28(12):3343-3348
Introduction
The clinical application of robotic surgery is increasing. The skills necessary to perform robotic surgery are unique from those required in open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (Fundamentals of Laparoscopic Surgery or FLS?) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool for robotic surgery. Our research group previously developed and validated a robotic training curriculum in a virtual reality (VR) simulator. We hypothesized that novice robotic surgeons could achieve proficiency levels defined by more experienced robotic surgeons on the VR robotic curriculum, and that this would result in improved performance on the actual daVinci Surgical System?.Methods
25 medical students with no prior robotic surgery experience were recruited. Prior to VR training, subjects performed 2 FLS tasks 3 times each (Peg Transfer, Intracorporeal Knot Tying) using the daVinci Surgical System? docked to a video trainer box. Task performance for the FLS tasks was scored objectively. Subjects then practiced on the VR simulator (daVinci Skills Simulator) until proficiency levels on all 5 tasks were achieved before completing a post-training assessment of the 2 FLS tasks on the daVinci Surgical System? in the video trainer box.Results
All subjects to complete the study (1 dropped out) reached proficiency levels on all VR tasks in an average of 71 (± 21.7) attempts, accumulating 164.3 (± 55.7) minutes of console training time. There was a significant improvement in performance on the robotic FLS tasks following completion of the VR training curriculum.Conclusions
Novice robotic surgeons are able to attain proficiency levels on a VR simulator. This leads to improved performance in the daVinci surgical platform on simulated tasks. Training to proficiency on a VR robotic surgery simulator is an efficient and viable method for acquiring robotic surgical skills. 相似文献5.
Rosenthal R Gantert WA Hamel C Hahnloser D Metzger J Kocher T Vogelbach P Scheidegger D Oertli D Clavien PA 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2007,17(4):407-413
BACKGROUND: The aim of this study was to assess whether virtual reality (VR) can discriminate between the skills of novices and intermediate-level laparoscopic surgical trainees (construct validity), and whether the simulator assessment correlates with an expert's evaluation of performance. METHODS: Three hundred and seven (307) participants of the 19th-22nd Davos International Gastrointestinal Surgery Workshops performed the clip-and-cut task on the Xitact LS 500 VR simulator (Xitact S.A., Morges, Switzerland). According to their previous experience in laparoscopic surgery, participants were assigned to the basic course (BC) or the intermediate course (IC). Objective performance parameters recorded by the simulator were compared to the standardized assessment by the course instructors during laparoscopic pelvitrainer and conventional surgery exercises. RESULTS: IC participants performed significantly better on the VR simulator than BC participants for the task completion time as well as the economy of movement of the right instrument, not the left instrument. Participants with maximum scores in the pelvitrainer cholecystectomy task performed the VR trial significantly faster, compared to those who scored less. In the conventional surgery task, a significant difference between those who scored the maximum and those who scored less was found not only for task completion time, but also for economy of movement of the right instrument. CONCLUSIONS: VR simulation provides a valid assessment of psychomotor skills and some basic aspects of spatial skills in laparoscopic surgery. Furthermore, VR allows discrimination between trainees with different levels of experience in laparoscopic surgery establishing construct validity for the Xitact LS 500 clip-and-cut task. Virtual reality may become the gold standard to assess and monitor surgical skills in laparoscopic surgery. 相似文献
6.
Background The use of simulation for minimally invasive surgery (MIS) skills training has many advantages over current traditional methods.
One advantage of simulation is that it enables an objective assessment of technical performance. The purpose of this study
was to determine whether the ProMIS augmented reality simulator could objectively distinguish between levels of performance
skills on a complex laparoscopic suturing task.
Methods Ten subjects — five laparoscopic experts and five laparoscopic novices — were assessed for baseline perceptual, visio-spatial,
and psychomotor abilities using validated tests. After three trials of a novel laparoscopic suturing task were performed on
the simulator, measures for time, smoothness of movement, and path distance were analyzed for each trial. Accuracy and errors
were evaluated separately by two blinded reviewers to an interrater reliability of >0.8. Comparisons of mean performance measures
were made between the two groups using a Mann-Whitney U test. Internal consistency of ProMIS measures was assessed with coefficient α.
Results The psychomotor performance of the experts was superior at baseline assessment (p < 0.001). On the laparoscopic suturing task, the experts performed significantly better than the novices across all three
trials (p < 0.001). They performed the tasks between three and four times faster (p < 0.0001), had three times shorter instrument path length (p < 0.0001), and had four times greater smoothness of instrument movement (p < 0.009). Experts also showed greater consistency in their performance, as demonstrated by SDs across all measures, which
were four times smaller than the novice group. Observed internal consistency of ProMIS measures was high (α = 0.95, p < 0.00001).
Conclusions Preliminary results of construct validation efforts of the ProMIS simulator show that it can distinguish between experts and
novices and has promising psychometric properties. The attractive feature of ProMIS is that a wide variety of MIS tasks can
be used to train and assess technical skills. 相似文献
7.
Virtual reality training improves operating room performance: results of a randomized,double-blinded study 总被引:33,自引:0,他引:33 下载免费PDF全文
Seymour NE Gallagher AG Roman SA O'Brien MK Bansal VK Andersen DK Satava RM 《Annals of surgery》2002,236(4):458-464
OBJECTIVE: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. SUMMARY BACKGROUND DATA: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. METHODS: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). RESULTS: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). CONCLUSIONS: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons. 相似文献
8.
Randomized clinical trial of virtual reality simulation for laparoscopic skills training 总被引:38,自引:0,他引:38
Grantcharov TP Kristiansen VB Bendix J Bardram L Rosenberg J Funch-Jensen P 《The British journal of surgery》2004,91(2):146-150
BACKGROUND: This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. METHODS: Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. RESULTS: No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. CONCLUSION: Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes. 相似文献
9.
Background Virtual reality simulation has a great potential as a training and assessment tool of laparoscopic skills. The study was carried
out to investigate whether the LapSim system (Surgical Science Ltd., Gothenburg, Sweden) was able to differentiate between
subjects with different laparoscopic experience and thus to demonstrate its construct validity.
Methods Subjects 24 were divided into two groups: experienced (performed > 100 laparoscopic procedures, n = 10) and beginners (performed <10 laparoscopic procedures, n = 14). Assessment of laparoscopic skills was based on parameters measured by the computer system.
Results Experienced surgeons performed consistently better than the residents. Significant differences in the parameters time and
economy of motion existed between the two groups in seven of seven tasks. Regarding error parameters, differences existed
in most but not all tasks.
Conclusion LapSim was able to differentiate between subjects with different laparoscopic experience. This indicates that the system measures
skills relevant for laparoscopic surgery and can be used in training programs as a valid assessment tool. 相似文献
10.
Sergio E. A. Araujo Conor P. Delaney Victor E. Seid Antonio R. Imperiale Alexandre B. Bertoncini Sergio C. Nahas Ivan Cecconello 《Surgical endoscopy》2014,28(9):2547-2554