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Introduction: Training on Veress needle (VN) insertion cannot be done by observation without practicing tactile feedback. In this study, a simple and reproducible VN insertion training model was created. The aim of this study was to evaluate the validity of using the proposed model in simulating actual real-life surgical experiences. Methods: The proposed VN insertion training model is made of three layers of synthetic rubber and plastic materials, simulating the tensile strength and texture of the three abdominal wall muscle layers. Surgeons and senior residents with experience in minimally invasive procedures were asked to practice VN insertion on this model, each completing the procedure three times. Participants were then asked to record their comments and answer six questions regarding their experience practicing on the model. Results: Ten surgeons and four senior residents participated in this study. All participants agreed or strongly agreed that the model simulates the surgery experience regarding the shape and overall structure, tactile feedback and confirmation of complete/successful insertion. Twelve participants (86%) agreed or strongly agreed that the pressure/force needed for VN insertion was like real surgery experience and that the overall experience with using this model is similar to the real surgical experience. Almost all participants (93%) agreed or strongly agreed that the model is a valuable resource for training before practicing the procedure on real patients. Conclusions: The VN insertion training model provides a valuable training opportunity on a demanding surgical skill. It is simple, reproducible and closely simulates surgery.

Exploring the application of 5E teaching model combined with virtual endoscopic surgical simulation system in surgical teaching. Eighty-six students who received standardized residency training in the Department of General Surgery at the Second Hospital of Shanxi Medical University from September 2022 to June 2023 were selected as the research subjects. They were randomly divided into experimental and control groups, with 43 students in each group. The experimental group adopts the 5E teaching mode combined with a virtual endoscopic surgery simulation system for teaching. In contrast, the control group was taught using traditional teaching and a simple endoscopic simulation training box. A comparison was made between the evaluation results, self-evaluation, and teaching mode evaluation of the two groups. A -test was performed on two sets of measurement data using SPSS 26.0 software. The theoretical test scores (  = 17.240,  = 0.000) and skill test scores (  = 21.335,  = 0.000) of students in the experimental group were higher than those in the control group. Compared to the control group, the experimental group showed significant improvement in operational skills (  = 3.557,  = 0.001), knowledge application (  = 4.936,  = 0.000), and overall performance (  = 2.999,  = 0.003) after training. The attitudes of students in the experimental group toward ability training (  = 3.818,  = 0.000), class order (  = 3.189,  = 0.002), teaching mode (  = 2.955,  = 0.004), and teaching level evaluation (  = 6.238,  = 0.000) were significantly higher than those in the control group. The virtual endoscopic surgery simulation system combined with the 5E teaching mode can significantly improve the theoretical knowledge and clinical practice skills of resident physicians in standardized training. Suggest applying it to clinical teaching.

BACKGROUND:With the decrease in the number of cerebral aneurysms treated surgically and the increase of complexity of those treated surgically, there is a need for simulation-based tools to teach future neurosurgeons the operative techniques of aneurysm clipping. OBJECTIVE:To develop and evaluate the usefulness of a new haptic-based virtual reality simulator in the training of neurosurgical residents. METHODS:A real-time sensory haptic feedback virtual reality aneurysm clipping simulator was developed using the ImmersiveTouch platform. A prototype middle cerebral artery aneurysm simulation was created from a computed tomographic angiogram. Aneurysm and vessel volume deformation and haptic feedback are provided in a 3-dimensional immersive virtual reality environment. Intraoperative aneurysm rupture was also simulated. Seventeen neurosurgery residents from 3 residency programs tested the simulator and provided feedback on its usefulness and resemblance to real aneurysm clipping surgery. RESULTS:Residents thought that the simulation would be useful in preparing for real-life surgery. About two-thirds of the residents thought that the 3-dimensional immersive anatomic details provided a close resemblance to real operative anatomy and accurate guidance for deciding surgical approaches. They thought the simulation was useful for preoperative surgical rehearsal and neurosurgical training. A third of the residents thought that the technology in its current form provided realistic haptic feedback for aneurysm surgery. CONCLUSION:Neurosurgical residents thought that the novel immersive VR simulator is helpful in their training, especially because they do not get a chance to perform aneurysm clippings until late in their residency programs.

Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.

The study aimed to evaluate the enhancement of minimally invasive surgery (MIS) suturing skills through intensive simulator training, to compare various experimentally measured movement parameters with the established scoring system and to identify movement parameters that may be crucial for achieving proficiency. 55 participants of the intensive practical course of endoscopic surgery in children were included. Training commenced with daily single surgical knot practice, progressed to executing on the final day an anastomosis resembling those performed in esophageal atresia repair. The training effectiveness was gauged by the successful completion of anastomosis. Skills were evaluated by simulator equipped with specialized sensors, which converted data into a set of instrument movement parameters. Additionally, two researchers assessed skills using recorded videos and the objective structured assessment of technical skills (OSATS) questionnaire. Significant improvements in single surgical knot proficiency were noted each day, specifically in metrics: time, movement economy, smoothness, acceleration, instrument activity, and overall score. Strong correlation was observed between automated and human assessments. 48/55 participants attempted anastomosis on the final day, among whom 70% (34/48) attained success (median score 5.1/10, only 16.7% scored above 7/10). Movement economy and instrument distance covered emerged as the most relevant predictors of the anastomosis success. Intensive simulation training significantly enhances endoscopic suturing skills.

