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Face validation of the Virtual Electrosurgery Skill Trainer (VEST©)

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Abstract

Background

Electrosurgery is a modality that is widely used in surgery, whose use has resulted in injuries, OR fires and even death. The SAGES has established the FUSE program to address the knowledge gap in the proper and safe usage of electrosurgical devices. Complementing it, we have developed the Virtual Electrosurgery Skill Trainer (VEST©), which is designed to train subjects in both cognitive and motor skills necessary to safely operate electrosurgical devices. The objective of this study is to asses the face validity of the VEST© simulator.

Methods

Sixty-three subjects were recruited at the 2014 SAGES Learning Center. They all completed the monopolar electrosurgery module on the VEST© simulator. At the end of the study, subjects assessed the face validity with questions that were scored on a 5-point Likert scale.

Results

The subjects were divided into two groups; FUSE experience (n = 15) and no FUSE experience (n = 48). The median score for both the groups was 4 or higher on all questions and 5 on questions on effectiveness of VEST© in aiding learning electrosurgery fundamentals. Questions on using the simulator in their own skills lab and recommending it to their peers also scored at 5. Mann–Whitney U test showed no significant difference (p > 0.05) indicating a general agreement. 46 % of the respondents preferred VEST compared with 52 % who preferred animal model and 2 % preferred both for training in electrosurgery.

Conclusion

This study demonstrated the face validity of the VEST© simulator. High scores showed that the simulator was visually realistic and reproduced lifelike tissue effects and the features were adequate enough to provide high realism. The self-learning instructional material was also found to be very useful in learning the fundamentals of electrosurgery. Adding more modules would increase the applicability of the VEST© simulator.

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References

  1. Cushing H, Bovie WT, S. P. C. of Chicago (1928) Electro-surgery as an aid to the removal of intracranial tumors: with a preliminary note on a new surgical current generator. In: Surgery, gynecology and obstetrics, vol 47. Surgical Publishing Company, Chicago

  2. Nduka CC, Super PA, Monson JR, Darzi AW (1994) Cause and prevention of electrosurgical injuries in laparoscopy. J Am Coll Surg 179(2):161–170

    CAS  PubMed  Google Scholar 

  3. Lee J (2002) Update on electrosurgery. Outpatient Surg 3(2). http://www.outpatientsurgery.net/surgical-services/electrosurgery/update-on-electrosurgery--02-02

  4. Willson PD, McAnena OJ, Peters EE (1994) A fatal complication of diathermy in laparoscopic surgery. Minim Invasive Ther Allied Technol 3(1):19–20

    Article  Google Scholar 

  5. Peterson HB, Ory HW, Greenspan JR, Tyler CW (1981) Deaths associated with laparoscopic sterilization by unipolar electrocoagulating devices, 1978 and 1979. Am J Obstet Gynecol 139(2):141–143

    CAS  PubMed  Google Scholar 

  6. ECRI Institute (2009) 2010 top 10 technology hazards. Health Devices 3(11)

  7. Hart SR, Yajnik A, Ashford J, Springer R, Harvey S (2011) Operating room fire safety. Ochsner J 11(1):37–42

    PubMed Central  PubMed  Google Scholar 

  8. Feldman LS, Fuchshuber P, Jones DB, Mischna J, Schwaitzberg SD, FUSE (Fundamental Use of Surgical Energy™) Task Force (2012) Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surg Endosc 26(10):2735–2739

    Article  PubMed  Google Scholar 

  9. Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K, SAGES FLS Committee (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135(1):21–27

    Article  PubMed  Google Scholar 

  10. Hazey JW, Marks JM, Mellinger JD, Trus TL, Chand B, Delaney CP, Dunkin BJ, Fanelli RD, Fried GM, Martinez JM, Pearl JP, Poulose BK, Sillin LF, Vassiliou MC, Melvin WS (2014) Why fundamentals of endoscopic surgery (FES)? Surg Endosc 28(3):701–703

    Article  PubMed  Google Scholar 

  11. Feldman L, Fuchshuber P, Jones DB (2012) The SAGES manual on the fundamental use of surgical energy (FUSE). Springer Science & Business Media, Berlin

