Search Results (403)

Simulation-based training is increasingly used to support skill acquisition in endoscopic sinus surgery (ESS), although many existing simulators lack objective methods for performance evaluation. This study aimed to assess the face and construct validity of a patient-specific, multi-material 3D-printed sinonasal simulator for ESS using both structured technical scoring and postoperative radiological analysis. Fifteen surgeons with different levels of experience (novices, intermediates, and experts; n = 5 per group) performed a standardized sequence of ESS procedures on identical 3D-printed models, including dacryocystorhinostomy, uncinectomy, maxillary antrostomy, anterior and posterior ethmoidectomy, sphenoidotomy, and frontal sinusotomy (DRAF I). Surgical performance was evaluated on video recordings using a modified Objective Structured Assessment of Technical Skills (OSATS) score. After simulation, each model underwent computed tomography (CT) scanning and a dedicated radiological checklist was applied to assess the adequacy of surgical steps, dimensional parameters of enlarged sinus ostia, and potential procedural complications. Mean OSATS scores differed significantly among expertise levels, with experts achieving higher scores (48.0 ± 1.9) than intermediates (39.4 ± 3.4) and novices (28.4 ± 3.8) (p < 0.01). CT analysis showed a significantly greater extent of ethmoidal cell removal in experts compared with novices (87.5% vs. 57.5%, p = 0.02) and a larger latero-lateral diameter of the frontoethmoidal recess compared with intermediates (p = 0.04). Questionnaire results indicated high perceived educational value, particularly among novices, despite some limitations in haptic realism. While the simulator appears to be a promising tool for ESS training, further studies are required to validate its effectiveness in improving surgical performance. Full article

Background: Gastroparesis is characterised by prolonged gastric emptying in the absence of mechanical gastric obstruction. When symptomatic, gastroparesis significantly impacts quality of life. While current consensus emphasises medical, surgical, or nutritional therapies, data evaluating the efficacy of alternative therapies remains scarce. Here, we review the efficacy of alternative therapies; acupuncture, electroacupuncture, moxibustion, and herbal medicine as management strategies. Methods: A systematic literature review of the literature was performed until February 2025. All papers were published from 2001 to 2024. This search focusses on the efficacy of acupuncture, electroacupuncture, moxibustion, and herbal medicines for management of gastroparesis. A comprehensive search was performed in PubMed, Embase, Medline, Google Scholar, Science Direct, and Web of Science. There were no language restrictions. Study outcomes were compared in a narrative synthesis and quality was assessed using Critical Appraisal Skills Programme (CASP) checklists. Results: We identified 68 studies of acupuncture, electroacupuncture, moxibustion, and herbal medicine as alternate therapies for gastroparesis. The total patient sample size of included studies was 4566, with a mean sample of 70.25 per study. The focus of studies comprising our review was electroacupuncture (11%), moxibustion (11%), acupuncture (29%), and herbal medicine (49%). Control comparisons were made with Mosapride, Metoclopramide, Domperidone, and Itopride. Conclusions: We found that alternative therapies are effective for the management of gastroparesis. However, the review was limited by heterogeneous study designs, incomplete methodological reporting, and publication bias. Future investigations must focus on long-term randomised control trials encompassing large sample sizes. Full article

The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on prostate, kidney, and bladder malignancies. Artificial intelligence tools, particularly those based on machine learning and deep learning, have demonstrated strong performance in analyzing imaging data, segmenting tumors, predicting pathological features, and supporting clinical decision-making. Intraoperatively, artificial intelligence enables skill assessment, personalized feedback, and real-time navigation by processing data from surgical videos and robotic system sensors. Augmented reality and intraoperative modeling further enhance visualization and margin control during complex procedures. The review also discusses emerging technologies such as single-port robotic platforms, which offer advantages in confined anatomical spaces and support less invasive approaches. Additionally, the growing field of telesurgery is addressed, highlighting its feasibility for complex urologic operations across vast distances. While many of these innovations are still in early stages of clinical validation, their integration into practice has the potential to improve oncologic and functional outcomes, expand access to expert care, and foster the development of next-generation surgical strategies in urologic oncology. Full article

