The feasibility and benefit of unsupervised at-home training of minimally invasive surgical skills

Optimizing skill acquisition: the role of self-assessment during a continuous training program for laparoscopic suturing

BACKGROUND

Mastering laparoscopic suturing, a critical aspect of minimally invasive surgery, remains a challenge. Self-assessment and 'reflection before practice' may enhance the learning curve of laparoscopic suturing. This study investigates the optimal frequency of self-assessment and reflection before practice in laparoscopic suturing training.

METHODS

Participants (medical students, surgical residents, and medical PhD students) underwent laparoscopic suturing training at home using a laparoscopic simulator (LaparoscopyBoxx). Three groups were formed: a 'control group' without self-assessment, a 'periodic self-assessment group', and a 'continuous self-assessment group'. The validated Laparoscopic Suturing Competency Assessment Tool (LS-CAT) served as self-assessment form. Participant's performance was quantified by objective parameters (time, distance, handedness, off-screen time, speed, acceleration, smoothness and distance between the instruments) measured by SurgTrac software.

RESULTS

No significant differences were observed between groups for primary outcome parameters time and distance across tests. However, significant differences emerged in secondary outcome parameters off-screen (baseline-test, p = 0.018), acceleration (baseline-test, p = 0.007), smoothness (baseline-test, p = 0.004; after-test, p = 0.038) and speed (after-test, p = 0.033) at various tests, favoring the self-assessment groups.

CONCLUSION

Self-assessment and reflection before practice may lead to more efficient instrument utilization and increased safety. A lower frequency of self-assessment and reflection before practice offered comparable benefits, which optimizes training efficiency, and is therefore recommended.

Comparison of laparoscopic performance using low-cost laparoscopy simulators versus state-of-the-art simulators: a multi-center prospective, randomized crossover trial

INTRODUCTION

Simulator training is an efficient method for the development of basic laparoscopic skills. We aimed to investigate if low-cost simulators are comparable to more expensive box trainers regarding surgeons usability, likability, and performance.

METHODS

This multi-center, randomized crossover study included 16 medical students, seven abdominal surgeons, and seven urological surgeons. Participants performed four laparoscopic tasks (peg transfer, circle cutting, balloon resection, suture and knot) on both, a "Low cost trainer" (LCT) or a "high cost trainer" (HCT) in a randomized order. The primary endpoint was the subjective rating of both training simulators in terms of camera view, depth perception, movement of instruments, pricing, and usability for training. Secondary endpoints were force parameters, task completion time, surgical errors, and psychological workload.

RESULTS

Participants rated the LCT better concerning view (p < 0.001), depth perception (p = 0.003), pricing (p < 0.001), and usability for digital training (p < 0.001), but worse in terms of instrument movement (p = 0.004). Overall, the LCT was rated better than the HCT (p = 0.015). Regarding force parameters, participants showed a significantly lower force exertion on the HCT during the peg transfer task (p = 0.008). The force exertion in the other tasks were comparable between both trainers. Participants were significantly faster using the HCT during the peg transfer (p = 0.049) and significantly slower in balloon resection (p = 0.049) and suture and knot task (p = 0.026). The assessment of the participants' workload showed no differences.

CONCLUSION

The LCT was generally rated better than the HCT. The differences concerning force exertion and task completion time showed better results during peg transfer at the HCT but were generally inconclusive and without systemic advantage for either trainer. However, the LCT could be a promising and cost-effective augmentation for modern laparoscopic training.

An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology

Introduction

Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms.

Methods

We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents.

Results

Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28).

Discussion

This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.

Alcohol's impact on fine motor skills: Insights from minimally invasive surgical simulation

Background

Alcohol misuse among medical professionals poses a significant concern, and there is a lack of clarity in (inter)national guidelines regarding alcohol use during work. Moreover, there exists an insufficient body of research on the specific impact of alcohol on fine motor skills within the medical sector, specifically surgery. This study aims to investigate the impact of alcohol on fine motor skills in a minimally invasive surgical setting.

Methods

A cross-sectional study was conducted at Lowland Science on August 19th, 20th, and 21st, 2022, during the Lowlands music festival in Biddinghuizen, the Netherlands. Participants were divided into five groups based on measured alcohol consumption. Exclusion criteria included drug use, prior surgical experience, being underage, and previous participation. The main outcomes were the number of correctly transferred rings during the PEG transfer task and the number of errors. Blood alcohol concentration (BAC) was measured using a breathalyser.

Results

A total of 1056 participants were included in the study. The results indicated an inverse relationship between BAC levels and surgical performance, with higher alcohol levels associated with a decrease in performance (p = 0.023). However, there was no significant difference in the number of errors among the five groups (p = 0.597). The group with the highest alcohol consumption (BAC >0.08 %) exhibited significantly worse performance compared to the group with a BAC of 0.0 % (p = 0.002).

Conclusion

This study uncovers a negative impact of increased alcohol intake on fine motor skills in a minimally invasive surgery simulation exercise. While there was no effect on the occurrence of errors. Professional medical organizations should reconsider and explicate their position on alcohol use in (surgical) healthcare.

Experts in Minimally Invasive Surgery are Outperformed by Trained Novices on Suturing Skills

INTRODUCTION

Learning minimally invasive suturing can be challenging, creating a barrier to further implementation, especially with the development of easier methods. Nevertheless, mastering intracorporeal knot tying is crucial when alternative techniques prove inadequate. Therefore, the minimally invasive surgery (MIS) suturing skills of MIS experts are compared with a group of novices during their learning curve on a simulator.

METHODS

The novice participants repeatedly performed the intracorporeal suturing task on the EoSim MIS simulator (up to a maximum of 20 repetitions). The experts (>50 MIS procedures and advanced MIS experience) completed the same task once. The first and last exercises of the novices and the expert tasks were all blindly recorded and assessed by two independent assessors using the Laparoscopic Suturing Competency Assessment Tool (LS-CAT). Additionally, objective assessment parameters, "time" and "distance", using instrument tracking, were collected. The scores of the experts were then compared with the novices.

RESULTS

At the end of the training, novices significantly outperformed the experts on both the expert assessment (LS-CAT: 16.8 versus 26.8, P = 0.001) and objective parameters (median time: 190 s versus 161 s, P < 0.001; median distance: 6.1 m versus 3.6 m, P < 0.001). Although the experts showed slightly better performance than the novices during their first task, the difference was not significant on the expert assessment (LS-CAT experts 16.8, novices 20.5, P = 0.057).

CONCLUSIONS

Our findings underscore the significance of continued MIS suturing training for both residents and surgeons. In this study, trained novices demonstrated a significant outperformance of experts on both quantitative and qualitative outcome parameters within a simulated setting.