Evaluation of high‐fidelity simulation as a training tool in transoral robotic surgery

Bur, Andrés M.; Gomez, Ernest; Newman, Jason G.; Weinstein, Gregory S.; O’Malley, Bert W.; Rassekh, Christopher H.; Kuchenbecker, Katherine J.

doi:10.1002/lary.26733

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…First, as discussed, there is a concern regarding the use of the GEARS assessment scoring system as applied to TORS, specifically because it has never been validated in this surgical application. However, in study design planning, it was clear that the GEARS measurement is still the current standard for robotic surgical skills assessment and continues to be utilized in other publications regarding TORS skills research 44 . The limited sample size was also a discussed limitation of the study.…”

Section: Discussionmentioning

confidence: 99%

“…This represents a critical goal of ultimately achieving improved patient outcomes through higher skilled surgical performances, which was shown in the frequently referenced New England Journal of Medicine article by Berkmeyer and colleagues, which demonstrated precisely this relationship between surgical skill and surgical outcome. 38 A review of all English language peer-reviewed published TORS cirrulum proposals [39][40][41][42][43][44][45][46][47] along with their relative strengths and limitations, are summarized in Table I. After a thorough analysis of these proposed TORS-specific training curricula, a few patterns emerge.…”

Section: Literature Review Of Tors Training Curriculamentioning

confidence: 99%

“…However, in study design planning, it was clear that the GEARS measurement is still the current standard for robotic surgical skills assessment and continues to be utilized in other publications regarding TORS skills research. 44 The limited sample size was also a discussed limitation of the study. Several possible study designs were considered during the planning stages, including the recruitment of novice robotic users or established (expert) TORS surgeons along with resident trainees.…”

Section: Surgical Simulationmentioning

confidence: 99%

“…A review of all English language peer‐reviewed published TORS cirrulum proposals 39–47 along with their relative strengths and limitations, are summarized in Table I. After a thorough analysis of these proposed TORS‐specific training curricula, a few patterns emerge.…”

Section: Introductionmentioning

confidence: 99%

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Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

et al. 2020

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In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. Methods: Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). Results: Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor r...

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Section: Discussionmentioning

confidence: 99%

Section: Literature Review Of Tors Training Curriculamentioning

confidence: 99%

Section: Surgical Simulationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

et al. 2020

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“…There are now VR-based modules to simulate subspecialized operations such as TORS. 26 Comprehensive programs for training in robotic pancreaticoduodenectomy use time-based proficiency goals for allowing trainees to progress to more complex steps of the operation. 2,16,17 Despite the abundance of VR-based training, tissue-based models still retain some relevance for training to perform advanced procedures.…”

Section: Simulation Of Complex Operationsmentioning

confidence: 99%

Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods

Thornblade

Fong

2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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While robotic surgery has grown in popularity and scope over the past decade, there is a persistent need for simulation-based training as surgeons adapt from the working at the bedside to the immersive and multisensory tasks at the console. From dry laboratory to virtual reality (VR) environments, simulation can be used to train surgeons in basic tasks, complex operative steps, and coordination of whole operations with members of the entire operating room (OR) staff. By integrating simulation into mentored training programs, surgeons can reduce the number of cases required to master a complex operation. Future VR based simulation will become essential to the adaptation of the surgical workforce to new technologies and adoption of emerging robotic platforms. Ultimately, robotic simulation will set standards for credentialing of new surgeons.

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Advanced head and neck surgery training during the COVID‐19 pandemic

et al. 2020

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Background: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. Methods: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018-2019 graduates. Results: Despite reduction in operative volume, 82% of current AHNS fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic. Conclusions: Despite the impact of the COVID-19 pandemic, current accredited trainees remain well positioned to obtain proficiency and enter the work-force.

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Evaluation of high‐fidelity simulation as a training tool in transoral robotic surgery

Abstract: NA. Laryngoscope, 127:2790-2795, 2017.

Cited by 14 publications

References 17 publications

Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods

Advanced head and neck surgery training during the COVID‐19 pandemic

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