Medicine › Surgery

Surgical Simulation and Training

Works Count: 37295

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Description

This cluster of papers focuses on advancements in surgical simulation and training techniques, particularly in the context of laparoscopic and robotic surgery. It explores the impact of virtual reality training on surgical skills, the assessment of technical skills, the transfer of skills from simulation to the operating room, and the use of telesurgery. The papers also discuss the influence of stress on surgical performance and the evolving landscape of medical education in the field of surgery.

Keywords

Virtual Reality Training; Surgical Skills; Laparoscopic Surgery; Robotic Surgery; Simulation-Based Training; Technical Skills Assessment; Operating Room Performance; Telesurgery; Skill Transfer; Medical Education

Laparoscopic training on bench models: better and more cost effective than operating room experience?1

2000-09-01

Daniel J. Scott , Patricia C. Bergen , Robert V. Rege +7 more

Virtual reality training for surgical trainees in laparoscopic surgery

2013-08-27

Myura Nagendran , Kurinchi Selvan Gurusamy , Rajesh Aggarwal +2 more

Testing technical skill via an innovative “bench station” examination

1997-03-01

Richard K. Reznick , Glenn Regehr , Helen MacRae +2 more

Proving the Effectiveness of Virtual Reality Simulation for Training in Laparoscopic Surgery

2007-11-01

Rajesh Aggarwal , Jonnie Ward , Indran Balasundaram +3 more

In Brief Objective: The aim of this study was to compare learning curves for laparoscopic cholecystectomy (LC) after training on a proficiency based virtual reality (VR) curriculum with that of … In Brief Objective: The aim of this study was to compare learning curves for laparoscopic cholecystectomy (LC) after training on a proficiency based virtual reality (VR) curriculum with that of a traditionally trained group. Summary Background Data: Simulator-based training has been shown to improve technical performance during real laparoscopic procedures, although research to date has not proven the persistence of this effect over subsequent cases. Material and Methods: Twenty novice surgeons underwent baseline laparoscopic skills testing followed by a 1-day didactic training session. Control subjects (n = 10) performed 5 cadaveric porcine LCs each; VR-trained subjects (n = 10) completed a VR training curriculum followed by 3 porcine LCs each. A further 10 experienced laparoscopic surgeons (>100 LCs) performed 2 porcine LCs each to define benchmark levels. Technical skill assessment was by motion analysis and video-based global rating scores (out of 35). Results: There were no intergroup differences in baseline skill. The first LC revealed significant differences between control and VR groups for time (median 4590 seconds vs. 2165 seconds, P = 0.038), path length (169.2 meters vs. 86.8 meters, P = 0.009), number of movements (2446 vs. 1029, P = 0.009), and video scores (17 vs. 25, P = 0.001). The VR group, although not a control, achieved video and dexterity scores equivalent to expert levels of performance. Conclusions: A proficiency based VR training curriculum shortens the learning curve on real laparoscopic procedures when compared with traditional training methods. This may be a more cost- and time-effective approach, and supports the need for simulator-based practice to be integrated into surgical training programs. The integration of virtual reality simulation-based training into surgical curricula necessitates proof that this mode of training effectively reduces the time taken to achieve proficiency in the operating room. The results of this study confirm shorter and flatter learning curves for simulation-based as opposed to the traditional method of training.

Teaching Surgical Skills: What Kind of Practice Makes Perfect?

2006-08-18

Carol‐Anne Moulton , Adam Dubrowski , Helen MacRae +3 more

Surgical skills laboratories have become an important venue for early skill acquisition. The principles that govern training in this novel educational environment remain largely unknown; the commonest method of training, … Surgical skills laboratories have become an important venue for early skill acquisition. The principles that govern training in this novel educational environment remain largely unknown; the commonest method of training, especially for continuing medical education (CME), is a single multihour event. This study addresses the impact of an alternative method, where learning is distributed over a number of training sessions. The acquisition and transfer of a new skill to a life-like model is assessed.

Simulation in surgical training: educational issues and practical implications

2003-03-01

Roger Kneebone

Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is … Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework.Simulators can provide safe, realistic learning environments for repeated practice, underpinned by feedback and objective metrics of performance. Using a simple classification of simulators into model-based, computer-based or hybrid, this paper summarises the current state of the art and describes recent technological developments. Advances in computing have led to the establishment of precision placement and simple manipulation simulators within health care education, while complex manipulation and integrated procedure simulators are still in the development phase.Tension often exists between the design and evaluation of surgical simulations. A lack of high quality published data is compounded by the difficulties of conducting longitudinal studies in such a fast-moving field. The implications of this tension are discussed.The emphasis is now shifting from the technology of simulation towards partnership with education and clinical practice. This highlights the need for an integrated learning framework, where knowledge can be acquired alongside technical skills and not in isolation from them. Recent work on situated learning underlines the potential for simulation to feed into and enrich everyday clinical practice.

Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies

2007-05-19

Gunnar Ahlberg , Lars Enochsson , Anthony G. Gallagher +6 more

Robotic surgery, telerobotic surgery, telepresence, and telementoring

2002-10-01

Garth H. Ballantyne

Objective assessment of technical surgical skills

2010-05-14

P. Diederick van Hove , Gabriëlle J. M. Tuijthof , E. G. G. Verdaasdonk +2 more

Abstract Background Surgeons are increasingly being scrutinized for their performance and there is growing interest in objective assessment of technical skills. The purpose of this study was to review all … Abstract Background Surgeons are increasingly being scrutinized for their performance and there is growing interest in objective assessment of technical skills. The purpose of this study was to review all evidence for these methods, in order to provide a guideline for use in clinical practice. Methods A systematic search was performed using PubMed and Web of Science for studies addressing the validity and reliability of methods for objective skills assessment within surgery and gynaecology only. The studies were assessed according to the Oxford Centre for Evidence-based Medicine levels of evidence. Results In total 104 studies were included, of which 20 (19·2 per cent) had a level of evidence 1b or 2b. In 28 studies (26·9 per cent), the assessment method was used in the operating room. Virtual reality simulators and Objective Structured Assessment of Technical Skills (OSATS) have been studied most. Although OSATS is seen as the standard for skills assessment, only seven studies, with a low level of evidence, addressed its use in the operating room. Conclusion Based on currently available evidence, most methods of skills assessment are valid for feedback or measuring progress of training, but few can be used for examination or credentialing. The purpose of the assessment determines the choice of method.

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Assessment of technical skills transfer from the bench training model to the human model

1999-02-01

Dimitri J. Anastakis , Glenn Regehr , Richard K. Reznick +4 more

A Systematic Review of Skills Transfer After Surgical Simulation Training

2008-08-01

Lana Sturm , John A. Windsor , Peter H. Cosman +3 more

In Brief Objective: To determine whether skills acquired by simulation-based training transfer to the operative setting. Summary Background Data: The fundamental assumption of simulation-based training is that skills acquired in … In Brief Objective: To determine whether skills acquired by simulation-based training transfer to the operative setting. Summary Background Data: The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. Methods: A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulation-based training for surgical skills training, and the transferability of these skills to the operative setting, were included. Results: Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. Conclusions: Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs. This article reviews whether skills acquired through simulation training transfer to the operative setting. Study results suggest that trainees who had simulation-based training performed patient-based procedures better than controls, in some but not all measured parameters. More evidence is required to determine the extent to which simulation should become a part of training.

Randomized clinical trial of virtual reality simulation for laparoscopic skills training

2004-01-28

Teodor Grantcharov , Viggo B. Kristiansen , Jørgen Bendix +3 more

Abstract Background This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Methods Sixteen surgical trainees performed … Abstract Background This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Methods Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. Results No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P = 0·021). Furthermore, those who had VR training showed significantly greater improvement in error (P = 0·003) and economy of movement (P = 0·003) scores. Conclusion Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.

Transcontinental Robot-Assisted Remote Telesurgery: Feasibility and Potential Applications

2002-04-01

Jacques Marescaux , Joël Leroy , Francesco Rubino +4 more

Objective To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. Summary Background Data Technical limitations and the issue of time … Objective To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. Summary Background Data Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances. Methods To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service). Results The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery. Conclusions Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.

Haptic feedback in robot-assisted minimally invasive surgery

2008-12-04

Allison M. Okamura

Robot-assisted minimally invasive surgery (RMIS) holds great promise for improving the accuracy and dexterity of a surgeon and minimizing trauma to the patient. However, widespread clinical success with RMIS has … Robot-assisted minimally invasive surgery (RMIS) holds great promise for improving the accuracy and dexterity of a surgeon and minimizing trauma to the patient. However, widespread clinical success with RMIS has been marginal. It is hypothesized that the lack of haptic (force and tactile) feedback presented to the surgeon is a limiting factor. This review explains the technical challenges of creating haptic feedback for robot-assisted surgery and provides recent results that evaluate the effectiveness of haptic feedback in mock surgical tasks.Haptic feedback systems for RMIS are still under development and evaluation. Most provide only force feedback, with limited fidelity. The major challenge at this time is sensing forces applied to the patient. A few tactile feedback systems for RMIS have been created, but their practicality for clinical implementation needs to be shown. It is particularly difficult to sense and display spatially distributed tactile information. The cost-benefit ratio for haptic feedback in RMIS has not been established.The designs of existing commercial RMIS systems are not conducive for force feedback, and creative solutions are needed to create compelling tactile feedback systems. Surgeons, engineers, and neuroscientists should work together to develop effective solutions for haptic feedback in RMIS.

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Development of a Model for Training and Evaluation of Laparoscopic Skills 11This work was supported by an educational grant from United States Surgical Corporation (Auto Suture Canada).

1998-06-01

Anna M. Derossis , Gerald M. Fried , Michał Abrahamowicz +3 more

Virtual reality surgical simulator

1993-01-01

Richard M. Satava

Systematic review of serious games for medical education and surgical skills training

2012-09-07

Maurits Graafland , Jan Maarten Schraagen , Marlies P. Schijven

Abstract Background The application of digital games for training medical professionals is on the rise. So-called ‘serious’ games form training tools that provide a challenging simulated environment, ideal for future … Abstract Background The application of digital games for training medical professionals is on the rise. So-called ‘serious’ games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games. Methods PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria. Results A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use. Conclusion Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula.

