The Graz learning and training model for arthroscopic surgery

Up to 30% of all operative procedures in orthopaedic surgery are performed arthroscopically. Because of the steadily increasing number of residents, it seems to be difficult both to maintain high standards and to guarantee an adequate training in arthroscopic surgery. However, in contrast to many other surgical techniques it is possible to learn and practice arthroscopy using artificial models and cadaver joints, provided that experienced surgeons and anatomists act as supervisors and instructors. The aim of this paper is to assess practice models and training programs which should guarantee sufficient practical experience during the training period.     

A virtual training simulator for learning cataract surgery with phacoemulsification

This paper presents the development of a low-cost cataract surgery simulator for trainees to practise phacoemulsification procedures with computer-generated models in virtual environments. It focuses on the training of cornea incision, capsulorrhexis and phaco-sculpting, which are simulated interactively with computationally efficient algorithms developed for tissue deformation, surface cutting and volume sculpting. Intuitive two-handed human-computer interactions are achieved with six degrees-of-freedom haptic devices. Performance of trainees on manual dexterity is recorded with quantifiable metrics. The proposed virtual-reality system has the potential to serve as an alternative training tool to supplement conventional cataract surgery education.     

关节镜下治疗各型膝关节脱位的中期疗效评价

目的 探讨关节镜下治疗各型膝关节脱位的可行性及中期临床疗效。方法 回顾性分析2007年2月—2012年8月收治的35例膝关节脱位患者的临床资料。按照Schenck分型：KD-Ⅱ型4例,KD-ⅢL型6例,KD-ⅢM型18例,KD-Ⅳ型2例,KD-Ⅴ型5例。根据Lysholm功能评分、Tegner评分、膝关节活动度及膝关节稳定性对手术前后患膝功能进行评估,并采用配对t检验统计分析。结果 所有患者均获随访,平均随访24.8个月（6～48个月）。末次随访时,Lysholm膝关节功能评分由术前（36.7±5.7）（0～70）分提高至（86.5±11.2）（49～100）分,Tegner膝关节运动水平评分由术前（0.8±0.6）（0～2）分提高至（5.4±1.2）（3～6）分,膝关节关节活动度由术前73.2°±15.1°（15°～125°）提高至120.1°±7.3°（90°～135°）,差异均有统计学意义（P值均〈0.05）。结论 关节镜下治疗各型膝关节脱位是治疗膝关节脱位的安全、有效方法,具体治疗策略应根据脱位分型以及膝关节损伤情况来制定。     

Cadaver versus simulator based arthroscopic training in shoulder surgery

IntroductionThere are few studies that compare the cadaver dissections with the medical simulators in means of talent improvement. Therefore, the aim of this study is to find out if using cadaver dissections is still the golden standard for surgical training or using the medical simulators in surgery could replace cadaver dissections.Materials and methodsThe study is conducted during the European Orthopaedics & Traumatology Education Platform accredited Shoulder Club International Cadaver Course including a number of 34 orthopedics trainees. The participants were randomly divided into two groups to be trained with the simulator (Group 1) and on cadavers (Group 2), followed by a test performed on shoulder arthroscopy simulator (Virtamed ArthroS, Switzerland). There was no conflict of interest before, during, or after the study. Informed consent was obtained from all individual participants included in the study.ResultsGroup 2 had statistically significant higher simulation overview procedure time values than Group 1 (p < 0.05), the meaning of which is participants trained with the simulator completed the given tasks in a shorter period of time. Group 2 had statistically significant higher scratching of humerus cartilage values than Group 1 (p < 0.05), which means that participants trained with simulation have less scratching done on the humerus cartilage than the participants trained on a cadaver.ConclusionTo the best of our knowledge, this study is the first one to compare virtual reality (VR) simulators with cadavers for surgical education in an objective manner, while using qualitative and quantitative data. According to this study, it is possible to state that VR simulators are just as effective as cadavers in means of training subjects. As medical education will face a total change all around the world after the COVID-19 pandemic, this study has the potential to be an important guide during and after this period.     

