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Lang F, Gerhäuser AS, Wild C, Wennberg E, Schmidt MW, Wagner M, Müller-Stich BP, Nickel F. Video-based learning of coping strategies for common errors improves laparoscopy training-a randomized study. Surg Endosc 2023; 37:4054-4064. [PMID: 36944741 PMCID: PMC10156798 DOI: 10.1007/s00464-023-09969-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
AIMS The aim of this study was to investigate whether shifting the focus to solution orientation and developing coping strategies for common errors could increase the efficiency of laparoscopic training and influence learning motivation. The concept of coping has been particularly defined by the psychologist Richard Lazarus [Lazarus and Folkman in Stress, appraisal, and coping, Springer publishing company, New York, 1984]. Based on this model, we examined the use of observational learning with a coping model for its effectiveness as a basic teaching model in laparoscopic training. METHODS 55 laparoscopically naive medical students learned a standardized laparoscopic knot tying technique with video-based instructions. The control group was only offered a mastery video that showed the ideal technique and was free from mistakes. The intervention group was instructed on active error analysis and watched freely selectable videos of common errors including solution strategies (coping model) in addition to the mastery videos. RESULTS There was no statistically significant difference between the intervention and control groups for number of knot tying attempts until proficiency was reached (18.8 ± 5.5 vs. 21.3 ± 6.5, p = 0.142). However, there was a significantly higher fraction of knots achieving technical proficiency in the intervention group after first use of the coping model (0.7 ± 0.1 vs. 0.6 ± 0.2, p = 0.026). Additionally, the proportion of blinded attempts that met the criteria for technical proficiency was significantly higher for the intervention group at 60.9% vs. 38.0% in control group (p = 0.021). The motivational subscore "interest" of the validated score on current motivation (QCM) was significantly higher for the intervention group (p = 0.032), as well as subjective learning benefit (p = 0.002) and error awareness (p < 0.001). CONCLUSION Using video-based learning of coping strategies for common errors improves learning motivation and understanding of the technique with a significant difference in its qualitative implementation in laparoscopy training. The ability to think in a solution-oriented, independent way is necessary in surgery in order to recognize and adequately deal with technical difficulties and complications.
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Affiliation(s)
- F Lang
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - A S Gerhäuser
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - C Wild
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - E Wennberg
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - M W Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - M Wagner
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Paludo ADO, Knijnik P, Brum P, Cachoeira E, Gorgen A, Burttet L, Cabral R, Puliatti S, Rosito T, Berger M, Neto BS. Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy. JOURNAL OF SURGICAL EDUCATION 2021; 78:1725-1734. [PMID: 33849788 DOI: 10.1016/j.jsurg.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents' laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. METHODS We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named 'LPN eras' 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. RESULTS 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). CONCLUSIONS Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.
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Affiliation(s)
- Artur de Oliveira Paludo
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil.
| | - Pedro Knijnik
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Pietro Brum
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Cachoeira
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Antonio Gorgen
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Burttet
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Renan Cabral
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Stefano Puliatti
- ORSI Academy - Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia - Modena, Italy
| | - Tiago Rosito
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Milton Berger
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Brasil Silva Neto
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
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Lodinger NR, DeLucia PR. Angle of Camera View Influences Resumption Lag in a Visual-Motor Task. HUMAN FACTORS 2019; 61:793-804. [PMID: 30148650 DOI: 10.1177/0018720818794526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether top-view and side-view camera angles, which putatively impose different cognitive demands, differentially affect the resumption lag in a visual-motor task relevant to laparoscopic surgery. BACKGROUND Prior research showed that the time to resume a primary task after performing an interrupting task (resumption lag) increases with increases in the subjective workload of the primary task. Camera views used in laparoscopic surgery provide different views of the anatomy and have different cognitive costs and associated levels of workload. METHOD Participants completed a peg transfer task while interrupted with a mental rotation task of different durations and angles of stimulus rotation. RESULTS Participants required significantly more time to resume the peg transfer task when using a side view than a top view and when interrupted for a longer duration. Participants' ratings of subjective workload were consistent with these patterns of performance data; the side view resulted in longer resumption lags and was rated as greater in mental demand. Additionally, the time needed to resume the peg transfer task decreased across trials for both views. CONCLUSION More time is required to resume an interrupted visual-motor task when it is more cognitively demanding than when it is less cognitively demanding possibly due to needing more time to learn the visual-motor mapping of the task higher in cognitive demand. APPLICATION Training for laparoscopic surgery should include interruptions to allow surgeons to practice resuming a surgery-related task after an interruption and consequently shorten the time needed to resume the surgery-related task.
