Simon Bann

The benfits of stereoscopic vision in robotic-assisted performance on bench models

Background: Previous studies have failed to establish clear advantages for the use of stereoscopic visualization systems in minimal-access surgery. The aim of this study was to objectively assess whether stereoscopic visualization improves performance on bench models using the da Vinci robotic system. Methods: Eleven surgeons carried out a series of four tasks. Positional data streamed from the da Vinci system was analyzed by means of a previously validated custom-designed software-package. An independent blinded observer scored errors. Statistical analysis included the Wilcoxon signed rank test. A p < 0.05 was deemed significant. Results: We found significant improvements in all tasks and for all parameters (p < 0.05). In addition, a significantly lower number of errors was scored using the stereoscopic mode as compared to the standard two-dimensional image (p < 0.001). Conclusion: Robotic-assisted performance on bench models is more efficient and accurate using stereoscopic visualization.

The effect of stress-inducing conditions on the performance of a laparoscopic task

Background: The availability of objective means for assessment of surgical skills has made it possible to evaluate the effect of adverse environmental conditions on surgical performance. Methods: Participants performed a laparoscopic transfer task under five conditions: a simple verbal mathematical task (M), operating theatre background noise at 80 to 85 dB (N), performance as quickly as possible (T), all three stressors combined (A), and quiet conditions (Q). The effect of these conditions on performance was evaluated by using a motion analysis system and an error score. Results: The study included 13 right-handed surgeons with varying levels of laparoscopic experience. There was a significant increase in the path length per movement of the right hand (p = 0.001) under T and a significant increase in the path length per movement of the left hand under M (p = 0.002), T (p = 0.0l), and A (p = 0.02). A significantly higher number of errors occurred under all four stress-inducing conditions. The effect was more pronounced when all the stressors were applied in combination (p = 0.001) followed by performance under M (p = 0.005), then T (p = 0.01) and N (p = 0.03). Conclusions: All three stressors led to impaired dexterity and an increase in the incidence of errors.

Technical skills examination for general surgical trainees

The technical skills of surgical trainees are difficult to assess and compare objectively. This study involved a structured, multistation, technical skills examination that enables the stratification of surgical trainees.

The surgical error examination is a novel method for objective technical knowledge assessment.

BACKGROUNDnObjective analysis of surgical skill is necessary. A novel method of assessment using simple error analysis in synthetic models is examined for construct validity.nnnMETHODSnTwo examination protocols were devised using synthetic models. These contained either a purpose made error or were representative of good surgical practice. Protocol one contained models of skin closure and minor operations. Protocol two in addition more complex procedures. Face validity was established by the approval of senior surgeons. Junior surgeons were recruited to undertake the assessment. A p value of less than 0.05 was deemed to be significant.nnnRESULTSnEighty-nine surgeons were recruited. Both protocol one and two were able to discriminate between groups at statistically significant levels.nnnCONCLUSIONSnConstruct validity has been established by showing that error analysis is able to distinguish surgeons with varying levels of experience.

Assessing surgical skill using bench station models.

Background: The acquisition of surgical skill is one of the essentials of good surgical practice. The training of plastic surgeons is presently unstructured, with few objective measures of surgical skill. The trainee’s time to acquire skills may be inadequate because of the shortened time for training with the Calman system. There is also increasing pressure from the government to introduce testing of surgical competency for all surgeons. The authors introduce a series of tasks that allow assessment of technical skill among plastic surgical trainees. Methods: A range of surgeons with differing surgical skill were tested. They performed three tasks designed to assess their ability to suture skin, take a medium-thickness skin graft, and repair a tendon. The candidates were videotaped during the procedures and scored by four independent observers using the Objective Structured Assessment of Technical Skill scoring system. Each candidate was then given an overall competence score. Results: Sixty-five candidates were tested with an experience range from consultant to junior senior health officer. Results showed significant differences down the grades, with consultants performing the tasks with greater competency than their juniors (p = 0.004). Conclusions: The authors have demonstrated a valid and reliable method of objectively measuring the surgical skill of plastic surgical trainees. The authors have shown that consultants perform better than the juniors and that the tasks are easily reproduced. This has implications for future assessment in that these tests may be used as formal assessment programs for testing and teaching trainees throughout their careers.