The rabbit nephrectomy model for training in laparoscopic surgery

BACKGROUND: Laparoscopic surgical training is generally done with the teacher-student model using complex exercises. This study was performed to evaluate a new training model that emphasizes the repetition of simple procedures. METHODS: Laparoscopic surgery was performed in rabbits (n=200) using conventional instruments. Gynaecologists (n=10) and medical students (n=10) performed a series of exercises during 20 full days training. Nephrectomy was chosen to evaluate and score laparoscopic skills, i.e. duration of surgery and complication rate, since it mimics the surgical challenge and involves dissection of major vessels. Each surgeon performed 20 nephrectomies, alternating left and right sides. RESULTS: Duration of surgery and complications decreased with training. For duration of surgery, a two-phase exponential decay learning curve, with different decays for gynaecologists and students, was observed. Gynaecologists achieved shorter operating times than students for real and calculated times in the first procedure (P<0.0001 and P<0.0001) and for calculated time in the last procedure (P=0.001). Severe complications were more frequent in students than in gynaecologists (P=0.0003). CONCLUSION: The rabbit nephrectomy model is suitable for training in laparoscopic surgery. Since it implies the repetition of short and well-defined exercises, progression is easier to monitor and the necessity for continuous supervision is less, making training less expensive.     

A meta-analysis of tourniquet assisted arthroscopic knee surgery

The purpose was to compare the intra- and post-operative outcomes of tourniquet assisted to non-tourniquet-assisted surgery during arthroscopic knee procedures. A systematic review was undertaken of the electronic databases MEDLINE, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. The evidence-base was critically appraised using the Cochrane Bone, Joint and Muscle Trauma Group quality assessment tool. Study heterogeneity was statistically measured using the Chi² and I² statistical tests. When appropriate, a random-effect meta-analysis was undertaken to pool the results of the primary studies assessing the mean difference of each outcome. Nine studies were identified evaluating seven outcome measures and parameters. Arthroscopic ACL reconstruction knee surgery with a tourniquet experienced less operative visualisation difficulties compared to surgery without a tourniquet. There was no significant difference between tourniquet and non-tourniquet arthroscopic knee surgery for all other outcomes. The evidence-base exhibited a number of methodological limitations. There is limited evidence to suggest that a tourniquet assists in arthroscopic knee surgery. The methodological quality of the present evidence-base remains weak. Further study is required to answer this research question.     

反向导引过线器在关节镜手术中的应用

目的 探讨反向导引过线器在关节镜下对半月板、前交叉韧带、肩袖进行缝合过线操作中的应用效果。方法 回顾性队列研究。纳入2015年8月—2020年12月赤峰市第二医院106例关节镜下缝合重建患者的临床资料。其中男55例、女51例,年龄24~82岁。按照缝合工具分组：使用普通缝合钩41例,为对照组;使用反向导引过线器65例,为观察组。观察指标：根据2种缝合工具的操作复杂程度、缝合过线难易程度、缝合过线操作时间、副损伤、缝合质量、完成情况自制评分标准,进行综合评分,评价和比较2组缝合效果的优良率。结果 患者术后手术切口均一期愈合。2组患者的年龄、性别、受伤缝合部位等基线资料比较,差异均无统计学意义（P值均>0.05）。对照组缝合效果：优14例、良15例、差12例,优良率70.73%（29/41）;观察组缝合效果：优47例、良18例、差0例,优良率100.00%（65/65）,2组比较差异有统计学意义（χ²=18.64,P<0.001）。结论 反向导引过线器在关节镜下对半月板、交叉韧带及肩袖过线缝合操作时,具有操作便捷、缝合质量可靠、缝合强度大、操作时间短、副损伤小等优点,在临床中具有较好的推广价值。     

