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For: Moorthy K, Munz Y, Orchard TR, Gould S, Rockall T, Darzi A. An innovative method for the assessment of skills in lower gastrointestinal endoscopy. Surg Endosc 2004;18:1613-9. [PMID: 15931472 DOI: 10.1007/s00464-004-9002-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 05/27/2004] [Indexed: 10/26/2022]

For:	Moorthy K, Munz Y, Orchard TR, Gould S, Rockall T, Darzi A. An innovative method for the assessment of skills in lower gastrointestinal endoscopy. Surg Endosc 2004;18:1613-9. [PMID: 15931472 DOI: 10.1007/s00464-004-9002-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 05/27/2004] [Indexed: 10/26/2022]

Number

Cited by Other Article(s)

Reperfused human cadaver as a new simulation model for colonoscopy: a pilot study. Surg Endosc 2022;37:3224-3232. [PMID: 36443563 PMCID: PMC9707156 DOI: 10.1007/s00464-022-09763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]

Abstract

BACKGROUND

The reperfused human cadaver is a validated simulator for surgery. We aimed to use it as a colonoscopy simulator.

METHODS

Novices, intermediates and skilled participants in gastrointestinal endoscopy were included. They performed one colonoscopy on a reperfused human cadaver and reaching rates, time, and length needed to reach anatomical landmarks were reported for construct validity analysis. We also assessed our model realism (SRS survey), educational content (CVS survey) and task load (NASA-TLX index). Score items were collected and defined as "favorable" when items were rated ≥ 5/7 with an inter-quartile range (IQR) overlapping four, and "very favorable" when rated ≥ 5/7 with an IQR excluding four (neutral). Primary endpoints were the rectosigmoid junction (RSJ) reaching rate and the descending colon (DC) reaching time. Secondary objectives were SRS, CVS and NASA-TLX questionnaire results.

RESULTS

A total of 11 skilled participants, 5 intermediates and 8 novices were included. Skilled participants reached RSJ more often than novice and intermediary groups, respectively, 100%, 80% and 75% without differing significantly. They reached DC more frequently (100% for skilled, 80% for intermediates and 50% for novices, p = 0.018). The median time to reach RSJ (59, 272 and 686 s for skilled, intermediates and novices group, respectively) and DC (90, 534 and 1360 s for skilled, intermediates and novices) was significantly shorter for skilled participants (both p < .01). Nineteen out of the 22 items composing the realism survey obtained "very favorable" and "favorable" scores. Educational content was designated as "very favorable". Mental, physical, and technical demands were gradually higher the lower the initial level of experience.

CONCLUSIONS

Reperfused human cadaver model has the potential to be valid simulation tool for diagnostic colonoscopy training.

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Dokoutsidou E, Alodat M, Mavrogiannis C, Georgiou K, Giannakoulopoulou E, Galanis P, Loukas C, Enochsson L, Georgiou E. Performance Assessment of Subjects With Nursing Education Trained in Sigmoidoscopy by Means of a Simulator. Gastroenterol Nurs 2020;43:411-421. [PMID: 33055543 DOI: 10.1097/sga.0000000000000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open

Affiliation(s)

Eleni Dokoutsidou Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Moussa Alodat Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Christos Mavrogiannis Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Konstantinos Georgiou Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Eleftheria Giannakoulopoulou Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Petros Galanis Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Constantinos Loukas Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Lars Enochsson Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Evangelos Georgiou Eleni Dokoutsidou, PhD, is Assistant Professor of Nursing, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Moussa Alodat, MD, is Consultant Gastroenterologist, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Christos Mavrogiannis, PhD, is Professor of Gastroenterology, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Konstantinos Georgiou, PhD, Biochemistry Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleftheria Giannakoulopoulou, PhD, is Lecturer, Hepatogastroenterology Department, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Petros Galanis, PhD, is Lecturer, Center for Health Services Management and Evaluation, School of Health Sciences, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.,Constantinos Loukas, PhD, is Assistant Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Lars Enochsson, PhD, is Professor of Surgery, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Evangelos Georgiou, PhD, is Professor of Medical Physics, Medical Simulation Center, Medical Physics Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece

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European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper on Training in Paediatric Endoscopy. J Pediatr Gastroenterol Nutr 2020;70:127-140. [PMID: 31799965 DOI: 10.1097/mpg.0000000000002496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Walsh CM, Cohen J, Woods KL, Wang KK, Andersen DK, Anderson MA, Dunkin BJ, Edmundowicz SA, Faigel DO, Law JK, Marks JM, Sedlack RE, Thompson CC, Vargo JJ. ASGE EndoVators Summit: simulators and the future of endoscopic training. Gastrointest Endosc 2019;90:13-26. [PMID: 31122744 DOI: 10.1016/j.gie.2018.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023]

Abstract

Interest in the use of simulation for acquiring, maintaining, and assessing skills in GI endoscopy has grown over the past decade, as evidenced by recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines encouraging the use of endoscopy simulation training and its incorporation into training standards by a key accreditation organization. An EndoVators Summit, partially supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, (NIH) was held at the ASGE Institute for Training and Technology from November 19 to 20, 2017. The summit brought together over 70 thought leaders in simulation research and simulator development and key decision makers from industry. Proceedings opened with a historical review of the role of simulation in medicine and an outline of priority areas related to the emerging role of simulation training within medicine broadly. Subsequent sessions addressed the summit's purposes: to review the current state of endoscopy simulation and the role it could play in endoscopic training, to define the role and value of simulators in the future of endoscopic training and to reach consensus regarding priority areas for simulation-related education and research and simulator development. This white paper provides an overview of the central points raised by presenters, synthesizes the discussions on the key issues under consideration, and outlines actionable items and/or areas of consensus reached by summit participants and society leadership pertinent to each session. The goal was to provide a working roadmap for the developers of simulators, the investigators who strive to define the optimal use of endoscopy-related simulation and assess its impact on educational outcomes and health care quality, and the educators who seek to enhance integration of simulation into training and practice.

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Walsh CM. In-training gastrointestinal endoscopy competency assessment tools: Types of tools, validation and impact. Best Pract Res Clin Gastroenterol 2016;30:357-74. [PMID: 27345645 DOI: 10.1016/j.bpg.2016.04.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 01/31/2023]

Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016;65:607-15. [PMID: 25636697 DOI: 10.1136/gutjnl-2014-307173] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]

Abstract

INTRODUCTION

Training procedural skills in GI endoscopy once focused on threshold numbers. As threshold numbers poorly reflect individual competence, the focus gradually shifts towards a more individual approach. Tools to assess and document individual learning progress are being developed and incorporated in dedicated training curricula. However, there is a lack of consensus and training guidelines differ worldwide, which reflects uncertainties on optimal set-up of a training programme.

AIMS

The primary aim of this systematic review was to evaluate the currently available literature for the use of training and assessment methods in GI endoscopy. Second, we aimed to identify the role of simulator-based training as well as the value of continuous competence assessment in patient-based training. Third, we aimed to propose a structured training curriculum based on the presented evidence.

METHODS

A literature search was carried out in the available medical and educational literature databases. The results were systematically reviewed and studies were included using a predefined protocol with independent assessment by two reviewers and a final consensus round.

RESULTS

The literature search yielded 5846 studies. Ninety-four relevant studies on simulators, assessment methods, learning curves and training programmes for GI endoscopy met the inclusion criteria. Twenty-seven studies on simulator validation were included. Good validity was demonstrated for four simulators. Twenty-three studies reported on simulator training and learning curves, including 17 randomised control trials. Increased performance on a virtual reality (VR) simulator was shown in all studies. Improved performance in patient-based assessment was demonstrated in 14 studies. Four studies reported on the use of simulators for assessment of competence levels. Current simulators lack the discriminative power to determine competence levels in patient-based endoscopy. Eight out of 14 studies on colonoscopy, endoscopic retrograde cholangiopancreatography and endosonography reported on learning curves in patient-based endoscopy and proved the value of this approach for measuring performance. Ten studies explored the numbers needed to gain competence, but the proposed thresholds varied widely between them. Five out of nine studies describing the development and evaluation of assessment tools for GI endoscopy provided insight into the performance of endoscopists. Five out of seven studies proved that intense training programmes result in good performance.