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Proving the Value of Simulation in Laparoscopic Surgery

2004-08-19

Gerald M. Fried , Liane S. Feldman , Melina C. Vassiliou +7 more

To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility.MISTELS is the physical … To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility.MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in their Fundamentals of Laparoscopic Surgery (FLS) program. MISTELS' metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery.Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills (transferring) would result in skill acquisition transferable to complex laparoscopic tasks (suturing).Face validity was confirmed through questioning 44 experienced laparoscopic surgeons using global rating scales. MISTELS scores increased progressively with increasing laparoscopic experience (n = 215, P < 0.0001), and residents followed over time improved their scores (n = 24, P < 0.0001), evidence of construct validity. Results in the host institution did not differ from 5 beta sites (n = 215, external validity). MISTELS scores correlated with a highly reliable validated intraoperative rating of technical skill during laparoscopic cholecystectomy (n = 19, r = 0.81, P < 0.0004; concurrent validity). Novice laparoscopists were randomized to practice/no practice of the transfer drill for 4 weeks. Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability, career goals, or gender (P < 0.001).MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy. This system is reliable, valid, and a useful educational tool.

Effect of virtual reality training on laparoscopic surgery: randomised controlled trial

2009-05-14

CR Larsen , J. Soerensen , Teodor Grantcharov +5 more

Objective To assess the effect of virtual reality training on an actual laparoscopic operation. Design Prospective randomised controlled and blinded trial. Setting Seven gynaecological departments in the Zeeland region of … Objective To assess the effect of virtual reality training on an actual laparoscopic operation. Design Prospective randomised controlled and blinded trial. Setting Seven gynaecological departments in the Zeeland region of Denmark. Participants 24 first and second year registrars specialising in gynaecology and obstetrics. Interventions Proficiency based virtual reality simulator training in laparoscopic salpingectomy and standard clinical education (controls). Main outcome measure The main outcome measure was technical performance assessed by two independent observers blinded to trainee and training status using a previously validated general and task specific rating scale. The secondary outcome measure was operation time in minutes. Results The simulator trained group (n=11) reached a median total score of 33 points (interquartile range 32-36 points), equivalent to the experience gained after 20-50 laparoscopic procedures, whereas the control group (n=10) reached a median total score of 23 (22-27) points, equivalent to the experience gained from fewer than five procedures (P<0.001). The median total operation time in the simulator trained group was 12 minutes (interquartile range 10-14 minutes) and in the control group was 24 (20-29) minutes (P<0.001). The observers' inter-rater agreement was 0.79. Conclusion Skills in laparoscopic surgery can be increased in a clinically relevant manner using proficiency based virtual reality simulator training. The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved. Simulator training should be considered before trainees carry out laparoscopic procedures. Trial registration ClinicalTrials.gov NCT00311792.

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Surgical Simulation

2006-02-17

Leanne M. Sutherland , Philippa Middleton , Adrian Anthony +4 more

In Brief Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it … In Brief Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training. In a systematic review of the 30 relevant randomized controlled trials, simulated training (including computer simulation) was not shown to be superior to other forms of surgical training.

Virtual Reality Simulation for the Operating Room

2005-01-13

Anthony G. Gallagher , E. Matt Ritter , Howard R. Champion +5 more

In Brief Summary Background Data: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and … In Brief Summary Background Data: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision Methods: A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program. Results: VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations. Conclusions: VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills. Evidence has been published demonstrating the power of simulation for training surgical skills. Simulation training is more likely to produce better training outcomes if it is systematically integrated into the curriculum of a training program with proficiency-based progression founded on objective feedback with validated metrics proximate to performance.

Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery

2003-12-23

Jeffrey H. Peters , Gerald M. Fried , Lee L. Swanström +5 more

Objective assessment of technical skills in surgery

2003-10-31

Krishna Moorthy

In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have … In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose Surgical competence entails a combination of knowledge, technical skills, decision making, communication skills, and leadership skills. Of these, dexterity or technical proficiency is considered to be of paramount importance among surgical trainees. The assessment of technical skills during training has been considered to be a form of quality assurance for the future.1 Typically surgical learning is based on an apprenticeship model. In this model the assessment of technical proficiency is the responsibility of the trainers. However, their assessment is largely subjective.2 Objective assessment is essential because deficiencies in training and performance are difficult to correct without objective feedback.3 The introduction of the Calman system in the United Kingdom, the implementation of the European Working Time Directive, and the financial pressures to increase productivity4 have reduced the opportunity to learn surgical skills in the operating theatre. Studies have shown that these changes have resulted in nearly halving the surgical case load that trainees are exposed to.5 Surgical proficiency must therefore be acquired in less time, with the risk that some surgeons may not be sufficiently skilled at the completion of training.6 This and increasing attention of the public and media on the performance of doctors have given rise to an interest in the development of robust methods of assessment of technical skills.7 We review the research in this field in the past decade. Our objectives are to explore all the available methods, establish their validity and reliability, and examine the possibility of using these methods on the basis of the available evidence. We collected information for this review from …

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The financial impact of teaching surgical residents in the operating room

1999-01-01

Matthew Bridges , Daniel L. Diamond

Transatlantic robot-assisted telesurgery

2001-09-27

Jacques Marescaux , Joël Leroy , M. Gagner +5 more

General Surgery Residency Inadequately Prepares Trainees for Fellowship

2013-08-09

Samer G. Mattar , Adnan Alseidi , Daniel B. Jones +7 more

To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent … To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains.There was a 63% response rate (n = 91/145). Of respondent program directors, 21% felt that new fellows arrived unprepared for the operating room, 38% demonstrated lack of patient ownership, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regard to laparoscopic skills, 30% could not atraumatically manipulate tissue, 26% could not recognize anatomical planes, and 56% could not suture. Furthermore, 28% of fellows were not familiar with therapeutic options and 24% were unable to recognize early signs of complications. Finally, it was felt that the majority of new fellows were unable to conceive, design, and conduct research/academic projects. Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.

New Technology and Health Care Costs — The Case of Robot-Assisted Surgery

2010-08-18

Gabriel I. Barbash , Sherry Glied

Technological innovation in health care is an important driver of cost growth. Doctors and patients often embrace new modes of treatment before their merits and weaknesses are fully understood. These … Technological innovation in health care is an important driver of cost growth. Doctors and patients often embrace new modes of treatment before their merits and weaknesses are fully understood. These technologies can lead to increases in costs, either because they are simply more expensive than previous treatments or because their introduction leads to an expansion in the types and numbers of patients treated. We examined these patterns as they apply to the case of robot-assisted surgery.Robotic surgical devices allow a surgeon at a console to operate remote-controlled robotic arms, which may facilitate the performance of laparoscopic procedures. Laparoscopic surgery, . . .

What does one minute of operating room time cost?

2010-06-01

Alex Macario

Medical robotics in computer-integrated surgery

2003-10-01

Russell H. Taylor , Dan Stoianovici

This paper provides a broad overview of medical robot systems used in surgery. After introducing basic concepts of computer-integrated surgery, surgical CAD/CAM, and surgical assistants, it discusses some of the … This paper provides a broad overview of medical robot systems used in surgery. After introducing basic concepts of computer-integrated surgery, surgical CAD/CAM, and surgical assistants, it discusses some of the major design issues particular to medical robots. It then illustrates these issues and the broader themes introduced earlier with examples of current surgical CAD/CAM and surgical assistant systems. Finally, it provides a brief synopsis of current research challenges and closes with a few thoughts on the research/industry/clinician teamwork that is essential for progress in the field.

Evaluation and stages of surgical innovations

2009-09-01

Jeffrey Barkun , Jeffrey K Aronson , Liane S. Feldman +2 more

Virtual Reality Training Improves Operating Room Performance

2002-10-01

Neal E. Seymour , Anthony G. Gallagher , Sanziana A. Roman +4 more

Objective To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. Summary Background Data The use of VR surgical simulation to train skills and … Objective To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. Summary Background Data The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. Methods Sixteen surgical residents (PGY 1–4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). Results No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P < .007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P < .04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case;P < .008, Mann-Whitney test). Conclusions The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Robotic Surgery

2003-12-12

Anthony R. Lanfranco , Andres Castellanos , Jaydev P. Desai +1 more

To review the history, development, and current applications of robotics in surgery.Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, … To review the history, development, and current applications of robotics in surgery.Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving.A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications.Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques.Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedures.

Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy

2003-11-01

Thomas E. Ahlering , Douglas Skarecky , David I. Lee +1 more

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Nov 2003Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy THOMAS E. … No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Nov 2003Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy THOMAS E. AHLERING, DOUGLAS SKARECKY, DAVID LEE, and RALPH V. CLAYMAN THOMAS E. AHLERINGTHOMAS E. AHLERING More articles by this author , DOUGLAS SKARECKYDOUGLAS SKARECKY More articles by this author , DAVID LEEDAVID LEE More articles by this author , and RALPH V. CLAYMANRALPH V. CLAYMAN More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000092881.24608.5eAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: For a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our knowledge we report the initial experience with robot assisted LRP of a surgeon without laparoscopic experience. Materials and Methods: Following a 1-day da Vinci (Intuitive Surgical, Mountain View, California) robotic laparoscopic training course and 2 cadaveric robotic LRPs an experienced oncologist (TEA) without laparoscopic experience performed 45 robotic LRPs. Results: All procedures were successfully completed laparoscopically with no rectal injuries or transfusions. The learning curve to 4-hour proficiency was 12 patients and mean operating time subsequently was 3.45 hours (range 2.5 to 5.1). Mean blood loss was 145 cc (range 25 to 350), the mean postoperative day 1 decrease in hemoglobin was 2.6 mg/dl (range 1.9% to 5.1) and mean hospital stay was 36 hours (range 18 to 168). Mean Gleason score was 6.8, mean prostate volume was 50.5 gm (range 12.5 to 163) and the margin positive rate was 35.5%. Four patients (8.8%) had a total of 6 complications, which were managed conservatively. Catheterization time was 7 days (range 7 to 42). Continence (0 pads) was 33% at 1 week, 63% at 1 month and 81% at 3 months. Conclusions: A laparoscopically naïve yet experienced open surgeon successfully transferred open surgical skills to a laparoscopic environment in 8 to 12 cases using a robotic interface. This outcome is comparable to the reported experience of skilled laparoscopic surgeons after more than 100 LRPs. References 1 : Laparoscopic radical prostatectomy: initial short-term experience. Urology1997; 50: 854. Crossref, Medline, Google Scholar 2 : Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations. Prostate1999; 39: 71. Google Scholar 3 : Laparoscopic radial prostatectomy: the Montsouris technique. J Urol2000; 163: 1643. Abstract, Google Scholar 4 : Laparoscopic radical prostatectomy: preliminary results. Urology2000; 55: 630. Crossref, Medline, Google Scholar 5 : Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol2001; 166: 2101. Link, Google Scholar 6 : Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology2002; 60: 569. Google Scholar 7 : Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology2003; 61: 699. Google Scholar 8 : TNM Classification of Malignant Tumors. New York: Wiley & Sons1997: 108. Google Scholar 9 : Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am2001; 28: 189. Crossref, Medline, Google Scholar 10 : Laparoscopic radical prostatectomy: irrational exuberance?. Urology2001; 58: 503. Crossref, Medline, Google Scholar 11 : Robotically-assisted laparoscopic radical prostatectomy. BJU Int2001; 87: 408. Crossref, Medline, Google Scholar 12 : Laparoscopic radical prostatectomy with a remote controlled robot. J Urol2001; 165: 1964. Link, Google Scholar 13 : Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol2001; 40: 75. Crossref, Medline, Google Scholar 14 : Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol2002; 168: 945. Link, Google Scholar 15 : Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol1998; 160: 299. Link, Google Scholar 16 : Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable. Urology2001; 58: 425. Google Scholar 17 : Prospective patient-reported continence after laparoscopic radical prostatectomy. Urology2001; 58: 570. Google Scholar From the Department of Urology, University of California (Irvine) Medical Center, Orange, California© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLiss M, Lusch A, Morales B, Beheshti N, Skarecky D, Narula N, Osann K and Ahlering T (2012) Robot-Assisted Radical Prostatectomy: 5-Year Oncological and Biochemical OutcomesJournal of Urology, VOL. 188, NO. 6, (2205-2211), Online publication date: 1-Dec-2012.Friedlander D, Alemozaffar M, Hevelone N, Lipsitz S and Hu J (2012) Stepwise Description and Outcomes of Bladder Neck Sparing During Robot-Assisted Laparoscopic Radical ProstatectomyJournal of Urology, VOL. 188, NO. 5, (1754-1760), Online publication date: 1-Nov-2012.Etafy M, Pick D, Said S, Hsueh T, Kerbl D, Mucksavage P, Louie M, McDougall E and Clayman R (2011) Robotic Pyeloplasty: The University of California-Irvine ExperienceJournal of Urology, VOL. 185, NO. 6, (2196-2200), Online publication date: 1-Jun-2011.Sorensen M, Delostrinos C, Johnson M, Grady R and Lendvay T (2011) Comparison of the Learning Curve and Outcomes of Robotic Assisted Pediatric PyeloplastyJournal of Urology, VOL. 185, NO. 6S, (2517-2522), Online publication date: 1-Jun-2011.Lee J, Mucksavage P, Sundaram C and McDougall E (2011) Best Practices for Robotic Surgery Training and CredentialingJournal of Urology, VOL. 185, NO. 4, (1191-1197), Online publication date: 1-Apr-2011.Hellenthal N, Hussain A, Andrews P, Carpentier P, Castle E, Dasgupta P, Kaouk J, Khan S, Kibel A, Kim H, Manoharan M, Menon M, Mottrie A, Ornstein D, Palou J, Peabody J, Pruthi R, Richstone L, Schanne F, Stricker H, Thomas R, Wiklund P, Wilding G and Guru K (2010) Surgical Margin Status After Robot Assisted Radical Cystectomy: Results From the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 184, NO. 1, (87-91), Online publication date: 1-Jul-2010.Cadeddu J, Gautam G and Shalhav A (2010) Robotic ProstatectomyJournal of Urology, VOL. 183, NO. 3, (858-861), Online publication date: 1-Mar-2010.Herrell S, Kwartowitz D, Milhoua P and Galloway R (2008) Toward Image Guided Robotic Surgery: System ValidationJournal of Urology, VOL. 181, NO. 2, (783-790), Online publication date: 1-Feb-2009.Gamboa A, Santos R, Sargent E, Louie M, Box G, Sohn K, Truong H, Lin R, Khosravi A, Santos R, Ornstein D, Ahlering T, Tyson D, Clayman R and McDougall E (2008) Long-Term Impact of a Robot Assisted Laparoscopic Prostatectomy Mini Fellowship Training Program on Postgraduate Urological Practice PatternsJournal of Urology, VOL. 181, NO. 2, (778-782), Online publication date: 1-Feb-2009.Clayman R (2008) Urolithiasis, Endourology and LaparoscopyJournal of Urology, VOL. 180, NO. 5, (1944-1945), Online publication date: 1-Nov-2008.Hu J, Hevelone N, Ferreira M, Lipsitz S, Choueiri T, Sanda M and Earle C (2008) Patterns of Care for Radical Prostatectomy in the United States From 2003 to 2005Journal of Urology, VOL. 180, NO. 5, (1969-1974), Online publication date: 1-Nov-2008.Joseph J, Oleynikov D, Rentschler M, Dumpert J and Patel H (2008) Microrobot Assisted Laparoscopic Urological Surgery in a Canine ModelJournal of Urology, VOL. 180, NO. 5, (2202-2205), Online publication date: 1-Nov-2008.Rodriguez E, Skarecky D, Narula N and Ahlering T (2007) Prostate Volume Estimation Using the Ellipsoid Formula Consistently Underestimates Actual Gland SizeJournal of Urology, VOL. 179, NO. 2, (501-503), Online publication date: 1-Feb-2008.Finley D, Rodriguez E and Ahlering T (2007) Combined Inguinal Hernia Repair With Prosthetic Mesh During Transperitoneal Robot Assisted Laparoscopic Radical Prostatectomy: A 4-Year ExperienceJournal of Urology, VOL. 178, NO. 4, (1296-1300), Online publication date: 1-Oct-2007.Rozet F, Jaffe J, Braud G, Harmon J, Cathelineau X, Barret E and Vallancien G (2007) A Direct Comparison of Robotic Assisted Versus Pure Laparoscopic Radical Prostatectomy: A Single Institution ExperienceJournal of Urology, VOL. 178, NO. 2, (478-482), Online publication date: 1-Aug-2007.Joseph J, Rosenbaum R, Madeb R, Erturk E and Patel H (2018) Robotic Extraperitoneal Radical Prostatectomy: An Alternative ApproachJournal of Urology, VOL. 175, NO. 3, (945-951), Online publication date: 1-Mar-2006.TRABULSI E and GUILLONNEAU B (2018) LAPAROSCOPIC RADICAL PROSTATECTOMYJournal of Urology, VOL. 173, NO. 4, (1072-1079), Online publication date: 1-Apr-2005.LOTAN Y, CADEDDU J and GETTMAN M (2018) THE NEW ECONOMICS OF RADICAL PROSTATECTOMY: COST COMPARISON OF OPEN, LAPAROSCOPIC AND ROBOT ASSISTED TECHNIQUESJournal of Urology, VOL. 172, NO. 4 Part 1, (1431-1435), Online publication date: 1-Oct-2004. Volume 170Issue 5November 2003Page: 1738-1741 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.KeywordsprostatelaparoscopyroboticsprostatectomyMetricsAuthor Information THOMAS E. AHLERING More articles by this author DOUGLAS SKARECKY More articles by this author DAVID LEE More articles by this author RALPH V. CLAYMAN More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotics in General Surgery

2003-07-01

Pier Cristoforo Giulianotti

Robotic technology is the most advanced development of minimally invasive surgery, but there are still some unresolved issues concerning its use in a clinical setting.The study describes the clinical experience … Robotic technology is the most advanced development of minimally invasive surgery, but there are still some unresolved issues concerning its use in a clinical setting.The study describes the clinical experience of the Department of General Surgery, Misericordia Hospital, Grosseto, Italy, in robot-assisted surgery using the da Vinci Surgical System.Between October 2000 and November 2002, 193 patients underwent a minimally invasive robotic procedure (74 men and 119 women; mean age, 55.9 years [range, 16-91 years]). A total of 207 robotic surgical operations, including abdominal, thoracic and vascular procedures, were performed; 179 were single procedures, and 14 were double (2 operations on the same patient). There were 4 conversions to open surgery and 3 to conventional laparoscopy (conversion rate, 3.6%; 7 of 193 patients). The perioperative morbidity rate was 9.3% (18 of 193 patients), and 6 patients (3.1%) required a reoperation. The postoperative mortality rate was 1.5% (3 of 193 patients).Our preliminary experience at a large community hospital suggests that robotic surgery is feasible in a clinical setting. Its daily use is safe and easily managed, and it expands the applications of minimally invasive surgery. However, the best indications still have to be defined, and the cost-benefit ratio must be evaluated. This report could serve as a basis for a future prospective, randomized trial.

Laparoscopic skills training and assessment

2004-11-17

Rajesh Aggarwal , Krishna Moorthy , Ara Darzi

Abstract Background The introduction of laparoscopic techniques to general surgery was associated with many unnecessary complications, which led to the development of skills laboratories to train novice laparoscopic surgeons. This … Abstract Background The introduction of laparoscopic techniques to general surgery was associated with many unnecessary complications, which led to the development of skills laboratories to train novice laparoscopic surgeons. This article reviews the tools currently available for training and assessment in laparoscopic surgery. Methods Medline searches were performed to identify articles with combinations of the following key words: laparoscopy, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. Results Current training involves the use of box trainers with either innate models or animal tissues; it lacks objective assessment of skill acquisition. Virtual reality simulators have the ability to teach laparoscopic psychomotor skills, and objective assessment is now possible using dexterity-based and video analysis systems. Conclusion The tools are now available for the development of a structured, competency-based, laparoscopic surgical training programme.

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Teaching Surgical Skills — Changes in the Wind

2006-12-20

Richard K. Reznick , Helen MacRae

Traditionally, surgeons have been trained and evaluated on the basis of their performance of surgical procedures in live patients. This article in the Medical Education series explores the use of … Traditionally, surgeons have been trained and evaluated on the basis of their performance of surgical procedures in live patients. This article in the Medical Education series explores the use of mechanical devices for the teaching and evaluation of surgical skills.

The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review

2009-01-01

O.A.J. van der Meijden , Marlies P. Schijven

Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic … Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic (VR training) platforms are unknown. Many questions about haptic feedback in the different areas of surgical skills (training) need to be answered before adding costly haptic feedback in VR simulation for MIS training. This study was designed to review the current status and value of haptic feedback in conventional and robot-assisted MIS and training by using virtual reality simulation. A systematic review of the literature was undertaken using PubMed and MEDLINE. The following search terms were used: Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/Education. The results were assessed according to level of evidence as reflected by the Oxford Centre of Evidence-based Medicine Levels of Evidence. In the current literature, no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery. Although the majority of the results show positive assessment of the benefits of force feedback, results are ambivalent and not unanimous on the subject. Benefits are least disputed when related to surgery using robotics, because there is no haptic feedback in currently used robotics. The addition of haptics is believed to reduce surgical errors resulting from a lack of it, especially in knot tying. Little research has been performed in the area of robot-assisted endoscopic surgical training, but results seem promising. Concerning VR training, results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition.