An endoscopic training and assessment model for argon plasma coagulation

PurposeArgon plasma coagulation (APC) is a standard modality for the treatment of gastrointestinal bleeding. However, there are no metrics to assess technical proficiency. We aimed to determine if a Quick APC Training Test (QAPCTT) can improve performance and assess proficiency with this modality.Materials and methodsEndoscopy trainees at various levels of training were asked to perform the QAPCTT with an in vivo model before and after an APC curriculum with didactic lectures and additional hands-on experience. As trainees performed the test, endoscopic supervisors recorded the time required to complete each task as well as the number of inadvertent mucosal touchdowns. Each partipant was assigned a technical proficiency score by supervising endoscopists.ResultsFourteen adult gastroenterology fellows participated in the course. 100% of fellows were comfortable with generator settings and APC equipment after the course compared to only 21% (p < 0.001) on the pre-test questionnaire. Those deemed technically proficient on the post-course QAPCTT required significantly less time for the task of making a square (100 s vs. 215 s; p = 0.006) and had significantly fewer inadvertent mucosal touchdowns (5 vs. 19; p = 0.0017).ConclusionsDedicated APC training is required to achieve competence with this modality. A structured curriculum improves knowledge about the technique and hands-on training is important for achieving technical proficiency. The QAPCTT appears improve APC technique and may readily identify trainees in need of additional APC experience to gain proficiency.     

Depression and conservative surgery for breast cancer

BACKGROUND:

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE:

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS:

Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS:

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126).

CONCLUSION:

Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.     

临床应用解剖学在妇科盆底手术教学中的应用

女性盆底功能障碍性疾病普遍采用的手术方式有损伤盆底神经血管造成严重并发症的风险.为有效进行盆底手术的教学培训,本研究从手术路径的临床解剖学研究;磁共振(MRI)图像的三维立体重建制作教学立体解剖图及仿真动画;创立临床解剖培训中心,完善盆底重建手术教学培训模式3个层面,使培训更加系统化和科学化,并与国际接轨.     

Metric analysis of the upper space of the temporomandibular joint (TMJ) in pigs (Sus scrofa domestica) for evaluation of the pig as a model for arthroscopic TMJ surgery

Minimally invasive arthroscopic surgery of the temporomandibular joint (TMJ) is more technically demanding than procedures in larger joints. The acquisition of adequate arthroscopic skills for TMJ surgery requires extensive specialized training that can hardly be obtained from patients. In order to introduce a proper animal model for TMJ arthroscopy, this study focuses on the morphology of the upper joint cavity of pigs at different ages. Plastic casts of the upper joint cavity were obtained from a mixed-sex sample of eight unfixed juvenile pig heads. The morphometric evaluation of these plastic casts revealed that the TMJ of pigs with a body weight of about 30 kg resemble the situation of the human TMJ best, and thus may serve as a model for arthroscopic exercises and examinations of the TMJ.     

The impact of training in transfusion medicine

Background Basic training skills and program for all health care providers working in the blood transfusion services is important and essential. All blood transfusion staff should have active participation in a training program that includes teaching all national and international regulations related to blood transfusion administration and guidelines of safe blood and blood products. The blood bank staff (physicians, medical technologists and nurses) should pass proper assessment procedures in order to work in this vita health related services. All staff working in blood transfusion services should receive a proper education and learning skills in this field of medicine. Awareness of blood safety and Good Manufacturing Practice (GMP) in blood transfusion should be greatly increased among them. Methods and Results Sustainable national and international education and training in blood transfusion services are needed and should be considered as a priority. Methods of teaching and training may include courses or workshops consist of a series of lectures, practical sessions, problem based learning and computer based distance learning programs. A proper training and continuous medical education in blood transfusion services have played an important role in minimizing the risk of transfusion related complications in many countries. Conclusions Creating an effective learning and training environment is a real challenge for most developing countries. Transfusion medicine is a branch of medicine which has a great link with almost all medical and surgical specialties. Blood transfusion safety plays an important and significant role in the patient's management. Proper qualified training personnel are the key of delivering safe blood components and the Good Manufacturing Practice (GMP) in blood transfusion services.     

