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BackgroundIn 2017, the utilization of robotic-assisted surgery had grown 10–40-fold relative to laparoscopic surgery in common general surgery procedures. The rapid rise in the utilization of robotic-assisted surgery has necessitated a standardized training curriculum. Many curricula are currently being developed and validated. Additionally, advancements in virtual reality simulators have facilitated their integration into robotic-assisted surgery training. This review aims to highlight and discuss the features of existing curricula and robotic-assisted surgery training simulators and to provide updates on their respective validation process.Materials and methodsA literature review was conducted using PubMed from 2000–2019 and commercial websites. Information regarding availability, content, and status of validation was collected for each current robotic-assisted surgery curriculum. This review did not qualify as human subjects research, so institutional review board approval was not required.ResultsThe daVinci Technology Training Pathway and Fundamentals of Robotic Surgery are purely web-based and self-paced robotic-assisted surgery training. The Society of American Gastrointestinal and Endoscopic Surgeon Robotic Masters Series, Fundamental Skills of Robot-Assisted Surgery training program, and the Robotics Training Network curriculum require trainees to be on site in order to provide expert feedback on surgical techniques and robot maintenance. Currently, there are few virtual reality simulators for robotic-assisted surgical training available on the market.ConclusionsDidactic courses are available in all of these training programs, but their contents are inconsistent. Furthermore, the availability and nature of hands-on training offered by these curriculums are widely variable.

BackgroundWomen surgeons may experience more ergonomic challenges while performing surgery. We aimed to assess ergonomics between men and women surgeons.MethodsLaparoscopic surgeons from a single institution were enrolled. Demographics and intraoperative data were collected. Muscle groups were evaluated objectively using surface electromyography (EMG; TrignoTM, Delsys, Inc., Natick, MA), and comprised upper trapezius (UT), anterior deltoid, flexor carpi radialis (FCR), and extensor digitorum (ED). Comparisons were made between women (W) and men (M) for each muscle group, assessing maximal voluntary contraction (MVC) and median frequency (MDF). The Piper Fatigue Scale-12 (PFS-12) was used to assess self-perceived fatigue. Statistical analyses were performed using SPSS v26.0, α = 0.05.Results18 surgeries were recorded (W:8, M:10). Women had higher activation of UT (32% vs 23%, p < 0.001), FCR (33% vs 16%, p < 0.001), and ED (13% vs 10%, p < 0.001), and increased effort of ED (90.4 ± 18.13 Hz vs 99.1 ± 17.82 Hz). Comparisons were made between W and M for each muscle group, assessing MVC and MDF.ConclusionsAfter controlling for surgeon’s height and duration of surgery, an increase in muscle activation was seen for women laparoscopic surgeons. Since poor ergonomics could be a major cause of work-related injuries, we must understand differences in ergonomics between men and women and evaluate which factors impact these variations.

BackgroundOur aim was to determine how objectively-measured and self-reported muscle effort and fatigue of the upper-limb differ between surgeons performing laparoscopic (LAP) and robotic-assisted (ROBOT) surgeries.MethodsSurgeons performing LAP or ROBOT procedures at a single-institution were enrolled. Objective muscle activation and self-reported fatigue were evaluated, and comparisons were made between approaches. Muscle activation of the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR), and extensor digitorum (ED) were recorded during the surgical procedure using Trigno wireless surface electromyography (EMG). The maximal voluntary contraction (MVC) was obtained to normalize root-mean-square muscle activation as %MVCRMS. The median frequency (MDF) was calculated to assess muscle fatigue. Each surgeon also completed the validated Piper Fatigue Scale-12 (PFH-12) before and after the procedure for self-perceived fatigue assessment. Statistical analysis was done using SAS/STAT software, with α = 0.05.Results28 surgeries were recorded (LAP: N = 18, ROBOT: N = 10). EMG analysis revealed the ROBOT group had a higher muscle activation than LAP for UT (37.7 vs. 25.5, p = 0.003), AD (8.9 vs. 6.3, p = 0.027), and FCR (14.4 vs. 10.9, p = 0.019). Conversely, LAP required more effort for the ED, represented by a significantly lower MDF compared to the ROBOT group (91.2 ± 1.5 Hz vs. 102.8 ± 1.5 Hz, p < 0.001). Survey analysis revealed no differences in self-reported fatigue before and after the surgery between approaches, p = 0.869.ConclusionsOur analysis revealed surgeons show similar fatigue levels performing the first case of the day using either robotic or LAP surgery. Surgeons performing LAP surgery had more fatigue in the forearm, robotic surgery required more shoulder and neck use, but neither was superior. Neither technique produced significant overall fatigue on survey. Long-term selective use of these different muscles could be correlated with different patterns of injury. Future studies are needed to fully understand long-term implications of prolonged surgery on occupational injury.