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Teaching Vaginal Hysterectomy via Simulation: Creation and Validation of the Objective Skills Assessment Tool for Simulated Vaginal Hysterectomy on a Task Trainer and Performance Among Different Levels of Trainees. Female Pelvic Med Reconstr Surg 2018; 25:298-304. [DOI: 10.1097/spv.0000000000000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen CY, Ragle CA, Lencioni R, Fransson BA. Comparison of 2 training programs for basic laparoscopic skills and simulated surgery performance in veterinary students. Vet Surg 2017; 46:1187-1197. [DOI: 10.1111/vsu.12729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/21/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Chi-Ya Chen
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Claude A. Ragle
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Rachael Lencioni
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Boel A. Fransson
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
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Elessawy M, Wewer A, Guenther V, Heilmann T, Eckmann-Scholz C, Schem C, Maass N, Noe KG, Mettler L, Alkatout I. Validation of psychomotor tasks by Simbionix LAP Mentor simulator and identifying the target group. MINIM INVASIV THER 2017; 26:262-268. [PMID: 28326904 DOI: 10.1080/13645706.2017.1303516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study addresses target group reliability and task validity for training on a laparoscopic simulator. MATERIAL AND METHODS Data were collected on 64 participants prospectively at the Department of OB/GYN, University Hospitals Schleswig-Holstein, Campus Kiel. The Simbionix LAP Mentor for laparoscopic simulation was used to test trainees. Each participant received a questionnaire to clarify his/her medical position, surgical experience, and previous virtual reality (VR) experience, including video gaming experience. Pre- and post-tests were performed. Performances were analyzed for task completion and total time. RESULTS All participants revealed a significant improvement in the post-test compared with the pre-test (p < .005), independent of their previous level of experience. Regarding accomplishment of the assigned task, the experts revealed in the pre-test an advantage in tasks 1-4 and 6-8. The beginners revealed wide-ranging improvements in tasks 3, 5, 8, and 9 between the pre-test and the post-test compared with novices in laparoscopic surgery (residents), and a wide range of improvements relative to experts. VR experience and video gaming exposure revealed an advantage in the pre-test; however, participants without previous exposure were able to narrow the gap, revealing extensive improvements in the post-test. CONCLUSION The trainer could be beneficial for medical students and surgical novices.
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Affiliation(s)
- Mohamed Elessawy
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Arne Wewer
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Veronika Guenther
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Thorsten Heilmann
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Christel Eckmann-Scholz
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Christian Schem
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Nicolai Maass
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Karl-Günter Noe
- b Department of Obstetrics and Gynecology , University of Witten-Herdecke, Community Hospital Dormagen , Dormagen , Germany
| | - Liselotte Mettler
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
| | - Ibrahim Alkatout
- a Department of Gynecology and Obstetrics , University Hospitals Schleswig-Holstein , Kiel , Germany
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DeLucia PR, Hoskins ML, Griswold JA. Laparoscopic Surgery: Are Multiple Viewing Perspectives Better than one? ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120404801507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Imaging systems are used increasingly in surgical procedures such as laparoscopy. Depth perception is degraded compared with open surgery because the image provided by a laparoscopic camera is two-dimensional and represents a single viewing perspective. One way to compensate for this loss of depth information is with multiple cameras, each providing a different perspective. We measured performance of a pick-and-place task when observers viewed the task environment with three cameras concurrently (top, front, side views) or with one camera. Performance was slower with camera viewing compared with direct viewing and slowest with the side view. Although concurrent presentation of three camera views did not improve performance, observers looked almost exclusively at one of these views (top). Future research should determine whether observers can be trained to use depth information provided by multiple cameras. It is important to determine how to configure imaging systems so that surgical procedures can be optimized.
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Affiliation(s)
- Patricia R. DeLucia
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
| | - Melody L. Hoskins
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
| | - John A. Griswold
- Texas Tech University, Texas Tech University Health Sciences Center Lubbock, Texas
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Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 2016; 31:2155-2165. [DOI: 10.1007/s00464-016-5213-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
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9
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Fransson BA, Chen CY, Noyes JA, Ragle CA. Instrument Motion Metrics for Laparoscopic Skills Assessment in Virtual Reality and Augmented Reality. Vet Surg 2016; 45:O5-O13. [DOI: 10.1111/vsu.12483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Boel A. Fransson
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Chi-Ya Chen
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Julie A. Noyes
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
| | - Claude A. Ragle
- Department of Veterinary Clinical Sciences; Washington State University; Pullman Washington
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Abstract
BACKGROUND Opportunities for surgical skills practice using high-fidelity simulation in the workplace are limited due to cost, time and geographical constraints, and accessibility to junior trainees. An alternative is needed to practise laparoscopic skills at home. Our objective was to undertake a systematic review of low-cost laparoscopic simulators. METHOD A systematic review was undertaken according to PRISMA guidelines. MEDLINE/EMBASE was searched for articles between 1990 and 2014. We included articles describing portable and low-cost laparoscopic simulators that were ready-made or suitable for assembly; articles not in English, with inadequate descriptions of the simulator, and costs >£1500 were excluded. Validation, equipment needed, cost, and ease of assembly were examined. RESULTS Seventy-three unique simulators were identified (60 non-commercial, 13 commercial); 55 % (33) of non-commercial trainers were subject to at least one type of validation compared with 92 % (12) of commercial trainers. Commercial simulators had better face validation compared with non-commercial. The cost ranged from £3 to £216 for non-commercial and £60 to £1007 for commercial simulators. Key components of simulator construction were identified as abdominal cavity and wall, port site, light source, visualisation, and camera monitor. Laptop computers were prerequisite where direct vision was not used. Non-commercial models commonly utilised retail off-the-shelf components, which allowed reduction in costs and greater ease of construction. CONCLUSION The models described provide simple and affordable options for self-assembly, although a significant proportion have not been subject to any validation. Portable simulators may be the most equitable solution to allow regular basic skills practice (e.g. suturing, knot-tying) for junior surgical trainees.