    Book  Google Scholar 

  12. Madani A, Jones DB, Fuchshuber P, Robinson TN, Feldman, LS (2014) Fundamental use of surgical energy™ (FUSE): a curriculum on surgical energy-based devices. Surg Endosc 28(9):2509–2512. http://www.ncbi.nlm.nih.gov/pubmed/24939162

    Article  PubMed  Google Scholar 

  13. Feldman LS, Brunt LM, Fuchshuber P, Jones DB, Jones SB, Mischna J, Munro MG, Rozner MA, Schwaitzberg SD, Schwaitzberg, and SAGES FUSE™ Committee (2013) Rationale for the fundamental use of surgical Energy™ (FUSE) curriculum assessment: focus on safety. Surg Endosc 27(11):4054–4059

    Article  PubMed  Google Scholar 

  14. Lindenmayer A (1968) Mathematical models for cellular interactions in development. I. Filaments with one-sided inputs. J Theor Biol 18(3):280–299

    Article  CAS  PubMed  Google Scholar 

  15. Crane K, Llamas I, Tariq S (2007) GPU Gems 3—Chapter 30. Real-time simulation and rendering of 3D Fluids. In: GPU Gems 3, 2nd ed., Addison-Wesley Professional

  16. Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 22(140):1–55

    Google Scholar 

  17. Sutton PA, Awad S, Perkins AC, Lobo DN (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel™ and the Ligasure™. Br J Surg 97(3):428–433

    Article  CAS  PubMed  Google Scholar 

  18. Polychronidis A, Tsaroucha AK, Karayiannakis AJ, Perente S, Efstathiou E, Simopoulos C (2005) Delayed perforation of the large bowel due to thermal injury during laparoscopic cholecystectomy. J Int Med Res 33(3):360–363

    Article  CAS  PubMed  Google Scholar 

  19. Willson PD, van der Walt JD, Moxon D, Rogers J (1997) Port site electrosurgical (diathermy) burns during surgical laparoscopy. Surg Endosc 11(6):653–654

    Article  CAS  PubMed  Google Scholar 

  20. Sankaranarayanan G, Resapu RR, Jones DB, Schwaitzberg S, De S (2013) Common uses and cited complications of energy in surgery. Surg Endosc 27(9):3056–3072

    Article  PubMed Central  PubMed  Google Scholar 

  21. Allen BF, Jones DB, Schwaitzberg SD, Suvranu D (2014) Survey-based analysis of fundamental tasks for effective use of electrosurgical instruments. Surg Endosc 28(4):1166–1172

    Article  PubMed Central  PubMed  Google Scholar 

  22. Madani A, Watanabe Y, Vassiliou MC, Fuchshuber P, Jones DB, Schwaitzberg SD, Fried GM, Feldman LS (2014) Impact of a hands-on component on learning in the Fundamental Use of Surgical Energy™ (FUSE) curriculum: a randomized-controlled trial in surgical trainees. Surg Endosc 28:2772

    Article  PubMed  Google Scholar 

  23. Dale E (1969) Audiovisual methods in teaching. Third Edition

  24. Masters K (2013) Edgar Dale’s Pyramid of Learning in medical education: a literature review. Med Teach 35(11):e1584–e1593

    Article  PubMed  Google Scholar 

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Acknowledgments

This project was supported by National Institutes of Health (NIH) Grant NIH/NIBIB 2R01EB005807, 5R01EB010037, 1R01EB009362, 1R01EB014305. We thank Mr. Adam Ryason, graduate student at the Center for Modeling, Simulation and Imaging in Medicine (CeMSIM) for 3D printing and assembling the tissue pad.