Purpose To systematically examine and summarize the current evidence regarding the effects of virtual reality (VR) on physical, cognitive, and psychological outcomes in cancer rehabilitation. Methods Six bioscience and engineering databases were searched. Two independent reviewers screened the titles and abstracts of 2397 records and retrieved 25 full-text articles. Inclusion criteria included patients with a current or previous diagnosis of cancer; VR was used as an intervention for physical, cognitive, or psychological impairments and functional limitations; and clinical trials with at least two arms and with both pre- and post-intervention assessments. Reviewers assessed methodological quality using the Physiotherapy Evidence Database scale. Results Seventeen studies including 799 patients with cancer were identified. Within-group pooled analysis indicated that patients demonstrated significant improvement in pain ( P  < 0.001), fatigue ( P  < 0.001), anxiety ( P  < 0.001), upper extremity function ( P  < 0.001), and quality of life ( P  = 0.008) after VR intervention. Between-group pooled analysis indicated significant improvements with VR in pain ( P  = 0.004), anxiety ( P  < 0.001), and upper extremity function ( P  < 0.001) compared with the control. Three studies reported the positive effects of VR on cognition. Conclusions VR demonstrates promising effects in physical, cognitive, and psychological aspects of patients with cancer. VR can be incorporated into a comprehensive cancer rehabilitation program to alleviate impairments and functional limitations.

Background and Aims Virtual reality is an emerging technology in rehabilitation. This umbrella review aimed to identify, critically appraise, and summarize current systematic reviews on the effects of virtual reality on stroke rehabilitation. Methods Five biomedical databases, PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched from inception to December 30th, 2023, for systematic reviews with or without meta‐analyses published in English. Two reviewers independently conducted screening, full‐text selection, and quality assessments. The methodological quality of included studies was evaluated by the Assessing the Methodological Quality of Systematic Reviews 2. Results were qualitatively synthesized according to domains of function to ascertain the effects of virtual reality intervention on functional improvement within stroke rehabilitation. Results A total of 78 articles were included; 23 were systematic reviews, and 55 were systematic reviews with meta‐analyses. Among them, 30 studies were evaluated as critically low quality, 32 as low, 15 as moderate, and one as good. Outcomes regarding upper extremity motor function, upper extremity activity, participation, functional independence, balance, functional mobility, walking speed, and cognitive function were summarized. While positive effects in favor of virtual reality were revealed by a majority of systematic reviews on these outcomes, evidence supporting the significantly different effects of virtual reality compared to conventional rehabilitation on participation and cognitive function was lacking. Conclusion The umbrella review demonstrated promising clinical outcomes regarding the use of virtual reality as an advanced therapeutic approach in stroke rehabilitation to optimize patient care. Future systematic reviews and meta‐analyses in this field should adhere to established guidelines to enhance the quality of evidence.

An efficient obstacle avoidance strategy when stepping over a single obstacle was reported in the literature – the total impulse of the leading and of the trailing legs are equal even though the kinematics parameters of two legs are different. However, does this efficient obstacle avoidance strategy exist when stepping over multiple obstacles? The study attempted to answer this question. Nineteen healthy young adults (25.84 ± 3.35 years) were recruited and performed multiple obstacle crossings when intervals between two obstacles were one-step, two-step, and three-step away, respectively. The dependent variables were foot integrated pressure (FIP) and other kinematic parameters – horizontal distance (HD, a heel-contact-to-obstacle distance of the leading leg/toe-off-to-obstacle distance of the trailing leg) and vertical distance (VD, toe clearance of both legs). A significant interaction among the effect of different legs, different intervals, and different obstacles on FIP, and kinematic parameters of HD and VD was found (p < 0.0001, p = 0.001, p < 0.001). Also, when the obstacle intervals were two-step and three-step away, the FIPs of the leading leg were significantly greater when stepping over the second obstacle than when stepping over the first one (p < 0.05, p < 0.01, respectively). These significantly greater FIPs might be attributed to the shorter HD (p < 0.001, p < 0.001) of the trailing leg, and the longer HD (p < 0.001, p < 0.001) of the leading leg. These results suggested that there is an inefficient obstacle avoidance pattern when stepping over the second obstacle.