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Affiliation(s)
- Mimi M Li
- Faculty of Medicine, Imperial College London, London, UK.
| | - Joseph George
- Department of Cardiothoracic Surgery, Morriston Hospital, Swansea, UK
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Shepherd G, von Delft D, Truck J, Kubiak R, Ashour K, Grant H. A simple scoring system to train surgeons in basic laparoscopic skills. Pediatr Surg Int 2016; 32:245-52. [PMID: 26597708 DOI: 10.1007/s00383-015-3841-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
AIM To develop and validate a scoring system for a training assessment tool using a box trainer which can objectively demonstrate progression in laparoscopic skills. METHOD 170 assessments were performed over a 5-year period by doctors working in a busy paediatric surgical department. Each participant was scored based on experience and then undertook six laparoscopic tasks in a box trainer in a dry skills lab. The quicker and more accurate the performance, the lower the score. Validity and reliability tests were applied. RESULTS Pearson correlation coefficient demonstrated that more experienced surgeons performed better than novices with an r of -0.63 (p < 0.001). The mean assessment scores improved (reduced) with increasing experience score [4140 (0-20), 2696 (21-40), 1969 (>40) p < 0.001]. Improvement in score was seen at all experience levels with greatest improvement seen in the less experienced (2315, 1820, 1571 p < 0.001). Cronbach's alpha was 0.70 and the intraclass correlation coefficient for test-retest reliability was 0.81. CONCLUSION Construct validity with adequate reliability has been demonstrated for this simple training tool and scoring system. All experience levels demonstrated improvement in their laparoscopic skills by simulation training in a laparoscopic box trainer.
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Affiliation(s)
- Gregory Shepherd
- Department of Paediatric Surgery, Oxford Children's Hospital, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Dirk von Delft
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Johannes Truck
- Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
| | - Rainer Kubiak
- Department of Paediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Heidelberg, Germany
| | - Khaled Ashour
- Department of Paediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hugh Grant
- Department of Paediatric Surgery, Oxford Children's Hospital, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Factors influencing forces during laparoscopic pinching: Towards the design of virtual simulator. Int J Surg 2015; 18:211-5. [DOI: 10.1016/j.ijsu.2015.04.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/15/2015] [Accepted: 04/14/2015] [Indexed: 11/20/2022]
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Azarnoush H, Alzhrani G, Winkler-Schwartz A, Alotaibi F, Gelinas-Phaneuf N, Pazos V, Choudhury N, Fares J, DiRaddo R, Del Maestro RF. Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection. Int J Comput Assist Radiol Surg 2014; 10:603-18. [DOI: 10.1007/s11548-014-1091-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/09/2014] [Indexed: 01/22/2023]
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Akdemir A, Şendağ F, Öztekin MK. Laparoscopic virtual reality simulator and box trainer in gynecology. Int J Gynaecol Obstet 2014; 125:181-5. [DOI: 10.1016/j.ijgo.2013.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/23/2013] [Accepted: 01/17/2014] [Indexed: 01/22/2023]
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A systematic review on low-cost box models to achieve basic and advanced laparoscopic skills during modern surgical training. Surg Laparosc Endosc Percutan Tech 2013; 23:109-20. [PMID: 23579503 DOI: 10.1097/sle.0b013e3182827c29] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low-cost box models (BMs) are a valuable tool alternative to virtual-reality simulators. We aim to provide surgical trainees with a description of most common BMs and to present their validity to achieve basic and advanced laparoscopic skills. MATERIALS AND METHODS A literature search was undertaken for all studies focusing on BMs, excluded were those presenting data on virtual-reality simulators only. Databases were screened up to December 2011. RESULTS Numerous studies focused on various BMs to improve generic tasks (ie, instrument navigation, coordination, and cutting). Only fewer articles described models specific for peculiar operations. All studies showed a significant improvement of basic laparoscopic skills after training with BMs. Furthermore, their low costs make them easily available to most surgical trainees. CONCLUSIONS BMs should be developed by all surgical trainees during their training. Fields for future improvement regard endoscopy and complex laparoscopic operations for which ad hoc BMs are not available.
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The investigation of laparoscopic instrument movement control and learning effect. BIOMED RESEARCH INTERNATIONAL 2013; 2013:349825. [PMID: 23984348 PMCID: PMC3741957 DOI: 10.1155/2013/349825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 12/04/2022]
Abstract
Laparoscopic surgery avoids large incisions for intra-abdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has been published in the essential movement characteristics such as magnification, amplitude, and angle. For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts' task and to develop an instrument movement time predicting model. Ten right-handed subjects made discrete Fitts' pointing tasks using a laparoscopic trainer. The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, no significant differences were observed in the improvement rate for movement time and throughput between these three factors. As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts' law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program, and the predictive model can be used to establish standards in the training procedure.
