Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation.

Objective: The purpose of this study was to determine quality improvement outcomes following the pilot implementation of an in-situ simulation designed to enhance surgical safety checklist performance.

Background: OR Black Box (ORBB) technology allows near real-time assessment for surgical safety checklist performance. Before our study, timeout quality was 73.

Creating a Practical Transformational Change Management Model for Novel Artificial Intelligence-Enabled Technology Implementation in the Operating Room.

Objective: To identify change management (CM) strategies for implementing novel artificial intelligence and similar novel technologies in operating rooms and create a new CM model for future trials and applications inspired by the abovementioned strategies and established models.

Methods: Key phases of technology implementation were defined, and strategies for transformational CM were created and applied in a recent CM experience at our institution between October 15, 2020 and October 15, 2021. We appraised existing CM models and propose the newly created model.

Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury.

Background: Bile duct injury sustained during laparoscopic cholecystectomy is associated with high morbidity and mortality, and can be a devastating complication for a general surgeon. We introduce a novel, individualized surgical coaching program for surgeons who recently injured a bile duct in laparoscopic cholecystectomy. We aim to explore the perception of coaching among these surgeons and to assess surgeons' experiences in the coaching program.

Assessing the effect of a hands-on oncoplastic surgery training course: A survey of Canadian surgeons.

Background: The adoption of oncoplastic surgery in North America is poor despite evidence supporting the benefits. Surgeons take courses to acquire oncoplastic techniques, however, the effect of these courses is unknown. This study aimed to assess the impact of a hands-on oncoplastic course on surgeons' comfort with oncoplastic techniques and rate of adoption of these techniques in their practice.

Implementing new surgical technology: a national perspective on case volume requirement for proficiency in transanal total mesorectal excision.

Background: Early data suggest that transanal total mesorectal excision (TaTME) is a safe alternative to the abdominal approach for rectal cancer. This study aims to understand the approach to the management of rectal cancer in Canada and to ascertain perspectives on introducing TaTME.

Methods: Surgeons were invited to complete a survey that asked about their management practices relating to rectal cancer and their opinions regarding TaTME.

A framework to build capacity for a reflex-testing program for Lynch syndrome.

Purpose: Lynch syndrome (LS) is the most common inherited cause of colorectal cancer. Although testing all colorectal tumors for LS is recommended, the uptake of reflex-testing programs within health systems has been limited. This multipronged study describes the design of a provincial program for reflex testing in Ontario, Canada.

Learning by Example: An International Perspective on Reflex-Testing for Lynch Syndrome.

Background: Lynch syndrome (LS), an autosomal dominant cancer syndrome, is the most common cause of hereditary colon cancer. Currently, however, less than 5% of patients with LS have been identified. Reflex-testing programs (in which tumors of patients with colorectal cancer are routinely evaluated for LS) have been proposed for better identification of affected individuals, yet the uptake of these programs within health care systems is limited.

Peer coaching to teach faculty surgeons an advanced laparoscopic skill: A randomized controlled trial.

Background: Preliminary evidence suggests that coaching is an effective adjunct in resident training. The learning needs of faculty, however, are different from those of trainees. Assessing the effectiveness of peer coaching at improving the technical proficiency of practicing surgeons is an area that remains largely unexplored.

Laparoscopic translevator approach to abdominoperineal resection for rectal adenocarcinoma: feasibility and short-term oncologic outcomes.

Background: The extra-levator approach to abdominal perineal resection (APR) was developed in order to reduce the rates of positive circumferential resection margin. This approach, however, is associated with significant morbidity. We postulate that a less radical resection of the levators done laparoscopically could significantly decrease the rate of perineal complications while ensuring an oncologically adequate specimen.

Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: a randomized controlled trial.

Objective: The purpose of this study was to investigate whether individualized deliberate practice on a virtual reality (VR) simulator results in improved technical performance in the operating room.

Background: Training on VR simulators has been shown to improve technical performance in the operating room (OR). Currently described VR curricula consist of trainees practicing the same tasks until expert proficiency is reached.

Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial.

Objective: : To develop and validate an ex vivo comprehensive curriculum for a basic laparoscopic procedure.

Background: : Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Moreover, neither the effect of ex vivo training on learning curves in the operating room (OR), nor the effect on nontechnical proficiency has been investigated.

Comprehensive training curricula for minimally invasive surgery.

