Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system

Wahba, Roger; Kleinert, Robert; Hellmich, Martin; Heiermann, N.; Dieplinger, Georg; Schlößer, Hans; Buchner, Denise; Kurschat, Christine; Stippel, Dirk L.

doi:10.1007/s00464-016-5264-4

Cited by 14 publications

(9 citation statements)

References 17 publications

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“…Depending on the different factors (e.g. structured teaching programs, talent of the surgeon, kind of operation, equipment), 30–100 procedures could be necessary to adopt a complex minimally invasive operation [3, 4, 9]. It seems possible, that an optimal display system could also optimize this teaching and learning process.…”

Section: Discussionmentioning

confidence: 99%

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3D vs. 4K Display System - Influence of “State-of-the-art”-Display Technique On Surgical Performance (IDOSP-Study) in minimally invasive surgery: protocol for a randomized cross-over trial

Wahba

Datta

Hedergott

et al. 2019

Trials

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Background Three-dimensional (3D) stereoscopic vision is crucial to perform any kind of manual task. The reduction from real life 3D to virtual two-dimensional (2D) sight is a major challenge in minimally invasive surgery (MIS). A 3D display technique has been shown to reduce operation time and mistakes and to improve the learning curve. Therefore, the use of a3D display technique seems to optimize surgical performance for novice and experienced surgeons. Inspired by consumer electronics, a 4K display technique was recently introduced to MIS. Due to its high resolution and zoom effect, surgeons should benefit from it. The aim of this study is to evaluate if “state-of-the-art” 3D- vs. 4K-display techniques could influence surgical performance. Methods A randomized, cross-over, single-institution, single-blinded trial is designed. It compares the primary outcome parameter “surgical performance”, represented by “performance time ”and “number of mistakes”, using a passive polarizing 3D and a 4K display system (two arms) to perform different tasks in a minimally invasive/laparoscopic training parkour. Secondary outcome parameters are the mental stress load (National Aeronautics and Space Administration (NASA) Task Load Index) and the learning curve. Unexperienced novices (medical students), non-board-certified, and board-certified abdominal surgeons participate in the trial (i.e., level of experience, 3 strata). The parkour consists of seven tasks (for novices, five tasks), which will be repeated three times. The 1st run of the parkour will be performed with the randomized display system, the 2nd run with the other one. After each run, the mental stress load is measured. After completion of the parkour, all participants are evaluated by an ophthalmologist for visual acuity and stereoscopic vision with five tests. Assuming a correlation of 0.5 between measurements per subject, a sample size of 36 per stratum is required to detect a standardized effect of 0.5 (including an additional 5% for a non-parametric approach) with a power of 80% at a two-sided type I error of 5%. Thus, altogether 108 subjects need to be enrolled. Discussion Complex surgical procedures are performed in a minimally invasive/laparoscopic technique. This study should provide some evidence to decide which display technique a surgeon could choose to optimize his performance. Trial registration ClinicalTrials.gov, NCT03445429. Registered on 7 February 2018.

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Section: Discussionmentioning

confidence: 99%

“…The learning curve and performance, especially in complex surgical procedures, e.g. vascular preparation during retroperitoneoscopic donor nephrectomy, could be optimized and simplified [9]. The recent European Association for Endoscopic Surgery (EAES) consensus statement recommended the use of 3D vision to reduce operative time [7].…”

Section: Introductionmentioning

confidence: 99%

3D vs. 4K Display System - Influence of “State-of-the-art”-Display Technique On Surgical Performance (IDOSP-Study) in minimally invasive surgery: protocol for a randomized cross-over trial

Wahba

Datta

Hedergott

et al. 2019

Trials

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“…Learning curves derived from the operating time have been previously reported. Chin et al [32] reported that the learning curve for LLDN plateaued after 150 cases, Pal et al [8] reported that the learning curve for RPLDN was 35 cases, and Wahba et al [33] reported that the learning curve for HARPLDN was 30 cases. According to published studies, the learning curve associated with our method is shorter than those of LLDN and RPLDN and is comparable to that of HARPLDN.…”

Section: Intraoperative Complicationsmentioning

confidence: 99%

Cumulative Sum Analysis of the Learning Curve for Modified Retroperitoneoscopic Living-Donor Nephrectomy