The aim of study was to evaluate the efficacy of the use of three-dimensional (3D) printing model for preoperative planning in treatment of tibial plateau fracture. Besides, we also investigated the effect of 3D printing technology on the communication between doctors and patients. Thirty-three patients with tibial plateau fractures were enrolled in the study from March 2022 to July 2023. A 3D digital model of each tibial plateau fracture was constructed, and the individual model was exported to a 3D printer for the construction of a full solid model. This 3D-printing model, along with the Three-Column classification, was utilized to plan the operation. During each operation, the operative time and amount of blood loss were recorded as primary outcome measures. Patients were followed to evaluate surgical outcomes using Rasmussen scores and radiological evaluation, which served as secondary outcome measures. Additionally, satisfaction for patients was assessed using questionnaires developed by Yiting Lou. Two-column fractures accounted for the highest proportion at 45.5%. Isolated posterior column fractures constituted 9.1%. The average 3D printing time was 7.1 ± 0.9 h; a material cost of 1 USD per model. Complex fracture cases had significantly longer 3D printing times ( p  = 0.001) and provided more information to the surgical team than simple fractures. Patient satisfaction with 3D models was rated at 7.4 ± 0.7 out of 10 points. Malalignment and gap width were not correlated with surgical time ( p  = 0.3 and 0.2). The infection rate was 3%, and the rate of secondary loss of reduction at six months was 25%, with no correlation with Rasmussen scores ( P  > 0.05, Fisher’s test). Our study revealed that 3D printing models effectively assist the surgeons in planning operations, especially in complex cases, and may enhances communication between surgeons and patients. Follow-up 6 months after surgery showed good knee function.

Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379–381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379–381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.

While robotic procedures are growing rapidly, medical students have a limited role in robotic surgeries. Curricula are needed to enhance engagement. We examined feasibility of augmenting Intuitive Surgical (IS) robotic training for medical students. As a pilot, 18 senior students accepted an invitation to a simulation course with a daVinci robot trainer. Course teaching objectives included introducing robotic features, functionalities, and roles. A 1-h online module from the IS learning platform and a 4-h in-person session comprised the course. The in-person session included an overview of the robot by an IS trainer (1.5 h), skills practice at console (1.5 h), and a simulation exercise focused on the bedside assist role (1 h). Feasibility included assessing implementation and acceptability using a post-session survey and focus group (FG). Survey responses were compiled. FG transcripts were analyzed using inductive thematic analysis techniques. Fourteen students participated. Implementation was successful as interested students signed up and completed each of the course components. Regarding acceptability, students reported the training valuable and recommended it as preparation for robotic cases during core clerkships and sub-internships. In addition, FGs revealed 4 themes: (1) perceived expectations of students in the OR; (2) OR vs. outside-OR learning; (3) simulation of stress; and (4) opportunities to improve the simulation component. To increase preparation for the robotic OR and shift robotic training earlier in the surgical education continuum, educators should consider hands-on simulation for medical students. We demonstrate feasibility although logistics may limit scalability for large numbers of students.

Objective This study aims to evaluate the feasibility and utility of a novel, open‐source 3D printed simulator for practicing laryngeal surgery skills in the clinic setting. Study Design Device development and validation. Setting A tertiary medical center. Methods A laryngeal surgery simulator was created using computer‐aided design software and 3D printed. Ten otolaryngology residents completed exercises utilizing the simulator and a flexible video laryngoscope for visualization. The training involved 3 microsurgery tasks: (1) suture removal from simulated vocal cords, (2) removal of silicone vocal cord polyps, and (3) simulated flap creation by peeling a grape's skin. Participant demographics, task completion time, and video recordings were collected. Participants provided subjective feedback through 5‐point Likert‐style questions assessing content and face validity. Results Both novice and experienced otolaryngology resident physicians reported positive perceptions of the simulator and its efficacy as an educational device, with average agreement more than neutral (P < .01). Participants praised the simulator's utility for practicing microsurgery skills using a flexible video laryngoscope and for handling instruments such as Kleinsasser forceps and micro scissors (P < .01). Preliminary findings suggest improvements in task completion time with higher post‐graduate year. Participants also reported the need for greater realism. Conclusion This study of a 3D‐printed simulator for laryngeal surgery skills using a flexible video laryngoscope demonstrated promising utility as an educational device. Positive feedback reflects the potential value as a training tool for residents to practice fine motor skills required for laryngeal surgery. Further research with larger sample sizes is needed to validate these findings.

Purpose The healthcare industry has a growing need for realistic modeling and efficient simulation of surgical scenes. With effective models of deformable surgical scenes, clinicians are able to conduct surgical planning and surgery training on scenarios close to real-world cases. However, a significant challenge in achieving such a goal is the scarcity of high-quality soft tissue models with accurate shapes and textures. To address this gap, we present a data-driven framework that leverages emerging neural radiance field technology to enable high-quality surgical reconstruction and explore its application for surgical simulations. Method We first focus on developing a fast NeRF-based surgical scene 3D reconstruction approach that achieves state-of-the-art performance. This method can significantly outperform traditional 3D reconstruction methods, which have failed to capture large deformations and produce fine-grained shapes and textures. We then propose an automated creation pipeline of interactive surgical simulation environments through a closed mesh extraction algorithm. Results Our experiments have validated the superior performance and efficiency of our proposed approach in surgical scene 3D reconstruction. We further utilize our reconstructed soft tissues to conduct FEM and MPM simulations, showcasing the practical application of our method in data-driven surgical simulations. Conclusion We have proposed a novel NeRF-based reconstruction framework with an emphasis on simulation purposes. Our reconstruction framework facilitates the efficient creation of high-quality surgical soft tissue 3D models. With multiple soft tissue simulations demonstrated, we show that our work has the potential to benefit downstream clinical tasks, such as surgical education.