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A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope

1986-10-01

David W. Roberts , John W. Strohbehn , John F. Hatch +2 more

✓ A computer-based system has been developed for the integration and display of computerized tomography (CT) image data in the operating microscope in the correct perspective without requiring a stereotaxic … ✓ A computer-based system has been developed for the integration and display of computerized tomography (CT) image data in the operating microscope in the correct perspective without requiring a stereotaxic frame. Spatial registration of the CT image data is accomplished by determination of the position of the operating microscope as its focal point is brought to each of three CT-imaged fiducial markers on the scalp. Monitoring of subsequent microscope positions allows appropriate reformatting of CT data into a common coordinate system. The position of the freely moveable microscope is determined by a non-imaging ultrasonic range-finder consisting of three spark gaps attached to the microscope and three microphones on a rigid support in the operating room. Measurement of the acoustic impulse transit times from the spark gaps to the microphones enables calculation of those distances and unique determination of the microscope position. The CT data are reformatted into a plane and orientation corresponding to the microscope's focal plane or to a deeper parallel plane if required. This reformatted information is then projected into the optics of the operating microscope using a miniature cathode ray tube and a beam splitter. The operating surgeon sees the CT information (such as a tumor boundary) superimposed upon the operating field in proper position, orientation, and scale.

The Role of Haptics in Medical Training Simulators: A Survey of the State of the Art

2010-04-28

Timothy R. Coles , Dwight Meglan , Nigel W. John

This review paper discusses the role of haptics within virtual medical training applications, particularly, where it can be used to aid a practitioner to learn and practice a task. The … This review paper discusses the role of haptics within virtual medical training applications, particularly, where it can be used to aid a practitioner to learn and practice a task. The review summarizes aspects to be considered in the deployment of haptics technologies in medical training. First, both force/torque and tactile feedback hardware solutions that are currently produced commercially and in academia are reviewed, followed by the available haptics-related software and then an in-depth analysis of medical training simulations that include haptic feedback. The review is summarized with scrutiny of emerging technologies and discusses future directions in the field.

A global assessment tool for evaluation of intraoperative laparoscopic skills

2005-06-21

Melina C. Vassiliou , Liane S. Feldman , Christopher G. Andrew +4 more

Fundamentals of Laparoscopic Surgery simulator training to proficiency improves laparoscopic performance in the operating room—a randomized controlled trial

2009-12-18

Gideon Sroka , Liane S. Feldman , Melina C. Vassiliou +3 more

Minimally Invasive and Robotic Surgery

2001-02-07

Michael J. Mack

Advances in surgery have focused on minimizing the invasiveness of surgical procedures, such that a significant paradigm shift has occurred for some procedures in which surgeons no longer directly touch … Advances in surgery have focused on minimizing the invasiveness of surgical procedures, such that a significant paradigm shift has occurred for some procedures in which surgeons no longer directly touch or see the structures on which they operate. Advancements in video imaging, endoscope technology, and instrumentation have made it possible to convert many procedures in many surgical specialties from open surgeries to endoscopic ones. The use of computers and robotics promises to facilitate complex endoscopic procedures by virtue of voice control over the networked operating room, enhancement of dexterity to facilitate microscale operations, and development of virtual simulator trainers to enhance the ability to learn new complex operations. Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.

Robotic technology in surgery: Past, present, and future

2004-10-01

David B. Camarillo , Thomas M. Krummel , J. Kenneth Salisbury

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Simulation Technology for Health Care Professional Skills Training and Assessment

1999-09-01

S. Barry Issenberg

Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology … Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos

2016-07-22

Andru Putra Twinanda , Sherif Shehata , Didier Mutter +3 more

Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, … Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, surgical phase recognition has been studied in the context of several kinds of surgeries, such as cataract, neurological, and laparoscopic surgeries. In the literature, two types of features are typically used to perform this task: visual features and tool usage signals. However, the used visual features are mostly handcrafted. Furthermore, the tool usage signals are usually collected via a manual annotation process or by using additional equipment. In this paper, we propose a novel method for phase recognition that uses a convolutional neural network (CNN) to automatically learn features from cholecystectomy videos and that relies uniquely on visual information. In previous studies, it has been shown that the tool usage signals can provide valuable information in performing the phase recognition task. Thus, we present a novel CNN architecture, called EndoNet, that is designed to carry out the phase recognition and tool presence detection tasks in a multi-task manner. To the best of our knowledge, this is the first work proposing to use a CNN for multiple recognition tasks on laparoscopic videos. Experimental comparisons to other methods show that EndoNet yields state-of-the-art results for both tasks.

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Systematic review on the effectiveness of augmented reality applications in medical training

2016-02-23

Esther Z. Barsom , Maurits Graafland , Marlies P. Schijven

Surgical data science for next-generation interventions

2017-09-11

Lena Maier‐Hein , S. Swaroop Vedula , Stefanie Speidel +7 more

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Medicine Meets Virtual Reality 14

2005-10-11

Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic

2020-04-03

Robert C. Chick , Guy T. Clifton , Kaitlin M. Peace +4 more

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Assessment of face and content validity of performance metrics for basic robotic surgery skills PBP curriculum: a J-ERUS/YAU consensus on dry-lab training models

2025-06-25

Gabriele Sorce , Marco Paciotti , Christoph Würnschimmel +7 more | Journal of Robotic Surgery

Optimising ergonomics in minimally invasive gynaecological surgery: a comprehensive review and practice recommendations

2025-06-24

Dimitrios Balafoutas , Ralf Joukhadar , Nikolaos Vlahos | Facts Views and Vision in ObGyn

Modern minimally invasive gynaecological surgery greatly contributes to women's health; however, it can be physically demanding for surgeons. A plethora of available data shows that the optimisation of ergonomics in … Modern minimally invasive gynaecological surgery greatly contributes to women's health; however, it can be physically demanding for surgeons. A plethora of available data shows that the optimisation of ergonomics in the operating room (OR) is crucial for the health and efficiency of surgeons. To provide an overview of the importance of ergonomics and clinically useful, concise recommendations. A literature review with critical analysis of available data. Impact of ergonomics on the prevalence of musculoskeletal disorders (MSDs), fatigue levels, efficiency and subjective comfort among surgeons. Evidence suggests that MSDs are highly prevalent among minimally invasive gynaecological surgeons and that several ergonomic interventions can greatly reduce muscle strain and improve clinical practice, with the most important being the planning of brief intraoperative breaks, the selection of proper laparoscopic instruments and the positioning of the operating table and monitor at the correct height. The adoption of robotic surgery can also improve surgical ergonomics. Clinical practice recommendations for ergonomic improvement in gynaecological laparoscopy based on the existing evidence are provided. Surgeons must be aware of the optimal ergonomic settings in the OR and impose measures to reduce risks and achieve a comfortable environment. A comprehensive, praxis-oriented review with exact ergonomic advice for minimally invasive gynaecological surgeons.

Breaking Barriers: A Cost-Free Digital Workflow for Virtual Surgical Planning in Orthognathic Surgery

2025-06-24

Ricardo Grillo , Leite Neto , Mariana Aparecida Brozoski +1 more | International Journal of Oral and Maxillofacial Surgery

Deep Learning for Improved Soft Tissue Simulation in Orthognathic Surgery Planning

2025-06-24

Bo Berends , Freek Bielevelt , Frank Baan +4 more | International Journal of Oral and Maxillofacial Surgery

Computer-based Tracking of Microsurgical Instruments – A Novel Assessment Tool for Robotic-assisted and Conventional Microsurgery

2025-06-24

Viola A. Stögner , Kai J. Wessel , Xinyi Xie +7 more | Plastic & Reconstructive Surgery

Background: Efficient and objective tools for self-assessment of microsurgical skills are needed to ensure both proper microsurgical training as well as optimized management of surgeons’ time and resources. In addition, … Background: Efficient and objective tools for self-assessment of microsurgical skills are needed to ensure both proper microsurgical training as well as optimized management of surgeons’ time and resources. In addition, the broad clinical integration of microsurgical robots in operating rooms will strongly depend on efficient training and evaluation plans for microsurgeons, thus, requiring usability and validation of such assessment tools for both conventional and robotic-assisted microsurgery. Methods: Two deep convolutional neural network-based computer algorithms were developed to facilitate computer-assisted tracking of conventional and robotic microsurgical instruments. To train these models, supervised and semi-supervised learning was applied to a total of 84 microsurgical training videos and results statistically analyzed (t-test, ANOVA, linear regression, correlation). Results: Computer algorithms that automatically track conventional and robotic microinstruments in recorded microsurgical training videos were successfully developed. The outcome parameter total trajectory length positively correlated with procedure time and Structured Assessment of Microsurgical Skill results, evaluating operative efficiency and flow. Both procedure time and total trajectory length of robotic-assisted procedures were significantly longer in more experienced microsurgeons when compared to the conventional approach, but not in microsurgical beginners. The mean measured deviation intensity , which quantifies hand tremor throughout a microsurgical performance, was significantly reduced with the robotic-assisted compared to the conventional microsurgical approach, which was consistent throughout all user groups. Conclusions: The developed computer algorithms fill crucial gaps for the provision of more accessible, efficient and objective self-assessment in microsurgery, while for the first time also allowing for direct comparison of robotic-assisted and conventional microsurgical performances.

Comment on “Development and Validation of a Hybrid Simulation Model for Septoplasty Training”

2025-06-24

Hinpetch Daungsupawong , Viroj Wiwanitkit | Annals of Otology Rhinology & Laryngology

Unusual Cases in Orthognathic Surgery: Why 3D Virtual Surgical Planning Really Makes the Difference

2025-06-24

Giuliano Audino , B. Mattioli , S. Gangale +1 more | International Journal of Oral and Maxillofacial Surgery

Milled Surgical Guides as a Tool for Increasing the Precision of Static Navigation

2025-06-24

N. Redko , A. Drobyshev , D. Vaulina +4 more | International Journal of Oral and Maxillofacial Surgery

Letter to editor: development and application of an intelligent platform for automated recognition of surgical instruments in laparoscopic procedures: a multicenter retrospective study

2025-06-23

Ping Zhao , Hao Sun , Qianqian Han | International Journal of Surgery

Enhancing Surgical Precision: A Systematic Review of Wearable Medical Devices for Assisted Surgery

2025-06-23

Houneida Sakly , Ramzi Guetari , Naoufel Kraïem +2 more | Journal of Medical Systems

Medical students’ attitude toward robotic surgery: time to revise medical school curricula?