Zhu¹,

Hong²,

Zhu³

et al. 2018

Urol Int

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Objectives: To introduce our modified retroperitoneoscopic living-donor nephrectomy (RPLDN) techniques and estimate the learning curve. Methods: We retrospectively evaluated 121 consecutive donors who underwent modified RPLDN performed by a single surgeon. While the surgeon controlled the renal vessels, one hand was inserted through an abdominal incision for assistance. The kidney was manually retrieved through the abdominal incision. The learning curve was evaluated using the cumulative sum (CUSUM) method, which was a graphical method showing changes in individual surgical performance. Results: The mean operating time and warm ischemic time (WIT) were 129.4 min and 154.5 s, respectively. The mean estimated blood loss (EBL) was 44.4 mL. Regarding intraoperative complications, no open conversions or blood transfusions were required. The CUSUM learning curve included the following 3 unique phases: phase 1 (the initial 32 cases), representing the initial learning curve; phase 2 (the middle 38 cases), representing expert competence; and phase 3 (the final 51 cases), representing mastery. Conclusions: Our modified method has the advantages of a short operating time, an optimized WIT, a low EBL, and acceptable complication rates. The surgeon completed the initial learning phase of RPLDN after 32 cases and could effectively perform RPLDN after 70 cases.

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“…The learning curve and performance especially in complex surgical procedures, e.g. vascular preparation during retroperitoneoscopic donor nephrectomy could be optimized and simplified 9 . The recent EAES consensus statement recommended the use of 3D-vision to reduce operative time 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the different factors (e.g. structured teaching programs, talent of the surgeon, kind of operation, equipment), 30-100 procedures could be necessary to adopt a complex minimal invasive operation3,4,9 . It seems possible, that an optimal display system could also optimize this teaching and learning process.…”

mentioning

confidence: 99%

3D- vs. 4K-Display System - Influence of "State-of-the-art"-Display Technique On Surgical Performance (IDOSP-Study) in minimal invasive surgery: protocol for a randomized cross-over trial

Wahba

Datta

Hedergott

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background Three-dimensional (3D) stereoscopic vision is crucial to perform any kind of manual tasks. The reduction from real life 3D- to virtual two-dimensional (2D) sight is a major challenge in minimal invasive surgery (MIS). 3D-display technique has shown to reduce operation time, mistakes, and to improve the learning curve. Therefore it seems to optimize surgical performance for novice and experienced surgeons. Inspired by consumer electronics 4K-display technique was recently introduced to MIS. Due to its high resolution and zoom-effect surgeons should benefit from it. Aim of this study is to evaluate if “state-of-the-art” 3D- versus 4K- display techniques could influence surgical performance. Methods A randomized cross-over single-institution single-blinded trial is designed. It compares the primary outcome parameter “surgical performance”, represented by “performance time “ and “number of mistakes”, using a passive polarizing 3D- and a 4K-display system (2 arms) to perform different tasks in a minimal invasive/laparoscopic training parkour. Secondary outcome parameters are the mental stress load (NASA task load index) and the learning curve. Unexperienced novices (medical students), non-board certified and board-certified abdominal surgeons participate in the trial (i.e. level of experience, 3 strata). The parkour consists of 7 tasks (novices 5 tasks), which will be repeated 3 times. The 1st run of the parkour will be performed with the randomized display system, the 2nd run with the other one. After each run, the mental stress load is measured. After completion of the parkour, all participants are evaluated by an ophthalmologist for visual acuity and stereoscopic vision with five tests. Assuming a correlation of 0.5 between measurements per subject a sample-size of 36 per stratum is required to detect a standardized effect of 0.5 (including additional 5% for a non-parametric approach) with a power of 80% at two-sided type I error of 5%. Thus, altogether 108 subjects need to be enrolled. Discussion Complex surgical procedures are performed in minimal invasive/laparoscopic technique. This study should provide some evidence to decide which display technique a surgeon could choose to optimize his performance. Trial Registration This trial is registered at clinicaltrials.gov (trial number: NCT 03445429, registered February 7, 2018, http://www.clinicaltrials.gov)

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Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system

Cited by 14 publications

References 17 publications

3D vs. 4K Display System - Influence of “State-of-the-art”-Display Technique On Surgical Performance (IDOSP-Study) in minimally invasive surgery: protocol for a randomized cross-over trial

3D vs. 4K Display System - Influence of “State-of-the-art”-Display Technique On Surgical Performance (IDOSP-Study) in minimally invasive surgery: protocol for a randomized cross-over trial

Cumulative Sum Analysis of the Learning Curve for Modified Retroperitoneoscopic Living-Donor Nephrectomy

3D- vs. 4K-Display System - Influence of "State-of-the-art"-Display Technique On Surgical Performance (IDOSP-Study) in minimal invasive surgery: protocol for a randomized cross-over trial

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