Twitter as a communication tool for orthopedic surgery

Twitter is a social networking Web site that has changed the way information is communicated. This study involved identifying, categorizing, and reviewing orthopedic Twitter profiles. A total of 412 profiles were identified. Of those, 176 (50.3%) were surgeons; 89 (50.5%) were based in the United States and 77 (43.8%) were not (10 unclassified). Most surgeons were young; 66% of surgeons were board certified within the past 10 years. Only a small percentage of orthopedic surgeons and practices currently use Twitter, but the use of social networking for orthopedic communication is likely to play an increasing role in future clinical practice.     

Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot)

INTRODUCTION

This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool.

SUBJECTS AND METHODS

The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon''s knot. Thirty participants (18 novices, 12 experts) completed the procedures.

RESULTS

The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon''s knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants.

CONCLUSIONS

The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.     

Concurrent validity of augmented reality metrics applied to the fundamentals of laparoscopic surgery (FLS)

OBJECTIVE: Current skills assessment in the Fundamentals of Laparoscopic Surgery (FLS) program is labor intensive, requiring one proctor for every 1-2 subjects. The ProMIS Augmented Reality (AR) simulator (Haptica, Dublin IR) allows for objective assessment of physical tasks through instrument tracking technology. We hypothesized that the ProMIS metrics could differentiate between ability groups as well as standard FLS scoring with fewer personnel requirements METHODS: We recruited 60 volunteer subjects. Subjects were stratified based on their laparoscopic surgical experience. Those who had performed more than 100 laparoscopic procedures were considered experienced (n = 8). Those with fewer than 10 laparoscopic procedures were considered novices (n = 44). The rest were intermediates (n = 8). All subjects performed up to five trials of the peg transfer task from FLS in the ProMIS simulator. The FLS score, instrument path length, and instrument smoothness assessment were generated for each trial. RESULTS: For each of the five trials, experienced surgeons outperformed intermediates, who in turn outperformed novices. Statistically significant differences were seen between the groups across all trials for FLS score (p < 0.001), ProMIS path length (p < 0.001), and ProMIS smoothness (p < 0.001). When the FLS score was compared to the path length and smoothness metrics, a strong relationship between the scores was apparent for novices (r = 0.78, r = 0.94, p < 0.001) respectively), intermediates (r = 0.5, p = 0.2, r = 0.98, p < 0.001), and experienced surgeons (r = 0.86, p = 0.006, r = 0.99, p < 0.001). CONCLUSIONS: The construct that the standard scoring of the FLS peg transfer task can discriminate between experienced, intermediate, and novice surgeons is validated. The same construct is valid when the task is assessed using the metrics of the ProMIS. The high correlation between these scores establishes the concurrent validity of the ProMIS metrics. The use of AR for objective assessment of FLS tasks could reduce the personnel requirements of assessing these skills while maintaining the objectivity.     

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

Background  

The aims of this study are to determine construct validity for the HystSim virtual-reality (VR) training simulator for hysteroscopy via a new multimetric scoring system (MMSS) and to explore learning curves for both novices and experienced surgeons.     

Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries

Background  

Several challenges exist with laparoscopic skills training in resource-restricted countries, including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Botswana, Africa.     

The validity of multimodal intraoperative monitoring (MIOM) in surgery of 109 spine and spinal cord tumors

In a prospective study of 109 patients with tumor of the spine MIOM was performed during the surgical procedure between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during surgical procedure of spinal tumors. MIOM become an integrated procedure during surgical approach to intramedullar and extramedullar spine tumors. The combination of monitoring ascending and descending pathways may provide more sensitive and specific results than SEP alone giving immediate feedback information regarding any neurological deficit during the operation. Intraoperative sensory spinal and cerebral evoked potential combined with EMG recordings and motor evoked potential of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. One hundred and nine consecutive patients with spinal tumors of different aetiologies were monitored by the means of MIOM during the entire surgical procedure. Eighty-two patients presented true negative findings while two patients monitored false negative, one false positive and 24 patients true positive findings where neurological deficits after the operation were present. All patients with neurological deficit recovered completely or to pre-existing neurological situation. The sensitivity of MIOM applied during surgery of spinal tumors has been calculated of 92% and specificity 99%. Based upon the results of the study MIOM is an effective method of monitoring the spinal cord and nerve root function during surgical approach of spinal tumors and consequently can reduce or prevent the occurrence of postoperative neurological deficit.

     

Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the intensive care unit

Background Autopsy studies confirm that many intensive care unit (ICU) patients die from unrecognized sources of abdominal sepsis or ischemia. Computed tomography (CT) scans can be of limited use for these diagnoses and difficult to obtain in critically ill patients who require significant support for transport. Bedside laparoscopy has been described but still is cumbersome to perform. Bedside flexible endoscopy as a diagnostic tool or for placement of gastrostomy tubes is a standard ICU procedure. Natural orifice transluminal endoscopic surgery (NOTES) can provide access to the peritoneal cavity as a bedside procedure and may decrease the number of patients with unrecognized intra-abdominal catastrophic events. Methods Pigs were anesthetized and peritoneal access with the flexible endoscope was obtained using a guidewire, needle knife cautery, and balloon dilatation. The transgastric endoscope was used to explore all quadrants of the abdominal cavity. The small bowel was visualized to complete the exploration. The transgastric access location was then managed with the use of a gastrostomy tube. The animals were euthanized and analyzed. Results Eight pigs were studied and complete abdominal exploration, including diaphragm visualization, was possible in all cases. Endoscopy-guided biopsies were performed, adhesions lysed, and the gallbladder successfully drained percutaneously. The small bowel was run successfully with percutaneous needlescopic suture graspers. Conclusions These animal studies support the concept that NOTES, with management of the gastric opening with a gastrostomy tube, may be another approach for finding unrecognized sources of abdominal sepsis or mesenteric ischemia in difficult ICU patients. These encouraging results warrant a prospective human trial to assess safety and efficacy. Presented at the Scientific Session of the Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, TX, 26–29 April 2006 Disclosure: Case Western Reserve University, University Hospitals of Cleveland, Raymond P. Onders M.D., and Anthony Ignagni have the intellectual property of the devices used or equity in Synapse Biomedical which manufactured the diaphragm pacing technology used in this study     

Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills

Background

Construct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS).

Methods

Participants were asked to perform a standardized intracorporeal suturing task. They were classified as novices, intermediates, and experts. Motion in the four degrees of freedom available during traditional MAS (PITCH, YAW, ROLL and SURGE) was assessed using range, velocity, and acceleration.

Results

Analysis of motion allowed discrimination between the 75 participants according to level of expertise. The most discriminating motion parameter was the acceleration in performing the ROLL (pronation/supination) with values of 30 ± 27 for novices, 15 ± 5 for intermediates, and 3.7 ± 3 for experts (p < 0.001).

Conclusions

Tracking and analyzing the motion of instruments within the PLS simulator allow discrimination between novices, intermediates, and experts, thus establishing construct validity. Further development may establish motion analysis as a useful “real time” modality to teach and assess MAS skills.     

计算机辅助骨科技术的现状与未来

近年来，计算机技术在外科领域应用日益广泛，计算机辅助骨科技术(CAOS)在神经外科导航的基础上发展迅猛，成功地应用到越来越多的骨科疾病中。它是在计算机技术支持下进行的骨科手术，包括了医学图像数据的获取、术前计划和模拟、配准、术中导航和机器人系统。它的应用提高了手术的准确性，减小了手术创伤，更好的进行手术计划和模拟，并且减少了射线的暴露量。章评述了CAOS的发展现状，提出了未来研究的设想。