Daniel Glassman

Faster simulated laparoscopic cholecystectomy with haptic feedback technology

Virtual reality simulators have been gradually introduced into surgical training. One of the enhanced features of the latest virtual simulators is haptic feedback. The useful-ness of haptic feedback technology has been a matter of controversy in recent years. Previous studies have assessed the importance of haptic feedback in executing parts of a procedure or basic tasks, such as tissue grasping. The aim of this study was to assess the role of haptic feed-back within a structured educational environment, based on the performance of junior surgical trainees after undergoing substantial simulation training.

Perceptions About the Present and Future of Surgical Simulation: A National Study of Mixed Qualitative and Quantitative Methodology.

OBJECTIVES Assess expert opinion on the current and future role of simulation in surgical education. DESIGN Expert opinion was sought through an externally validated questionnaire that was disseminated electronically. PARTICIPANTS Heads of Schools of Surgery (HoS) (and deputies) and Training Program Directors (TPD) (and deputies). RESULTS Simulation was considered a good training tool (HoS: 15/15, TPD: 21/21). The concept that simulation is useful mostly to novices and for basic skills acquisition was rejected (HoS: 15/15, TPDs: 21/21; HoS: 13/15, TPDs: 18/21). Further, simulation is considered suitable for teaching nontechnical skills (HoS: 13/15, TPDs: 20/21) and re-enacting stressful situations (HoS: 14/15, TPDs: 15/21). Most respondents also felt that education centers should be formally accredited (HoS: 12/15, TPDs: 16/21) and that consultant mentors should be appointed by every trust (HoS: 12/15, TPDs: 19/21). In contrast, there were mixed views on its use for trainee assessment (HoS: 6/15, TPDs: 14/21) and whether it should be compulsory (HoS: 8/15, TPDs: 11/21). CONCLUSION The use of simulation for the acquirement of both technical and nontechnical skills is strongly supported while views on other applications (e.g., assessment) are conflicting. Further, the need for center accreditation and supervised, consultant-led teaching is highlighted.

A multi-specialty surgical course for residents transitioning from early to intermediate training

It has been estimated that approximately 15000 to 20000 hours are required to train a surgeon.1 However, several time-constrains imposed globally2 have significantly reduced training time in the Operating Room (OR) posing a significant challenge for surgical educators and creating an impetus for the development of new educational methods.3 Since August 2005, all medical graduates in the United Kingdom must enter a 2 year postgraduate programme prior to commencing training in their chosen medical or surgical specialty.4 What is the problem? Despite this two-year programme being a good introduction to duties as a doctor there have been some concerns that the trainees do not gain significant experience in surgical procedures leading to reduced confidence.5 Which can make transition from a second year postgraduate (Foundation) doctor (PGY2) to a surgical resident particular difficult. To gain more experience a large number of doctors undertaking additional posts, which are not part of the recognised training scheme, in the UK and abroad, or roles such as anatomy demonstrators, in order to broaden their skills and relevant knowledge prior to progressing to surgical training.6

Efficacy and Safety of a Biweekly Viscosupplementation Regimen for Knee Osteoarthritis.

Osteoarthritis is the most common form of arthritis in the Western world, causing disabling symptoms in 10% of people older than 55 years. Hyaluronic acid injections can reduce osteoarthritic pain but require three to five doses administered weekly. This preliminary study aims to assess the efficacy of a more flexible viscosupplementation regimen. Patients were given three sodium hyaluronate isotonic solution injections (Ostenil; TRB Chemedica SA, Vouvry, Switzerland), biweekly. They were then asked to record their pain before and after administration of the injections, on a visual analog score. A total of 91 knees were injected. Analysis of the data showed that the viscosupplementation injections significantly reduced the baseline pain within the first 24 to 48 hours post first injection (before injection, 68.8mm; 2 days postinjection, 48.9 mm; p < 0.001); these effects were maintained up to 6 months. No adverse effects were reported. The proposed regimen appears safe and efficient in reducing osteoarthritic pain of the knee joint. A randomized controlled study is needed to confirm these results.