CONCLUSIONS

The use of validated VR simulators in the early training setting accelerates the learning of practical skills. Learning curves are valuable for the continuous assessment of performance and are more relevant than threshold numbers. Future research will strengthen these conclusions by evaluating simulation-based as well as patient-based training in GI endoscopy. A complete curriculum with the assessment of competence throughout training needs to be developed for all GI endoscopy procedures.

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Performance of different categories of operators in simulated diagnostic colonoscopy. Gastroenterol Nurs 2015;38:180-7. [PMID: 25946476 DOI: 10.1097/sga.0000000000000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open

Abstract

The possible involvement, although limited to the diagnostic phase of the procedure, of nonmedical staff (particularly endoscopy nurses) in lower digestive endoscopy has recently been suggested. Computer-based simulators have demonstrated objective evaluation of technical skills in digestive endoscopy. The aim of this study was to evaluate basic colonoscopy skills of endoscopy nurses (naive operators), as compared with junior physician staff and senior endoscopists, through a virtual reality colonoscopy simulator. In this single-center, prospective, nonrandomized study, 3 groups of digestive endoscopy operators (endoscopy nurses, junior doctors [<150 previous colonoscopies], expert doctors [>500 previous colonoscopies and >200/year]) completed six diagnostic cases generated by an endoscopic simulator (AccuTouch, Immersion Medical, Gaithersburg, MD). The performance parameters, collected by the simulator, were compared between groups. Five parameters have been considered for statistical analysis: time spent to reach the cecum; pain of any degree; severe/extreme pain; amount of insufflated air; percentage of visualized mucosa. Statistical analysis to compare the three groups has been performed by means of Wilcoxon test for two independent samples and by means of Kruskal-Wallis test for three independent samples (p < .05). Sixteen operators have been studied (six endoscopy nurses, five junior doctors, and five senior doctors); 96 colonoscopic procedures have been evaluated. Statistically significant differences between experts and naive operators were observed regarding time to reach the cecum and induction of severe/extreme pain, with both Kruskal-Wallis and Wilcoxon test (p < .05); all other comparisons did not reach statistical significance. Although, as expected, expert doctors exceeded both junior doctors and naive operators in some relevant quality parameters of simulated diagnostic colonoscopies, the results obtained by less expert performers--and particularly by nursing staff--appear satisfactory as in regards to most of the considered quality parameters and suggest a potential value of this device in effectively teaching basic lower digestive endoscopy to beginners in a relatively short time.

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Jirapinyo P, Thompson CC. Current status of endoscopic simulation in gastroenterology fellowship training programs. Surg Endosc 2014;29:1913-9. [PMID: 25303910 DOI: 10.1007/s00464-014-3884-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/04/2014] [Indexed: 01/06/2023]

Abstract

BACKGROUND AND AIMS

Recent guidelines have encouraged gastroenterology and surgical training programs to integrate simulation into their core endoscopic curricula. However, the role that simulation currently has within training programs is unknown. This study aims to assess the current status of simulation among gastroenterology fellowship programs.

METHODS

DESIGN

This questionnaire study consisted of 38 fields divided into two sections. The first section queried program directors' experience on simulation and assessed the current status of simulation at their institution. The second portion surveyed their opinion on the potential role of simulation on the training curriculum.

SETTING

The study was conducted at the 2013 American Gastroenterological Association Training Directors' Workshop in Phoenix, Arizona.

PARTICIPANTS

The participants were program directors from Accreditation Council for Graduate Medical Education accredited gastroenterology training programs, who attended the workshop.

RESULTS

The questionnaire was returned by 69 of 97 program directors (response rate of 71%). 42% of programs had an endoscopic simulator. Computerized simulators (61.5%) were the most common, followed by mechanical (30.8%) and animal tissue (7.7%) simulators, respectively. Eleven programs (15%) required fellows to use simulation prior to clinical cases. Only one program has a minimum number of hours fellows have to participate in simulation training. Current simulators are deemed as easy to use (76%) and good educational tools (65%). Problems are cost (72%) and accessibility (69%). The majority of program directors believe that there is a need for endoscopic simulator training, with only 8% disagreeing. Additionally, a majority believe there is a role for simulation prior to initiation of clinical cases with 15% disagreeing.

