The future of surgical assessment

Abstract

We took great interest in the review by Spiteri et al 1 regarding the teaching and assessment of cataract surgery skills. We have recently employed the Kitaro wet and dry lab system at the University of Rochester and have found the accuracy of the simulation to be excellent. We believe the fidelity of this system will fundamentally change the role of phacoemulsification training outside the operating theatre. The authors mention virtual reality systems as an alternative to human and animal wet lab models, but we have found the cost of these systems restrictive. The major advantages of the virtual reality system are its instantaneous feedback, its objectivity and its standardisation, but a minority of training programmes in the USA are able to afford the expense.Regarding assessment of operative performance using video-based methods, we have found the major impediment is time. For an attending to review a single cataract surgery in detail and provide feedback on the case, it can consume more than 30 min. In addition to the time cost of video-based review, its objectivity can be questionable, especially when the input of only one attending is used. We have also had difficulty tracking resident performance over time using video-based assessments because of the time constraints involved and because of objectivity issues.With the growing number of factors that often limit opportunities for resident surgical education, it is of great importance that effective methods of phacoemulsification training be developed. Objective, valid and reliable tools that provide rapid feedback are essential for training in the wet lab and in the operating theatre. We are not there yet. REFERENCE 1. Spiteri A, Aggarwal R, Kersey T, et al. Phacoemulsification skills training and assessment. Br J Ophthalmol 2010;94:536e41.Author's response I would like to thank Khalifa et al. We too believe that simulation technology is here to stay and that it can only improve with its further development and more research in software validation, highlighting its strengths and weaknesses. To this aim, our group has completed one such validation trial which we hope to share with the published community shortly.Regarding the cost of these systems, we agree that these are currently restrictive (although we have already witnessed a substantial drop in price). We think that, for this reason, simulation based training works better on a regional training basis rather than individual hospitals investing heavily for a limited number of trainees. However, the increased demand caused by higher trainee to machine ratios will raise issues regarding how much minimum training will be required and for how long. Studies plotting learning curves required to reach standards set by validation trials are thus beckoning. These will produce more targeted training rather than simply 'the-more-the-better ' practising.Although we are not there yet, once these initial obstacles are overcome there are multiple advantages to look forward to. Running costs are minimal; reduced complica...

A computer vision-based approach to grade simulated cataract surgeries

“…The Kitaro system consists of a synthetic cornea and cataract that mimics the anatomy and spatial relationships of a human eye. Trainees can practice all steps of cataract surgery using this system [29]. Cataract surgery consists of seven surgical stages: (1) incisions, (2) capsulorhexis, (3) hydrodissection, (4) phacoemulsification, (5) cortical clean-up, (6) lens insertion, and (7) closing.…”