Daisuke Sumitani

Scientific assessment of endoscopic surgical skills.

Abstract Recently, significant attention has been focused on training and education for safe endoscopic surgery. A new assessment method, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), has been designed at Hiroshima University to evaluate the smoothness of the movement of endoscopic instruments from velocity. Experts (with experience in performing more than 100 laparoscopic surgeries) and novices (with no experience in performing laparoscopic surgery) were recruited for this study. The aim of task 1 was to move the tip of the endoscopic instrument on the tops of poles from A to C, and task 2 was to move it from the right pole B to the left pole D. The peak velocity (Vp) and the time when peak velocity appears (Tp) were analyzed. Both the peak velocity (Vp) and the time when peak velocity appears (Tp) to perform task 1 and task 2 were significantly faster in the expert group than in the novice group. The peak velocity (Vp) and the time when peak velocity appears (Tp) in HUESAD, which indicate the smoothnes of the endoscopic procedure, are among the most important factors for assessing endoscopic surgical skills.

Retroperitoneal abscess complicated with necrotizing fasciitis of the thigh in a patient with sigmoid colon cancer

BackgroundNecrotizing fasciitis of the thigh due to the colon cancer, especially during chemotherepy, has not been previously reported.Case presentationA 67-year-old man admitted to the hospital was diagnosed with sigmoid colon cancer that had spread to the left psoas muscle. Multiple hepatic metastases were also found, and combination chemotherapy with irinotecan and S-1 was administered. Four months after the initiation of chemotherapy, the patient developed gait disturbance and high fever and was therefore admitted to the emergency department of our hospital. Blood examination revealed generalized inflammation with a high C-reactive protein level. Computed tomography of the abdomen and pelvis showed gas and fluid collection in the retroperitoneum adjacent to the sigmoid colon cancer. The abscess was locally drained under computed tomographic guidance; however, the infection continued to spread and necrotizing fasciitis developed. Consequently, emergent debridement was performed. The patient recovered well, and the primary tumor was resected after remission of the local inflammation.ConclusionNecrotizing fasciitis of the thigh due to the spread of sigmoid colon cancer is unusual, but this fatal complication should be considered during chemotherapy for patients with unresectable colorectal cancer.

Approaching time is important for assessment of endoscopic surgical skills

Abstract This study aimed to verify whether the approaching time (the time taken to reach the target point from another point, a short distance apart, during point-to-point movement in endoscopic surgery), assessed using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), could distinguish the skill level of surgeons. Expert surgeons (who had performed more than 50 endoscopic surgeries) and novice surgeons (who had no experience in performing endoscopic surgery) were tested using the HUESAD. The approaching time, total time, and intermediate time (total time – approaching time) were measured and analyzed using the trajectory of the tip of the instrument. The approaching time and total time were significantly shorter in the expert group than in the novice group (p < 0.0001). The intermediate time did not significantly differ between the groups (p > 0.05). The approaching time, which is a component of the total time, is very mportant in the measurement of the total time to assess endoscopic surgical skills. Further, the approaching time was useful for skill assessment by the HUESAD for evaluating the skill of surgeons performing endoscopic surgery.

The Importance of Stressing the Use of Laparoscopic Instruments in the Initial Training for Laparoscopic Surgery Using Box Trainers: A Randomized Control Study

BACKGROUND The goal of this study was to improve the efficiency of initial box training for laparoscopic surgery. MATERIALS AND METHODS The study used the following task: suturing and knot tying task under a combination of four conditions. (1) The C (use of conventional instruments)-D (direct vision); (2) the C-V (indirect vision via a video monitor); (3) the L (use of laparoscopic instruments)-D; and (4) the L-V (the standard laparoscopic suturing and knot tying). The first study assessed 11 medical students undergoing L-V training. The time to complete each of the four assessment tasks was recorded pre- and post-training. The second study was a randomized, controlled trial involving 36 students grouped according to three types of training methods: the L-D, the C-V, and the L-V group. The improvement in the time to complete the L-V task was assessed and the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD) was used for assessment as well. RESULTS In the first study, a significant improvement in the performance time between pre- and post-training for the L-D task was found, but not for the C-V task. The second study found that the improvement rate of the L-D trained group was significantly greater than that of the C-V and L-V groups. The HUESAD assessment also showed the similar results. CONCLUSIONS A training program stressing the use of laparoscopic instruments and compensating for the fulcrum effect is more effective for novices using box trainers in the initial laparoscopic surgery instruction than one emphasizing performing the tasks via a video monitor.

Virtual reality training followed by box training improves the laparoscopic skills of novice surgeons

Abstract Background: The detailed influence of virtual reality training (VRT) and box training (BT) on laparoscopic performance is unknown; we aimed to determine the optimal order of imparting these training programs. Material and methods: This randomized controlled trial involved two groups, each with 20 participants without prior laparoscopic surgical experience: A BT-VRT group (60 min BT followed by 60 min VRT) and a VRT-BT group (60 min VRT followed by 60 min BT). We objectively assessed the laparoscopic skills with a motion-analysis system (Hiroshima University Endoscopic Surgical Assessment Device: HUESAD), which reliably assesses surgical dexterity. Skill assessment was performed before and after the training session. Results: No inter-group differences were identified in the study measures at the pre-training assessment. In both groups, the performance on all tasks was significantly better at the post-training assessment than at the pre-training assessment. However, the outcome of the tests using the HUESAD was significantly better in the VRT-BT group than in the BT-VRT group at the post-training assessment. Conclusions: VRT followed by BT effectively improves the dexterity of novice surgeons during initial laparoscopic (combination) training.

Non-Contact Tumor Imager for Video-Assisted Thoracic Surgery - Application to animal experiment -

This paper discusses a proposed Non-Contact Tumor Imager capable of detecting a lung tumor for application during Video-Assisted Thoracic Surgery (VATS); this imager is based on the phase differential technique. The developed sensor comprises an air supply system and an optical fiber-based distance sensor adjacent to the air nozzle. A removed human lung was used to assess the performance of the developed sensor. With regard to clinical application, both the tumor detection capability and the safety to the lung tissues of the developed sensor were confirmed through in vivo experiments using pig lungs.