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Sarker SJ, Telfah MM, Onuba L, Patel BP. Objective assessment of skills acquisition during laparoscopic surgery courses. Surg Innov 2012; 20:530-8. [PMID: 23242519 DOI: 10.1177/1553350612468960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this prospective study is to objectively assess the acquisition of skills of trainees attending laparoscopic surgery courses. METHODS Thirty-four junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate runs of 3-day core skills in laparoscopic surgery course. Nine control trainees were also included who did not attend the course. Three virtual tasks (camera navigation, hand-eye coordination, and 2-handed maneuver) were used from a virtual reality simulator (Simbionix) for assessment. Camera navigation was assessed by completion time and maintenance of horizontal view, whereas the other 2 tasks were assessed by completion time, path length (both hands), and the number of movements (both hands). A composite score of overall performance was calculated by combining all the 12 parameters. RESULTS The course significantly (P < 0.001) improved 91% of the junior trainees' precourse laparoscopic skills. Around 70% to 85% of the participants had improvement in skills in all the parameters following the course. The significant improvements were seen in 10 out of 12 task-specific parameters (P ≤ .004) except path length of the left hand. No significant improvement in skills was seen in any 1 of the 12 parameters for the control participants except for a slight reduction in performance matrics. Foundation and core trainees had acquired significantly (P = .02) more skills (23% improvement) than the specialist trainees (8% improvement). Overall acquired skills did not differ significantly in terms of age, sex, or dominant hand of trainees. CONCLUSION Objective validated methods can be used to demonstrate course efficacy in addition to providing participants with an insight into their skills. Junior trainees with little or no previous experience benefit the most from such courses irrespective of their age, sex, and dominant hand.
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Mason JD, Ansell J, Warren N, Torkington J. Is motion analysis a valid tool for assessing laparoscopic skill? Surg Endosc 2012; 27:1468-77. [PMID: 23233011 DOI: 10.1007/s00464-012-2631-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The use of simulation for laparoscopic training has led to the development of objective tools for skills assessment. Motion analysis represents one area of focus. This study was designed to assess the evidence for the use of motion analysis as a valid tool for laparoscopic skills assessment. METHODS Embase, MEDLINE and PubMed were searched using the following domains: (1) motion analysis, (2) validation and (3) laparoscopy. Studies investigating motion analysis as a tool for assessment of laparoscopic skill in general surgery were included. Common endpoints in motion analysis metrics were compared between studies according to a modified form of the Oxford Centre for Evidence-Based Medicine levels of evidence and recommendation. RESULTS Thirteen studies were included from 2,039 initial papers. Twelve (92.3 %) reported the construct validity of motion analysis across a range of laparoscopic tasks. Of these 12, 5 (41.7 %) evaluated the ProMIS Augmented Reality Simulator, 3 (25 %) the Imperial College Surgical Assessment Device (ICSAD), 2 (16.7 %) the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), 1 (8.33 %) the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) and 1 (8.33 %) the Robotic and Video Motion Analysis Software (ROVIMAS). Face validity was reported by 1 (7.7 %) study each for ADEPT and ICSAD. Concurrent validity was reported by 1 (7.7 %) study each for ADEPT, ICSAD and ProMIS. There was no evidence for predictive validity. CONCLUSIONS Evidence exists to validate motion analysis for use in laparoscopic skills assessment. Valid parameters are time taken, path length and number of hand movements. Future work should concentrate on the conversion of motion data into competency-based scores for trainee feedback.
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Affiliation(s)
- John D Mason
- Cardiff University School of Medicine, Welsh Institute of Minimal Access Therapy, Cardiff Medicentre, Heath Park, Cardiff, UK.
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Addis M, Aguirre M, Frecker M, Haluck R, Matthew A, Pauli E, Gopal J. Development of tasks and evaluation of a prototype forceps for NOTES. JSLS 2012; 16:95-104. [PMID: 22906337 PMCID: PMC3407464 DOI: 10.4293/108680812x13291597716186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few standardized testing procedures exist for instruments intended for Natural Orifice Translumenal Endoscopic Surgery. These testing procedures are critical for evaluating surgical skills and surgical instruments to ensure sufficient quality. This need is widely recognized by endoscopic surgeons as a major hurdle for the advancement of Natural Orifice Translumenal Endoscopic Surgery. METHODS Beginning with tasks currently used to evaluate laparoscopic surgeons and instruments, new tasks were designed to evaluate endoscopic surgical forceps instruments. RESULTS Six tasks have been developed from existing tasks, adapted and modified for use with endoscopic instruments, or newly designed to test additional features of endoscopic forceps. The new tasks include the Fuzzy Ball Task, Cup Drop Task, Ring Around Task, Material Pull Task, Simulated Biopsy Task, and the Force Gauge Task. These tasks were then used to evaluate the performance of a new forceps instrument designed at Pennsylvania State University. CONCLUSIONS The need for testing procedures for the advancement of Natural Orifice Translumenal Endoscopic Surgery has been addressed in this work. The developed tasks form a basis for not only testing new forceps instruments, but also for evaluating individual performance of surgical candidates with endoscopic forceps instruments.