CONCLUSION

Gastroenterology fellowship program directors widely recognize the importance of simulation. Nevertheless, simulation is used by only 42% of programs and only 15% of programs require that trainees use simulation prior to clinical cases. No programs currently use simulation as part of the evaluation process.

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Development of the gastrointestinal endoscopy competency assessment tool for pediatric colonoscopy (GiECAT KIDS). J Pediatr Gastroenterol Nutr 2014;59:480-6. [PMID: 24590220 DOI: 10.1097/mpg.0000000000000358] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]

Abstract

OBJECTIVES

Many aspects of pediatric colonoscopy differ from adult practice. To date, there is no validated measure of endoscopic competence for use in pediatrics. Using Delphi methodology, we aimed to determine expert consensus regarding items required on a checklist and global rating scale designed to assess the competence of clinicians performing colonoscopy on pediatric patients.

METHODS

A total of 41 North American pediatric endoscopy experts rated potential checklist and global rating items for their importance as indicators of the competence of trainees learning to perform pediatric colonoscopy. Responses were analyzed and re-sent to the panel for further ratings until consensus was reached. Items that ≥ 80% of experts rated as ≥ 4 out of 5 were included in the final instrument. Consensus items were compared with those items deemed by adult endoscopy experts as fundamental to assessing the performance of adult colonoscopy.

RESULTS

Five rounds of surveys were completed with response rates ranging from 76% to 100%. Seventy-five checklist and 38 global rating items were reduced to 18 checklist and 7 global rating items that reached consensus. Three pediatric checklist items differed from those considered to be critical adult indicators, whereas 4 items on the latter did not reach consensus among pediatric experts.

CONCLUSIONS

Delphi methodology allowed for achievement of expert consensus regarding essential items to be included in the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS), a measure of endoscopic competence specific to performing pediatric colonoscopy. Key differences in the checklist items, compared with items reaching consensus during a separate adult Delphi process using the same indicators, emphasize the need for a pediatric-specific tool.

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Walsh CM, Ling SC, Khanna N, Cooper MA, Grover SC, May G, Walters TD, Rabeneck L, Reznick R, Carnahan H. Gastrointestinal Endoscopy Competency Assessment Tool: development of a procedure-specific assessment tool for colonoscopy. Gastrointest Endosc 2014;79:798-807.e5. [PMID: 24321390 DOI: 10.1016/j.gie.2013.10.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/17/2013] [Indexed: 02/08/2023]

Abstract

BACKGROUND

Ensuring competence remains a seminal objective of endoscopy training programs, professional organizations, and accreditation bodies; however, no widely accepted measure of endoscopic competence currently exists.

OBJECTIVE

By using Delphi methodology, we aimed to develop and establish the content validity of the Gastrointestinal Endoscopy Competency Assessment Tool for colonoscopy.

DESIGN

An international panel of endoscopy experts rated potential checklist and global rating items for their importance as indicators of the competence of trainees learning to perform colonoscopy. After each round, responses were analyzed and sent back to the experts for further ratings until consensus was reached.

MAIN OUTCOME MEASUREMENTS

Consensus was defined a priori as ≥80% of experts, in a given round, scoring ≥4 of 5 on all remaining items.

RESULTS

Fifty-five experts agreed to be part of the Delphi panel: 43 gastroenterologists, 10 surgeons, and 2 endoscopy managers. Seventy-three checklist and 34 global rating items were generated through a systematic literature review and survey of committee members. An additional 2 checklist and 4 global rating items were added by Delphi panelists. Five rounds of surveys were completed before consensus was achieved, with response rates ranging from 67% to 100%. Seven global ratings and 19 checklist items reached consensus as good indicators of the competence of clinicians performing colonoscopy.

LIMITATIONS

Further validation required.

CONCLUSION

Delphi methodology allowed for the rigorous development and content validation of a new measure of endoscopic competence, reflective of practice across institutions. Although further evaluation is required, it is a promising step toward the objective assessment of competency for use in colonoscopy training, practice, and research.

