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Design of a Dynamic Force Measurement System for Training and Evaluation of Suture Surgical Skills

  • Education & Training
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Abstract

The aim of this study is to present the SurgeForce system, a tissue handling training device for analysis of dynamic force applied to the tissue and objective assessment of basic surgical skills during the suture process. The SurgeForce system consists of a mechanical base formed by two platforms joint with three stainless steel springs and a three axial digital accelerometer attached to the upper platform, which detects the dynamic force caused by a surgeon when performing a suture task over a synthetic tissue pad. Accelerometer data is sent to a control unit where preprocessing to transform the raw data into a force signal is done, and then, the force signal is sent to a computer application, which register the force exerted over the synthetic tissue pad. For validation, 17 participants (6 surgeons and 11 medical students) performed three simple interrupted sutures with knot tying using the SurgeForce system. Ten force-based metrics were proposed to evaluate their performance during the suturing task. Results of the validation showed statistical differences in 8 of 10 force-based parameters for assessment of basic surgical skills during the suture task. The SurgeForce system demonstrated its capacity to differentiate force-based performance of surgeons and medical students. The SurgeForce system has been successfully validated. This system was able to distinguish force performance between experts and novices, showing its potential to distinguish surgeons with basic suture skills from those who are not yet prepared.

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References

  1. Sylvester S, Magin P, Sweeney K, Morgan S, Henderson K. (2011) Procedural skills in general practice vocational training - what should be taught?. Aust Fam Physician 40(1-2):50-54.

    PubMed  Google Scholar 

  2. Liddell MJ, Davidson SK, Taub H, Whitecross LE. (2002) Evaluation of procedural skills training in an undergraduate curriculum. Med Educ 36(11): 1035-1041.

    Article  Google Scholar 

  3. Ochsmann EB, Zier U, Drexler H, Schmid K. (2011) Well prepared for work? Junior doctors’ self-assessment after medical education. BMC Med Educ 11:99. doi:https://doi.org/10.1186/1472-6920-11-99.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Goldacre MJ, Lambert TW, Svirko E. (2014) Foundation doctors’ views on whether their medical school prepared them well for work: UK graduates of 2008 and 2009. Postgrad Med J 90(1060):63-68. doi:https://doi.org/10.1136/postgradmedj-2012-131321.

    Article  PubMed  Google Scholar 

  5. Goldacre MJ, Lambert T, Evans J, Turner G. (2003) Preregistration house officers’ views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ 326(7397):1011-1012. doi:https://doi.org/10.1136/bmj.326.7397.1011.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Illing JC, Morrow GM, Rothwell nee Kergon CR, Burford BC, Baldauf BK, Davies CL, Peile EB, Spencer JA, Johnson N, Allen M, Morrison J. (2013) Perceptions of UK medical graduates’ preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ 13:34. doi:https://doi.org/10.1186/1472-6920-13-34.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stefanescu MC, Sterz J, Hoefer SH, Ruesseler M. (2018) Young surgeons’ challenges at the start of their clinical residency: a semi-qualitative study. Innov Surg Sci 3(4):235-243. doi:https://doi.org/10.1515/iss-2018-0015.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag J. (2010) Burnout and medical errors among American surgeons. Ann Surg. 251(6):995-1000. doi:https://doi.org/10.1097/SLA.0b013e3181bfdab3.

    Article  PubMed  Google Scholar 

  9. Proctor ML, Pastore J, Gerstle JT, Langer JC. (2003) Incidence of medical error and adverse outcomes on a pediatric general surgery service. J Pediatr Surg 38(9):1361-1365. doi:https://doi.org/10.1016/s0022-3468(03)00396-8.

    Article  PubMed  Google Scholar 

  10. Makary MA, Daniel M. (2016) Medical error-the third leading cause of death in the US. BMJ 353:i2139. doi:https://doi.org/10.1136/bmj.i2139.

    Article  PubMed  Google Scholar 

  11. Murphy JFA. (2016) Medical error as a cause of death revisited. Ir Med J 109(8):446.

    CAS  PubMed  Google Scholar 

  12. Raines DA. (2000) Making mistakes. Prevention is key to error-free health care. AWHONN lifelines 4(1):35-39. doi:https://doi.org/10.1111/j.1552-6356.2000.tb01161.x

    Article  CAS  PubMed  Google Scholar 

  13. Horeman T, Rodrigues SP, Jansen FW, Dankelman J, van den Dobbelsteen JJ. (2012) Force Parameters for Skills Assessment in Laparoscopy. IEEE Trans Haptics. 5(4):312-322l. doi: https://doi.org/10.1109/TOH.2011.60.