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Affiliation(s)
- Matthew Addis
- Department of Mechanical & Nuclear Engineering, Penn State University, University Park, PA, USA
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The Importance of Stressing the Use of Laparoscopic Instruments in the Initial Training for Laparoscopic Surgery Using Box Trainers: A Randomized Control Study. J Surg Res 2012; 174:90-7. [DOI: 10.1016/j.jss.2010.11.906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/04/2010] [Accepted: 11/19/2010] [Indexed: 11/17/2022]
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Alevizos L, Brinkman W, Fingerhut A, Jakimowicz J, Leandros E. Novice surgeons versus experienced surgeons in laparoendoscopic single-site (LESS) surgery: a comparison of performances in a surgical simulator. World J Surg 2012; 36:939-944. [PMID: 22354488 DOI: 10.1007/s00268-012-1487-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION During the past years, there has been increasing interest in simulation-based training of technical skills especially in laparoscopy. The purpose of this study was to compare the performances of novice and experienced laparoscopic surgeons on a LESS simulator. METHODS The study recruited 20 surgeons classified into two groups: group NS consisted of ten residents without any laparoscopic experience, and group ES consisted of ten surgeons with experience in conventional laparoscopy (performed >90 laparoscopic cholecystectomies) but without any experience in LESS surgery. Both groups completed a mini-trainee course that included four repetitions of a standardized task of circle pattern cutting (CIRCLE). Time, path length, and economy of movement were measured and compared. RESULTS Group ES presented significantly better time scores than group NS in all four repetitions. Economy of movement did not differ significantly between the two groups, whereas path length was shorter for beginners at the forth effort. Moreover, group ES failed to improve path length and economy of movement scores, whereas group NS improved their performance significantly in these parameters. CONCLUSIONS It seems that previous laparoscopic experience in conventional laparoscopy may not necessarily be an advantage in all parameters of LESS surgery and the learning process can be longer than expected even for experienced surgeons.
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Affiliation(s)
- Leonidas Alevizos
- First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 114 Queen's Sofia Avenue, Athens Medical School Greece, 115 27, Athens, Greece.
| | - Willem Brinkman
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Jack Jakimowicz
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emmanuel Leandros
- First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 114 Queen's Sofia Avenue, Athens Medical School Greece, 115 27, Athens, Greece
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Botchorishvili R, Rabischong B, Larraín D, Khoo CK, Gaia G, Jardon K, Pouly JL, Jaffeux P, Aublet-Cuvelier B, Canis M, Mage G. Educational value of an intensive and structured interval practice laparoscopic training course for residents in obstetrics and gynecology: a four-year prospective, multi-institutional recruitment study. JOURNAL OF SURGICAL EDUCATION 2012; 69:173-179. [PMID: 22365862 DOI: 10.1016/j.jsurg.2011.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/25/2011] [Accepted: 08/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the educational value of an ongoing interval practice laparoscopy training program among obstetrics and gynecology residents. DESIGN Prospective cohort, multi-institutional recruitment study. We conducted structured laparoscopic training sessions for residents, using both inanimate and porcine models. The 6-day course was separated into two 3-day long modules conducted 2 months apart. A prospective evaluation of standardized tasks was performed using validated scales. Resident's performance was compared using the Student t test and Wilcoxon signed-rank test when appropriate. SETTING International Center of Endoscopic Surgery (CICE), Clermont-Ferrand, France. PARTICIPANTS 191 PGY2 or PGY3 residents from different institutions. RESULTS Significant improvement in time and technical scores for both laparoscopic suturing and porcine nephrectomy was noted (p < 0.0001). After 2 months, we found no improvement in suturing time (p = 0.59) or technical scores (p = 0.62), and significant technical deterioration was observed for the right hand (p = 0.02). Porcine nephrectomy improvement remained significant after 2 months (p < 0.0001). CONCLUSIONS Despite significant short-term educational value of interval practice in laparoscopic performance, some acquired skills seem to deteriorate faster than anticipated.
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Affiliation(s)
- Revaz Botchorishvili
- Service de Gynecologie-Obstetrique et Medecine de la Reproduction, CHU Estaing, Clermont-Ferrand, France.