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Affiliation(s)

Catharine M Walsh Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
Simon C Ling Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
Nitin Khanna Division of Gastroenterology, St. Joseph's Health Centre, University of Western Ontario, Toronto, Ontario, Canada
Mary Anne Cooper Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Samir C Grover Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Gary May Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Thomas D Walters Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
Linda Rabeneck Cancer Care Ontario, Queen's University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Richard Reznick Faculty of Health Sciences, Queen's University, Toronto, Ontario, Canada
Heather Carnahan Centre for Ambulatory Care Education, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada

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Effects of robotic manipulators on movements of novices and surgeons. Surg Endosc 2014;28:2145-58. [PMID: 24519031 DOI: 10.1007/s00464-014-3446-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023]

Abstract

BACKGROUND

Robot-assisted surgery is widely adopted for many procedures but has not realized its full potential to date. Based on human motor control theories, the authors hypothesized that the dynamics of the master manipulators impose challenges on the motor system of the user and may impair performance and slow down learning. Although studies have shown that robotic outcomes are correlated with the case experience of the surgeon, the relative contribution of cognitive versus motor skill is unknown. This study quantified the effects of da Vinci Si master manipulator dynamics on movements of novice users and experienced surgeons and suggests possible implications for training and robot design.

METHODS

In the reported study, six experienced robotic surgeons and ten novice nonmedical users performed movements under two conditions: teleoperation of a da Vinci Si Surgical system and freehand. A linear mixed model was applied to nine kinematic metrics (including endpoint error, movement time, peak speed, initial jerk, and deviation from a straight line) to assess the effects of teleoperation and expertise. To assess learning effects, t tests between the first and last movements of each type were used.

RESULTS

All the users moved slower during teleoperation than during freehand movements (F(1,9343) = 345; p < 0.001). The experienced surgeons had smaller errors than the novices (F(1,14) = 36.8; p < 0.001). The straightness of movements depended on their direction (F(7,9343) = 117; p < 0.001). Learning effects were observed in all conditions. Novice users first learned the task and then the dynamics of the manipulator.

CONCLUSIONS

The findings showed differences between the novices and the experienced surgeons for extremely simple point-to-point movements. The study demonstrated that manipulator dynamics affect user movements, suggesting that these dynamics could be improved in future robot designs. The authors showed the partial adaptation of novice users to the dynamics. Future studies are needed to evaluate whether it will be beneficial to include early training sessions dedicated to learning the dynamics of the manipulator.

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Våpenstad C, Buzink SN. Procedural virtual reality simulation in minimally invasive surgery. Surg Endosc 2012;27:364-77. [DOI: 10.1007/s00464-012-2503-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/19/2012] [Indexed: 12/16/2022]

Plooy AM, Hill A, Horswill MS, Cresp ASG, Watson MO, Ooi SY, Riek S, Wallis GM, Burgess-Limerick R, Hewett DG. Construct validation of a physical model colonoscopy simulator. Gastrointest Endosc 2012;76:144-50. [PMID: 22726473 DOI: 10.1016/j.gie.2012.03.246] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/15/2012] [Indexed: 02/08/2023]

Systematic review of validity testing in colonoscopy simulation. Surg Endosc 2012;26:3040-52. [DOI: 10.1007/s00464-012-2332-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 04/25/2012] [Indexed: 01/06/2023]

Hill A, Horswill MS, Plooy AM, Watson MO, Karamatic R, Basit TA, Wallis GM, Riek S, Burgess-Limerick R, Hewett DG. Assessing the realism of colonoscopy simulation: the development of an instrument and systematic comparison of 4 simulators. Gastrointest Endosc 2012;75:631-40. [PMID: 22341108 DOI: 10.1016/j.gie.2011.10.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/22/2011] [Indexed: 02/08/2023]

Abstract

BACKGROUND

No useful comparative data exist on the relative realism of commercially available devices for simulating colonoscopy.

OBJECTIVES

To develop an instrument for quantifying realism and provide the first wide-ranging empiric comparison.

DESIGN

Repeated measures, observational study. Nineteen experienced colonoscopists completed cases on 4 colonoscopy simulators (AccuTouch, GI Mentor II, Koken, and Kyoto Kagaku) and evaluated each device.

SETTING

A medical simulation center in a large tertiary hospital.

MAIN OUTCOME MEASURES

For each device, colonoscopists completed the newly developed Colonoscopy Simulator Realism Questionnaire (CSRQ), which contains 58 items grouped into 10 subscales measuring the realism of different aspects of the simulation. Subscale scores are weighted and combined into an aggregated score, and there is also a single overall realism item.