    Article  CAS  PubMed  Google Scholar 

  14. Horeman T, Rodrigues SP, Jansen FW, Dankelman J, van den Dobbelsteen JJ. (2010) Force measurement platform for training and assessment of laparoscopic skills. Surg Endosc 24(12):3102-3108. doi:https://doi.org/10.1007/s00464-010-1096-9

    Article  PubMed  PubMed Central  Google Scholar 

  15. Horeman T, Blikkendaal MD, Feng D, van Dijke A, Jansen F, Dankelman J, van den Dobbelsteen JJ. (2014) Visual force feedback improves knot-tying security. J Surg Educ 71(1):133-141. doi:https://doi.org/10.1016/j.jsurg.2013.06.021.

    Article  PubMed  Google Scholar 

  16. Gavrilovic B, Fahy AS, Carrillo B, Nasr A, Gerstle JT, Azzie G. (2018) Development of an Open-Source Laparoscopic Simulator Capable of Motion and Force Assessment: High Tech at Low Cost. J Laparoendosc Adv Surg Tech A 28(10):1253-1260. doi:https://doi.org/10.1089/lap.2018.0126.

    Article  PubMed  Google Scholar 

  17. Downing SM. (2003) Validity: on meaningful interpretation of assessment data. Med Educ. 37(9):830-7. doi: https://doi.org/10.1046/j.1365-2923.2003.01594.x.

    Article  PubMed  Google Scholar 

  18. Oropesa I, Sánchez-González P, Lamata P, Chmarra MK, Pagador JB, Sánchez-Margallo JA, Sánchez-Margallo FM, Gómez EJ. (2011) Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery. J Surg Res. 171(1):e81-95. doi: https://doi.org/10.1016/j.jss.2011.06.034.

    Article  PubMed  Google Scholar 

  19. Rodrigues SP, Horeman T, Dankelman J, van den Dobbelsteen JJ, Jansen F-W. (2012) Suturing intraabdominal organs: when do we cause tissue damage? Surg Endosc. 26(4):1005-1009. doi:https://doi.org/10.1007/s00464-011-1986-5.

    Article  PubMed  Google Scholar 

  20. Hardon SF, Horeman T, Bonjer HJ, Meijerink W. (2018) Force-based learning curve tracking in fundamental laparoscopic skills training. Surg Endosc, 32(8), 3609–3621. https://doi.org/10.1007/s00464-018-6090-7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Horeman T, Dankelman J, Jansen FW, van den Dobbelsteen JJ (2014) Assessment of laparoscopic skills based on force and motion parameters. IEEE Trans Biomed Eng, 61(3), 805–813. https://doi.org/10.1109/TBME.2013.2290052

    Article  PubMed  Google Scholar 

  22. Rodrigues SP, Horeman T, Dankelman J, van den Dobbelsteen JJ, Jansen FW (2015) Tying different knots: what forces do we use?. Surg Endosc, 29(7), 1982–1989. https://doi.org/10.1007/s00464-014-3898-7

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work has been carried out with the support of the UNAM-DGAPA-PAPIME program, (project PE217020). The authors would like to thank all medical students and surgeons from Department of Surgery at Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM) for their kindly and enthusiastic participation in this study. Special thanks to José Rodolfo Rosas-Ortiz and Victor Gabriel Hernández Valderrama for their technical assistance in the design, manufacture, and assembly of this device.

Funding

The authors declare that no grants or funding sources were received for this work.

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Authors and Affiliations

  1. Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, Mexico

    Fernando Pérez-Escamirosa

  2. Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV–IPN), Av. Instituto Politécnico Nacional No. 2508, Col. San Pedro Zacatenco, 07360, Ciudad de México, Mexico

    Salvador Montoya-Alvarez & Arturo Minor-Martínez

  3. Departamento de Cirugía Endoscópica, Hospital Infantil de México Federico Gómez, Calle Dr. Márquez No. 162, Cuahtémoc, Doctores, 06720, Ciudad de México, Mexico

    Ricardo Manuel Ordorica-Flores

  4. Servicio de Cirugía Experimental, Unidad de Microcirugía, CMN 20 de Noviembre ISSSTE, Félix Cuevas 540, Col. del Valle Sur, 03100, Ciudad de México, Mexico

    Luis Padilla-Sánchez

  5. Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Circuito Interior, Av. Universidad 3000, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, Mexico

    José Luis Jiménez-Corona

  6. Hospital Ángeles Pedregal, Camino de Sta Teresa 1055-S, Héroes de Padierna, La Magdalena Contreras, 10700, Ciudad de México, Mexico

    Jorge Ruíz-Lizarraga

Authors
  1. Fernando Pérez-Escamirosa
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  2. Salvador Montoya-Alvarez
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  3. Ricardo Manuel Ordorica-Flores
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  4. Luis Padilla-Sánchez
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  5. José Luis Jiménez-Corona
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  6. Jorge Ruíz-Lizarraga
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  7. Arturo Minor-Martínez
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Correspondence to Salvador Montoya-Alvarez.

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Pérez-Escamirosa, F., Montoya-Alvarez, S., Ordorica-Flores, R.M. et al. Design of a Dynamic Force Measurement System for Training and Evaluation of Suture Surgical Skills. J Med Syst 44, 174 (2020). https://doi.org/10.1007/s10916-020-01642-2

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