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Pagador JB, Sánchez-Margallo FM, Sánchez-Peralta LF, Sánchez-Margallo JA, Moyano-Cuevas JL, Enciso-Sanz S, Usón-Gargallo J, Moreno J. Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment. Int J Comput Assist Radiol Surg 2011; 7:305-13. [DOI: 10.1007/s11548-011-0650-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 08/02/2011] [Indexed: 12/30/2022]
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Leandros E, Gomatos IP, Konstadoulakis MM, Menenakos E, Alexakis N, Alevizos L, Albanopoulos K, Karagiannakos P, Fingerhut A. Prospective appraisal of a 2-day training course on laparoscopic sleeve gastrectomy: the ELTC experience. Surg Endosc 2010; 24:2140-4. [DOI: 10.1007/s00464-010-0912-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023]
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McBeth PB, Louw DF, Yang F, Sutherland GR. Quantitative measures of performance in microvascular anastomoses. ACTA ACUST UNITED AC 2010; 10:173-80. [PMID: 16321915 DOI: 10.3109/10929080500229694] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Methods of evaluating surgical performance are mainly subjective. This study introduces a method of evaluating surgical performance using a quantitative analysis of tool tip kinematics. METHODS One experienced surgeon performed eight rat microvascular anastomoses over a 2-day interval. An optoelectronic motion analysis system acquired tool tip trajectories at frequencies of 30 Hz. On the basis of a hierarchical decomposition, the procedure was segmented into specific surgical subtasks (free space movement, needle placement and knot throws) from which characteristic measures of performance (tool tip trajectory, excursion and velocity) were evaluated. Comparisons of performance measures across each procedure were indexed (D scale) using the Kolmogorov-Smirnov statistic. RESULTS Despite the marker occlusions, tool tip data were obtained 92 +/- 7% (mean +/- SD) of the time during manipulation tasks. Missing data segments were interpolated across gaps of less than 10 sample points with errors less than 0.4 mm. The anastomoses were completed in 27 +/- 4 min (range 20.5-31.4 min) with 100% patency. Tool tip trajectories and excursions were comparable for each hand, while right and left hand differences were found for velocity. Performance measures comparisons across each procedure established the benchmark for an experienced surgeon. The D-scale range was between 0 and 0.5. CONCLUSION The study establishes a reproducible method of quantitating surgical performance. This may enhance assessment of surgical trainees at various levels of training.
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Affiliation(s)
- Paul B McBeth
- Division of Neurosurgery, Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada.
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Adaptation to a dynamic visual perspective in laparoscopy through training in the cutting task. Surg Endosc 2009; 24:1341-6. [DOI: 10.1007/s00464-009-0771-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 11/11/2009] [Indexed: 10/20/2022]
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Rulli F, Maura A, Galatà G, Olivi G, Grande M, Farinon AM. A dry lab for medical engineers? ANNALS OF SURGICAL INNOVATION AND RESEARCH 2009; 3:9. [PMID: 19646220 PMCID: PMC2727519 DOI: 10.1186/1750-1164-3-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 07/31/2009] [Indexed: 11/29/2022]
Abstract
Introduction We describe a teaching and training method with objective evaluation to improve medical engineering students' knowledge and analysis skills about Minimally Invasive Surgery (MIS) instrumentation and techniques through hands-on experience. Training has been scheduled during a three-month course. Methods Twenty medical engineering students were trained to perform three times on a pelvic trainer a sequence of standardized drills connected with the selected MIS techniques, in order to improve their dexterity. The time required to perform each dexterity drill was recorded in seconds. Then, the participants were divided into groups and asked to write an essay about an instrument they chose, analyzing and criticizing the instrument itself. Results All the trainees showed steady improvement in skill acquisition on the laparoscopic simulator and discussed their essays, making proposals in order to improve the instrument they tested. Conclusion Significant improvement in performance with increasing skillness has been measured; during the course and during their discussion the participants showed deep knowledge of the instrument, ability to analyze and criticize it and ability to make improvement proposals. Dry lab experience for medical engineering students is useful for teaching and improving analysis and management of laparoscopic devices, allowing identification of problems and developing better devices.
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Affiliation(s)
- Francesco Rulli
- Department of Surgery, University of the Study of Rome Tor Vergata, Rome, Italy.
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Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 2009:CD006575. [PMID: 19160288 DOI: 10.1002/14651858.cd006575.pub2] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. OBJECTIVES To determine whether virtual reality training can supplement or replace conventional laparoscopic surgical training (apprenticeship) in surgical trainees with limited or no prior laparoscopic experience. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and grey literature until March 2008. SELECTION CRITERIA We included all randomised clinical trials comparing virtual reality training versus other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the standardised mean difference with 95% confidence intervals based on intention-to-treat analysis. MAIN RESULTS We included 23 trials with 612 participants. Four trials compared virtual reality versus video trainer training. Twelve trials compared virtual reality versus no training or standard laparoscopic training. Four trials compared virtual reality, video trainer training and no training, or standard laparoscopic training. Three trials compared different methods of virtual reality training. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors compared with no training; virtual reality group was more accurate than video trainer training group. In the participants with limited laparoscopic experience, virtual reality training reduces operating time and error better than standard in the laparoscopic training group; composite operative performance score was better in the virtual reality group than in the video trainer group. AUTHORS' CONCLUSIONS Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training. Further research of better methodological quality and more patient-relevant outcomes are needed.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
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Soyinka AS, Schollmeyer T, Meinhold-Heerlein I, Gopalghare DV, Hasson H, Mettler L. Enhancing laparoscopic performance with the LTS3E: a computerized hybrid physical reality simulator. Fertil Steril 2008; 90:1988-94. [DOI: 10.1016/j.fertnstert.2007.08.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 08/16/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
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30
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Zakashansky K, Chuang L, Gretz H, Nagarsheth NP, Rahaman J, Nezhat FR. A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program. Int J Gynecol Cancer 2007; 17:1075-82. [PMID: 17386041 DOI: 10.1111/j.1525-1438.2007.00921.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29–78 years). The mean pelvic lymph node count was 31 (range, 10–61) in the TLRH group versus 21.8 (range, 8–42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100–600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200–464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2–11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.