2025-06-22

Antonio Gangemi , Paolo Maria Russo , Lisa Argnani +7 more | Journal of Robotic Surgery

Interventions to Improve Nontechnical Skills in Surgery: A Systematic Review And Meta-Analysis

2025-06-21

Jesse D. Ey , Ellie Treloar , Victoria Kollias +6 more | Journal of surgical education

Many surgical adverse events are due to failures in nontechnical skills. Improving nontechnical skills has become a priority for surgical training organizations, yet there is little evidence to guide improvement … Many surgical adverse events are due to failures in nontechnical skills. Improving nontechnical skills has become a priority for surgical training organizations, yet there is little evidence to guide improvement activities. aim of this review was to investigate the effectiveness of interventions to improve surgeon nontechnical skills overall and by individual domains. A systematic search of Embase, Med-line (including PubMed), and PsycINFO were conducted using a predefined search strategy. Randomized controlled trials (RCTs), non-RCTs, and pre vs post intervention cohort studies from data-base inception to February 3, 2025, reporting change in surgeon nontechnical skills in the context of an improvement intervention were included. Two independent reviewers screened all articles first by title and abstract, then by full text. All disagreements were resolved by a third independent reviewer. Data was extracted by 2 independent reviewers in accordance with a predefined data extraction template in accordance with both PRISMA and MOOSE guidelines. Any disagreements were resolved by a third reviewer. Data was pooled using a random-effects model. Main outcome for meta-analysis was change in overall nontechnical skills measured either pre vs post intervention or control vs intervention. Secondary outcomes included change in nontechnical skill domains explored through narrative review. About 2682 studies were identified, after screening 65 were included comprised of 20 RCT's and 45 non-RCT's. Meta analysis demonstrated statistically significant association between nontechnical skill improvement and 4 intervention types: practice with debrief/feedback (SMD:1.80, 95%CI: 1.18,2.41), coaching (SMD:0.82, 95%CI: 0.25,1.40), checklists/standardized procedures (SMD:0.53, 95%CI: 0.12, 0.94), and didactic/workshop (SMD:1.26, 95%CI:0.49,2.04). Practice with debrief/feedback, coaching, and curriculum interventions demonstrated a trend towards improving individual NTS domains. The results of this meta-analysis provide evidence of the effectiveness of several intervention types to improve surgical nontechnical skill both overall and by individual domain. These effective interventions can be used to guide future non- technical skill improvement activities in real-world surgical settings.

A mixed-method survey study evaluating two robotic surgical training courses in Germany

2025-06-21

Sjaak Pouwels , Beniamino Pascotto , Rodolfo J. Oviedo +7 more | Journal of Robotic Surgery

Reshaping neurosurgical training: a novel simulation-based concept for structured skill acquisition and curriculum integration

2025-06-20

Belal Neyazi , Amir Amini , Vanessa M. Swiatek +3 more | Neurosurgical Review

Simuladores sintéticos de baixo custo no ensino de Cirurgia Plástica para estudantes de Medicina

2025-06-20

Artur Diógenes Vasques Farias , Ivens Rafael Resplande de Sá , Leticia Libório Santos +2 more | Revista Brasileira de Cirurgia Plástica

Resumo A simulação realística em educação médica permite adquirir experiência prática em cenários clínicos complexos, promovendo um aprendizado significativo e seguro. É uma estratégia importante para o ensino de habilidades … Resumo A simulação realística em educação médica permite adquirir experiência prática em cenários clínicos complexos, promovendo um aprendizado significativo e seguro. É uma estratégia importante para o ensino de habilidades cirúrgicas, área crítica para médicos recém-formados. Avaliar a efetividade de modelos sintéticos de baixo custo na aprendizagem de habilidades cirúrgicas por estudantes de Medicina em ações realizadas pela Liga Acadêmica de Cirurgia Plástica (LICIP) da Universidade de Fortaleza, Ceará. Trata-se de um estudo transversal descritivo, envolvendo estudantes de Medicina que participaram de um curso de treinamento de habilidades cirúrgicas promovido pela LICIP. O curso incluiu 40 horas de treinamento, divididas entre aulas teóricas virtuais e práticas com os modelos sintéticos. Os modelos foram produzidos pela Liga com materiais acessíveis e avaliados por professores e cirurgiões. A opinião sobre a efetividade de seu uso para a aprendizagem foi avaliada através de um questionário virtual autoaplicável. Dos 50 participantes, 68% nunca haviam tido contato com simuladores cirúrgicos antes. Após as aulas teóricas somente, a maioria avaliou seu conhecimento sobre técnicas cirúrgicas como insuficiente. Após o treinamento prático, 88% avaliaram seus conhecimentos como altos. Todos relataram que a prática com modelos aumentou seu interesse por cirurgia. A utilização de simuladores de baixo custo mostrou-se viável, econômica e efetiva para o treinamento cirúrgico de estudantes de Medicina, melhorando significativamente a retenção de conhecimento, a aquisição de habilidades práticas e a confiança dos alunos em realizar procedimentos cirúrgicos.

Prediction of surgery start for automated anesthesia using draping detection from surveillance videos

2025-06-20

Akihiko Ito , Sho Mitarai , Kazumasa Kishimoto +5 more | Journal of Clinical Monitoring and Computing

Abstract One of the primary goals of automated anesthesia is to reduce human intervention and reduce the workload of anesthesiologists. However, switching modes before the start of surgery still requires … Abstract One of the primary goals of automated anesthesia is to reduce human intervention and reduce the workload of anesthesiologists. However, switching modes before the start of surgery still requires manual operation. The present study aims to develop a system that predicts the start of surgery by analyzing the actions of medical staff in the operating room using surveillance camera footage, thereby enabling automated mode transitions in anesthesia systems. We analyzed 110 surveillance videos of elective laparoscopic surgeries at Kyoto University Hospital. Key medical staff actions to predict the start of surgery were identified, and the time intervals between each action and skin incision were recorded. We then developed a detection system to identify draping, the best key action, and evaluated it by comparing system-detected draping times with manually annotated times in 96 videos. Five key actions were identified: hand washing, sterilization, light activation, bed cradle set-up, and draping. The start of draping had the shortest median time interval to the skin incision (7.71 min, interquartile range: 5.89–9.72), which was significantly shorter than that of the other actions ( p < 0.05), and also had the shortest interquartile range. In the system evaluation, the median time error for detecting draping was 19.0 s (interquartile range: 16.0–50.0). The start of draping is a reliable predictor of the start of surgery, and the draping detection system demonstrated high accuracy. These results support advances in anticipatory automated anesthesia systems, enhancing workflow efficiency and patient safety in the operating room.

The rise of robotics and AI-assisted surgery in modern healthcare

2025-06-20

Jack Ng Kok Wah | Journal of Robotic Surgery

Abstract The integration of robotics and artificial intelligence (AI) in surgery represents a transformative advancement in modern healthcare, promising enhanced precision, efficiency, and patient outcomes. Recent studies indicate a rapid … Abstract The integration of robotics and artificial intelligence (AI) in surgery represents a transformative advancement in modern healthcare, promising enhanced precision, efficiency, and patient outcomes. Recent studies indicate a rapid adoption of AI-assisted robotic surgery across various surgical specialties, driven by improvements in accuracy and reduced complication rates. The research synthesizes findings from 25 recent peer-reviewed studies (2024–2025) on AI-driven robotic surgery. Systematic review and meta-analyses were conducted focusing on clinical efficacy, surgical precision, complication rates, and economic impacts. Quantitative data were extracted from retrospective trials, cohort studies, and systematic reviews to evaluate outcomes compared to manual surgical techniques. AI-assisted robotic surgeries demonstrated a 25% reduction in operative time and a 30% decrease in intraoperative complications compared to manual methods. Surgical precision improved by 40%, reflected in enhanced targeting accuracy during tumor resections and implant placements. Patient recovery times were shortened by an average of 15%, with lower postoperative pain scores. Additionally, studies reported an average 20% increase in surgeon workflow efficiency and a 10% reduction in healthcare costs over the conventional procedures. AI-enhanced robotic surgery significantly improves surgical outcomes through higher precision and efficiency, supporting widespread clinical adoption. Despite upfront costs and ethical concerns, continued innovation and integration promise substantial benefits for patient safety and healthcare resource optimization. Future research should focus on long-term patient outcomes and addressing ethical and training challenges.

High superficial resemblance versus high functional task alignment simulation for central venous catheterization training: A randomized crossover trial

2025-06-19

Ibrahim Gomaa , Rosa Anna Chorro , Andrés Climent +7 more | Surgery

Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation

2025-06-19

Sepehr Janghorbani , Victoria Weprinsky , Alexandre Caprio +2 more | Surgeries

Background: Transcervical radiofrequency ablation (TRFA), particularly using the SONATA® System, is a minimally invasive and uterus-preserving treatment for uterine fibroids. While effective, its reliance on intrauterine ultrasound (IUS) with limited … Background: Transcervical radiofrequency ablation (TRFA), particularly using the SONATA® System, is a minimally invasive and uterus-preserving treatment for uterine fibroids. While effective, its reliance on intrauterine ultrasound (IUS) with limited 2D visualization can present challenges, especially for trainees who must mentally reconstruct 3D anatomy in real-time from traditional radiology reports. Objective: This study explores the benefits of using 3D Smart MRI technology in improving procedural accuracy and user experience during simulated TRFA procedures performed by OB/GYN residents. Methods: In a randomized human subject study, 14 OB/GYN residents performed mock TRFA procedures on silicone uterine phantom models embedded with fibroids. The control group received standard written MRI reports, while the intervention group used the Smart MRI 3D visualization tool. We assessed quantitative outcomes including procedure time and fibroid miss rate. Additionally, participants completed post-procedure user experience questionnaires to assess the perceived utility and ease of use of the 3D tool. Results: While procedure time did not differ significantly between groups, there was a notable reduction in the miss rate for one of the fibroids (17% vs. 75%). Residents using Smart MRI reported higher confidence in identifying and treating all fibroids (83% vs. 43%) and rated their spatial understanding significantly higher on Likert-scale assessments (4.6 vs. 3.25). The technology also received high scores for its impact on clinical decision-making (4.8) and intraoperative efficiency (4.5). Conclusions: Overall, this study indicated that the use of 3D Smart MRI was well-received by residents, who reported enhanced intraoperative performance, including greater confidence, more informed decision-making, and improved procedural efficiency. Moreover, the notably lower miss rate observed in the Smart MRI group points to the tool’s potential in improving the detection and treatment of fibroids that may be missed otherwise.

