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Jack J. Jakimowicz - One of the best experts on this subject based on the ideXlab platform.
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Competency assessment tool for laparoscopic Suturing: development and reliability evaluation
Surgical Endoscopy, 2019Co-Authors: Wouter M. Ijgosse, Erik Leijte, Jan-maarten Luursema, Nader K. Francis, Sandeep Ganni, Jack J. Jakimowicz, Sanne M. B. I. BotdenAbstract:BackgroundLaparoscopic Suturing can be technically challenging and requires extensive training to achieve competency. To date no specific and objective assessment method for laparoscopic Suturing and knot tying is available that can guide training and monitor performance in these complex surgical skills. In this study we aimed to develop a laparoscopic Suturing competency assessment tool (LS-CAT) and assess its inter-observer reliability.MethodsWe developed a bespoke CAT tool for laparoscopic Suturing through a structured, mixed methodology approach, overseen by a steering committee with experience in developing surgical assessment tools. A wide Delphi consultation with over twelve experts in laparoscopic surgery guided the development stages of the tool. Following, subjects with different levels of laparoscopic expertise were included to evaluate this tool, using a simulated laparoscopic Suturing task which involved placing of two surgical knots. A research assistant video recorded and anonymised each performance. Two blinded expert surgeons assessed the anonymised videos using the developed LS-CAT. The LS-CAT scores of the two experts were compared to assess the inter-observer reliability. Lastly, we compared the subjects’ LS-CAT performance scores at the beginning and end of their learning curve.ResultsThis study evaluated a novel LS-CAT performance tool, comprising of four tasks. Thirty-six complete videos were analysed and evaluated with the LS-CAT, of which the scores demonstrated excellent inter-observer reliability. Cohen’s Kappa analysis revealed good to excellent levels of agreement for almost all tasks of both instrument handling and tissue handling (0.87; 0.77; 0.75; 0.86; 0.85, all with p
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Suturing training in augmented reality gaining proficiency in Suturing skills faster
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: Sanne M. B. I. Botden, I H J T De Hingh, Jack J. JakimowiczAbstract:Background: Providing informative feedback and setting goals tends to motivate trainees to practice more extensively. Augmented Reality simulators retain the benefit of realistic haptic feedback and additionally generate objective assessment and informative feedback during the training. This study researched the performance curve of the adapted Suturing module on the ProMIS Augmented Reality simulator. Methods: Eighteen novice participants were pretrained on the MIST-VR to become acquainted with laparoscopy. Subsequently, they practiced 16 knots on the Suturing module, of which the assessment scores were recorded to evaluate the gain in laparoscopic Suturing skills. The scoring of the assessment method was calculated from the “time spent in the correct area” during the knot tying and the quality of the knot. Both the baseline knot and the knot at the top of the performance curve were assessed by two independent objective observers, by means of a standardized evaluation form, to objectify the gain in Suturing skills. Results: There was a statistically significant difference between the scores of the second knot (mean 72.59, standard deviation (SD) 16.28) and the top of the performance curve (mean 95.82, SD 3.05; p < 0.001, paired t-test). The scoring of the objective observers also differed significantly (mean 11.83 and 22.11, respectively; SD 3.37 and 3.89, respectively; p < 0.001) (interobserver reliability Cronbach’s alpha = 0.96). The median amount of repetitions to reach the top of the performance curve was eight, which also showed significant differences between both the assessment score (mean 88.14, SD 13.53, p < 0.001) and scoring of the objective observers of the second knot (mean 20.51, SD 4.14; p < 0.001). Conclusions: This adapted Suturing module on the ProMIS Augmented Reality laparoscopic simulator is a potent tool for gaining laparoscopic Suturing skills.
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the importance of haptic feedback in laparoscopic Suturing training and the additive value of virtual reality simulation
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Sanne M. B. I. Botden, Fawaz Chikh Torab, Sonja N Buzink, Jack J. JakimowiczAbstract:Introduction Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic Suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic Suturing training.
Sanne M. B. I. Botden - One of the best experts on this subject based on the ideXlab platform.
