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RESUMEN Antecedentes: los sistemas de salud del mundo se han visto afectados en su lucha contra el COVID-19, generando efectos negativos tanto en la actividad asistencial como en la formación de los residentes. Suspender cirugías electivas, disminuir la participación de residentes en quirófano y otros cambios estructurales de los hospitales determinó que los residentes de cirugía experimenten un marcado déficit educacional en su formación. Material y métodos: modalidad observacional y transversal. Se realizó una encuesta anónima online de 20 preguntas a residentes de cirugía de la Argentina. Se confeccionó una base de datos para el análisis estadístico. Se valoraron variables categóricas y numéricas. Resultados: se recibieron 100 respuestas de la encuesta en la que se identificó predominio de residentes de instituciones públicas. Se calculó un descenso del 63% en la cantidad de cirugías en las que participaron los residentes durante la pandemia. El 77% usó plataformas virtuales para remediar el impacto en las instancias de formación académica. El 57% de los encuestados cuentan con programas de simulación quirúrgica en su hospital. La mayoría experimentó consecuencias negativas en sus habilidades quirúrgicas y en su formación durante la pandemia, pero se identificaron diferencias entre el grupo que dispone de simulación quirúrgica y el que no. Conclusión: para resolver el déficit educativo que generó la pandemia por COVID-19, y como medida para potenciar el aprendizaje de habilidades quirúrgicas en situaciones normales, este estudio recomendaría contar con programas de simulación quirúrgica y fomentar el uso de plataformas virtuales como herramienta de formación académica.
ABSTRACT Background: Health systems worldwide have been affected in their fight against COVID-19, generating negative effects on both healthcare activity and training of residents. Cancellation of elective surgeries, less participation of residents in the operating room and other structural changes in the hospitals resulted in an educational gap in the training of residents in surgery. Material and methods: We conducted an observational and cross-sectional study. A 20-question online survey was conducted among residents in surgery from Argentina. A database was created for statistical analysis of categorical and continuous variables. Results: The survey was responded by 100 residents in surgery; most of them belonged to public institutions. There was a 63% decrease in the number of surgeries in which the residents participated during the pandemic. Seventy-seven percent used virtual platforms to mitigate the impact on academic training and 57% count with surgical simulation programs in their hospitals. Most of them experienced negative consequences on their surgical skills and training during the pandemic, but there were differences identified between the group with and without surgical simulation programs. Conclusion: The availability of surgical simulation programs and the use of virtual platforms as an academic training tool could solve the educational gap generated by the COVID-19 pandemic and enhance the learning of surgical skills under normal conditions.
Subject(s)
General Surgery/education , Surgical Procedures, Operative/statistics & numerical data , Internship and Residency/statistics & numerical data , Argentina , Cross-Sectional Studies , Education, Distance , High Fidelity Simulation Training , COVID-19 , Medical Staff, Hospital/psychologyABSTRACT
@#AIM: To investigate the application and effect of virtual-reality surgery exercise in minimally invasive cataract surgery training for ophthalmology residents.<p>METHODS:Twenty ophthalmology residents with equal seniority who had completed 3a standardized residency training in the Affiliated Eye Hospital of Nanjing Medical University from 2019 to 2021 were prospectively enrolled. After passing the theoretical examination, residents were randomly divided into virtual surgery exercise(Dry-lab)group(<i>n</i>=10)and real animal surgery exercise(Wet-lab)group(<i>n</i>=10). Dry-lab and Wet-lab group residents performed training using the Eye SI surgical simulator and pig eye respectively. At the end of the training, the overall training effects of the residents in both groups were rated using the Eye SI surgical simulator and the real pig eye operation, and the module training effects of the residents in both groups were rated using the virtual surgical simulator. Furthermore, a questionnaire survey was used to objectively evaluate the two training methods.<p>RESULTS:Residents in Dry-lab group had significantly higher total scores on both operation assessments,simulator assessment and real pig eye operation assessment than Wet-lab group(88.03±1.34 <i>vs</i> 80.35±2.87, 87.50±3.03 <i>vs</i> 77.60±5.62, 88.57±1.89 <i>vs</i> 83.10±3.22, all <i>P</i><0.01). The simulator module assessment results showed that the residents in Dry-lab group scored significantly better than Wet-lab group in terms of scores and completion time on each module(<i>P</i><0.01). The questionnaire results showed that Dry-lab group rated better than Wet-lab group in terms of the novelty of training, the proximity to the real surgical experience, the degree of help to the improvement of microsurgery skills, the confidence to perform real surgery, and the overall satisfaction of surgical training(<i>P</i><0.05). <p>CONCLUSION:Applying virtual-reality surgery exercise to cataract surgery skills training for ophthalmology residents can significantly improve the cataract skills, increase overall training satisfaction, and help residents enhance their confidence, psychological quality, decision-making, and processing ability during real surgery at the initial stage of practice. This provides a new standard and model for establishing a formal and standardized cataract surgery training system for ophthalmology residents.