Augmented Reality for Identification of Temporal Bone Anatomy and Comparison to Conventional Imaging

2025-06-19

Bijoy Shah , Wanxin Xu , Ryan A. Bartholomew +7 more | Annals of Otology Rhinology & Laryngology

Objective: To design and validate an augmented reality application for identification of temporal bone anatomy. Background: The anatomy of the temporal bone is highly complex and can present challenges for … Objective: To design and validate an augmented reality application for identification of temporal bone anatomy. Background: The anatomy of the temporal bone is highly complex and can present challenges for operative planning and for education of both patients and medical trainees. Methods: An augmented reality application for visualization and identification of temporal bone anatomy in 3D was developed using Slicer, OpenGL, and Angle libraries on the Augmented Reality on Microsoft HoloLens (AR-MH). A total of 14 physicians, including 7 otolaryngologists (4 trainees and 3 attendings) and 7 radiologists (4 trainees and 3 attendings), participated in this study to visualize temporal bone structures using 2D CT imaging, 3D CT model visualization on a monitor, and AR-MH. Quantitative metrics to compare the users’ performance between modalities included time taken to identify structures, accuracy of identification, and the NASA Task Load Index. Results: The rendering rate for individual models was 60 fps, excluding the temporal bone model. The mean time for participants to identify 16 structures was 3:04 minutes on 2D, 2:02 minutes on 3D, and 2:09 minutes on AR-MH. The adjusted accuracy of identifying structures was 89.0% on 2D, 93.2% on 3D, and 91.6% on AR-MH. Mean NASA-TLX values showed no significant difference in workload metrics between modalities. Visualization of anatomy in 3D (either on a monitor or via AR-MH) resulted in greater speed and accuracy of anatomy identification for trainees but not attendings. Conclusion: Augmented reality provides a means of intuitively visualizing temporal bone anatomy which may function as an effective tool for surgical planning and education, particularly for novices.

Critical appraisal of “Multi‑perspective analysis of daVinci surgical virtual reality training: a prospective randomized controlled study”

2025-06-19

Mansoor Iqbal , M.R. Syed , Muhammad Abdul Haseeb Khan +2 more | Journal of Robotic Surgery

Revolutionizing Surgical Education: Integrating Virtual Reality-Based Simulation to Enhance Competency in Junior Surgeons

2025-06-18

Swapnil Tripathi , Apurba Ray , Tanya Dhawan +2 more | Cureus

Continuous curvilinear capsulorhexis training models for medical students: who might they benefit the most?

2025-06-18

Léa Dormegny , Younes Byfili , Rémi Yaïci +7 more | Research Square (Research Square)

<title>Abstract</title> <bold>Introduction:</bold> Ophthalmology simulation training enhances medical student microsurgery performance and confidence. Training efficacy may vary based on student characteristics. This study compared continuous curvilinear capsulorhexis (CCC) performance after guided … <title>Abstract</title> <bold>Introduction:</bold> Ophthalmology simulation training enhances medical student microsurgery performance and confidence. Training efficacy may vary based on student characteristics. This study compared continuous curvilinear capsulorhexis (CCC) performance after guided simulation training (EyeSi, HelpMeSee, or synthetic eye) in medical students with different baseline surgical levels and intended specialties. <bold>Methods:</bold> Thirty medical students were allocated to low (score <19/36 points) or high (≥19/36) baseline CCC performance group according to their performance on synthetic eye model. All followed simulation training on EyeSi (n=10), or HelpMeSee (n=10), or a synthetic eye model (n=10), according to inclusion order. Post-training CCC performance was assessed on the synthetic eye. Pre- and post-training questionnaires recorded participants’ intended choice of specialty and confidence in microsurgery. The modification of CCC score and confidence after simulation training was compared between the two groups. <bold>Results:</bold> CCC performance score and confidence improved post-training for all participants (p <0.001). Performance improvement was higher in the low baseline group (p=0.026), while confidence improvement did not differ between groups. Initial intended specialty choices (medical vs. surgical) varied significantly between groups (low baseline: 73% vs. 18%; high baseline: 32% vs. 63%; p=0.018) and remained unchanged after training. <bold>Discussion:</bold> Simulation training benefits students struggling with surgical skills. However, it may not solely determine interest in surgical careers. <bold>Conclusion:</bold> Simulation training effectively enhances surgical gesture performance in students with lower initial skills. While these programs may not directly influence students’ career choice, they could identify a potential aptitude for surgery and guide students towards exploring surgical career paths.

Exploring the impact of virtual reality on education, surgical planning, and interdisciplinary collaboration for clinicians in head and neck oncology

2025-06-18

Antoine Dubray‐Vautrin , Maria Lesnik , Joey Martin +2 more | Oral Oncology

Virtual reality (VR) technologies are transforming the landscape of oncology, particularly in the education and surgical planning of head and neck cancers. We conducted a narrative literature review using Scopus®, … Virtual reality (VR) technologies are transforming the landscape of oncology, particularly in the education and surgical planning of head and neck cancers. We conducted a narrative literature review using Scopus®, PubMed® to identify relevant studies enhancing surgical training, therapeutic planning, and interdisciplinary collaboration. Our findings reveal that VR provides immersive learning environments that significantly improve surgical skill development, including hand-eye coordination in procedures like ear surgeries. Moreover, VR facilitates the visualization of complex anatomical structures and vascular anatomy, aiding in preoperative tumor contouring and flap design for reconstructive surgery. The integration of VR with 3D printing allows for the creation of patient-specific models, enhancing preoperative planning by accurately representing tumors and surrounding tissues. Additionally, VR enhances collaborative decision-making in tumor boards by enabling multidisciplinary teams to visualize medical images in a shared virtual space. Despite its potential, further research is needed to assess the full impact of VR technologies on surgical outcomes and educational efficacy in head and neck oncology decision making. This review underscores the importance of continued exploration into VR applications to optimize patient care and improve training methodologies in surgical practices.

Correction: Measures of performance and proficiency in robotic assisted surgery: a systematic review

2025-06-18

Charlotte El‐Sayed , Andrew Yiu , Josh Burke +7 more | Journal of Robotic Surgery

Understanding and acceptance of open, laparoscopic, and robotic surgery among nursing students: implications for educational curricula based on a mixed-methods study

2025-06-18

Esra Özkan , Askeri Çankaya , Hatice Özsoy | Journal of Robotic Surgery

Robotic Surgery: Navigating the Frontier Between Technological Progress and Ethical Inquiries

2025-06-17

Farough Bahramiazar | Journal of Medical Research and Surgery

Robotic surgery has evolved as a state-of-the-art development in the field of medicine, altering traditional surgical methods. This article explores the increasing use of robotics in the field of surgery … Robotic surgery has evolved as a state-of-the-art development in the field of medicine, altering traditional surgical methods. This article explores the increasing use of robotics in the field of surgery and carefully analyzes the several complex factors related to this revolutionary technology. The conversation delves into the challenges concerning patient safety, cost-effectiveness, surgeon skill needs, and the broader ethical implications of automating surgical processes, while exploring the nexus of innovation and ethics. This essay seeks to thoroughly examine the consequences of robotic surgery in order to determine whether this technological advancement signifies significant progress or poses ethical challenges in the field of modern healthcare. This article examines the rapid increase in the use of robotic surgery, evaluating its effects on patient safety, cost efficiency, surgeon proficiency, and ethical implications. By highlighting the progress in technology, it also examines the difficulties surrounding these developments, raising important inquiries about the ethical consequences of automating surgical procedures. This investigation seeks to determine whether robotic surgery represents a groundbreaking advancement or presents an ethical dilemma in contemporary healthcare.

Recurrent multi-view 6DoF pose estimation for marker-less surgical tool tracking

2025-06-17

Niklas Agethen , Janis Roßkamp , Tom L. Koller +2 more | International Journal of Computer Assisted Radiology and Surgery

Smartphone-Based Augmented Reality Applications for Percutaneous Procedures: A Pragmatic Step Toward Clinical Use

2025-06-17

Uli Fehrenbach | CardioVascular and Interventional Radiology

Automatic Virtual‐to‐real Calibration and Dynamic Registration of Deformable Tissue for Endoscopic Submucosal Dissection

2025-06-17

Y. F. Wang , Huxin Gao , An Wang +1 more | Advanced Intelligent Systems

During endoscopic submucosal dissection, precise and intuitive sensing of target tissues enhances surgical accuracy. Augmented reality (AR) technology currently offers a solution to provide intuitive guidance. To enhance the AR … During endoscopic submucosal dissection, precise and intuitive sensing of target tissues enhances surgical accuracy. Augmented reality (AR) technology currently offers a solution to provide intuitive guidance. To enhance the AR user experience, an automated method for calibrating and dynamically registering deformable tissues is proposed. First, an automatic calibration method is proposed to help register the target tissue from the virtual to the real world. The calibration method is based on a 6D pose estimator, which is built on the feature‐matching network, SuperGlue and the depth estimation network, Metric3D. Subsequently, a dynamic registration method is proposed to track the deformation of the target tissue in real‐time. Moreover, a piece of cloth is utilized for four automatic calibration trials, resulting in a mean absolute error (MAE) of calibration accuracy at 3.79 ± 0.64 mm. The dynamic registration accuracy is also assessed by varying the deformation of the target, yielding an MAE of 6.03 ± 0.96 mm. Finally, an ex vivo experiment involving a piece of small intestine is conducted to validate the effectiveness of the proposed system, with an MAE of 3.11 ± 0.56 mm for AR calibration and 3.20 ± 1.96 mm for dynamic registration error.

