The Experts below are selected from a list of 542661 Experts worldwide ranked by ideXlab platform
Matt E Ritter - One of the best experts on this subject based on the ideXlab platform.
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construct validity of an Objective Assessment method for laparoscopic intracorporeal suturing and knot tying
American Journal of Surgery, 2008Co-Authors: Kent R Van Sickle, Daniel C Smith, Mercedeh Baghai, Ih Ping Huang, Adam Goldenberg, Matt E RitterAbstract:Abstract Background The ideal Objective Assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance Assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying. Methods Four groups of subjects—experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)—performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test. Results A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%–100%) and lowest with the NR group (85%, range 81%–98%). On average, the EX group significantly outperformed the other groups with regards to time ( P P P P = not significant [NS]), and outperformed the NR and MS groups with regards to time ( P P Conclusions This Assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes Assessment.
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real time Objective Assessment of knot quality with a portable tensiometer is superior to execution time for Assessment of laparoscopic knot tying performance
Surgical Innovation, 2005Co-Authors: Matt E Ritter, David A Mcclusky, Anthony G Gallagher, Daniel C SmithAbstract:Objective Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Currently, time to complete a knot is the most commonly used metric to assess the acquisition of this skill; however, without a measure of knot quality, time is a poor indicator of skills mastery. Others have shown that knot quality can be accurately assessed with a tensiometer, but obtaining this type of Assessment has typically been cumbersome. We investigated a new method of real-time Assessment of knot quality that allows for more practical use of knot quality as a performance metric. METHODS Eleven experienced endoscopic surgeons tied 100 intracorporeal knots in a standard box trainer. Each of the knots was immediately tested using the InSpec 2200 benchtop tensiometer (INSTRON, Canton MA) where a knot quality score (KQS) is generated based on the load handling properties of the knotted suture. The execution time was also recorded for each knot. RESULTS The Assessment of all knots ended with one of two end points: knots that slipped (n=48) or knots that held until the suture broke (n=52). Knots that slip are generally of poorer quality than those that held. Execution time did not correlate with knot-quality score (r=0.009, P=.9), and the mean execution time did not differ significantly between slipped and held knots (65 vs 68 seconds, P=.8). No completion time criteria were able to accurately predict slipped versus held knots. The mean KQS difference between held and slipped knots was highly significant (24 vs 12, P<.0001). A knot with a KQS exceeding 20 was nearly 10 times more likely to hold than slip. CONCLUSION Time to complete a knot is a poor metric for the Objective Assessment of intracorporeal knot-tying performance in the absence of a measure of knot quality. Real-time evaluation of the knot quality can accurately distinguish well-tied knots from poorly tied knots. This mode of Assessment should be incorporated into training curriculum for surgical knot tying.
Makoto Hashizume - One of the best experts on this subject based on the ideXlab platform.
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Objective Assessment of the suture ligature method for the laparoscopic intestinal anastomosis model using a new computerized system
Surgical Endoscopy and Other Interventional Techniques, 2015Co-Authors: Munenori Uemura, Satoshi Ieiri, Makoto Yamashita, Morimasa Tomikawa, Satoshi Obata, Ryota Souzaki, Kenoki Ohuchida, Noriyuki Matsuoka, Tamotsu Katayama, Makoto HashizumeAbstract:Background The purpose of this study was to develop a new Objective Assessment system for the suture ligature method employed in the laparoscopic intestinal anastomosis model. Suturing skills were evaluated Objectively using this system.
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Objective Assessment of laparoscopic suturing skills using a motion tracking system
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Shohei Yamaguchi, Takefumi Yasunaga, Hideaki Nakashima, Kozo Konishi, Kenichiro Tanoue, Satoshi Ieiri, Hajime Kenmotsu, Daisuke Yoshida, Makoto HashizumeAbstract:Background Laparoscopic suturing skills are important for advanced laparoscopic surgery. However, Objective Assessment of these skills has not yet been established. The aim of this study was to assess the laparoscopic suturing skills of novice and experienced surgeons using an electromagnetic motion-tracking system.
Buenaventura Coroleu - One of the best experts on this subject based on the ideXlab platform.
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what is a difficult transfer analysis of 7 714 embryo transfers the impact of maneuvers during embryo transfers on pregnancy rate and a proposal of Objective Assessment
Fertility and Sterility, 2017Co-Authors: Alejandro Kavabraverman, Francisca Martinez, Ignacio Rodriguez, Manuel Alvarez, Pedro N Barri, Buenaventura CoroleuAbstract:Objective To establish the relationship between the degree of difficulty of ET and pregnancy rate (PR), with a view to proposing an algorithm for the Objective Assessment of ET. Design Retrospective, observational study. Setting In vitro fertilization unit. Patient(s) Women undergoing assisted reproductive technology (ART) with ET after IVF/intracytoplasmic sperm injection, in whom fresh embryo transfer or frozen–thawed embryo transfer was performed. Intervention(s) None. Main Outcome Measure(s) Clinical pregnancy rate (CPR). Result(s) A total of 7,714 ETs were analyzed. The CPR was significantly higher in the cases of easy ET compared with difficult ET (38.2% vs. 27.1%). Each instrumentation needed to successfully deposit the embryos in the fundus involves a progressive reduction in the CPR: use of outer catheter sheath (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.79–1.01), use of Wallace stylet (OR 0.71; 95% CI 0.62–0.81), use of tenaculum (OR 0.54; 95% CI 0.36–0.79). Poor ultrasound visualization significantly diminish the CPR. Conclusion(s) The CPR decreases progressively with the use of additional maneuvers during ET. An Objective classification of the instrumentation applied during ET is proposed.