Introduction: Simulation-based training is a key component of surgical education; however, existing models, such as dry-laboratory and virtual reality simulators, have limitations in terms of realism and accessibility. The use of human cadaveric material is also challenging because of its high cost and limited availability. Objectives: To evaluate the effectiveness of biological models based on large animal cadaveric material, specifically cattle and pigs, for practicing head and neck surgical skills. Materials and Methods: The study included 100 third- and fourth-year students, who were divided into a study group and a comparison group, with 50 participants in each group. The study group practiced surgical skills using animal cadaveric material: a porcine mandible for bone graft harvesting and a bovine head for resection craniotomy. The comparison group practiced using 3D-printed models. The results were assessed using an anonymous 8-item Likert-scale questionnaire, followed by statistical analysis using the Mann–Whitney U test. Results: In the study group, statistically significant increases were observed in satisfaction with participation, fulfillment of expectations, perceived subjective acquisition of manual skills, and overall satisfaction with the training process (p < 0.001; median scores: 38.0 and 34.0, respectively). The greatest differences were observed in satisfaction with participation, where 54% of participants rated it as “Excellent” compared with 6% in the comparison group, and in perceived subjective acquisition of manual skills, reported by 80% of participants in the study group compared with 24% in the comparison group. Conclusions. The use of cadaveric specimens from large animals is associated with higher satisfaction and represents an accessible alternative for practicing basic and commonly performed head and neck surgical procedures that do not require fine dissection of neurovascular bundles. This model provides a high degree of tactile realism and anatomical context and is subjectively preferred over non-anthropomorphic simulators. Full article

Background: Objective performance assessment is essential in surgical skill training, yet current methods are labor-intensive and focus on observing the trainee rather than the end-product of the procedure. Machine learning (ML) methods offer reproducible feedback but have mainly relied on kinematic or video data, often reducing assessment to binary or ternary classification. Our objective was to compare ML regression models predicting expert-assigned scores of vascular anastomoses from computational fluid dynamics (CFD) features of the final product. Additionally, we aimed to assess biomechanical plausibility of predictions. Methods: A total of 146 participants performed 419 end-to-side anastomoses on case-specific three-dimensional (3D) printed simulators. Anastomoses were digitized via 3D scanning, ranked by experts, and characterized using CFD-derived hemodynamic features. These served as input for linear models (Ridge, Partial Least Squares), support vector machines, and tree-based ensembles (Random Forest, Extremely Randomized Trees, and Extreme Gradient Boosting [XGBoost]), evaluated using 10-fold nested cross-validation with genetic hyperparameter optimization. Results: Inter-rater reliability of expert indicated strong agreement (intraclass correlation coefficient ICC3k = 0.846). XGBoost achieved the lowest mean root mean squared error of 0.758 (95% bootstrap CI: 0.722–0.799) and a coefficient of determination (R²) of 0.673 (0.617–0.725), with the most stable performance across folds. Shapley additive explanations (SHAP) identified the wall shear stress gradient, transverse wall shear stress, and maximum pressure as the most influential features—variables associated with intimal hyperplasia and atherosclerotic remodeling. Conclusions: Tree-based ensemble methods, particularly XGBoost, effectively modeled biomechanical properties against expert scores. Combining CFD and ML can provide reproducible, mechanistically relevant feedback in vascular surgical skill training. Full article

Regional anesthesia is vital for modern surgical practices, but accessibility to training is often hampered by the high cost of commercial phantom models. This study aimed to develop and evaluate low-cost, realistic phantom alternatives using Ecoflex, borax-containing polyvinyl alcohol (PVA), and plastisol compositions. The models were evaluated under ultrasound for imaging properties, including needle visibility, tissue resistance, cost, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), axial full width at half maximum (FWHM), and compared to a commercial reference (Blue Phantom). Initial qualitative assessments were performed by three experienced evaluators, and inter-observer agreement demonstrated good to excellent reliability. In addition, a long-term usability assessment was conducted more than one year after phantom preparation, involving 20 participants using a structured Likert scale. A statistically significant difference was observed among materials (Friedman test, p < 0.05), with PVA hydrogel containing 20 g borax and the Blue Phantom demonstrating the highest tissue realism scores, without a significant difference between them. The results showed that plastisol softener and PVA (20 g borax) hydrogel provided excellent needle visibility and tissue resistance and achieved an imaging performance comparable to the commercial model. Notably, CNR and SNR values for these materials approached reference levels, while costs ranged from $0.5 to $2.50 per 100 mL, representing a significant reduction compared to $45 per 100 mL for commercial models. In conclusion, this research confirms that affordable materials such as PVA and plastisol can effectively simulate human tissue for ultrasound-guided training. Furthermore, the findings suggest that PVA-based hydrogels may provide sustained usability over time, offering a practical and accessible solution for enhancing clinical skill acquisition in resource-constrained settings. Full article