Forty-seven percent of falling accidents in older adults are caused by tripping over obstacles. Understanding what strategies are involved in obstacle negotiation in older adults could reduce fall risks. There is a paucity of research investigating how healthy adults negotiate multiple obstacles, which may better reflect the complexity of the real environment. The presence of a second obstacle has induced mixed results in the obstacle negotiation of healthy older adults with the interval between obstacles two steps apart. This study extended the knowledge to understand what strategies healthy younger and older adults used to step over two obstacles placed at three-step-length apart. Twenty healthy subjects performed 2 tasks: level ground walking and stepping over two obstacles. The height of each obstacle was set at 10% of subjects’ leg height. We found that aging significantly increased the toe clearance in leading and trailing legs when stepping over the obstacles at a three-step-length interval. Toe clearance was higher while stepping over the second obstacle than the first one in older adults. These results had two-fold meanings: the three-step-length interval was long enough to trigger the adjustment of the obstacle negotiation strategy, and aging led older adults to use conservative negotiation strategies.

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are neurodegenerative disorders that affect millions of individuals worldwide. As incidence of these conditions increases with age, there will undoubtedly be an increased prevalence of cases in the near future. Neuroinflammation is a hallmark in the development and progression of neurodegenerative diseases and prevention or resolution of chronic neuroinflammation may represent a novel approach to treatment. The present review highlights the potential of the anti-inflammatory and pro-resolving effects of polyunsaturated fatty acid (PUFA)-derived mediators (Specialized Pro-resolving Mediators - SPM) in neurodegenerative disorders.PUFA-derived SPM are biosynthesized in response to chemicals produced from acute inflammatory responses. Preclinical studies from both AD and PD models suggest a dysregulation of SPM and their receptors in neurological disorders. Decreased SPM may be due to inadequate substrate, an imbalance between SPM and pro-inflammatory mediators or a disruption in SPM synthesis.. SPMs hold great promise for neuroprotection in AD by altering expression of pro-inflammatory genes, modulating macrophage function, serving as a biomarker for AD status, and promoting resolution of neuroinflammation. In PD, data suggest SPM are able to cross the blood-brain barrier, inhibit microglial activation and decrease induced markers of inflammation, possibly as a result of their ability to downregulate NFκB signaling pathways. Several in vivo and in vitro studies suggest a benefit from administration of SPMs in both neurodegenerative disorders. However, extrapolation of these outcomes to humans is difficult as no models are able to replicate all features of AD or PD. Minimal data evaluating these PUFA-derived metabolites in humans with neurodegenerative disorders are available and a gap in knowledge exists regarding behavior of SPM and their receptors in patients with these conditions. There is also a large gap in our knowledge regarding which lipid mediator would be most effective in which model of AD or PD and how dietary intake or supplementation can impact SPM levels. Future direction should include focused, translational efforts to investigate SPM as an add-on (in addition to standard treatment) or as standalone agents in patients with neurodegenerative disorders.

Response to challenging situations is important to avoid falls, especially after medial perturbations, which require active control. There is a lack of evidence on the relationship between the trunk’s motion in response to perturbations and gait stability. Eighteen healthy adults walked on a treadmill at three speeds while receiving perturbations of three magnitudes. Medial perturbations were applied by translating the walking platform to the right at left heel contact. Trunk velocity changes in response to the perturbation were calculated and divided into the initial and the recovery phases. Gait stability after a perturbation was assessed using the margin of stability (MOS) at the first heel contact, MOS mean, and standard deviation for the first five strides after the perturbation onset. Faster speed and smaller perturbations led to a lower deviation of trunk velocity from the steady state, which can be interpreted as an improvement in response to the perturbation. Recovery was quicker after small perturbations. The MOS mean was associated with the trunk’s motion in response to perturbations during the initial phase. Increasing walking speed may increase resistance to perturbations, while increasing the magnitude of perturbation leads to greater trunk motions. MOS is a useful marker of resistance to perturbations.

Laparoscopic cholecystectomy (LC) is the standard procedure for gallbladder removal, but improper identification of anatomical structures can lead to biliary duct injury (BDI). The critical view of safety (CVS) is a standardized technique designed to mitigate this risk. However, existing surgical training systems primarily emphasize haptic feedback and physical skill development, making them expensive and less accessible. This paper presents the next-generation Portable Camera-Aided Surgical Simulator (PortCAS), a cost-effective, portable, vision-based surgical training simulator designed to enhance cognitive skill acquisition in LC. The system consists of an enclosed physical module equipped with a vision system, a single-board computer for real-time instrument tracking, and a virtual simulation interface that runs on a user-provided computer. Unlike traditional simulators, PortCAS prioritizes cognitive training over force-based interactions, eliminating the need for costly haptic components. The system was evaluated through user studies assessing accuracy, usability, and training effectiveness. Results demonstrate that PortCAS provides a sufficiently accurate tracking performance for training surgical skills such as CVS, offering a scalable and accessible solution for surgical education.