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Competency assessment tool for laparoscopic Suturing: development and reliability evaluation
Surgical Endoscopy, 2019Co-Authors: Wouter M. Ijgosse, Erik Leijte, Jan-maarten Luursema, Nader K. Francis, Sandeep Ganni, Jack J. Jakimowicz, Sanne M. B. I. BotdenAbstract:BackgroundLaparoscopic Suturing can be technically challenging and requires extensive training to achieve competency. To date no specific and objective assessment method for laparoscopic Suturing and knot tying is available that can guide training and monitor performance in these complex surgical skills. In this study we aimed to develop a laparoscopic Suturing competency assessment tool (LS-CAT) and assess its inter-observer reliability.MethodsWe developed a bespoke CAT tool for laparoscopic Suturing through a structured, mixed methodology approach, overseen by a steering committee with experience in developing surgical assessment tools. A wide Delphi consultation with over twelve experts in laparoscopic surgery guided the development stages of the tool. Following, subjects with different levels of laparoscopic expertise were included to evaluate this tool, using a simulated laparoscopic Suturing task which involved placing of two surgical knots. A research assistant video recorded and anonymised each performance. Two blinded expert surgeons assessed the anonymised videos using the developed LS-CAT. The LS-CAT scores of the two experts were compared to assess the inter-observer reliability. Lastly, we compared the subjects’ LS-CAT performance scores at the beginning and end of their learning curve.ResultsThis study evaluated a novel LS-CAT performance tool, comprising of four tasks. Thirty-six complete videos were analysed and evaluated with the LS-CAT, of which the scores demonstrated excellent inter-observer reliability. Cohen’s Kappa analysis revealed good to excellent levels of agreement for almost all tasks of both instrument handling and tissue handling (0.87; 0.77; 0.75; 0.86; 0.85, all with p
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Suturing training in augmented reality gaining proficiency in Suturing skills faster
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: Sanne M. B. I. Botden, I H J T De Hingh, Jack J. JakimowiczAbstract:Background: Providing informative feedback and setting goals tends to motivate trainees to practice more extensively. Augmented Reality simulators retain the benefit of realistic haptic feedback and additionally generate objective assessment and informative feedback during the training. This study researched the performance curve of the adapted Suturing module on the ProMIS Augmented Reality simulator. Methods: Eighteen novice participants were pretrained on the MIST-VR to become acquainted with laparoscopy. Subsequently, they practiced 16 knots on the Suturing module, of which the assessment scores were recorded to evaluate the gain in laparoscopic Suturing skills. The scoring of the assessment method was calculated from the “time spent in the correct area” during the knot tying and the quality of the knot. Both the baseline knot and the knot at the top of the performance curve were assessed by two independent objective observers, by means of a standardized evaluation form, to objectify the gain in Suturing skills. Results: There was a statistically significant difference between the scores of the second knot (mean 72.59, standard deviation (SD) 16.28) and the top of the performance curve (mean 95.82, SD 3.05; p < 0.001, paired t-test). The scoring of the objective observers also differed significantly (mean 11.83 and 22.11, respectively; SD 3.37 and 3.89, respectively; p < 0.001) (interobserver reliability Cronbach’s alpha = 0.96). The median amount of repetitions to reach the top of the performance curve was eight, which also showed significant differences between both the assessment score (mean 88.14, SD 13.53, p < 0.001) and scoring of the objective observers of the second knot (mean 20.51, SD 4.14; p < 0.001). Conclusions: This adapted Suturing module on the ProMIS Augmented Reality laparoscopic simulator is a potent tool for gaining laparoscopic Suturing skills.
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the importance of haptic feedback in laparoscopic Suturing training and the additive value of virtual reality simulation
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Sanne M. B. I. Botden, Fawaz Chikh Torab, Sonja N Buzink, Jack J. JakimowiczAbstract:Introduction Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic Suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic Suturing training.
Mamoru Mitsuishi - One of the best experts on this subject based on the ideXlab platform.