仿活体尸头模型的建立及导航辅助鼻内镜下解剖训练

目的自制仿活体的人尸头解剖模型,利用该模型,进行影像导航辅助鼻内镜下解剖训练,以提高鼻科医生手术技能,加深对影像学的理解。方法首先建立仿活体手术尸头解剖模型。解剖出尸头的颈总动脉及颈内静脉,分别给予仿人体动、静脉血液灌注,使血管内有"血液"充盈。在此模型基础上,影像导航辅助鼻内镜下进行鼻腔、鼻窦及前颅底解剖,首先对各解剖标志进行定位,辨认;当动脉解剖暴露时,可见血管内有血液充盈,受到损伤时,有血液喷出,在此情形下,可进行止血训练,比较接近真实的手术情景。结果 (1)通过对人尸头颈部血管灌注,建立仿活体手术尸头解剖模型。(2)仿活体手术尸头解剖训练达到了接近活体的术野情景。(3)解剖定位准确,加深对影像学的理解。结论仿活体手术尸头解剖模型的建立及影像导航辅助鼻内镜下解剖训练为鼻内镜下解剖训练提供了更加真实有效的方式。     

The role of gastrin in duodenal ulcer surgery

Summary The role of gastrin and of serum gastrin analysis in duodenal ulcer disease and duodenal ulcer surgery is analysed. As far as etiology and pathogenesis are concerned up to now gastrin has never been shown to play a significant role. Neither does it provide any diagnostic help in the typical duodenal ulcer disease (but it will allow for diagnosis of the retained antrum after Billroth II resection and of the Zollinger Ellison syndrome). Gastrin determination therefore is not helpful in the choice of the correct operative procedure for the ulcer disease. In today's clinical practice its major role consists in the control of surgical results. This is illustrated by a prospective randomized study on proximal selective vagotomy with and without pyloroplasty. In these patients serum gastrin analysis has shown that the omission of pyloroplasty is not followed by antral stasis. It furthermore always exhibits the typicel vagotomy profile, although vagotomy is incomplete in the 2-DODG-test.Presented at the meeting on Gastric and duodenal ulcer disease: Basic principles and clinics of treatment by drugs and operations, Marburg, November 22, 1975     

The box simulator is useful for training novice endoscopists in basic endoscopic techniques

Purpose

The present study was aimed at evaluating the usefulness of box simulators for training novice endoscopists.

Materials and Methods

An explanation of the goals, contents, and features of the simulator was given to study participants. The participants then received "hands-on training" in gastrointestinal endoscopy techniques using a box simulator. Subsequently, they were asked to answer 19 structured questions about the simulator. Ratings were scored on a scale from 1 to 5 for questions concerning their first impression of the simulator. Questions on the usefulness of the simulator and the training course were answered as "agree", "disagree", or "no opinion".

Results

A total of 32 participants filled out the questionnaire. The mean scores on the simulator''s usefulness, features, and realistic movements before the training were between 1.5 and 2.0. There were no significant differences between the mean values of the scores given by novice users compared to non-novice users. However, after receiving training on the simulator, 90.6% of the participants considered the box simulator a generally useful tool for learning basic endoscopic techniques, and 90.6% agreed that the simulator was useful for improving hand-eye coordination.

Conclusion

Box simulators may be useful for training novice endoscopists in basic gastrointestinal endoscopic techniques.     

