Surgery is known to be a craft profession requiring individuals with specific innate aptitude for manipulative skills, and visuospatial and psychomotor abilities. The present-day selection process of surgical trainees does not include aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We aimed to scrutinize the significance of innate aptitudes in surgical practice and impact of training on skills by systematically reviewing their significance on the surgical task performance. A systematic review was performed in compliance with PRISMA guidelines. An initial search was carried out on PubMed/Medline for English language articles published over 20 years from January 2001 to January 2021. Search strategy and terms to be used included ‘aptitude for surgery’, ‘innate aptitude and surgical skills, ‘manipulative abilities and surgery’, and ‘psychomotor skills and surgery’. MERSQI score was applied to assess the quality of quantitatively researched citations. The results of the present searches provided a total of 1142 studies. Twenty-one studies met the inclusion criteria out of which six citations reached high quality and rejected our three null hypothesis. Consequently, the result specified that all medical students cannot reach proficiency in skills necessary for pursuing a career in surgery; moreover, playing video games and/or musical instruments does not promote skills for surgery, and finally, there may be a valid test with predictive value for novices aspiring for a surgical career. MERSQI mean score was 11.07 (SD = 0.98; range 9.25–12.75). The significant findings indicated that medical students with low innate aptitude cannot reach skills necessary for a competent career in surgery. Training does not compensate for pictorial-skill deficiency, and a skill is needed in laparoscopy. Video-gaming and musical instrument playing did not significantly promote aptitude for microsurgery. The space-relation test has predictive value for a good laparoscopic surgical virtual-reality performance. The selection process for candidates suitable for a career in surgery requests performance in a simulated surgical environment.

/pdf/the-innate-aptitude-s-effect-on-the-surgical-task-9hm8903vrd.pdf

The innate aptitude's effect on the surgical task performance: a systematic review.

Laparoscopic skills assessment: an additional modality for pediatric surgery fellowship selection

Sur la base de precedents travaux de l’unite INSERM 1148, sur des films a base d’alcool polyvinylique, nous avons implante et evalue des protheses de moins de 2mm de diametre. L’ajout de gelatine in vitro a montre des capacites d’adherence cellulaires, compatibles avec une endothelialisation in situ, des implants garant, d’une permeabilite a long terme. Notre modele etait le remplacement de 1cm d’aorte sous renale de rat. Ces implants, ont ete utilisees comme modele d’entrainement basse fidelite a la microchirurgie, avec de meilleurs resultats sur l’acquisition de la technique d’anastomose microchirurgicale, que les tubes en silicone anterieurement utilise, lors de l’enseignement chez 71 etudiants. Un nouveau moyen d’imagerie pour l’exploration vasculaire par angiographie par resonance magnetique, en temps de vol sans injection chez l’animal, et la premiere application chez l’homme sont rapportes. Apres avoir presente notre methode de fabrication par reticulation physique (Lyophilisation Congelation) et chimique (STMP) Cdu PVA, directement sous forme de tubes, nous avons confirme l’hypothese que les micro implants a base de PVA associe a la gelatine a hauteur de 1%, a permis d’ameliorer la permeabilite par rapport au PVA seul, ou a tout autre ratio de gelatine ; et ce grâce a une endothelisation in situ constatees histologiquement. Les performances biomecaniques de l’implant ont aussi etaient evaluees. Au dela de 2 mois la permeabilite chute de 75% a 50%. Le vieillissement du materiel par son enraidissement, et le relargage de la gelatine pourrait expliquer cette diminution des performances au cours du temps.

Implantation et évaluation de micro-implants vasculaires (< 2mm), à base d’alcool polyvinylique

This study aimed to evaluate the efficiency of a multiple metrics assessment method to differentiate between surgeons of differing experience while performing a corneal suturing task. Volunteer ophthalmologists were assigned to three groups (senior [SG], junior [JG] and novice [NG]) according to their experience in corneal suturing. All participants performed three sessions of corneal wound closure by three stitches. Suturing and participant posture were recorded with cameras, and assessed by two blind assessors for stitch quality (using Zhang score) and ergonomics (using Rapid Upper Limb Assessment [RULA] score). Task duration was recorded. Objective analyses of stitches geometry and instrument position were carried out. We included 24 participants: 5 in the SG, 8 in the JG and 11 in the NG. Stitch quality was significantly better and time to perform the procedure significantly lower in more experienced groups (p < 0.001 and p = 0.002, respectively). SG participants better respected regular distance and parallelism between stitches compared to others (p = 0.01). Instrument position was similar between groups, although SG participants minimized their back-and-forth movements compared to NG participants. Ergonomics assessment was similar. Multiple metrics assessment efficiently determined how to differentiate between novices and experienced surgeons on corneal suturing skills, providing hints for future training studies. 

/pdf/multiple-metrics-assessment-method-for-a-reliable-evaluation-jgmi8t48.pdf

Multiple metrics assessment method for a reliable evaluation of corneal suturing skills

OBJECTIVE
Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC.


MATERIALS AND METHODS
A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy.


RESULTS
Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%).


CONCLUSION
We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice.


LEVEL OF EVIDENCE
Level 3 Laryngoscope, 2024.

Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP.

Objective Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand advanced psychomotor and visuospatial skills, and trainees possess these abilities to varying degrees. No method currently exists to predict who will possess an aptitude for microscopic surgery. Our goal was to determine whether performance can be predicted by background experiences or skills. Study design Retrospective cohort study. Setting Tertiary academic hospital. Subjects Students with no previous surgical experience. Interventions Subjects were surveyed on a wide range characteristics thought to affect surgical aptitude, with a primary focus on video gaming and musical training. Main outcome measure Subjects performed a microsurgical task using a novel simulator and their performance was assessed by blinded investigators. Results Forty-six students were assessed. There was no correlation between video gaming and improved microsurgical performance. Rather, video gamers obtained worse scores, although this difference did not reach significance. The majority of students played a musical instrument. Within this group, musicians who began playing at younger ages obtained higher scores, with the highest scores obtained by musicians who began playing before age 6. However, musicians did not obtain higher scores than non-musicians, regardless of their age of initiation. Conclusions No improvement in microsurgical aptitude was seen in subjects who had a history of video gaming or musical instrument playing.

Predicting Microsurgical Aptitude.

A radical parotidectomy with facial nerve sacrifice results in facial nerve paralysis as well as a volume and often cutaneous defect. Prior experience with nerve grafting and static suspension has yielded suboptimal results. The present report aims to examine the feasibility and outcomes of a combined free gracilis and profunda artery perforator (PAP) flap from a single donor site can reconstruct these extensive defects and potentially restore dynamic facial reanimation even in the setting of adjuvant radiation.

The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

Impact of Body Mass Index on Surgical Outcomes in Oncologic Microvascular Head and Neck Reconstruction

ASO Visual Abstract: Impact of Body Mass Index on Surgical Outcomes in Oncologic Microvascular Head and Neck Reconstruction

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Predicting Microsurgical Aptitude.

The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

Impact of Body Mass Index on Surgical Outcomes in Oncologic Microvascular Head and Neck Reconstruction

ASO Visual Abstract: Impact of Body Mass Index on Surgical Outcomes in Oncologic Microvascular Head and Neck Reconstruction