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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
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Ghesquière L, Garabedian C, Boukerrou M, Dennis T, Garbin O, Hery R, Rubod C, Cosson M. Implementation of laparoscopy surgery training via simulation in a low-income country. J Gynecol Obstet Hum Reprod 2018; 47:187-190. [PMID: 29510268 DOI: 10.1016/j.jogoh.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country. METHODS The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3). RESULTS Eight participants were included. The median time was significantly reduced (P<0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises. CONCLUSION Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.
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Affiliation(s)
- L Ghesquière
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France.
| | - C Garabedian
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France
| | - M Boukerrou
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Perinatal Studies Center of the Indian Ocean, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Faculty of Medicine, University of Reunion, 97490 Saint Denis, Réunion, France
| | - T Dennis
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France
| | - O Garbin
- CHU Strasbourg, CMCO, Gynecology Unit, 67000 Strasbourg, France
| | - R Hery
- CHU Befelatanana, Maternity of Befelatanana, Antananarivo University, Madagascar
| | - C Rubod
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
| | - M Cosson
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
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Szasz P, Louridas M, Harris KA, Aggarwal R, Grantcharov TP. Assessing Technical Competence in Surgical Trainees. Ann Surg 2015; 261:1046-55. [DOI: 10.1097/sla.0000000000000866] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Laparoscopic suturing learning curve in an open versus closed box trainer. Surg Endosc 2015; 30:315-22. [PMID: 25939742 PMCID: PMC4710670 DOI: 10.1007/s00464-015-4211-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/08/2015] [Indexed: 01/22/2023]
Abstract
Background The aim of this study was to examine the influence of training under direct vision prior to training with indirect vision on the learning curve of the laparoscopic suture task. Methods Novices were randomized in two groups. Group 1 performed three suturing tasks in a transparent laparoscopic box trainer under direct vision followed by three suturing tasks in a standard non-transparent laparoscopic box trainer equipped with a 0° laparoscope. Group 2 performed six suturing tasks in a standard laparoscopic box trainer. Performance time, motion analysis parameters (economy of movements) and interaction force parameters (tissue handling) were measured. Participants completed a questionnaire assessing: self-perceived dexterity before and after the training, their experienced frustration and the difficulty of the training. Results A total of 34 participants were included, one was excluded because of incomplete training. Group 1 used significantly less time to complete the total of six tasks (27 %). At the end of the training, there were no differences in motion or force parameters between the two groups. Group 2 rated their self-perceived dexterity after the training significantly lower than before the training and also reported significantly higher levels of frustration compared to group 1. Both groups rated the difficulty of the training similar. Conclusion Novices benefit from starting their training of difficult basic laparoscopic skills, e.g., suturing, in a transparent box trainer without camera. It takes less time to complete the tasks, and they get less frustrated by the training with the same results on their economy of movements and tissue handling skills.
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Hu Y, Goodrich RN, Le IA, Brooks KD, Sawyer RG, Smith PW, Schroen AT, Rasmussen SK. Vessel ligation training via an adaptive simulation curriculum. J Surg Res 2015; 196:17-22. [PMID: 25796112 DOI: 10.1016/j.jss.2015.01.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND A cost-effective model for open vessel ligation is currently lacking. We hypothesized that a novel, inexpensive vessel ligation simulator can efficiently impart transferrable surgical skills to novice trainees. MATERIALS AND METHODS VesselBox was designed to simulate vessel ligation using surgical gloves as surrogate vessels. Fourth-year medical students performed ligations using VesselBox and were evaluated by surgical faculty using the Objective Structured Assessments of Technical Skills global rating scale and a task-specific checklist. Subsequently, each student was trained using VesselBox in an adaptive practice session guided by cumulative sum. Posttesting was performed on fresh human cadavers by evaluators blinded to pretest results. RESULTS Sixteen students completed the study. VesselBox practice sessions averaged 21.8 min per participant (interquartile range 19.5-27.7). Blinded posttests demonstrated increased proficiency, as measured by both Objective Structured Assessments of Technical Skills (3.23 versus 2.29, P < 0.001) and checklist metrics (7.33 versus 4.83, P < 0.001). Median speed improved from 128.2 s to 97.5 s per vessel ligated (P = 0.001). After this adaptive training protocol, practice volume was not associated with posttest performance. CONCLUSIONS VesselBox is a cost-effective, low-fidelity vessel ligation model suitable for graduating medical students and junior residents. Cumulative sum can facilitate an adaptive, individualized curriculum for simulation training.
