The surgical treatment of obesity: a personal perspective.
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Adult↗
Biomedical subjects
James C Rosser
Publications and source records attributed to James C Rosser.
Telementoring.
Telementoring began in the 1950s and is an advanced application of telemedicine that involves the removed guidance of a procedure where the student has no or limited experience. In the past 10 to 15 years, telemedicine has been revisited as a result of the healthcare delivery crisis, budgetary concerns, and the impact of managed care. In recent years, telementoring has had a number of successes which have led to further recent telementoring investigations and developments. Telementoring programs were established because it was impractical for specialized minimally invasive surgeons to proctor fellow surgeons during the adoption phase of new techniques. This catalyzed the establishment of formal telementoring procedural guidelines and networks. Efforts have been made in the remote direction of laparoscopic spermatic vein ligations, renal biopsy, nephrectomy, varicocelectomy, fetoscopy, and ophthalmology. Pilot studies in 2000 have statistically validated that telementoring can be as effective as on-site mentoring. In order to successfully conduct telementoring missions, however, it is important to follow a precise algorithm. If a standardized protocol is followed, it will ensure that telementoring is practiced safely and efficiently.
General Surgery↗
Wireless virtual instrument measurement of surgeons' physical and mental workloads for robotic versus manual minimally invasive surgery.
The human-technology interface in traditional minimally invasive surgery (MIS) is difficult for the surgeon. Efforts to improve this interface include the use of robotic surgery systems. Ergonomics studies are required to help understand and improve the MIS user interface. We have developed a tetherless virtual instrument (VI) ergonomics workstation for measuring the physical workloads and stress levels of surgeons performing MIS. The workstation records physiological measures of workload and stress and audio and multiple channels of video. The workstation frees up the subject so that studies can be performed in complex and realistic settings, including the operating room. We illustrate the use of the tetherless ergonomics workstation in a study to compare performance and workload for manual and robotically-assisted MIS. The surgeon volunteers were experienced with manual MIS but had no previous experience with the robotic system. The study results showed that the robotic system reduced the workload and stress levels for these subjects but somewhat degraded their performance. Additional studies are needed to determine the relative effects on performance of user inexperience and the robotic interface.
Ergonomics↗
The Impact of Technology on the Resolution of Minimally Invasive Training and Credentialing Challenges of the 21st Century.
After the meteoric entry of minimally invasive surgery onto the general surgery scene 9 years ago, it currently stands at a crossroads with regard to the 21st century. Many challenges hamper safe and costeffective deployment of minimally invasive techniques. There must be a stabilization and reduction of complication rates associated with laparoscopic cholecystectomy. Common bile duct injuries are in fact two to three times higher for laparoscopic cholecystectomy than for the open procedure. This matter has been discussed only at local morbidity and mortality conferences or at national meetings. Patients are being injured. The surgical community has failed to police itself and the public knows it. This led in 1992 to New York State health officials setting standards of training and surgeon preparedness for performing laparoscopic cholecystectomy. If surgeons don't handle the problem, the politicians and the lawyers soon will.
Journal Article↗
The use of a "hybrid" trainer in an established laparoscopic skills program.
OBJECTIVES: Tabletop inanimate trainers have proven to be a safe, inexpensive, and convenient platform for developing laparoscopic skills. Historically, programs that utilize these trainers rely on subjective evaluation of errors and time as the only measures of performance. Virtual reality simulators offer more extensive data collection capability, but they are expensive and lack realism. This study reviews a new electronic proctor (EP), and its performance within the Rosser Top Gun Laparoscopic Skills and Suturing Program. This "hybrid" training device seeks to capture the strengths of both platforms by providing an affordable, reliable, realistic training arena with metrics to objectively evaluate performance. METHODS: An electronic proctor was designed for use in conjunction with drills from the Top Gun Program. The tabletop trainers used were outfitted with an automated electromechanically monitored task arena. Subjects performed 10 repetitions of each of 3 drills: "Cup Drop," "Triangle Transfer," and "Intracorporeal Suturing." In real time, this device evaluates for instrument targeting accuracy, economy of motion, and adherence to the rules of the exercises. A buzzer and flashing light serve to alert the student to inaccuracies and breaches of the defined skill transference parameters. RESULTS: Between July 2001 and June 2003, 117 subjects participated in courses. Seventy-three who met data evaluation criteria were assessed and compared with 744 surgeons who had previously taken the course. The total time to complete each task was significantly longer with the EP in place. The Cup Drop drill with the EP had a mean total time of 1661 seconds (average, 166.10) with 54.49 errors (average, 5.45) vs. 1252 seconds (average, 125.2) without the EP (P = 0.000, t = 6.735, df = 814). The Triangle Transfer drill mean total time was 556 seconds (average, 55.63) and 167.57 errors (average. 16.75) (EP) vs. 454 seconds (non-EP) (average. 45.4) (P = 0.000, t = 4.447, df = 814). The mean total times of the suturing task was 1777 seconds (average, 177.73) and 90.46 errors (average. 9.04) (EP) vs. 1682 seconds (non-EP) (average, 168.2) (P = 0.040, t = 1.150, df = 814). When compared with surgeons who had participated in the Top Gun course prior to EP, the participants in the study collectively scored in the 18.3th percentile with the Cup Drop drill, 22.6th percentile with the Triangle Transfer drill, and 36.7th percentile with the Intracorporeal Suturing exercise. When penalizing for errors recorded by the EP, participants scored collectively in the 9.9th, 0.1th, and 17.7th percentile, respectively. No equipment failures occurred, and the agenda of the course did not have to be modified to accommodate the new platform. CONCLUSIONS: The EP utilized during the Top Gun Course was introduced without modification of the core curriculum and experienced no device failures. This hybrid trainer offers a cost-effective inanimate simulator that brings quality performance monitoring to traditional inanimate trainers. It appears that the EP influenced student performance by alerting them to errors made, thus causing an increased awareness of and focus on precision and accuracy. This suggests that the EP could have internal guidance capabilities. However, validation studies must be done in the future.
Educational Measurement↗