Opportunity to Connect with International Research-Minded Surgeons

The collaborative international Accredited Education Institute (AEI) research paper, "Video analysis in basic skills training: A way to expand the value and use of BlackBox training?," was published in Surgical Endoscopy in January 2018, and this study has contributed to more international research being conducted with simulator training scenarios. Karolinska Institutet, Umeå University–Sweden, and Athens University–Greece are collaborating to advance this important work and welcome an open dialogue with AEI colleagues.

Last year, this newsletter published that Dr. Ninos Oussi successfully defended his PhD thesis, "Is it all about the money? The effects of low- and high-cost simulator training scenarios in surgical training"). The following information will provide the context of the study and its collaborators.

When aiming for a PhD in surgery and surgical education, regardless of the solitary nature of the work, one learns the importance of teamwork, and in particular the synergies of teamwork. Throughout the process, I was privileged to be supervised by the head supervisor, Professor Lars Enochsson, as well as my three co-supervisors, Lars Henningsohn, MD, PhD; Markus Castegren; and Ann Kjellin, MD, PhD.

Most of the research was done at the Center for Advanced Medical Simulation and Training (CAMST) at Karolinska University Hospital, Huddinge, Sweden, where Professor Li Felländer-Tsai was chair, and parts of the research were conducted in collaboration with Professor Evangelos Georgiou at the Medical Physics Lab-Simulation Center (MPLSC), Athens University Medical School, and Kapodistrian University of Athens, Greece.

One of the things we focused on was whether or not a low-cost laparoscopic simulator (a BlackBox built and given to us by MPLSC) could provide a level of training equal to a high-fidelity laparoscopic simulator (LapMentor, 3D Systems, formerly Simbionix Ltd., USA), as tested by a validated laparoscopic simulator (MIST-VR, Mentice Medical Simulation, Gothenburg, Sweden).^{2,3 href=''>4 href=''>}

Furthermore, we examined the impact of PC-gaming experience, gender, and visuospatial ability on various parameters of the MIST-VR simulator, which showed as previously described by Schlickum et al. the effects of PC-gaming and visuospatial ability on laparoscopic skills performance.^{4,7 href=''>}

Additionally, in a cross-over fashion, we compared a conventional laparoscopic needle holder (Macro Needle Holder, Karl Storz SE & Co KG, Germany) with a novel laparoscopic needle holder (Najar Needle Holder, Laprotech B, Västerås, Sweden) to study if this new technique could provide faster learning of laparoscopic suturing skills in novices using a more sophisticated BlackBox simulator (Simball Box, Surgical Science Sweden AB, formerly Simball, G-coder Systems, Gothenburg Sweden). The results, although with few participants, suggests a faster learning using the novel handle. Moreover, to evaluate laparoscopic knot-tying and suturing skills, we produced an objective video evaluation scoring table (OVEST).

In collaboration with Professor Evangelos Georgiou, MPLSC, Athens, Greece, we have had the opportunity to produce more research—using stress biomarkers to estimate novice endoscopist's stress while training in a simulator—which has just been accepted for publication in the Scandinavian Journal of Gastroenterology.

In the department of surgery and urology at Mälar Hospital we have five sections: breast and plastic surgery, upper- and lower-GI surgery, urology, and vascular surgery. One goal of our department's head of surgeons is to provide good conditions for surgical training and development across all sections, as well as increase the interest in research among surgeons. Recently, several colleagues have been recruited to our surgical department. To enhance the capabilities of our department, we are looking for future collaboration with other departments on both national and international levels.

Looking forward to connecting with research-minded surgeons!

Ninos Oussi, MD, PhD
Senior Consultant Surgeon and Urologist
Clinical Lead and Head of Surgeons at the Department of Surgery and Urology, Mälar Hospital, Eskilstuna, Sweden
Affiliated with the Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
ATLS Instructor Since 2009
ninos.oussi@ki.se

References

1. Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: Results of a randomized, double-blinded study. Ann Surg. 2002;236:458-463; discussion 463-464.
2. Li MM, George J. A systematic review of low-cost laparoscopic simulators. Surg Endosc. 2017;31:38-48.
3. Guedes HG, Câmara Costa Ferreira ZM, Ribeiro de Sousa Leão L, et al. Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis. Int J Surg. 2019;61:60-68.
4. Oussi N, Enochsson L, Henningsohn L, et al. Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor. J Surg Res. 2020;250:1-11.
5. Schlickum MK, Hedman L, Enochsson L, et al. Systematic video game training in surgical novices improves performance in virtual reality endoscopic surgical simulators: A prospective randomized study. World J Surg. 2009;33:2360-2367.
6. Schlickum M, Hedman L, Enochsson L, et al. Surgical simulation tasks challenge visual working memory and visual-spatial ability differently. World J Surg. 2011;35:710-715.
7. Oussi N, Renman P, Georgiou K, et al. Baseline characteristics in laparoscopic simulator performance: The impact of personal computer (PC)–gaming experience and visuospatial ability. Surg Open Sci. 2021;4:19-25.
8. Oussi N, Georgiou K, Larentzakis A, et al. Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment. Surg Innov. 2020;27:211-219.