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The coronavirus disease 2019 (COVID-19) pandemic has strained health care systems and personal protective equipment (PPE) supplies globally. We hypothesized that a collaborative robot system could perform health care worker effector tasks inside a simulated intensive care unit (ICU) patient room, which could theoretically reduce both PPE use and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposures. We planned a prospective proof-of-concept feasibility and design pilot study to test 5 discrete medical tasks in a simulated ICU room of a COVID-19 patient using a collaborative robot: push a button on intravenous pole machine when alert occurs for downstream occlusion, adjust ventilator knob, push button on ICU monitor to silence false alerts, increase oxygen flow on wall-mounted flow meter to allow the patient to walk to the bathroom and back (dial-up and dial-down oxygen flow), and push wall-mounted nurse call button. Feasibility was defined as task completion robotically. A training period of 45 minutes to 1 hour was needed to program the system de novo for each task. In less than 30 days, the team completed 5 simple effector task experiments robotically. Selected collaborative robotic effector tasks appear feasible in a simulated ICU room of the COVID-19 patient. Theoretically, this robotic approach could reduce PPE use and staff SARS-CoV-2 exposure. It requires future validation and health care worker learning similar to other ICU device training.

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Training adult learners to use ultrasound in clinical practice relies on the ability of the learner to apply visuospatial concepts to the anatomy of the human body. We describe a visuospatial trainer that replicates the housing of an ultrasound transducer, through which a linear laser projects light in the same plane and orientation as the ultrasonic sound waves. We use this trainer in combination with a porcine heart dissection laboratory to teach bedside cardiac ultrasound and transthoracic echocardiography (TTE). Off-the-shelf components, including an on/off switch, a laser, and 2 ampere batteries are connected in series and placed inside the 3-dimensional (3D)-printed housing. The trainer's laser emission projects a red line that visually represents the ultrasound's field. Learners project the laser against a porcine or human heart in the orientation of the TTE window they wish to obtain and then dissect the heart in that plane, allowing for visualization of how grayscale images are obtained from 3D structures. Previous research has demonstrated that visuospatial aptitude is correlated with ultrasound procedural performance. We present this trainer and educational method as a specific training intervention that could enhance the visuospatial ability of the ultrasound learner. This visuospatial trainer and educational method present a novel process for enhancing learner understanding of 2-dimensional ultrasound images as they relate to 3D structures. Having a clear understanding of how images are generated in cross section may translate into more proficient adaptation of cardiac ultrasound and TTE.

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INTRODUCTION: Intradetrusor injection of onabotulinumtoxinA (BTX-A) can be performed with rigid or flexible cystoscopy. The primary aim of this study was to analyze irrigant flow rate and total angle of deflection for the intradetrusor injection needles used for flexible cystoscopic injection of BTX-A to see if any needle provided a technical advantage. METHODS: Three commercially available intradetrusor injection needles were evaluated using two modern flexible cystourethroscopes. The three needles analyzed were the NBI070 (Coloplast, Minneapolis, MN), DIS200 (Laborie, Williston, VT), and NM-101C-0427/MAJ-565/MAJ-655 (Olympus, Center Valley, PA). Angles of deflection and irrigant flow rates were calculated with an empty working channel and each injection needle in the working channel of the two flexible cystoscopes. RESULTS: With the working channel empty, the Karl Storz 11272CU1 (KS) and Olympus CYF-V2 (O) cystoscopes had a total range of deflection of 341 degrees and 281 degrees, respectively. Total range of deflection with the KS cystoscope was reduced to 275 degrees, 250 degrees, and 311 degrees for the Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Total range of deflection with the O cystoscope was reduced to 195 degrees, 157 degrees, and 257 degrees for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Average flow rates with an empty working channel were 5.7 mL/s and 5.5 mL/s for the KS and O cystoscopes, respectively. Mean flow rate with the KS cystoscope was reduced to 1.0 mL/s, 0.1 mL/s, and 0.7 mL/s for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. Mean flow rate with the O scope was reduced to 0.5 mL/s, 0.1 mL/s, and 0.4 mL/s for Coloplast NBI070, Laborie DIS200, and Olympus NM-101C-0427 needles, respectively. CONCLUSION: Among commercially available intradetrusor BTX-A injection needles, the Olympus NM-101C-0427 allows for the greatest total range of deflection and has the greatest elasticity and flexibility. Coloplast NBI070 allows for the best flow rate.

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OBJECTIVE: To evaluate the use of 2 inexpensive laparoscopic trainers (iTrainers) constructed of easily attainable materials and portable tablets (iPads). METHODS: Two different laparoscopic trainers were constructed using a cardboard box, thumbtacks, and Velcro tape (box trainer). A separate box was constructed using the same supplies with a 3-ring binder (binder trainer). An iPad was used as the camera and monitor for both trainers. A total of 10 participants, including 4 junior surgical residents, 4 senior surgical residents, and 2 surgical staff, completed 3 Fundamentals of Laparoscopic Surgery (FLS) tasks using the 2 "iTrainers." Participants then completed the same tasks on a traditional FLS box trainer. All 10 participants were asked to complete a 13-question survey after the exercises. RESULTS: All the participants (100%) had access to an "iPad" for the visualization component. The 10 participants completed all 3 tasks on all 3 trainers. Senior residents outperformed junior residents on 6 of the 9 total tasks. Attending surgeons outperformed all residents on all tasks and trainers. Survey results revealed the cardboard box "iTrainer" to be the most practical and easiest to construct. CONCLUSION: "iTrainers" are an inexpensive and easy-to-construct alternative to traditional box trainers that might have construct validity as demonstrated in this trial. The box trainer might be easier to construct and have more similarities to the FLS trainer than the binder iTrainer.

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PURPOSE: We designed a three-phase bedside assistant training course for those involved with robot-assisted radical prostatectomy (RARP). We also examined whether an experienced RARP team (>1000 cases) would perceive benefit from this three-phase bedside assistant training course. MATERIALS AND METHODS: The 13 RARP bedside assistants were identified at our institution (three surgical technicians, two surgical assistants, four resident trainees, and four physician assistants). The course consisted of three phases that were taught at three separate morning sessions. Phase 1 focused on robot functionality. Phase 2 consisted of a step-by-step video session that focused on the assistant's role in each RARP step. Phase 3 involved three hands-on laparoscopic drills that were to be completed in a predetermined period. Pre- and postcourse questionnaires assessed learner knowledge pertaining to RARP. RESULTS: All 13 learners completed the three-phase training course. Nine of 13 learners thought this course would be beneficial, although, 9 of 13 already thought that they were good RARP assistants before the course. Ten of 13 learners were able to complete the hands-on drills in the predetermined periods. On completion of the course, every learner thought the course was beneficial and that it should be repeated annually. Twelve of 13 thought that the course made them a better assistant and that their intra-abdominal spatial orientation was greatly improved. Seven of the learners thought the hands-on drills were the most beneficial portion of the course, while the other six found the step-by-step lecture the most beneficial. CONCLUSIONS: A three-phase hands-on RARP bedside assistant training course is beneficial to and desired by an experienced RARP team at least annually.

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