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Affiliation(s)
- Yinin Hu
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robyn N Goodrich
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ivy A Le
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kendall D Brooks
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert G Sawyer
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Philip W Smith
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Anneke T Schroen
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sara K Rasmussen
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
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Borahay MA, Haver MC, Eastham B, Patel PR, Kilic GS. Modular Comparison of Laparoscopic and Robotic Simulation Platforms in Residency Training: A Randomized Trial. J Minim Invasive Gynecol 2013; 20:871-9. [DOI: 10.1016/j.jmig.2013.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 05/24/2013] [Accepted: 06/14/2013] [Indexed: 12/11/2022]
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Bharathan R, Setchell T, Miskry T, Darzi A, Aggarwal R. Gynecologic endoscopy skills training and assessment: review. J Minim Invasive Gynecol 2013; 21:28-43. [PMID: 23933352 DOI: 10.1016/j.jmig.2013.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
Training in and assessment of endoscopic skills is currently undergoing a period of evolution. Several recognized factors driving this evolution include working pattern, training opportunities, cost, and patient safety. In addition, the need to continuously monitor competence is punctuated by the rapid technologic changes and rising consumer expectation. These challenges present an opportunity to positively enhance the learning and performance of surgical practice.
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Affiliation(s)
- Rasiah Bharathan
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London; Nuffield Department of Obstetrics and Gynecology, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - Thomas Setchell
- Department of Obstetrics and Gynecology, Women's Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London
| | - Tariq Miskry
- Department of Obstetrics and Gynecology, Women's Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London
| | - Rajesh Aggarwal
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Burden C, Appleyard TL, Angouri J, Draycott TJ, McDermott L, Fox R. Implementation of laparoscopic virtual-reality simulation training in gynaecology: a mixed-methods design. Eur J Obstet Gynecol Reprod Biol 2013; 170:474-9. [PMID: 23932183 DOI: 10.1016/j.ejogrb.2013.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/10/2013] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Virtual-reality (VR) training has been demonstrated to improve laparoscopic surgical skills in the operating theatre. The incorporation of laparoscopic VR simulation into surgical training in gynaecology remains a significant educational challenge. We undertook a pilot study to assess the feasibility of the implementation of a laparoscopic VR simulation programme into a single unit. STUDY DESIGN An observational study with qualitative analysis of semi-structured group interviews. Trainees in gynaecology (n=9) were scheduled to undertake a pre-validated structured training programme on a laparoscopic VR simulator (LapSim(®)) over six months. The main outcome measure was the trainees' progress through the training modules in six months. Trainees' perceptions of the feasibility and barriers to the implementation of laparoscopic VR training were assessed in focus groups after training. RESULTS Sixty-six percent of participants completed six of ten modules. Overall, feedback from the focus groups was positive; trainees felt training improved their dexterity, hand-eye co-ordination and confidence in theatre. Negative aspects included lack of haptic feedback, and facility for laparoscopic port placement training. Time restriction emerged as the main barrier to training. CONCLUSIONS Despite positive perceptions of training, no trainee completed more than two-thirds of the modules of a self-directed laparoscopic VR training programme. Suggested improvements to the integration of future laparoscopic VR training include an additional theoretical component with a fuller understanding of benefits of VR training, and scheduled supervision. Ultimately, the success of a laparoscopic VR simulation training programme might only be improved if it is a mandatory component of the curriculum, together with dedicated time for training. Future multi-centred implementation studies of validated laparoscopic VR curricula are required.
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Affiliation(s)
- Christy Burden
- The Womens' Centre, Gloucestershire Hospital, Great Western Road, Gloucestershire GL1 3NN, UK; Research into Safety and Quality (RiSQ), Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK.
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Nieboer TE, Massa M, Weinans MJN, Vierhout ME, Kluivers KB, Stegeman DF. Does Training of the Nondominant Upper Extremity Reduce the Surgeon’s Muscular Strain During Laparoscopy? Surg Innov 2012; 20:292-8. [DOI: 10.1177/1553350612456099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. In laparoscopy, suboptimal ergonomics frequently lead to morbidity for surgeons. Physical complaints are more commonly reported on the dominant upper extremity. This may be the consequence of challenging laparoscopic tasks being easier to perform with the dominant side. The authors hypothesized that specific training of the nondominant upper extremity may equip this side better and lead to a more equal distribution of physical load. Materials and methods. Participants (medical doctors) were randomized to a 3-week training schedule or no training. The training program consisted of training the nondominant upper extremity. Participants were not allowed to train on a laparoscopic box or virtual reality trainer during the study period. Baseline and outcome measurements after 3 weeks were examined with the use of EMG measurements during a validated task on a laparoscopic box trainer. Muscle strain of the trapezius and deltoid muscles and effective alternation of brachioradial and abductor pollicis brevis muscles were used as outcome variables. Results. In all, 26 participants were included. EMG analysis revealed that participants in both intervention and control groups showed a decrease in muscle strain of trapezius and deltoid muscles. However, there were no significant differences between groups. Those in the intervention group showed significantly better alternation in the brachioradial muscle. Conclusion. Training the nondominant upper extremity leads to better alternated use of lower-arm muscles during a validated box trainer task. Repeating the task after 3 weeks led to less muscle tension in the trapezius and deltoid muscles.