Background/Objectives: Postgraduate training is an essential component for the development of professional skills in health sciences. Our research question was: How does the implementation of structured residency and fellowship programs in podiatry and foot and ankle surgery impact the acquisition of clinical and surgical skills, academic productivity, interprofessional integration, leadership development, and resident well-being compared to less structured or traditional programs? Methods: We conducted a systematic review of published research, between September and November 2025, selecting observational studies that evaluated structured training programs compared to traditional approaches. The studies included reported residency or fellowship programs in podiatry and foot and ankle surgery that described clinical, surgical or academic experiences, together with the factors that influence learning variability. Results: Eleven cross-sectional studies were included. Program structure, mentorship, clinical exposure, availability of educational resources, and individual motivation are determining factors in the variability of skills acquisition. Structured programs were associated with better academic and clinical performance, greater technical confidence, and professional leadership development. However, substantial heterogeneity was observed among programs, particularly regarding access to resources, which contributed to differences in the ultimate preparation of residents and fellows. The Newcastle–Ottawa Scale adapted assessed methodological quality, showing a low-to-moderate risk of bias. Conclusions: The literature suggests that although the programs generally achieve basic training objectives, the standardization and implementation of structured educational strategies could optimize skills acquisition and reduce variability across programs. Furthermore, multicenter research incorporating objective outcome measures would facilitate the development of internationally applicable standards for evaluation in health education. Full article

Minimal access cardiac surgery (MACS) can mitigate the increasing risk profile of cardiac surgery patients and is associated with improved postoperative outcomes. One of the ways to manage the steep learning curve of MACS is the use of surgical simulation training. We conducted a narrative review to identify the relevant literature discussing MACS simulation training. We identified 20 studies using our search strategy. Various platforms were represented: high-fidelity (n = 8), low-fidelity (n = 6), and animal studies (n = 6). Virtual reality (VR) appeared in two wet-lab studies as an adjunct. The surgical approach was video-assisted thoracoscopic surgery (VATS) in 11 and robotic-assisted thoracoscopic surgery (RATS) in nine. The most simulated procedure was minimal access mitral valve (MV) repair (n = 16). Most studies (n = 16) evaluated the impact of simulation training on the surgical skill of participants with varying baseline MACS experience. A small proportion of included studies (n = 4) carried out only fidelity testing. While some standardised assessment tools were used, there was considerable variation in how surgical skill and fidelity were assessed. There are an increasing number of publications on MACS simulation training, with equal focus on bench and animal models. MV procedures were the most simulated, suggesting a drive towards increasing the scope of minimal access MV training. Full article

Background/Objectives: This study aims to develop and validate a reproducible training model, built using common hospital items, for laparoscopic inguinal hernia repair with an intracorporeal suturing approach, specifically focusing on iliopubic tract redress in pediatric patients. Methods: Pediatric surgery residents and consultants were instructed on model building and engaged in training sessions. They practiced for four weeks with the handcrafted model and completed a post-simulation survey. The time taken to conclude the training task and the modified Objective Structured Assessment of Technical Skills score were compared between the initial and last sessions at the end of the training period. Additionally, the time required by consultants to perform the laparoscopic procedure in vivo, intraoperative complications, and recurrence rates were analyzed from the time they started the training. Results: A feasible model was created using a colostomy dressing support, Penrose drains, Foley catheters, feeding tubes, and surgical gloves to simulate. The sample involved a total of twelve residents and five consultants with an average age of 33 years old. All participants successfully completed the task during the session. Since the consultants started their training on the model, the operative results for laparoscopic inguinal hernia repair in the theater have improved. Conclusions: Training experience on this model led to improve laparoscopic skills such as cutting and dissection and intracorporeal tying and knotting. This study confirms that training outside clinical practice can significantly benefit laparoscopic proficiency and safety in vivo. Full article