P D Van Hove - One of the best experts on this subject based on the ideXlab platform.
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Objective Assessment of technical surgical skills
British Journal of Surgery, 2010Co-Authors: P D Van Hove, Gabrielle J M Tuijthof, Emiel G G Verdaasdonk, Laurents P S Stassen, Jenny DankelmanAbstract: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.
Daniel C Smith - One of the best experts on this subject based on the ideXlab platform.
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construct validity of an Objective Assessment method for laparoscopic intracorporeal suturing and knot tying
American Journal of Surgery, 2008Co-Authors: Kent R Van Sickle, Daniel C Smith, Mercedeh Baghai, Ih Ping Huang, Adam Goldenberg, Matt E RitterAbstract:Abstract Background The ideal Objective Assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent “VR2OR” studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance Assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying. Methods Four groups of subjects—experts (EX), surgery residents trained to expert criterion levels using simulation (TR), surgery residents receiving no supplemental training (NR), and medical students receiving simulation-based training (MS)—performed the fundal suturing portion of a laparoscopic Nissen fundoplication and were video-recorded for analysis. Two separate groups of surgeon reviewers (K.V.S. + M.B.; I.-P.H. + A.G.) were trained to evaluate laparoscopic suturing and knot tying performance using specific metrics. Subjects' operative performance was assessed by reviewers blinded to their training status and scored using an error-based, step specific scoring system to an inter-rater agreement of 80% or greater. Three primary performance measures were assessed: time, errors, and needle manipulations and comparisons between groups were made using a 1-way analysis of variance (ANOVA) with post-test. Results A total of 40 fundal sutures (10 in each group) were scored by 2 separate rater groups with inter-rater agreement consistently greater than 80%. Inter-rater agreement was highest with the EX group (91%, range 76%–100%) and lowest with the NR group (85%, range 81%–98%). On average, the EX group significantly outperformed the other groups with regards to time ( P P P P = not significant [NS]), and outperformed the NR and MS groups with regards to time ( P P Conclusions This Assessment method demonstrates discriminative validity. Time appears to be the most sensitive indicator of skill level, as significant differences between EX, TR, and NR/MS groups were seen. The methodology is transferable across different reviewers and is acceptable for high-stakes Assessment.
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real time Objective Assessment of knot quality with a portable tensiometer is superior to execution time for Assessment of laparoscopic knot tying performance
Surgical Innovation, 2005Co-Authors: Matt E Ritter, David A Mcclusky, Anthony G Gallagher, Daniel C SmithAbstract:Objective Laparoscopic intracorporeal knot tying is a difficult skill to acquire. Currently, time to complete a knot is the most commonly used metric to assess the acquisition of this skill; however, without a measure of knot quality, time is a poor indicator of skills mastery. Others have shown that knot quality can be accurately assessed with a tensiometer, but obtaining this type of Assessment has typically been cumbersome. We investigated a new method of real-time Assessment of knot quality that allows for more practical use of knot quality as a performance metric. METHODS Eleven experienced endoscopic surgeons tied 100 intracorporeal knots in a standard box trainer. Each of the knots was immediately tested using the InSpec 2200 benchtop tensiometer (INSTRON, Canton MA) where a knot quality score (KQS) is generated based on the load handling properties of the knotted suture. The execution time was also recorded for each knot. RESULTS The Assessment of all knots ended with one of two end points: knots that slipped (n=48) or knots that held until the suture broke (n=52). Knots that slip are generally of poorer quality than those that held. Execution time did not correlate with knot-quality score (r=0.009, P=.9), and the mean execution time did not differ significantly between slipped and held knots (65 vs 68 seconds, P=.8). No completion time criteria were able to accurately predict slipped versus held knots. The mean KQS difference between held and slipped knots was highly significant (24 vs 12, P<.0001). A knot with a KQS exceeding 20 was nearly 10 times more likely to hold than slip. CONCLUSION Time to complete a knot is a poor metric for the Objective Assessment of intracorporeal knot-tying performance in the absence of a measure of knot quality. Real-time evaluation of the knot quality can accurately distinguish well-tied knots from poorly tied knots. This mode of Assessment should be incorporated into training curriculum for surgical knot tying.