Disclosures

Dr. Daniel B. Jones is the chair of the SAGES FUSE committee and consultant to Allurion and Intuitive Surgical. Dr. Steven Schwaitzberg has served on advisory panels and has received an honorarium from Stryker and Olympus. He has served on advisory panels for Neatstitch and Surgicquest, Arch Therapeutics Acuity Bio and Human Extensions. He has also received a grant from Ethicon. Drs. Ganesh Sankaranarayanan and De serve as members in the SAGES FUSE committee. Mr Baichun Li, Drs. Amie Miller, Hussna Wakily, Stephanie B. Jones and Jaisa Olasky have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA

    Ganesh Sankaranarayanan, Baichun Li & Suvranu De

  2. School of Mechanical Engineering and Automation, Northeastern University, Sheyang, China

    Baichun Li

  3. Boon Shaft School of Medicine, Wright State University, Dayton, OH, USA

    Amie Miller

  4. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Hussna Wakily, Stephanie B. Jones & Daniel B. Jones

  5. Department of Surgery, Cambridge Health Alliance, Boston, MA, USA

    Steven Schwaitzberg

  6. Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn Street Suite 407, Cambridge, MA, 02138, USA

    Jaisa Olasky

Authors
  1. Ganesh Sankaranarayanan
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  2. Baichun Li
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  3. Amie Miller
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  4. Hussna Wakily
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  5. Stephanie B. Jones
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  6. Steven Schwaitzberg
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  7. Daniel B. Jones
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  8. Suvranu De
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  9. Jaisa Olasky
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Corresponding author

Correspondence to Jaisa Olasky.

Additional information

Accepted for poster presentation at the 2015 SAGES meeting.

Appendix: monopolar electrosurgery learning objective

Appendix: monopolar electrosurgery learning objective

Learning objectives

  1. a.

    Difference in waveforms between cutting and coagulation settings

  2. b.

    Different power settings and its effect on both cutting and coagulation

Cutting mode

Cutting mode is a continuous, relatively low-voltage waveform (waveform shown on the side of the screen). An incision is made by a process known as linear vaporization. Vaporization occurs when the cellular temperature is between 100 and 200 degrees Celsius. As the cell bursts or vaporizes, a steam pocket is made which results in an incision without significant tissue effect to the surrounding tissues. This is done when the electrosurgical instrument is held very close to, but not in direct contact to the target tissue.

In contrast, if the instrument is held in contact with the tissue, the current density decreases, resulting in less tissue effect. At temperature 60–95, the cellular protein bonds break and the tissue undergoes coagulation.

Task 1a: Set the electrosurgical pencil to pure “cutting” on 20 Watts. Hold it near but not in direct contact with tissues and activate in a straight line.

Task 1b: Now repeat the task while in direct contact with the tissue and activate it in a straight line.

Notice:

  1. 1.

    No visible coagulum when not in contact with the tissue

  2. 2.

    Visible coagulum when in contact with the tissue

Task 2a: Set the electrosurgical pencil to pure “cutting” on 40 Watts. Hold it near but not in direct contact with tissues and activate in a straight line.

Task 2b: Now repeat the task while in direct contact with the tissue and activate it in a straight line.

Notice:

  1. 1.

    No visible coagulum and larger incision compared with the power setting of 20 Watts when not in contact with the tissue.

  2. 2.

    Formation of black coagulum and no incision when in contact with the tissue.

Coagulation mode

“Coagulation” mode is an interrupted, high-voltage waveform (waveform shown on the side of the screen). Compared with “cutting,” there is an uneven and unpredictable coagulation pattern. The more superficial layers of the tissue become rapidly coagulated, increasing impedance, thereby preventing further transmission of the energy to the deeper layers of the tissue. There is not reliable sealing of vessels. When this is used without direct tissue contact, with high voltage, very high temperatures are reached, resulting in fulguration, which is useful for superficial coagulation of small capillaries and raw surfaces, such as the gallbladder fossa of the liver.

Task 3a: Set the electrosurgical pencil to pure “coagulation” on 60. Hold it in contact with the tissue and activate it in a painting like manner across the tissue.

Task 3b: Now repeat the task but hold it near and do not make contact with the tissue.

Notice:

  1. 1.

    When in contact, formation of black coagulum which flakes off when contact is released.

  2. 2.

    When not in contact, formation of widespread black coagulum

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Sankaranarayanan, G., Li, B., Miller, A. et al. Face validation of the Virtual Electrosurgery Skill Trainer (VEST©). Surg Endosc 30, 730–738 (2016). https://doi.org/10.1007/s00464-015-4267-x

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  • DOI: https://doi.org/10.1007/s00464-015-4267-x

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