The MISTELS program to measure technical skill in laparoscopic surgery. Surg Endosc

Steinberg-Bernstein Centre for Minimally Invasive Surgery, Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, #L9.309, Montreal, Quebec, H3G 1A4, Canada.
Surgical Endoscopy (Impact Factor: 3.26). 06/2006; 20(5):744-7. DOI: 10.1007/s00464-005-3008-y
Source: PubMed


The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) is a series of five tasks with an objective scoring system. The purpose of this study was to estimate the interrater and test-retest reliability of the MISTELS metrics and to assess their internal consistency.
To determine interrater reliability, two trained observers scored 10 subjects, either live or on tape. Test-retest reliability was assessed by having 12 subjects perform two tests, the second immediately following the first. Interrater and test-retest reliability were assessed using intraclass correlation coefficients. Internal consistency between tasks was estimated using Cronbach's alpha.
The interrater and test-retest reliabilities for the total scores were both excellent at 0.998 [95% confidence interval (CI), 0.985-1.00] and 0.892 (95% CI, 0.665-0.968), respectively. Cronbach's alpha for the first assessment of the test-retest was 0.86.
The MISTELS metrics have excellent reliability, which exceeds the threshold level of 0.8 required for high-stakes evaluations. These findings support the use of MISTELS for evaluation in many different settings, including residency training programs.

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    • "The MISTELS test battery evaluated the speed and quality of completion for five individual skills pertaining to manipulation of laparoscopic tools. These skills included: pattern cutting, intracorporeal knot tying, extracorporeal knot tying, placement of a ligating loop, and peg-board transfers (Fraser et al., 2003; Vassiliou et al., 2006). Interestingly, little research has explored the effect of stereoscopic viewing environments or spatial visualization ability (Vz) on the performance of skills like those sampled in the MISTELS tasks. "
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    ABSTRACT: Elevated spatial visualization ability (Vz) is thought to influence surgical skill acquisition and performance. Current research suggests that stereo visualization technology and its association with skill performance may confer perceptual advantages. This is of particular interest in laparoscopic skill training, where stereo visualization may confer learning advantages to novices of variant Vz. This study explored laparoscopic skill performance scores in novices with variable spatial ability utilizing stereoscopic and traditional monoscopic visualization paradigms. Utilizing the McGill Inanimate System for Teaching and Evaluating Laparoscopic Skills (MISTELS) scoring protocol it was hypothesized that individuals with high spatial visualization ability (HVz) would achieve higher overall and individual MISTELS task scores as compared to low spatial visualization ability (LVz) counterparts. Further, we also hypothesized that a difference would exist between HVz and LVz individual scores based on the viewing modality employed. No significant difference was observed between HVz and LVz individuals for MISTELS tasks scores, overall or individually under both viewing modalities, despite higher average MISTELS scores for HVz individuals. The lack of difference between scores obtained under the stereo modality suggested that the additional depth that is conferred by the stereoscopic visualization may act to enhance performance for individuals with LVz, potentially equilibrating their performance with their HVz peers. Further experimentation is required to better ascertain the effects of stereo visualization in individuals of high and low Vz, though it appears stereoscopic visualizations could serve as a prosthetic to enhance skill performance. Anat Sci Educ. © 2013 American Association of Anatomists.
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    • "Laparoscopic surgery requires high skill in the use of surgical instruments, adaptation to limited workspace, and adaptation to the loss of information due to the depth. Therefore, the training of the surgeon's skills [1], [2] and the development of new training systems which contribute significantly to the surgeon's improvement of surgical and technical skills are very important. Physical training systems [3], [4] and virtual reality and augmented reality simulators [5], [6] have shown their efficiency for learning and continuous improvement of the surgeon's psychomotor skills. "
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    • "Laparoscopic surgery brings significant benefits to patients intra-and post-operatively. Recently, a number of surgical simulators, both physical, model-based and softwarebased , have been developed, all allowing trainees to safely master the basics skills such as depth perception, dexterity, or hand-eye coordination [6], [8], [9], [13]. This paper focuses on the next generation of the Computer-Assisted Surgical Training System (CAST) [2], designed particularly for the skill-based behavior training of laparoscopic surgeons [3]. "
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    ABSTRACT: This paper describes a mechatronic (mechanical and electronic) realization of the optimal trajectory planning and guidance algorithms for minimally invasive surgical training. Specifically, the realization implements optimal navigation paths for surgical instruments in laparoscopic exercises. The underlying system platform is the Computer-Aided Surgical Trainer (CAST) that consist of mechanical fixtures equipped with encoders and servo motors. This hardware provides a means to accurately track the tip movements of laparoscopic instruments used in minimally invasive surgery. Furthermore it provides feedback to a PID controller which implements the optimal instrument trajectories. Supporting software provides all calibration procedures necessary to maintain the desired system's accuracy. Details of the mechanical, hardware, and software components are presented, along with their limitations and preliminary results.
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