RESULTS

Overall, current colonoscopy simulators were rated as only moderately realistic compared with real human colonoscopy (mean aggregated score, 56.28/100; range, 48.39-60.45, where 0 = "extremely unrealistic" and 100 = "extremely realistic"). On both overall realism measures, the GI Mentor II was rated significantly less realistic than the AccuTouch, Kyoto Kagaku, and Koken (P < .001). There were also significant differences between simulators on 9 subscales, and the pattern of results varied between subscales.

LIMITATIONS

The study was limited to commercially available simulators, excluding ex-vivo models. The CSRQ does not assess simulated therapeutic procedures.

CONCLUSIONS

The CSRQ is a useful instrument for quantifying simulator realism. There is no clear "first choice" simulator among those assessed. Each has unique strengths and weaknesses, reflected in the differing results observed across 9 subscales. These findings may facilitate the targeted selection of simulators for various aspects of colonoscopy training.

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Gupta S, Bassett P, Man R, Suzuki N, Vance ME, Thomas-Gibson S. Validation of a novel method for assessing competency in polypectomy. Gastrointest Endosc 2012;75:568-75. [PMID: 22154412 DOI: 10.1016/j.gie.2011.09.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/21/2011] [Indexed: 12/17/2022]

Abstract

BACKGROUND

There is a gap in the formal assessment of technical skills in polypectomy that is now considered an integral part of colonoscopy. Polypectomy has been shown to reduce the incidence of colorectal cancer but does have associated complications. Polypectomy competency assessment should arguably be a part of the certification process for all endoscopists. A polypectomy competency assessment tool (Direct Observation of Polypectomy Skills [DOPyS]) has been developed and its reliability examined. This study examined the ability of the DOPyS to reliably distinguish between endoscopists with different levels of experience, ie, its construct validity.

OBJECTIVE

To determine the construct validity of the DOPyS.

DESIGN

Videos of 32 polypectomies (endoscopic view only) were collected from 2 expert (> 1000 colonoscopies) endoscopists (17 polyps) and 6 intermediate-level (100-500 colonoscopies) endoscopists (15 polyps). The videos were edited to include only the entire polypectomy procedure, arranged in random order, and assessed blindly by 4 experienced endoscopists, only 2 of whom were familiar with polypectomy assessment by using the DOPyS before scoring. The differences in overall competency scores (range 1-4; competency, scores ≥ 3) for the expert and intermediate groups were compared by using the Fisher exact test.

SETTING

Single center.

RESULTS

The analysis suggested that both trained assessors familiar with the DOPyS could reliably distinguish between the expert and intermediate endoscopists (P = .049 and P < .001), with the expert group scoring higher than the intermediate one. For the assessors with no previous experience of the DOPyS, no such difference could be seen (P = .71 and P = .15).

LIMITATIONS

Small sample and polyp size.

CONCLUSIONS

The results of the analysis suggested that the DOPyS could reliably differentiate between polypectomies performed by endoscopists of different levels of experience, but only if the assessors were trained in the use of the assessment tool. Training is therefore required to use this tool reliably.

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Cantù P, Penagini R. Computer simulators: the present and near future of training in digestive endoscopy. Dig Liver Dis 2012;44:106-10. [PMID: 22019444 DOI: 10.1016/j.dld.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/01/2011] [Accepted: 09/15/2011] [Indexed: 02/07/2023]

Gupta S, Anderson J, Bhandari P, McKaig B, Rupert P, Rembacken B, Riley S, Rutter M, Valori R, Vance M, van der Vleuten CPM, Saunders BP, Thomas-Gibson S. Development and validation of a novel method for assessing competency in polypectomy: direct observation of polypectomy skills. Gastrointest Endosc 2011;73:1232-9.e2. [PMID: 21628015 DOI: 10.1016/j.gie.2011.01.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/29/2011] [Indexed: 12/13/2022]

Szilágyi L, Benyó Z. Development of a virtual reality guided diagnostic tool based on magnetic resonance imaging. ACTA ACUST UNITED AC 2010;97:267-80. [PMID: 20843765 DOI: 10.1556/aphysiol.97.2010.3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]

Virtual Reality in Surgical Skills Training. Surg Clin North Am 2010;90:605-17. [DOI: 10.1016/j.suc.2010.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]