0061 Should Simulation Training Be Compulsory For Trainees In All Surgical Specialties

Background Simulation is a useful adjunct to surgical training and there is a plethora of evidence demonstrating its value.1,2 In our region there are seven state of the art simulation centres hosting both low and high fidelity simulators. Use of these facilities requires commitment by both trainees and trainers. Thus, we have compared the uptake of simulation in ophthalmology where the programme is compulsory to both general surgery and gynaecology that run optional programmes. Methods One of the skills centres, hosts virtual reality simulators for ophthalmology (EyeSim/SimSci, US), general surgery (LapMentor, Simbionix/Israel) and obstetrics and gynaecology (LapMentor, Simbionix/Israel). Access to them has been booked online since August 2013. Data from the booking system was retrieved (Aug ’13-May ’14) to determine the use. Results EyeSim (SimSci, US) was used 163 times whilst the LapMentor (Simbionix/Israel) was used on 34 occasions (26/34 for research purposes rather than training) and 43 times by general surgery and gynaecology trainees respectively. Bookings for the EyeSim (SimSci, US) were made by 28 individuals, whilst only 7 general surgery trainees (including 2 research fellows conducting a trial) booked time on the LapMentor (Simbionix/Israel). By comparison 17 gynaecology trainees used the simulator. Within our region there are twice as many trainees in general surgery and gynaecology compared to ophthalmology. Discussion A significantly larger proportion of ophthalmology trainees have trained on simulators compared to both surgery and gynaecology with surgical trainees making least use of the facility. Furthermore, the frequency of usage by trainees was greater for ophthalmology trainees. This suggests that simulation training should become compulsory for trainees and that confirmation of appropriate learning should be demonstrated prior to operating on patients. References Kurashima Y, Feldman LS, Kaneva PA, Fried GM, Bergman S, Demyttenaere SV, Li C, Vassiliou MC. Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc. 2014 Mar;28(3):783–8 Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013;27:8

0075 Improving Trainees’ Confidence With A Novel Multidsciplinary Simulated Surgical Course

Background Due to increasing requirements of service provision and the introduction of the European Working Time Directive, Foundation trainees have limited exposure to surgical procedures.1 Confidence of novice trainees to perform procedures is improved by undergoing simulation training.2 We have therefore designed a novel, multidisciplinary course aiming to familiarise foundation doctors to surgical procedures. The aim of this study is to evaluate the impact of such a course on their confidence. Methodology 23 Foundation Year 2 doctors due to start Core Surgical Training from August 2014 attended the Essential Surgical Skills Course over 2 days. Trainees rotated around a circuit of sub-speciality skills workshops undertaking simulated procedures in General Surgery, Urology, Trauma and Orthopaedics and Plastic surgery, all led by Consultant faculty. Pre and post-course questionnaires were distributed, assessing confidence to perform each skill on a Likert scale (1–5). Results Median values were calculated across each speciality’s skills. General Surgery and Urology demonstrated an increase in median value for all 23 participants pre- and post-course. Median differences pre- and post-course ranged from 1–3.5 in both General Surgery and Urology. 22 out of 23 demonstrated an increase in median value for Trauma and Orthopaedics, (median difference range 1–4), one participant had equal median values. 20 out of 23 demonstrated an increase in median value for Plastic Surgery, (median difference range of 1–4), three participants had equal median values. Conclusions and recommendations Participants were overall increasingly confident in performing these core surgical skills having undertaken the course. Simulation is a critical part of surgical training in an era where surgical exposure in the operating theatre is more time-restricted. Trainees feel that a course simulating surgical skills, taught by Consultant surgeons, is important in enhancing confidence and skill acquisition; aiding in bridging the gap between completing foundation training and entering a surgical career. References Varley et al. Changes in caseload and the potential impact on surgical training: a retrospective review of one hospital’s experience. BMC Medical Education 2006;6:6 Green-Carlsen et alet al. Is Current Surgical Training Efficient? J Surg Educ 2014;71(3):367–74

INFRARENAL AORTIC ANEURYSM: AN INCIDENTAL RADIOLOGICAL FINDING

A 71-year-old man presented to the Emergency Department (ED) with worsening colicky left-sided flank pain radiating to his groin for 2 days. The patient had a 1-year history of intermittent left-sided pain, similar in nature but of reduced severity. There was no other significant past medical history. On arrival in the ED the patient was hemodynamically stable, with a pulse rate of 92 beats/min and a right arm blood pressure of 134/87 mm Hg. His physical examination revealed a tender left loin with guarding. The abdomen was otherwise soft with no palpable masses, no renal bruits, and normal bowel sounds. Femoral pulses were present bilaterally and of equal character. He had warm, pink-colored extremities with no evidence of hypoperfusion. Urine dipstick testing showed microscopic hematuria and proteinuria. Plain abdominal radiographic images were obtained and did not reveal any abnormal findings. According to his clinical features and initial investigation findings, an intravenous urogram (IVU) was performed to exclude ureteric calculi. The IVU was reported as having no renal tract calcifications with normal, unobstructed pelvicalyceal systems. A larger distance between the lumbar vertebrae and the left ureter in comparison to the right sidewas identified (Figure 1). This unusual radiological finding alerted the clinicians and radiologists to a possible alternative diagnosis. Abdominal computed