Background: The unique skill set required for minimally invasive surgery has in part contributed to a certain portion of surgical residency training transitioning from the operating room to the surgical skills laboratory. Simulation lends itself well as a method to shorten the learning curve for minimally invasive surgery by allowing trainees to practice the unique motor skills required for this type of surgery in a safe, structured environment. Although a significant amount of important work has been done to validate simulators as viable systems for teaching technical skills outside the operating room, the next step is to integrate simulation training into a comprehensive curriculum.

Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial.

Objective: To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery.

Background: Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures.

A comparison of 2 ex vivo training curricula for advanced laparoscopic skills: a randomized controlled trial.

Objective: To compare the effectiveness and cost of 2 ex vivo training curricula for laparoscopic suturing.

Background: Although simulators have been developed to teach laparoscopic suturing, a barrier to their wide implementation in training programs is a lack of knowledge regarding their relative training benefit and their associated cost.

Method: This prospective single-blinded randomized trial allocated 24 surgical residents to train to proficiency using either a virtual reality (VR) simulator or box trainer.

A prospective study demonstrating the reliability and validity of two procedure-specific evaluation tools to assess operative competence in laparoscopic colorectal surgery.

Background: Laparoscopic colorectal surgery is considered an advanced minimally invasive procedure with a long, variable learning curve. Developing an evaluation tool is essential to ensure that individuals reach a certain level of competence prior to performing this procedure independently. To achieve standardization and wide implementation, an assessment tool must be reflective of practice across many institutions.

Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: a Delphi approach.

Background: Although task training on virtual reality (VR) simulators has been shown to transfer to the operating room, to date no VR curricula have been described for advanced laparoscopic procedures. The purpose of this study was to develop a proficiency-based VR technical skills curriculum for laparoscopic colorectal surgery.

Methods: The Delphi method was used to determine expert consensus on which VR tasks (on the LapSim simulator) are relevant to teaching laparoscopic colorectal surgery.

Ex vivo technical skills training transfers to the operating room and enhances cognitive learning: a randomized controlled trial.

Background: Surgical training in the operating room includes acquiring technical skills and cognitive knowledge. Technical skills training on simulated models has been shown to improve technical performance in the operating room, and may also enhance the acquisition of other skills by freeing cognitive capacity. This has yet to be investigated.

Development of an objective evaluation tool to assess technical skill in laparoscopic colorectal surgery: a Delphi methodology.

Background: Laparoscopic colorectal surgery (LCS) is an advanced procedure for which no objective tools exist to assess technical skill. The aim of this study was to determine expert consensus regarding items required on a rating scale for LCS, using a Delphi technique.

Methods: Experts rated the substeps of LCS from 1 to 5.

Virtual reality in surgical skills training.

With recent concerns regarding patient safety, and legislation regarding resident work hours, it is accepted that a certain amount of surgical skills training will transition to the surgical skills laboratory. Virtual reality offers enormous potential to enhance technical and non-technical skills training outside the operating room. Virtual-reality systems range from basic low-fidelity devices to highly complex virtual environments.

Resident perceptions of advanced laparoscopic skills training.

Background: The purpose of this study was to explore resident perceptions regarding four current models for teaching laparoscopic suturing and to assess the current quality of training in advanced minimally invasive surgical techniques at an academic teaching center.

Methods: This study included 14 senior general surgery residents (PGY 3-5) participating in a workshop in advanced laparoscopy. Four training tools were used in the course curriculum: the Fundamentals of Laparoscopic Surgery (FLS) black box suturing model, a synthetic Nissen fundoplication model, a virtual reality (VR) simulator suturing task, and a porcine jejuno-jejunostomy model.

Neuronal activity in the globus pallidus of multiple system atrophy patients.

The pathophysiological changes in neural activity that characterize multiple system atrophy (MSA) are largely unknown. We recorded the activity of pallidal neurons in 3 patients with clinical and radiological features of MSA who underwent unilateral microelectrode-guided pallidotomy for disabling parkinsonism. Findings in these patients were compared with 4 control patients with a clinical diagnosis of Parkinson's disease (PD).

Stimulation-induced inhibition of neuronal firing in human subthalamic nucleus.

The subthalamic nucleus (STN) is an important component of the basal ganglia (BG) and plays a major role in the pathogenesis of Parkinson's disease (PD). Hyperactivity of STN as a consequence of the loss of dopaminergic inputs to the BG is believed to be a major factor in producing the motor symptoms of PD. High-frequency (HF) deep brain stimulation (DBS) of the STN has recently become an important treatment in PD patients where medications no longer provide satisfactory therapy.