Explainable Machine Learning Using EMG and Accelerometer Sensor Data to Quantify Surgical Skill: Identification of Biomarkers of Expertise

2025-06-17

Rahul Soangra , Alamgir Hossain , Jay Sonagra +1 more | Research Square (Research Square)

<title>Abstract</title> Traditional evaluations of surgical skill rely heavily on subjective assessments, limiting precision and scalability in modern surgical education. With the emergence of robotic platforms and simulation-based training, there is … <title>Abstract</title> Traditional evaluations of surgical skill rely heavily on subjective assessments, limiting precision and scalability in modern surgical education. With the emergence of robotic platforms and simulation-based training, there is a pressing need for objective, interpretable, and scalable tools to assess technical proficiency in surgery. This study introduces an explainable machine learning (XAI) framework using surface electromyography (sEMG) and accelerometer data to classify surgeon skill levels and uncover actionable neuromuscular biomarkers of expertise. Twenty-six participants, including novices, residents, and expert urologists, performed standardized robotic tasks (suturing, knot tying, and peg transfers) while sEMG and motion data were recorded from 12 upper-extremity muscle sites using Delsys® Trigno™ wireless sensors. Time- and frequency-domain features, along with nonlinear dynamical measures such as Lyapunov exponents, entropy, and fractal dimensions, were extracted and fed into multiple supervised machine learning classifiers (SVM, Random Forest, XGBoost, Naïve Bayes). Classification performance was evaluated using accuracy, F1-score, MCC, and AUC. To ensure interpretability, SHAP and LIME were employed to identify and visualize key features distinguishing skill levels. Ensemble models (XGBoost and Random Forest) outperformed others, achieving classification accuracies above 72%, with high F1-scores for all classes. Nonlinear features, particularly Mean_Long_Lyapunov exponent, Correlation Dimension, Approximate Entropy, and Hurst exponent, consistently ranked among the top predictors. Expert surgeons exhibited higher movement complexity and temporal consistency, reflected in higher entropy and correlation dimension, and lower Lyapunov exponents compared to novices. XAI methods revealed that different classes were driven by distinct feature sets: entropy measures best identified novice patterns, while fractal and stability features were more predictive of expert performance. SHAP and LIME enabled both global and instance-specific interpretation of classifier decisions, enhancing transparency and enabling targeted feedback. This study demonstrates the feasibility and utility of combining multimodal wearable sensor data with explainable machine learning to assess robotic surgical skill. The identified biomarkers capture nuanced aspects of motor control—such as adaptability, complexity, and stability—that distinguish novice, intermediate, and expert surgeons. Beyond classification, the explainable framework offers interpretable insights into why specific skill levels were assigned, providing a pathway for personalized surgical feedback and training. This approach advances the development of objective, transparent, and clinically meaningful assessment tools in surgical education.

Virtual Reality in Preclinical Orthognathic Surgery Education for Dental Students

2025-06-17

Hanghang Liu , Zhaokun Zhu , Liwei Huang +5 more | European Journal Of Dental Education

ABSTRACT Purpose Orthognathic surgery is a complex and critical field within oral and maxillofacial surgery, necessitating extensive training and precise knowledge. Traditional educational methods have been supplemented with advanced technologies, … ABSTRACT Purpose Orthognathic surgery is a complex and critical field within oral and maxillofacial surgery, necessitating extensive training and precise knowledge. Traditional educational methods have been supplemented with advanced technologies, such as virtual reality (VR), to enhance learning outcomes. This study aims to evaluate the effectiveness of VR‐based preclinical training compared to traditional training methods among fifth‐year dental students (undergraduates). Materials and Methods Twenty‐six participants with no prior experience in orthognathic surgery were randomly assigned to either a traditional training group or a VR training group. Both groups underwent a 2‐week preclinical training programme. Assessments conducted immediately after and 1 year following the training included professional knowledge evaluations, difficulty and effectiveness surveys and study burden assessments. Results The results indicated that the VR group outperformed the traditional group in both immediate (86.77 ± 5.00 vs. 78.62 ± 8.98, p = 0.0086) and long‐term knowledge assessments (80.71 ± 6.55 vs. 57.76 ± 13.55, p < 0.0001). Participants in the VR group reported higher confidence in understanding the steps of the procedure and lower perceived difficulty and workload. Discussion VR technology represents a significant advancement in the teaching of orthognathic surgery. VR‐based training can substantially improve the quality of dental education, providing valuable support for the training of future orthognathic surgeons. Conclusion These findings underscore the potential of VR technology to significantly improve educational outcomes in orthognathic surgery training, providing a more engaging and efficient learning experience.

Developing a deep learning-based surgical-skill assessment model focused on instrument handling in laparoscopic colorectal surgery

2025-06-17

Kei Nakajima , Shin Takenaka , Daichi Kitaguchi +5 more | European Journal of Surgical Oncology

A Survey on Twenty Years of Robotic Surgery in Italy: Evaluating Distribution, Bioetic Impact, and Future Directions.

2025-06-17

Francesco Guzzi , U G Falagario , Andrea Mari +7 more | PubMed

The Italian Society of Urology conducted a comprehensive survey across Italy's urology specialists to assess the prevalence and integration of robotic surgery in the country's medical landscape. The survey aimed … The Italian Society of Urology conducted a comprehensive survey across Italy's urology specialists to assess the prevalence and integration of robotic surgery in the country's medical landscape. The survey aimed to examine the diffusion and acceptance of robotic surgical platforms and to ascertain surgeons' preferences regarding the most frequently performed urological procedures. The Italian Society of Urology surveyed Italian urologists via SURVEYMONKEY. Emails were sent to society members and clinic heads, covering geographic location, robotic practices, and procedures. The 44-question survey, open from March to June 2023, gathered data on clinic location, equipment, cases, and techniques. Descriptive statistics were used, reporting median and inter-quartile range for continuous variables, and rates for categorical ones. Analysis included respondent characteristics, robotic surgery availability, applications, and technical modifications. Stata 16 conducted statistical analyses (StataCorp LP, College Station, TX, USA). The study included 339 urologists with varied institutional and professional backgrounds, investigating aspects like the availability of robotic technology, preferences in procedures, surgical methodologies, and training programs. Participants included 50% affiliated with university hospitals, 25% with non-university hospitals, and 25% with IRCCS institutions and accredited private hospitals. The survey showcased significant geographic diversity, receiving responses from urologists across all regions of Italy, with Lombardy being the most represented (19.7%), followed by Lazio (12.9%) and Veneto (11.2%). Notably, 93.7% of respondents associated robotic surgery with economic benefits, attributing to reduced hospital stays and increased facility attractiveness. Among urological procedures, robotic-assisted techniques were preferred for Radical Prostatectomies (88%), partial nephrectomy (87%), and pyeloplasty (79%), while cystectomies and radical nephrectomy were commonly performed using open or lap-aroscopic approaches. The survey findings highlight the widespread use and influence of robotic surgery in Italian urology, showcasing enhanced patient care but also indicating technique discrepancies and restricted access in certain facilities. Standardization, accessibility, and ongoing training are vital for maximizing robotic surgery's potential across specialties.

Integrating Artificial Intelligence and Virtual Reality in Orthopedic Surgery: A Comprehensive Review

2025-06-17

Robert Koucheki , Johnathan R. Lex , Michael Brock +1 more | HSS Journal® The Musculoskeletal Journal of Hospital for Special Surgery

Artificial intelligence (AI) and virtual reality (VR) are being used in orthopedic surgery, with goals of enhancing surgical precision, trainee education, patient engagement, and personalized surgical strategies. AI-based predictive modeling, … Artificial intelligence (AI) and virtual reality (VR) are being used in orthopedic surgery, with goals of enhancing surgical precision, trainee education, patient engagement, and personalized surgical strategies. AI-based predictive modeling, automated computer vision and image analytics, and robotic surgery are changing orthopedic preoperative planning and intraoperative decision-making, with the ultimate aim of improving postoperative outcomes through reduced variability in surgery. VR technologies are being used in orthopedic surgical simulations to provide safe environments for skill development in surgical trainees, helping them practice complex procedures before performing live surgeries. VR platforms are also being studied in-patient rehabilitation, focusing on interactive and gamified approaches that could enhance patients' adherence, recovery, and outcomes. Major pitfalls and challenges that need to be addressed include technical and logistical barriers, ethical concerns surrounding patient data privacy, and resistance to change among surgeons, trainees, and scientists. Improved infrastructure, standardized protocols, and further research to validate the long-term benefits will be imperative for the integration of AI and VR technologies into clinical and surgical workflows.

AngioSim: A Novel Augmented-Reality Angiography Simulator for Radiation-Free Neurointerventional Training

2025-06-16

Jan Minkenberg , S K Khandelwal , Ilya Digel +2 more | Applied Sciences

Cardiovascular diseases require fast and precise treatment, often involving angiography for diagnosis and intervention. However, training in angiographic procedures often entails exposure to ionizing radiation, which carries inherent risks. To … Cardiovascular diseases require fast and precise treatment, often involving angiography for diagnosis and intervention. However, training in angiographic procedures often entails exposure to ionizing radiation, which carries inherent risks. To reduce this exposure and enhance training realism, we developed AngioSim—a novel augmented-reality angiography simulation system combined with a vascular silicone simulator. This study evaluates the realism, effectiveness, and potential benefits of AngioSim for neurointerventional training. AngioSim was tested during neurointerventional training sessions with 24 physicians at RWTH Aachen University Hospital. Participants completed a questionnaire assessing realism, usefulness, and preferences compared to other simulators using a Likert scale. Responses were converted to binary categories and McNemar tests were applied for paired comparisons. A total of 92% of physicians rated guidewire and catheter visibility during fluoroscopy as sufficient, while 86% found RM and DSA simulations realistic. AngioSim was preferred over camera-based silicone simulators by 93%, and 96% of physicians rated it necessary for training—significantly more than other simulators (p < 0.05). These results demonstrate the high acceptance and perceived realism of the system and suggest that AngioSim offers advantages over existing training methods. AngioSim offers a realistic, cost-effective, and radiation-free training solution while maintaining the benefits of silicone models. It showed high utility for training purposes, making it a promising addition to neurointerventional programs.

Intravesical Injection of Bulking Agents: Validation of the Ghent University Hospital Porcine Teaching Model

2025-06-16

Caroline Jamaer , Manon De Loof , Jolien Van der Jeugt +7 more | European Urology Open Science

The real evolution: robotic surgery as a teaching tool, not a threat

2025-06-15

Zucchini Nicolas , Nagliati Carlo , Frederico Di Giovanni | Journal of Robotic Surgery

Research trends in virtual reality surgical simulation for education: a systematic review

2025-06-15

Changhyun Choi , Hongrae Kim , Dae Kyung Sohn | Daehan nae'si'gyeong bog'gang'gyeong oe'gwa haghoeji/Journal of minimally invasive surgery

Virtual reality (VR) has emerged as a transformative tool in surgical education, offering a controlled and repeatable training environment that mitigates ethical and legal challenges associated with traditional apprenticeship models. … Virtual reality (VR) has emerged as a transformative tool in surgical education, offering a controlled and repeatable training environment that mitigates ethical and legal challenges associated with traditional apprenticeship models. By simulating real-life surgical scenarios, VR allows trainees to practice procedures safely while improving skill acquisition and procedural efficiency. In this study, we systematically reviewed research trends in VR-based surgical education to provide insights into its current applications and future potential. A comprehensive literature search was conducted on PubMed, identifying 395 studies. Of these, 92 studies met predefined inclusion criteria and were selected for analysis. The selected studies were analyzed based on publication period, surgical procedure, medical specialty, country of origin, and outcome measures. Study findings revealed that research on VR surgical simulation peaked between 2005 and 2009, followed by a decline in recent years. Laparoscopic and endoscopic training were the most frequently studied procedures, with general surgery and gastroenterology being the most predominant specialties. The United States contributed the highest number of publications. Common outcome measures for evaluating VR training effectiveness included time, movement economy, subject evaluation, error rates, proficiency scales, and accuracy. These findings illustrate the historical trajectory and current landscape of VR use in surgical training. While the initial surge in interest has waned, VR remains a valuable tool for procedural skill development, particularly in laparoscopic and endoscopic training, and its future potential may depend on improvements in realism, cost-efficiency, and curriculum integration.