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Affiliation(s)
- K Zakashansky
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York, USA
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Abstract
To reduce the complication rate associated with laparoscopic surgery and to improve training, several simulators have been incorporated into training curricula and skills courses. We discuss the advantages and disadvantages and compare the different types of simulators available. We also reviewed the literature to assess the acquisition of skills using these simulators and their transfer to real operations. It is important to realize that currently, any form of simulation is merely an adjunct to, and not a replacement for, traditional methods of training and that supervision and feedback are essential. More collaboration is needed between urologists and simulator companies to produce operation-specific simulated modules for urologic procedures.
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Affiliation(s)
- Shabnam Undre
- Department of Bio-Surgery and Surgical Technology, Imperial College, St. Mary's Hospital, London, U.K.
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Bruynzeel H, de Bruin AFJ, Bonjer HJ, Lange JF, Hop WCJ, Ayodeji ID, Kazemier G. Desktop simulator: key to universal training? Surg Endosc 2007; 21:1637-40. [PMID: 17294302 DOI: 10.1007/s00464-007-9222-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 08/29/2006] [Accepted: 09/15/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Training of skills in simulators is preferred over learning on patients so as to avoid undue injury to patients and to allow more efficient use of resources. Most simulators are costly and require a dedicated space. The aim of this study was to evaluate a simple desktop simulator, the Mirror Trainer. METHODS Thirty medical students were randomly assigned to three groups. One group was taught laparoscopic suturing in the Mirror Trainer, the second group used a pelvic training box, while the third group served as a control group and did not receive any training. All suture attempts during training were recorded on video. A blinded, independent investigator analyzed the videos. At the completion of training, the suturing skills of each participant were evaluated in an animal model. RESULTS Training with the Mirror Trainer required less time than with the pelvic trainer (p < 0.001). Compared with the control group, the Mirror Trainer group and the pelvic trainer group were significantly faster at creating three knots in the pig (p = 0.001 and p = 0.004, respectively). Both training groups performed equally well on the animal model (p = 0.99). CONCLUSION The Mirror Trainer and the pelvic trainer are equally effective in teaching laparoscopic suturing skills but training with the Mirror Trainer requires less time, can be done on any desktop, and is less costly.
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Affiliation(s)
- Hanna Bruynzeel
- Department of Surgery, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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Abstract
Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.
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Affiliation(s)
- Terry M Peters
- Robarts Research Institute, University of Western Ontario, PO Box 5015, 100 Perth Drive, London, ON N6A 5K8, Canada.
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Lord JL, Cottam DR, Dallal RM, Mattar SG, Watson AR, Glasscock JM, Ramanathan R, Eid GM, Schauer PR. The impact of laparoscopic bariatric workshops on the practice patterns of surgeons. Surg Endosc 2006; 20:929-33. [PMID: 16738985 DOI: 10.1007/s00464-005-0182-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 09/27/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was designed to evaluate the impact of a 2-day laparoscopic bariatric workshop on the practice patterns of participating surgeons. METHODS From October 1998 to June 2002, 18 laparoscopic bariatric workshops were attended by 300 surgeons. Questionnaires were mailed to all participants. RESULTS Responses were received from 124 surgeons (41%), among whom were 56 bariatric surgeons (open) (45%), 30 advanced laparoscopic surgeons (24%), and 38 surgeons who performed neither bariatric nor advanced laparoscopic surgery (31%). The questionnaire responses showed that 46 surgeons (37%) currently are performing laparoscopic gastric bypass (LGB), 38 (31%) are performing open gastric bypass, and 39 (32%) are not performing bariatric surgery. Since completion of the course, 46 surgeons have performed 8,893 LGBs (mean, 193 cases/surgeon). Overall, 87 of the surgeons (70%) thought that a limited preceptorship was necessary before performance of LGB, yet only 25% underwent this additional training. According to a poll, the respondents thought that, on the average, 50 cases (range, 10-150 cases) are needed for a claim of proficiency. CONCLUSION Laparoscopic bariatric workshops are effective educational tools for surgeons wishing to adopt bariatric surgery. Open bariatric surgeons have the highest rates of adopting laparoscopic techniques and tend to participate in more adjunctive training before performing LGB. There was consensus that the learning curve is steep, and that additional training often is necessary. The authors propose a mechanism for post-residency skill acquisition for advanced laparoscopic surgery.