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Resumen La cirugía laparoscópica colorrectal (CLCR) se realiza desde hace más de dos décadas y a pesar de la amplia evidencia que apoya sus beneficios para los pacientes, su difusión y utilización han sido lentas. Su curva de aprendizaje prolongada es uno de los principales factores restrictivos para su más amplia utilización en la práctica clínica en nuestro país. La realización de esta técnica mínimamente invasiva requiere de habilidades avanzadas y específicas que no necesariamente se adquieren con el aprendizaje de la cirugía tradicional o abierta. El objetivo de este documento es resumir las diferentes estrategias de simulación actualmente disponibles para el entrenamiento en CLCR y la evidencia que avala su implementación en los programas de cirugía colorrectal.
Abstract Laparoscopic colorectal surgery (LCRS) is performed more than two decades ago and despite the wide evidence supporting its benefits for patients, its diffusion and utilization has been slow. Its prolonged learning curve is one of the main restrictive factors for its wider use in clinical practice in our country. The realization of this minimally invasive technique requires advanced and specific skills that are not necessarily acquired with the learning of traditional or open surgery. The objective of this paper is to summarize the different simulation strategies currently available for LCRS training and the evidence supporting its implementation in colorectal surgery programs.
Subject(s)
Humans , Colorectal Neoplasms/surgery , Laparoscopy/education , Colorectal Surgery/education , Simulation TrainingABSTRACT
Virtual reality technology and force feedback technology are novel human-machine interaction technologies. The virtual surgery simulation training system combined with these two technologies provides a new method for orthopedic surgery training, which can improve the training efficiency,thereby reducing the training costs and shortening the growth cycle of young orthopedic surgeons. In recent years, the virtual drilling bone surgery simulation technology have been researched broadly and obtained a preliminary application. In this paper, the existing research statusof virtual bone drilling operation depended on visuo-haptic techniques were studied, classified and summarized, the main content focused on three key techniques: bone modeling, drilling bone force prediction model and tactile simulation, and then analyzed the advantages and disadvantages of existing methods. Finally,some perspectives for related technology development trend of the virtual simulation bone drilling surgery in future was pointed out.
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Objective To provide patients with clear understanding of their conditions and treatment plans,in order to solve the problems of asymmetric information and trust crisis between doctors and patients.Methods Three-dimension (3D)visualization doctor-patient communication platform for department of orthopedics was constructed.Dynamic display of anatomical structure of the joint,common diseases,treatment plans and surgical procedures was realized.Six functions were built into the platform including positioning,reset,paint brush,highlighting,screenshot and dual screen contrast,which were easy to be explained to the patients.Results The platform had the advantages of convenient operation,clear and visualized picture and lively animation effects of surgery simulation.Conclusions This platform enables the doctors and patients to communicate more conveniently,therefore significantly improve the doctor-patient relationship.
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Objective To explore the application of a three-dimensional simulation system in extended liver resections.Methods A three-dimensional surgical simulation system was used for preoperative assessment and for computer simulation to estimate the resected liver volume,the residual liver volume,and the surgical resection margins.The software virtual liver resection was used to choose the most optimal surgical option.The actual resection,the postoperative liver volume and the actual surgical resection margins were compared.Results 1 patient was diagnosed by ultrasound to develop ascites on post-operative day 2.Another patient was diagnosed by transthoracic ultrasound to have moderate pleural effusion on postoperative day 1.Postoperative liver failure developed in 1 patient.There was no patient who developed bile leakage.The average length of stay was 6 ～ 85 days (average 22 d).There was no recurrence within 1 month after surgery and there was no postoperative deaths.Condusions The three-dimensional surgery simulation system was effective.It gave an accurate evaluation and simulation of the liver surgery.In extended liver resection,it gave good guidance and help.
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Three-dimensional virtual surgery experiment is the application of virtual reality technology in the medical field.Doctors use the information in the virtual environment to develop surgical planning,surgical drills.surgical teaching,surgical skills training,to lead the surgical technique and postoperative rehabilitation,and the information is available for surgery every sur-gical member to share.Virtual Surgery experiments combined with the real operation together constitute complete experimental teaching system,making telemedicine experimental teaching methods and teaching content rich and varied.
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For the minimally invasive surgery, endoscopic surgery has been being a useful technique in diagnosis and treatment of many kind of human diseases and injuries. But, performing endoscopic operations demand expert skills which allow surgeon to learn navigating complex organs in the body through limited view of endoscope as well as manipulating surgical instruments. So the virtual reality based endoscopic surgery simulator has been great increasingly developed with improvements in computing power, graphic hardware, and haptic device in the recent few years. A good balance between surgical realism and real-time interactive rates of simulation is one of most challenging problems in surgical simulation. And when coupled with precise computations of the forces and deformation of organs, it may be possible for the surgeon to feel haptic sensations close to reality. We describe the virtual laparoscopic cholecystectomy simulator using force-feedback device. A goal of this paper is to improve the realism of simulator through real-time interaction between force-feedback and visual-feedback. To calculate deformation of virtual objects separately from the force-feedback, because the latter must be updated much more frequently, the two feedbacks are implemented in each processor. And pre-calculated data set which used for reducing amount of calculation about deformation results in improvement of the real-time interactive rates between the two feedbacks. When virtual surgical tool, manipulated by the user, was collided with isosurface based organ, the surface was deformed in real-time and the graphics, including tissue deformation, performed at 20~30 frames per second. Simultaneously, force-feedback was transmitted to the user at about 500 times per second, therefore we could implement real-time interactive virtual laparoscopic surgery simulator.