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Affiliation(s)
| | - Mark Massa
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | - Mark E. Vierhout
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | - Dick F. Stegeman
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
- VU University Amsterdam, Amsterdam, Netherlands
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Single versus multimodality training basic laparoscopic skills. Surg Endosc 2012; 26:2172-8. [PMID: 22350237 PMCID: PMC3392502 DOI: 10.1007/s00464-012-2184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 01/19/2012] [Indexed: 01/22/2023]
Abstract
Introduction Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality training of basic laparoscopic skills. Methods Thirty-six medical students without laparoscopic experience performed six training sessions of 45 min each, one per day, in which four different basic tasks were trained. Participants in the single-modality group (S) (n = 18) practiced solely on a virtual reality (VR) simulator. Participants in the multimodality group (M) (n = 18) practiced on the same VR simulator (2x), a box trainer (2x), and an augmented reality simulator (2x). All participants performed a pre-test and post-test on the VR simulator (the four basic tasks + one additional basic task). Halfway through the training protocol, both groups performed a salpingectomy on the VR simulator as interim test. Results Both groups improved their performance significantly (Wilcoxon signed-rank, P < 0.05). The performances of group S and group M in the additional basic task and the salpingectomy did not differ significantly (Mann–Whitney U test, P > 0.05). Group S performed the four basic tasks in the post-test on the VR faster than group M (P ≤ 0.05), which can be explained by the fact that they were much more familiar with these tasks. Conclusions Training of basic laparoscopic tasks on single or multiple modalities does not result in different training outcome. Both training methods seem appropriate for the attainment of basic laparoscopic skills in future curricula.
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van Empel PJ, van der Veer WM, van Rijssen LB, Cuesta MA, Scheele F, Bonjer HJ, Meijerink WJ. Mapping the maze of minimally invasive surgery simulators. J Laparoendosc Adv Surg Tech A 2011; 22:51-60. [PMID: 22145607 DOI: 10.1089/lap.2010.0467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Chmarra MK, Klein S, de Winter JCF, Jansen FW, Dankelman J. Objective classification of residents based on their psychomotor laparoscopic skills. Surg Endosc 2009; 24:1031-9. [PMID: 19915915 PMCID: PMC2860557 DOI: 10.1007/s00464-009-0721-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 09/20/2009] [Indexed: 01/22/2023]
Abstract
Background From the clinical point of view, it is important to recognize residents’ level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as “experienced,” “intermediates,” or “novices” according to their technical abilities. This study introduces a classification method for recognizing residents’ level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone. Methods For this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10–100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out cross-validation. Results Of 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices. Conclusions The proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers.
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Affiliation(s)
- Magdalena K Chmarra
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands.
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Validation of laparoscopic surgical skills training outside the operating room: a long road. Surg Endosc 2009; 23:1476-82. [DOI: 10.1007/s00464-009-0379-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 01/19/2009] [Indexed: 01/22/2023]
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Retention of basic laparoscopic skills after a structured training program. ACTA ACUST UNITED AC 2009; 6:229-235. [PMID: 20234837 PMCID: PMC2837243 DOI: 10.1007/s10397-008-0458-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 12/29/2008] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer. Scores were calculated by adding up the time to completion of the task with penalty points, consequently rewarding speed and precision. The sum score was the sum of the five scores. One year later, seven of them underwent retention testing for the current study. The final test results were compared with retention test results as a measure of durability of acquired skills. Novices’ scores did not worsen significantly for four out of five tasks (i.e., placing a pipe cleaner p = 0.46, placing beads p = 0.24, cutting a circle p = 0.31, and knot tying p = 0.13). However, deterioration was observed in the performance on stretching a rubber band (p < 0.05), as well as in the sum score (p < 0.05). Nevertheless, all retention scores remained better than the baseline results. In conclusion, basic laparoscopic skills acquired during a short training program merely sustain over time. However, ongoing practice is advisable, especially to preserve tissue-handling skills, since these may be the first to deteriorate.
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Towbin AJ, Paterson BE, Chang PJ. Computer-based Simulator for Radiology: An Educational Tool. Radiographics 2008; 28:309-16. [DOI: 10.1148/rg.281075051] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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