Design and implementation of modular laparoscopic general surgery models for surgical education

2025-06-15

Sung Hyun Kim , Sang Sik Cho , In Geol Ho +2 more | Daehan nae'si'gyeong bog'gang'gyeong oe'gwa haghoeji/Journal of minimally invasive surgery

Appendectomy, cholecystectomy, and inguinal herniorrhaphy are fundamental procedures in general surgery. These surgeries help trainees develop essential surgical skills, including technical proficiency and surgical planning. In this study, we aimed … Appendectomy, cholecystectomy, and inguinal herniorrhaphy are fundamental procedures in general surgery. These surgeries help trainees develop essential surgical skills, including technical proficiency and surgical planning. In this study, we aimed to design and produce modular laparoscopic surgical training models tailored to the needs of surgical education. Modular laparoscopic models for appendectomy, cholecystectomy, and inguinal herniorrhaphy were developed. The cholecystectomy and appendectomy models consisted of two components: a frame and a module, whereas the herniorrhaphy model included a pelvic cavity and peritoneum. A surgical resident with two years of laparoscopic experience at the Department of Surgery at Severance Hospital evaluated the simulators. The modular laparoscopic surgical training models developed in this study are cost-effective, realistic, and capable of precisely simulating surgical environments. These models provide an effective educational tool for enhancing surgical training.

Surgical ergonomics in urology

2025-06-14

Angus Luk , James L. Leighton , Ajaya Nand Jha | Journal of Clinical Urology

As urological procedures grow in complexity and service demands increase, the importance of ergonomics in urology has become increasingly evident. Work-related musculoskeletal disorders (WRMDs) pose a significant occupational hazard for … As urological procedures grow in complexity and service demands increase, the importance of ergonomics in urology has become increasingly evident. Work-related musculoskeletal disorders (WRMDs) pose a significant occupational hazard for urologists, with consequences extending beyond individual pain and injury to broader implications for surgical performance, workforce sustainability, and patient outcomes. Emerging data highlight an alarming prevalence of WRMDs among urologists, with some studies reporting that nearly 90% experience work-related pain annually. Common conditions include cervical and lumbar spine disease, rotator cuff injuries, and carpal tunnel syndrome, leading to absenteeism, procedural modifications, and, in some cases, early retirement. Ergonomics is the study of the relationship between humans and the systems in which they work, with the aim of optimising efficiency and reducing the risk of harm. This article introduces some core ergonomic principles and explores practical strategies urologists can adopt to improve workplace conditions across physical, cognitive, and organisational domains. While recognition of the importance of ergonomics in urology is growing, integration of ergonomic education into the training curriculum is essential to ensure widespread adoption of best practices. Systemic and organisational changes such as equipment design, workload optimisation, and improving workplace culture, are critical for achieving sustainable improvements in the well-being of urologists and reducing WRMD risk across the urological workforce. Level of evidence: Not applicable

Application of the Hugo™ RAS robotic system in general surgery: a scoping review

2025-06-14

Juan Manuel Romero , Ana Sánchez-Romero , Sandra González-Abós +6 more | Journal of Robotic Surgery

The use of simulators for oocyte collection and embryo transfer in medically assisted reproduction: A safe training to improve skills

2025-06-14

Luisa Marin , Giulia Garbin , Silvia Agusson +3 more | Journal of Gynecology Obstetrics and Human Reproduction

Automaticity of performance and the ability to anticipate adverse events are the characteristics that define an expert surgeon. Developing these skills requires not only procedural volume but also competency-based approaches. … Automaticity of performance and the ability to anticipate adverse events are the characteristics that define an expert surgeon. Developing these skills requires not only procedural volume but also competency-based approaches. Simulation-based training has emerged as an innovative solution, allowing trainees to refine their techniques before practicing on patients. In the field of reproductive endocrinology and infertility procedures such as oocyte retrieval and embryo transfer significantly impact clinical outcomes. This study aims to analyze skill acquisition in performing assisted reproductive technology procedures following two training sessions with high-fidelity simulators for both oocyte retrieval and embryo transfer. This prospective, single-center study was conducted at the IVF center of the University Hospital of Padua between May 1 and September 30, 2024. Thirty-four Ob/Gyn residents with no prior experience participated in the training sessions. For oocyte retrieval, data were collected on procedure duration, number of aspirated follicles, precision of follicle aspiration, and incidence of adverse events. For embryo transfer, parameters included procedure duration, embryo release position in the uterus, fundal touches, and release velocity of the embryo. Results showed significant improvements in efficiency, speed, and accuracy for both procedures. A notable reduction in surgical complications was observed during oocyte retrieval training. These findings confirm that simulator-based training is an effective and valuable tool and should be integrated into assisted reproductive technology training programs to enhance clinical competence and patient safety.

Building high-performing teams: Cultivating a culture of success in complex urological surgery

2025-06-14

Samuel Davies , Mohamed Hegazy , Francesco Del Giudice +1 more | Journal of Clinical Urology

The complexity of modern urological surgery demands excellence not only in individual technical skill but also in cohesive team performance. Complex surgical procedures such as retroperitoneal lymph node dissection (RPLND), … The complexity of modern urological surgery demands excellence not only in individual technical skill but also in cohesive team performance. Complex surgical procedures such as retroperitoneal lymph node dissection (RPLND), single kidney surgeries, and caval interventions represent some of the most challenging operations in the urological domain and indeed the wider surgical domain, with narrow margins for error and significant potential complications. Success in these high-stakes environments depends fundamentally on the cultivation of high-performing surgical teams that function as unified entities rather than collections of individuals. This paper examines the critical elements of building such teams for complex urological surgery, focusing on specific strategies and structures that foster excellence in the operating theatre. Level of evidence: Not applicable

Exploratory assessment of an endolaryngeal surgical model with a novel hyperangulated 3D printed laryngoscope

2025-06-14

Viola D. Hahn , Gabriel L Gschwend , Linus L. Kienle +5 more | European Archives of Oto-Rhino-Laryngology

Determining the metrics of competence in robotic hysterectomy: a systematic review

2025-06-13

Kayla Arcamo , Sita Murugappan , Kirsten Larkins +5 more | Journal of Robotic Surgery

Embedding mental rehearsal in surgery: a comprehensive review of the evidence

2025-06-13

Josephine Walshaw , Bright Huo , Paul Barach +7 more | Frontiers in Surgery

Background Mental rehearsal (MR), the deliberate practice of skills specific to a procedure, has been successfully used in sports and music training for decades, but has not been adopted in … Background Mental rehearsal (MR), the deliberate practice of skills specific to a procedure, has been successfully used in sports and music training for decades, but has not been adopted in surgery. This narrative review explores MR's role in surgical training and clinical practice, evaluating its effectiveness in motor skill acquisition, technical and non-technical skill development, and real world clinical implementation. Our aim was to assess MR's impact on both surgical education and clinical performance, while identifying the barriers to its routine adoption in surgical training. Methods We searched for relevant studies on the topic and impacts of MR in surgery using the Medline database up to December 2024. A range of studies were included covering mental rehearsal, surgical education, surgical training, and surgical outcomes. The primary outcomes were to provide insights into the mechanisms and implementation of MR in surgery and to assess the potential impact of MR on surgical outcomes. Results The narrative review provides scientific insights into the mechanisms of MR in surgery and describes in detail the implementation methodology. The majority of evidence demonstrates that MR is beneficial when used as an adjunct approach to other forms of training. Moreover, there is evidence to support MR as a low-cost and valuable learning technique. Many questions remain regarding training schedules including the optimal duration and nature of the MR sessions, accommodating the surgeon's prior experience, optimal number of repetitions, and addressing the abilities of the participants to perform mental imagery. Most studies have heterogenous methods, diffuse aims and poor descriptions of the specific intervention components. Several studies applied MR in demanding real-life surgical environments and demonstrated feasibility in surgery. Conclusions The preliminary findings suggest that MR may improve the performance of operators and operating teams as an efficient adjuvant to traditional surgical skills training methods. More work is needed to better understand how MR interventions can best be implemented to improve training, practice, and outcomes in routine surgical practice.

A national study of neurosurgical residency competency development

2025-06-01

Syed Khalid , Ankit I. Mehta , Gursant Atwal +3 more | PubMed

OBJECTIVE The aim of this study was to evaluate milestone progression across 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies and 20 subcompetencies among neurosurgery residents, focusing on … OBJECTIVE The aim of this study was to evaluate milestone progression across 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies and 20 subcompetencies among neurosurgery residents, focusing on the attainment of level 4 proficiency by the final postgraduate year (PGY 7), and to identify patterns of co-occurring deficiencies. METHODS A retrospective cohort analysis was conducted using national ACGME Milestone data from 2478 neurosurgery residents across 120 programs in the United States, covering 2018 to June 2022 evaluations. Semiannual milestone scores were analyzed using mean, standard deviation, median, and interquartile range. The proportion of residents not achieving level 4 by PGY 7 was assessed, and co-occurring deficiencies were identified through pairwise analysis and the variance-to-mean ratio (VMR). RESULTS Residents demonstrated significant progression from PGY 1 to PGY 7, with mean scores increasing from 1.2–1.7 in PGY 1 to 4.20–4.36 by PGY 7. By PGY 7, 445 of 997 residents (44.6%) had not achieved level 4 in at least one subcompetency. Patient Care (PC) had the highest proportion below level 4 (35.5%), particularly in specialized areas such as Surgical Treatment of Epilepsy and Movement Disorders (mean 4.08 ± 0.48) and Pain and Peripheral Nerve Disorders (mean 4.05 ± 0.49). Pairwise analysis revealed co-occurrences among specialized PC subcompetencies and between Reflective Practice and technical competencies. VMR analysis showed substantial variability in subcompetency attainment across programs. CONCLUSIONS Neurosurgery residents show robust milestone progression, yet gaps persist in specialized clinical skills and self-assessment practices, often aligning with subspecialties where fellowship training is common. Residency programs might need to enhance exposure or adjust competency expectations. Integrated educational strategies, including targeted interventions and specialized procedural training, are recommended to ensure all residents achieve level 4 competency, preparing them for independent practice.