Initial and Long‐term Retention of Robotic Technical Skills in an Otolaryngology Residency Program

Shay, Sophie; Chrin, Jonathan D.; Wang, Marilene B.; Mendelsohn, Abie H.

doi:10.1002/lary.27425

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…They found that the approach was feasible and led to appropriate improvement in clinical skills, with 85% of trainees completing a skills assessment within their allotted time. Shay et al 29 also implemented a multiphase robotic skills training course with components of robotic device docking/draping, simulator training, and dry lab exercises. This led to skill acquisition and retention at one and six month follow-up.…”

Section: Discussionmentioning

confidence: 99%

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

McCrary

McLean

Luman

et al. 2021

Ann Otol Rhinol Laryngol

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Objective: The aim of this study is to describe the current state of robotic surgery training among Otolaryngology—Head and Neck Surgery (OHNS) residency programs in the United States. Methods: This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. Results: A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. Conclusion: This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. Level of Evidence: IV

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Section: Discussionmentioning

confidence: 99%

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

McCrary

McLean

Luman

et al. 2021

Ann Otol Rhinol Laryngol

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“…Our group therefore set out to investigate the specific technical aspects that differentiate TORS from the other robotic‐assisted surgical specialties. Based on previous experience with resident robotic surgical training, 47 as well as experience as a established surgeon proctoring, the least intuitive aspect of TORS performance is the maneuvering within the fixed space confined by the teeth, tongue, and mandible. Uncountable episodes would see trainees (as well as established surgeons) aiming to reach a target within the pharyngolarynx by advancing the instrument in a direct vector of motion, only to be frustrated by some unseen obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…This represents a critical goal of ultimately achieving improved patient outcomes through higher skilled surgical performances, which was shown in the frequently referenced New England Journal of Medicine article by Berkmeyer and colleagues, which demonstrated precisely this relationship between surgical skill and surgical outcome. 38 A review of all English language peer-reviewed published TORS cirrulum proposals [39][40][41][42][43][44][45][46][47] along with their relative strengths and limitations, are summarized in Table I. After a thorough analysis of these proposed TORS-specific training curricula, a few patterns emerge.…”

Section: Literature Review Of Tors Training Curriculamentioning

confidence: 99%

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Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

et al. 2020

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In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. Methods: Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). Results: Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor r...

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“…6,8 These simulation-based models are known to improve safety and provide cost-savings to the health care system via a reduction in morbidity. 2,4,9,10 The aim of this study is to validate a wax-based model which can reliably differentiate experienced and inexperienced cast saw users.…”

mentioning

confidence: 99%

Validation of a Cost-effective Cast Saw Simulation-based Educational Module to Improve Cast Removal Safety

Liles

Wieschhaus

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Inexperience in cast removal in the pediatric population can lead to a range of cast saw-related injuries. The purpose of this study is to validate a simple simulation-based wax model that is both reproducible and economical while providing a valuable tool that can be used to grade cast saw use performance in trainees. Methods: Cylindrical wax models were used as an analog for a pediatric upper extremity. The wax models were casted in a proscribed reproducible fashion for consistency. Two groups, the first consisting of 15 experienced cast saw users and the second consisting of 15 inexperienced individuals, completed 4 sequential longitudinal cuts in the casted wax models. After removal of the cast material, marks left by the cast saw in the wax were counted and measured. Indentation length, maximum depth, and maximum width were measured on each wax model. The total length of the cast saw indentations per cast saw user was also calculated.Results: For the inexperienced cast saw users, the average total length of the cast saw indentations was 526.56 mm, average maximum depth was 1.91 mm, and average maximum width was 3.24 mm. For experienced cast saw users, the average total length of the cast saw indentations was 156.57 mm with an average maximum depth of 1.06 mm and average maximum width of 2.19 mm. Receiver operating characteristic curves of the total number of errors, total error length, maximum error depth, and maximum error width show effective discrimination of experienced from inexperienced trainees. Conclusions: This study provides valid evidence supporting a cost-effective, time-efficient, and easily reproducible educational simulation module that can objectively measure cast saw the performance in trainees. This model demonstrates construct validity and can distinguish novice from experienced cast saw users. It is sensitive enough to identify mistakes even in the most experienced cast saw users, creating a platform that can provide performance-based feedback to cast saw users of all experience levels. Level of Evidence: Level III-diagnostic test.

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Initial and Long‐term Retention of Robotic Technical Skills in an Otolaryngology Residency Program

Abstract: NA.

Cited by 10 publications

References 31 publications

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

Transoral Robotic Surgical Proficiency Via Real‐Time Tactile Collision Awareness System

Validation of a Cost-effective Cast Saw Simulation-based Educational Module to Improve Cast Removal Safety

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