Sarker SK, Albrani T, Zaman A, Kumar I. Procedural Performance in Gastrointestinal Endoscopy: Live and Simulated. World J Surg 2010;34:1764-70. [DOI: 10.1007/s00268-010-0579-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]

Procedural performance in gastrointestinal endoscopy: An assessment and self-appraisal tool. Am J Surg 2008;196:450-5. [DOI: 10.1016/j.amjsurg.2007.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 10/11/2007] [Accepted: 10/11/2007] [Indexed: 11/21/2022]

Rückert JC, Ismail M, Swierzy M, Sobel H, Rogalla P, Meisel A, Wernecke KD, Rückert RI, Müller JM. Thoracoscopic Thymectomy with the da Vinci Robotic System for Myasthenia Gravis. Ann N Y Acad Sci 2008;1132:329-35. [DOI: 10.1196/annals.1405.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]

Fitzgerald TN, Duffy AJ, Bell RL, Berman L, Longo WE, Roberts KE. Computer-based endoscopy simulation: emerging roles in teaching and professional skills assessment. JOURNAL OF SURGICAL EDUCATION 2008;65:229-235. [PMID: 18571138 DOI: 10.1016/j.jsurg.2008.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 01/23/2008] [Accepted: 02/28/2008] [Indexed: 05/26/2023]

Kneebone R, Nestel D, Wetzel C, Black S, Jacklin R, Aggarwal R, Yadollahi F, Wolfe J, Vincent C, Darzi A. The human face of simulation: patient-focused simulation training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006;81:919-24. [PMID: 16985358 DOI: 10.1097/01.acm.0000238323.73623.c2] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]

Mehrabi A, Yetimoglu CL, Nickkholgh A, Kashfi A, Kienle P, Konstantinides L, Ahmadi MR, Fonouni H, Schemmer P, Friess H, Gebhard MM, Büchler MW, Schmidt J, Gutt CN. Development and evaluation of a training module for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery. Surg Endosc 2006;20:1376-1382. [PMID: 16858531 DOI: 10.1007/s00464-005-0612-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Accepted: 02/15/2006] [Indexed: 11/28/2022]

Abstract

BACKGROUND

With the increasing use of the surgical robotic system in the clinical arena, appropriate training programs and assessment systems need to be established for mastery of this new technology. The authors aimed to design and evaluate a clinic-like training program for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery.

METHODS

Four trainees with different surgical levels of experience participated in this study using the da Vinci telemanipulator. Each participant started with an initial evaluation stage composed of standardized visceral and vascular operations (cholecystectomy, gastrotomy, anastomosis of the small intestine, and anastomosis of the aorta) in a porcine model. Then the participants went on to the training stage with the rat model, performing standardized visceral and vascular operations (gastrotomy, anastomosis of the large and small intestines, and anastomosis of the aorta) four times in four rats. The final evaluation stage was again identical to the initial stage. The operative times, the number of complications, and the performance quality of the participants were compared between the two evaluation stages to assess the impact of the training stage on the results.

RESULTS

The operative times in the final evaluation stage were considerably shorter than in the initial evaluation stage and, except for cholecystectomies, all the differences reached statistical significance. Also, significantly fewer complications and improved quality for each operation in the final evaluation stage were documented, as compared with their counterparts in the initial evaluation stage. These improvements were recorded at each level of experience.

CONCLUSIONS

The presented experimental small and large animal model is a standardized and reproducible training method for robotic surgery that allows evaluation of the surgical performance while shortening and optimizing the learning-curve.

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Heemskerk J, Zandbergen R, Maessen JG, Greve JWM, Bouvy ND. Advantages of advanced laparoscopic systems. Surg Endosc 2006;20:730-3. [PMID: 16528462 DOI: 10.1007/s00464-005-0456-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 11/06/2005] [Indexed: 02/07/2023]

Judkins TN, Oleynikov D, Narazaki K, Stergiou N. Robotic surgery and training: electromyographic correlates of robotic laparoscopic training. Surg Endosc 2006;20:824-9. [PMID: 16508816 DOI: 10.1007/s00464-005-0334-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2005] [Accepted: 10/25/2005] [Indexed: 11/28/2022]