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Virtual Fixture Assistance for Suturing in Robot-Aided Pediatric Endoscopic Surgery
IEEE Robotics and Automation Letters, 2020Co-Authors: Murilo M. Marinho, Kyoichi Deie, Kanako Harada, Hisashi Ishida, Mamoru MitsuishiAbstract:The limited workspace in pediatric endoscopic surgery makes surgical Suturing one of the most difficult tasks. During Suturing, surgeons have to prevent collisions between instruments and also collisions with the surrounding tissues. Surgical robots have been shown to be effective in adult laparoscopy, but assistance for Suturing in constrained workspaces has not been yet fully explored. In this letter, we propose guidance virtual fixtures to enhance the performance and the safety of Suturing while generating the required task constraints using constrained optimization and Cartesian force feedback. We propose two guidance methods: looping virtual fixtures and a trajectory guidance cylinder, that are based on dynamic geometric elements. In simulations and experiments with a physical robot, we show that the proposed methods increase precision and safety in-vitro.
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virtual fixture assistance for Suturing in robot aided pediatric endoscopic surgery
arXiv: Robotics, 2019Co-Authors: Murilo M. Marinho, Kyoichi Deie, Kanako Harada, Hisashi Ishida, Mamoru MitsuishiAbstract:The limited workspace in pediatric endoscopic surgery makes surgical Suturing one of the most difficult tasks. During Suturing, surgeons have to prevent collisions between tools and also collisions with the surrounding tissues. Surgical robots have been shown to be effective in adult laparoscopy, but assistance for Suturing in constrained workspaces has not been yet fully explored. In this letter, we propose guidance virtual fixtures to enhance the performance and the safety of Suturing while generating the required task constraints using constrained optimization and Cartesian force feedback. We propose two guidance methods: looping virtual fixtures and a trajectory guidance cylinder, that are based on dynamic geometric elements. In simulations and experiments with a physical robot, we show that the proposed methods achieve a more precise and safer looping in robot-assisted pediatric endoscopy.
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A multi-degree-of-freedom needle driver with a short tip and small shaft for pediatric laparoscopic surgery: in vivo assessment of multi-directional Suturing on the vertical plane of the liver in rabbits
Surgical Endoscopy, 2016Co-Authors: Shinya Takazawa, Jun Fujishiro, Naohiko Sugita, Kyoichi Deie, Kanako Harada, Tetsuya Ishimaru, Masahiro Fujii, Mamoru Mitsuishi, Tadashi IwanakaAbstract:BackgroundLaparoscopic Kasai portoenterostomy has been performed in infants with biliary atresia at several institutions, but laparoscopic anastomosis requiring multi-directional Suturing on a vertical plane of the liver remains a challenge. To assist multi-directional Suturing, we developed a multi-degree-of-freedom (DOF) needle driver whose tip length was 15 mm and shaft diameter was 3.5 mm. The tip of the multi-DOF needle driver has three DOFs for grasp, flection and rotation. The aim of this study was to evaluate the performance of the multi-DOF needle driver in two kinds of in vivo experiments.MethodsSurgeons were asked to perform four-directional laparoscopic Suturing on a vertical plane of the liver in six rabbits using the multi-DOF needle driver or a conventional needle driver. The needle grasping time, the needle handling time, the number of needle insertions, the number of liver lacerations, the Suturing width and depth, and the area of necrotic tissues were analyzed and compared. Additionally, one surgeon was asked to perform laparoscopic hepato-jejunostomy in four rabbits to assess the feasibility of Kasai portoenterostomy using the multi-DOF needle driver.ResultsThe Suturing depth using the multi-DOF needle driver was significantly larger than that using the conventional needle driver in both the right and downward Suturing directions. No statistically significant differences were found in other metrics. Liver lacerations were observed only when Suturing was performed using the conventional needle driver. The experimental laparoscopic hepato-jejunostomy using the multi-DOF needle driver was successful.ConclusionsUsing the multi-DOF needle driver, uniform multi-directional Suturing on a vertical plane of the liver could be performed. The short distal tip of the multi-DOF needle driver demonstrated its advantages in multi-directional Suturing in a small body cavity. The multi-DOF needle driver may be able to be used to perform complex tasks in laparoscopic Kasai portoenterostomy.
Sergey V Kantsevoy - One of the best experts on this subject based on the ideXlab platform.