微创外科机器人力反馈跟踪控制

针对微创外科机器人(MIRS)力觉反馈缺失问题,构建了主从机器人力反馈控制系统,采用Newton-Euler法建立了力反馈机器人的动力学模型,提出了实时力反馈控制策略。实验验证了该系统及其方法的有效性,具有理论研究和临床应用价值,可用于外科机器人的远程手术。     

肩袖损伤经关节镜辅助小切口和全关节镜肩袖修补的疗效比较

目的研究关节镜辅助小切口及全关节镜肩袖修补术对肩袖损伤的疗效。方法选取2013年5月~2015年5月骨科收治的72例肩袖损伤患者为研究对象,按照随机数字表法进行分组,对照组(36例)进行关节镜下小切口肩袖修补术治疗,研究组(36例)进行全关节镜肩袖修补术治疗。对比归纳两组患者临床治疗情况、住院时间、关节功能恢复等。结果两组手术前后加州大学肩关节(UCLA)评分、美国肩与肘协会(ASES)评分、关节活动度、肌力等比较,0.05,无明显差异;研究组术后视觉疼痛量表(VAS)评分、住院时间优于对照组,0.05,差异显著;组内比较:两组术后VAS评分、UCLA评分、ASES评分、关节活动度、肌力等均优于术前,差异明显(0.05)。结论全关节镜与关节镜辅助小切口肩袖修补对肩袖损伤的治疗近期疗效相当,患者术后肩关节肌力、功能恢复佳;但全关节镜治疗患者术后疼痛轻,恢复迅速,具有较高的临床治疗意义。     

Educational intervention (CUIDAR) in cancer patients treated with surgery: A quasi-experimental study

ObjectiveTo assess the effect of an educational intervention (CUIDAR) in cancer patients during the post-operatory, aimed to strength the competence to care patients at home in the dimensions knowledge, instrumental unicity, enjoy, anticipation and social relationships and interactions.MethodsQuantitative quasi-experimental design with control and intervention groups, 192 patients who received surgery in the Instituto Nacional de Cancerología in Bogotá, Colombia. The intervention was conducted since the admission to the sixth week after release. Measurements of the home care competence and number of readmissions were made before and after the treatment.ResultsIn the intervention group a positive and statistically significant effect was observed in six dimensions, as well as the reduction of hospital readmissions.ConclusionThe educational intervention CUIDAR is a feasible strategy that increases the capacity to care at home and significantly reduces the readmissions to emergency services in cancer patients treated with surgery.Practice implicationsEducational intervention (CUIDAR) may be used as a tool in cancer patients treated with surgery.     

The challenge of education and training in pathology--the Basle response

The aim of pregraduate teaching is to form young physicians who are masters in theart of observation and of biological reasoning, two faculties for which pathology is particularly suitable as a teaching instrument. In Basle we teach general pathology in the 3rd year in lecturesand in coordinated histology courses which are programmed. Thus, the student following his booklet with sketches, works up some slides, each step guided by questions which he has to answer in order to go on. In the 4th year the same schedule is followed for special pathology, which in the 6th year is applied at autopsy demonstrations. At these demonstrations a clinician first discusses the clinical history with the students thus preparing the questions which the pathologist has to answer by demonstrating his findings on color television. In other courses the students receive the clinical data and a week later a real clinico-pathological conference is held. Finally pathology is taught in small groups with fresh and formalin-fixed specimens. A great number of audiovisual courses are at the disposition of the students. We use them exclusively for repetition and not for initial teaching. The most important thing for a young pathologist is to learn how to work up biopsies including the knowledge where to find necessary help in the literature, an understandingof the clinical problems, and the precise final diagnois. In doing autopsies he must be able to understand and answer the clinical questions as well as to see the scientific problems. The programme spans 5 years including 1 in clinical work. During the 4 years in pathology the young pathologist, according to a schedule, rotates from one specialist to the other working up the biopsies under supervision. The attendance of several slide seminars organized by the society of pathology is compulsory. The young pathologist does about 300 autopsies and learns how to work up autopsies of junior colleagues. For self-education we prepared audiovisual courses with microscopic sets of slides. The main point in postgraduate education is the conviction of all permanent members of a department that teaching is one of our most important tasks, since with a thorough education of the next generation we are significantly helping to produce better pathologists.