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Background: Surgical training emphasizes technical competence. Growing evidence indicates that nontechnical skills are also significant in determining performance. Critically, surgeons should be aware how performance is affected by pressure or distraction. We assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We hypothesized that the stressors would worsen performance, and that stress-induced diminution in performance would be inversely related to surgical experience. Methods: Twenty participants (10 surgeons and 10 medical students) completed a peg-threading task using a laparoscopic simulator: three times under control conditions, next with a visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance), and then with an auditory distraction overlay (operating theater environment noise). Task completion time and instrument tracking metrics (instrument tip distance traveled and instrument smoothness) were measured. Results: Under control conditions, surgeons completed the task significantly faster, with greater economy of movement, and improved instrument smoothness-compared with students. When exposed to distracting stimuli, the groups behaved differently. Surgeons completed the task more slowly, instrument movements became less smooth (significantly so under audio distraction conditions), but total distance traveled by instruments was unchanged. By contrast, student performance was not impaired and, in some ways, improved. Conclusion: The impact of visual and auditory distraction on surgical performance can be modeled in a laparoscopic simulation environment. The effect of distraction varies according to expertise. This environment may be an effective setting within which to learn to mitigate stress-induced diminution in performance. [ABSTRACT FROM AUTHOR]

Introduction: Objective performance feedback has potential to maximize the training benefit of laparoscopic simulators. Instrument movement metrics are, however, currently the preserve of complex and expensive systems. We aimed to develop and validate affordable, user-ready software that provides objective feedback by tracking instrument movement in a "take-home" laparoscopic simulator. Materials and Methods: Computer-vision processing tracks the movement of colored bands placed around the distal instrument shafts. The position of each instrument is logged from the simulator camera feed and movement metrics calculated in real time. Ten novices (junior doctors) and 13 general surgery trainees (StR) (training years 3-7) performed a standardized task (threading string through hoops) on the eoSim (eoSurgical™ Ltd., Edinburgh, Scotland, United Kingdom) take-home laparoscopic simulator. Statistical analysis was performed using unpaired t tests with Welch's correction. Results: The software was able to track the instrument tips reliably and effectively. Significant differences between the two groups were observed in time to complete task (StR versus novice, 2 minutes 33 seconds versus 9 minutes 53 seconds; P=.01), total distance traveled by instruments (3.29 m versus 11.38 m, respectively; P=.01), average instrument motion smoothness (0.15 mm/second(3) versus 0.06 mm/second(3), respectively; P<.01), and handedness (mean difference between dominant and nondominant hand) (0.55 m versus 2.43 m, respectively; P=.03). There was no significant difference seen in the distance between instrument tips, acceleration, speed of instruments, or time off-screen. Conclusions: We have developed software that brings objective performance feedback to the portable laparoscopic box simulator. Construct validity has been demonstrated. Removing the need for additional motion-tracking hardware makes it affordable and accessible. It is user-ready and has the potential to enhance the training benefit of portable simulators both in the workplace and at home. [ABSTRACT FROM AUTHOR]

Introduction: Objective performance feedback has potential to maximize the training benefit of laparoscopic simulators. Instrument movement metrics are, however, currently the preserve of complex and expensive systems. We aimed to develop and validate affordable, user-ready software that provides objective feedback by tracking instrument movement in a 'take-home' laparoscopic simulator. Materials and Methods: Computer-vision processing tracks the movement of colored bands placed around the distal instrument shafts. The position of each instrument is logged from the simulator camera feed and movement metrics calculated in real time. Ten novices (junior doctors) and 13 general surgery trainees (StR) (training years 3-7) performed a standardized task (threading string through hoops) on the eoSim (eoSurgical™ Ltd., Edinburgh, Scotland, United Kingdom) take-home laparoscopic simulator. Statistical analysis was performed using unpaired t tests with Welch's correction. Results: The software was able to track the instrument tips reliably and effectively. Significant differences between the two groups were observed in time to complete task (StR versus novice, 2 minutes 33 seconds versus 9 minutes 53 seconds; P=.01), total distance traveled by instruments (3.29 m versus 11.38 m, respectively; P=.01), average instrument motion smoothness (0.15 mm/second3 versus 0.06 mm/second3, respectively; P<.01), and handedness (mean difference between dominant and nondominant hand) (0.55 m versus 2.43 m, respectively; P=.03). There was no significant difference seen in the distance between instrument tips, acceleration, speed of instruments, or time off-screen. Conclusions: We have developed software that brings objective performance feedback to the portable laparoscopic box simulator. Construct validity has been demonstrated. Removing the need for additional motion-tracking hardware makes it affordable and accessible. It is user-ready and has the potential to enhance the training benefit of portable simulators both in the workplace and at home. [ABSTRACT FROM AUTHOR]