Gentleness, defined as the ability to handle tissues delicately while minimizing unnecessary force, is a critical indicator of surgical proficiency. Objective and real-time assessment of gentleness in virtual reality (VR)-based training can improve the understanding of both psychomotor and cognitive components of surgical skill. This study evaluates and classifies participants’ gentleness during VR-based laparoscopic simulations using fNIRS-derived hemodynamic features. Twenty-three volunteers with no prior laparoscopic experience performed a VR-based double-grasper task while hemodynamic activity over frontal and motor cortical regions was recorded using eighteen fNIRS channels. In parallel, subjective workload (NASA-TLX), error counts, and gentleness performance score (GPS) were collected. Temporal features, including slope, root mean square, and standard deviation, were extracted from the fNIRS signals and used to train multiple machine learning classifiers. Performance labels were binarized into low and high groups using median splits of the gentleness performance score. Models were evaluated using stratified 5-fold cross-validation. Results revealed stronger right-frontal HbO activity and increased left-motor HbR responses in the low-performance group, suggesting higher cognitive effort and less efficient motor strategies. Across classifiers, slope-based features consistently outperformed variability- and amplitude-based metrics. The highest classification performance was achieved using HbR slope features with Random Forest classifiers (accuracy ≈ 0.85, AUC up to 0.93). These findings highlight the potential of fNIRS-based metrics for automated performance assessment in VR surgical training. Full article

Zygomatic implant perforated (ZIP) flap reconstruction offers immediate surgical rehabilitation following maxillectomy, integrating oncologic zygomatic implants with a fascio-cutaneous free flap. A critical technical challenge is safely perforating the free flap skin paddle to accommodate implants’ abutments without damaging its vasculature. Near-infrared (NIR) vein visualization technology provides real-time mapping of subcutaneous vessels and has been widely investigated in settings such as pediatric intravenous (IV) cannulation. By projecting vein pathways onto the skin, NIR visualization facilitates precise vascular identification, potentially reducing complications. We describe a case of ZIP flap reconstruction in a 25-year-old patient utilizing NIR vein visualization to preemptively locate flap vasculature and minimize the risk of vessel puncture. Our discussion places these findings within the context of the existing literature on NIR devices, underscoring their benefits of non-invasive operation, rapid imaging, and minimal need for advanced operator skills, and highlighting their utility in microvascular reconstructive surgery. Full article

Background/Objectives: Simulation has become an integral part of contemporary surgical training, allowing safe acquisition of technical skills with objective performance assessment. Microsurgery and robotic surgery share several technical features, including fine bimanual coordination, precise instrument control, and stereoscopic vision. This study aimed to evaluate whether a structured microsurgical course is associated with improved performance on a robotic surgical simulator and to explore its potential role within robotic training pathways. Methods: A prospective study was conducted between October 2022 and November 2025 at a single academic center, including 56 participants divided into three groups. Group A consisted of surgical residents attending a 3-day Basic Microsurgery Course; Group B included residents who did not undergo training during the same period; and Group C comprised experienced microsurgeons. Groups A and B performed two robotic simulation tasks at baseline (T0) and after three days (T1). Group C was assessed at T1 only as a reference benchmark. Performance was evaluated using simulator-derived metrics. Statistical analysis was performed using paired and unpaired t-tests. Results: Group A showed significant improvement across several performance parameters following training, whereas no comparable changes were observed in Group B. At T1, Group A demonstrated better performance than Group B in multiple metrics. Group C achieved the highest scores and was considered a reference group. Conclusions: Structured microsurgical training was associated with improved performance in a robotic simulation setting. These findings suggest that microsurgical skills may be transferable to robotic tasks and may contribute to the early phases of robotic skill acquisition. Further studies are required to assess their impact in clinical practice. Full article