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endoscopic management of colonic perforations clips versus Suturing closure with videos
Gastrointestinal Endoscopy, 2016Co-Authors: Sergey V Kantsevoy, Marianne Bitner, Gulara Hajiyeva, Paulina M Mirovski, Thomas Swope, Kelly Alexander, Nora Meenaghan, Lawrence J Fitzpatrick, Vadim GushchinAbstract:Background and Aims Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations. Methods We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic Suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up. Results Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic Suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic Suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic Suturing closure (1 patient). Two patients had abdominal pain after endoscopic Suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic Suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients. Conclusion Endoscopic Suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery, and appears more effective than closure with hemostatic endoscopic clips.
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endoscopic Suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible fast and eliminates the need for hospitalization with videos
Gastrointestinal Endoscopy, 2014Co-Authors: Sergey V Kantsevoy, Marianne Bitner, Aleksandr A Mitrakov, Paul J ThuluvathAbstract:Background Endoscopic submucosal dissection (ESD) is less invasive than surgical resection, but the large mucosal defects after ESD may lead to adverse events necessitating hospitalizations. Objective To evaluate the use of an endoscopic Suturing device for closure of large mucosal defects after ESD. Design and Setting Retrospective, single-center study. Patients Twelve consecutive patients underwent ESD. Interventions All lesions were removed by using a previously described ESD technique. The large mucosal defects post-ESD were completely closed with the endoscopic Suturing device, and all patients were discharged home with subsequent clinical and endoscopic follow-up. Main Outcome Measurements Bleeding and perforation rates after ESD with mucosal defect closure. Results ESD followed by endoscopic Suturing of the mucosal defects was performed in 12 patients (mean age, 64.7 ± 11.2 years, 4 lesions in the stomach, 8 lesions in the colon; mean lesion size, 42.5 ± 14.8 mm) over a period of 8 months. All lesions (100%) were removed en bloc. Closure of post-ESD defects with an endoscopic Suturing device was technically feasible and fast (mean closure time, 10.0 ± 5.8 minutes per patient). Only 1 stitch (continuous Suturing line) was required for complete closure in 8 patients. In the other 4 patients, the mucosal defect was closed with 2 to 4 separate stitches (mean number of sutures per patient, 1.6 ± 1.0). There were no immediate or delayed adverse events in any of the study patients. Limitations Retrospective study. Conclusions Closure of large post-ESD defects with the Overstitch endoscopic Suturing device is technically feasible and fast and can significantly decrease treatment cost by eliminating the need for hospitalization.
Makoto Hashizume - One of the best experts on this subject based on the ideXlab platform.
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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, Hajime Kenmotsu, Takefumi Yasunaga, Hideaki Nakashima, Kazuo Tanoue, Daisuke Yoshida, Kozo Konishi, Satoshi Ieiri, 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.
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Objective assessment of laparoscopic Suturing skills using a motion-tracking system
Surgical Endoscopy, 2011Co-Authors: Shohei Yamaguchi, Hajime Kenmotsu, Takefumi Yasunaga, Hideaki Nakashima, Kazuo Tanoue, Daisuke Yoshida, Kozo Konishi, Satoshi Ieiri, 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.\n\nMETHODS: A total of 18 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: 9 novice surgeons (fewer than 10 laparoscopic procedures) and 9 experienced surgeons (more than 50 laparoscopic procedures). The subjects performed an intracorporeal Suturing task in an inanimate box laparoscopic trainer while the movements of their forceps were evaluated using an electromagnetic motion-tracking system. Their laparoscopic skills were assessed on the basis of the time, path length, and average speed of the forceps in each hand.\n\nRESULTS: Experienced surgeons completed the Suturing task significantly faster than novice surgeons did. The left path length was significantly shorter for experienced surgeons than for novice surgeons, whereas the right path lengths did not differ. The right average speed of knot tying was significantly faster for experienced surgeons than for novice surgeons, whereas the left average speeds did not differ.\n\nCONCLUSIONS: Evaluation of psychomotor skills in laparoscopic Suturing using an electromagnetic motion-tracking system revealed better results for experienced surgeons than for novice surgeons in terms of the time taken, left path length, and right speed of knot-tying. Furthermore, surgical proficiency due to experience can affect surgical dexterity of each hand differently. The present study also demonstrates the efficacy of this system for objective evaluation of laparoscopic Suturing skills.
