Association between Surgical Technical Skills and Clinical Outcomes: A Systematic Literature Review and Meta-Analysis

Woods, Michael S.; Liberman, Joshua N.; Rui, Pinyao; Wiggins, Emily; White, Joan; Ramshaw, Bruce; Stulberg, Jonah J.

doi:10.4293/jsls.2022.00076

Cited by 6 publications

(3 citation statements)

References 75 publications

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“…Skill measurements are often discussed when surgical training is concerned [29]. Still, skill variations among certified surgeons exist and are rarely directly analyzed and thematized with their outcome consequences [30]. This seems to be an unspoken truth.…”

Section: Randomized Controlled Trials In Surgerymentioning

confidence: 99%

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Evidence-Based Surgery: What Can Intra-Operative Images Contribute?

Regazzoni,

Jupiter,

Liu

et al. 2023

JCM

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Evidence-based medicine integrates results from randomized controlled trials (RCTs) and meta-analyses, combining the best external evidence with individual clinical expertise and patients’ preferences. However, RCTs of surgery differ from those of medicine in that surgical performance is often assumed to be consistent. Yet, evaluating whether each surgery is performed to the same standard is quite challenging. As a primary issue, the novelty of this review is to emphasize—with a focus on orthopedic trauma—the advantage of having complete intra-operative image documentation, allowing the direct evaluation of the quality of the intra-operative technical performance. The absence of complete intra-operative image documentation leads to the inhomogeneity of case series, yielding inconsistent results due to the impossibility of a secondary analysis. Thus, comparisons and the reproduction of studies are difficult. Access to complete intra-operative image data in surgical RCTs allows not only secondary analysis but also comparisons with similar cases. Such complete data can be included in electronic papers. Offering these data to peers—in an accessible link—when presenting papers facilitates the selection process and improves publications for readers. Additionally, having access to the full set of image data for all presented cases serves as a rich resource for learning. It enables the reader to sift through the information and pinpoint the details that are most relevant to their individual needs, allowing them to potentially incorporate this knowledge into daily practice. A broad use of the concept of complete intra-operative image documentation is pivotal for bridging the gap between clinical research findings and real-world applications. Enhancing the quality of surgical RCTs would facilitate the equalization of evidence acquisition in both internal medicine and surgery. Joint effort by surgeons, scientific societies, publishers, and healthcare authorities is needed to support the ideas, implement economic requirements, and overcome the mental obstacles to its realization.

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Section: Randomized Controlled Trials In Surgerymentioning

confidence: 99%

“…As a result, current paradigms must be challenged by the collaboration of scientists, surgeons, industry, and regulatory authorities. The clinical expertise of the individual surgeon and their intraoperative performance quality represent the most relevant components of Evidence-Based Surgery [25,30].…”

Section: Publication Formatsmentioning

confidence: 99%

Evidence-Based Surgery: What Can Intra-Operative Images Contribute?

Regazzoni,

Jupiter,

Liu

et al. 2023

JCM

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“…Although investigation of the force interaction between surgical instruments and tissue is a relatively new field of surgical research, it has been established that correct tissue handling is essential for surgical performance and patient safety [ 10 ]. Tissue handling as such is only part of a surgeon's technical skills, but these technical skills are generally associated with fewer complications, a lower risk of bleeding or the risk of re-operation [ 11 ]. Also, for laparoscopic surgery Tang et al could demonstrate a correlation between excessive force and surgical errors [ 12 , 13 ].…”

mentioning

confidence: 99%

The development of tissue handling skills is sufficient and comparable after training in virtual reality or on a surgical robotic system: a prospective randomized trial

von Bechtolsheim,

Franz,

Schmidt

et al. 2024

Surg Endosc

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Background Virtual reality is a frequently chosen method for learning the basics of robotic surgery. However, it is unclear whether tissue handling is adequately trained in VR training compared to training on a real robotic system. Methods In this randomized controlled trial, participants were split into two groups for “Fundamentals of Robotic Surgery (FRS)” training on either a DaVinci VR simulator (VR group) or a DaVinci robotic system (Robot group). All participants completed four tasks on the DaVinci robotic system before training (Baseline test), after proficiency in three FRS tasks (Midterm test), and after proficiency in all FRS tasks (Final test). Primary endpoints were forces applied across tests. Results This trial included 87 robotic novices, of which 43 and 44 participants received FRS training in VR group and Robot group, respectively. The Baseline test showed no significant differences in force application between the groups indicating a sufficient randomization. In the Midterm and Final test, the force application was not different between groups. Both groups displayed sufficient learning curves with significant improvement of force application. However, the Robot group needed significantly less repetitions in the three FRS tasks Ring tower (Robot: 2.48 vs. VR: 5.45; p < 0.001), Knot Tying (Robot: 5.34 vs. VR: 8.13; p = 0.006), and Vessel Energy Dissection (Robot: 2 vs. VR: 2.38; p = 0.001) until reaching proficiency. Conclusion Robotic tissue handling skills improve significantly and comparably after both VR training and training on a real robotic system, but training on a VR simulator might be less efficient.

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