Objectives: Arthroscopic surgery requires complex visuospatial coordination and psychomotor skills, which are traditionally acquired through mentorship and cadaveric training. High-fidelity simulators are effective but often costly and inaccessible. This study evaluates the technical effectiveness of a novel home-based 3D-printed arthroscopic simulator (“Arthrozero”) for improving basic arthroscopic skills among orthopedic residents. Methods: Thirty-three orthopedic residents (25–36 years) from two Italian university centers were randomized into three groups: ZERO (Arthrozero training), ARTHRO (real arthroscope training), and CONTROL (theoretical session). Training was performed on a FAST-like workstation through four progressively complex tasks. Performance metrics included task completion time, number of looks down, and skill progression during a final Shoulder Challenge (SHO-CHA) assessment. A web-based Likert questionnaire evaluated participant satisfaction and perceived educational value. Results: Both ZERO and ARTHRO groups demonstrated significant improvement across training sessions (p < 0.05) for all tasks, while the CONTROL group showed minimal gains. In the SHO-CHA assessment, mean completion times were 394.1 ± 140.7 s (ZERO), 456.1 ± 123.2 s (ARTHRO), and 745.5 ± 190.7 s (CONTROL) (p < 0.01). No significant difference was observed between ZERO and ARTHRO groups (p = 0.276). Conclusions: The home-based Arthrozero simulator demonstrated improvements in basic arthroscopic skill performance, suggesting that it may represent an accessible training tool to support early arthroscopic skill acquisition alongside traditional training methods. Full article

Introduction: The potential aggravation of the shortage of skilled professionals in surgical specialties presents challenges. The lack of work–life balance and the pressure of training may deter aspiring surgeons. Surgical disciplines still remain predominantly male so that feminization combined with factors such as part-time work and pregnancy-related absence may aggravate workforce shortages. Studies show that the next generation of physicians places more value on work–life balance and seeks a pleasant work environment. This raises the question of whether these developments pose a threat to the future of surgical disciplines or whether generational change may also offer new opportunities. Methodology: This prospective observational study was conducted among a cohort of third-year medical students at a medical university in Germany. A non-validated, self-administered questionnaire was used for data collection. Responses on the Likert scale were dichotomized and the results were statistically analysed using chi-square test and logistic regression. Results: Job expectations differed only marginally across specialties. Students generally rated work–life balance and a pleasant work environment significantly higher than career, income or prestige. Students interested in surgery place significantly less emphasis on work–life balance than non-surgical peers, particularly in orthopedics and trauma surgery (77% vs. 90%, p = 0.025). There was a significant association between interest in surgical specialties and leadership ambitions. Male students were significantly more likely than females to aspire to leadership roles (58.1% vs. 32.7%, p = 0.001) and to choose surgical specialties (46.0% vs. 28.3%, p = 0.018). Female students were not significantly less interested in trauma surgery. Conclusions: Although our data interpretation should be drawn with caution, the increasing feminization of medicine does not appear to exacerbate the shortage of physicians in trauma surgery. In our cohort, we made the indicative suggestion that aspiring surgeons might be willing to trade leisure for career advancement. Specialized curricula could promote identification with the field and develop leadership skills, so that an initial attachment to a specific specialty endures throughout medical studies and results in a corresponding choice of specialty. Full article

Traditional methods to learn soft-tissue surgical procedures rely on cadaver labs or patient-based learning, which are costly and geographically limited, and raise ethical questions. Virtual reality (VR) with haptic feedback offers a scalable alternative, but most current platforms emphasize bone-based rather than soft-tissue procedures learned by feel. We developed a VR+haptic simulation for preoperative training of retropubic midurethral sling (MUS) surgery. This study examines the usability of this platform with thirteen expert urogynecologic surgeons and subsequently makes improvements (e.g., in haptics) to evaluate the platform with twelve trainees based on the NASA Task Load Index for workload and a UTAUT-informed usability survey. Objective performance scores were recorded as participants completed up to four levels of increasing realism and difficulty, starting with a transparent body and a reference surgical trajectory. Trainees reported high usability, immersion, and engagement. Experts rated the platform as valuable for sling training and skill assessment. NASA-TLX results indicated low physical and temporal demand, low mental demand and frustration, and moderate effort. These findings suggest that SurgicalEd VR is acceptable and has appropriate workload characteristics for surgical education. Future studies could examine how using VR+ haptic training improves intraoperative performance. Full article