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Affiliation(s)
- J L Lord
- Sacred Heart Institute for Surgical Weight Loss, Pensacola, Florida, USA
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Abstract
During the past decade, the clinical applications of laparoscopic surgery in urology have been growing steadily. The laparoscopic version of various procedures, such as nephrectomy, is becoming the standard of care. This has led to an increased need for laparoscopic training in urology and focused the attention on the various modalities for laparoscopic skill acquisition. The common training modalities for laparoscopy are box trainers, animal and cadaveric laparoscopy, and virtual reality simulators. Each modality carries its own benefits to the practicing surgeon. The box trainers are the first practiced and are basic training simulators. They were first designed to help with training in basic laparoscopic skills and to assist surgeons in getting acquainted with instruments. However, these simple boxes are being upgraded constantly by tissue- and organ-specific models, allowing the surgeon to train in a convenient and cost-effective environment. This article describes the ways to work with box trainers, from basic skills to advanced laparoscopic tasks, and discusses the contribution of these trainers to real surgery as well as their role in defining criterion levels of surgical performance.
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Affiliation(s)
- Ran Katz
- Department of Urology, Hadassah Medical Centre, PO Box 12000 Ein Kerem, Jerusalem 91120 Israel.
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DeLucia PR, Mather RD, Griswold JA, Mitra S. Toward the improvement of image-guided interventions for minimally invasive surgery: three factors that affect performance. HUMAN FACTORS 2006; 48:23-38. [PMID: 16696254 DOI: 10.1518/001872006776412162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The objectives were to measure the impact of specific features of imaging devices on tasks relevant to minimally invasive surgery (MIS) and to investigate cognitive and perceptual factors in such tasks. BACKGROUND Although image-guided interventions used in MIS provide benefits for patients, they pose drawbacks for surgeons, including degraded depth perception and reduced field of view (FOV). It is important to identify design factors that affect performance. METHOD In two navigation experiments, observers fed a borescope through an object until it reached a target. Task completion time and object shape judgments were measured. In a motion perception experiment, observers reported the direction of a line that moved behind an aperture. A motion illusion associated with reduced FOV was measured. RESULTS Navigation through an object was faster when a preview of the object's exterior was provided. Judgments about the object's shape were more accurate with a preview (compared with none) and with active viewing (compared with passive viewing). The motion illusion decreased with a rectangular or rotating octagonal viewing aperture (compared with circular). CONCLUSIONS Navigation performance may be enhanced when surgeons develop a mental model of the surgical environment, when surgeons (rather than assistants) control the camera, and when the shape of the image is designed to reduce visual illusions. APPLICATION Unintentional contact between surgical tools and healthy tissues may be reduced during MIS when (a) visual aids permit surgeons to maintain a mental model of the surgical environment, (b) images are bound by noncircular apertures, and (c) surgeons manually control the camera.
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Affiliation(s)
- Patricia R DeLucia
- Psychology Department, MS 2051, Texas Tech University, Lubbock, TX 79409-2051, USA.
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Hance J, Aggarwal R, Moorthy K, Munz Y, Undre S, Darzi A. Assessment of psychomotor skills acquisition during laparoscopic cholecystectomy courses. Am J Surg 2005; 190:507-11. [PMID: 16105545 DOI: 10.1016/j.amjsurg.2005.05.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 05/03/2005] [Accepted: 05/03/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardized short courses in laparoscopic cholecystectomy aim to teach laparoscopic skills to surgical trainees, although end-of-course assessments of performance remain subjective. The current study aims to objectively assess psychomotor skills acquisition of trainees attending laparoscopic cholecystectomy courses. METHODS Thirty-seven junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate 2-day courses (A, B, and C), all with identical format. Assessments were comprised of a standardized simulated laparoscopic task, with performance measured using a valid electromagnetic hand-motion tracking device. RESULTS Overall, trainees made significant improvements in path length (P=.006), number of movements (P<.001), and time taken (P<.001). Analyzing the 3 courses separately, only trainees attending courses A and C made significant improvements. DISCUSSION Objective validated methods can be used to assess learning of psychomotor skills on courses. In addition to providing participants with an insight into their skills, these data can be used to demonstrate course efficacy.
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Affiliation(s)
- Julian Hance
- Department of Surgical Oncology and Technology, St. Mary's Hospital, Imperial College London, London, UK.
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Abstract
Although the use of performance efficiency measures (speed, movement economy, errors) and ergonomic assessments are relatively well established, the evaluation of cognitive outcomes is rare. This report makes the case for assessment strategies that include mental workload measures as a way to improve training scenarios and training/operating environments. These mental workload measures can be crucially important in determining the difference between well-intentioned but subtly distracting technologies and true breakthroughs that will enhance performance and reduce stress.
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Affiliation(s)
- C Melody Carswell
- Department of Psychology, University of Kentucky, Lexington, KY 40506, USA.
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Uchal M, Tjugum J, Martinsen E, Qiu X, Bergamaschi R. The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial. Am J Surg 2005; 189:753-7. [PMID: 15910732 DOI: 10.1016/j.amjsurg.2005.03.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 09/18/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND To compare the impact of sleep deprivation after 24-hour duty (post-call) with that of 8-hour work (post-work) on product quality (PQ) and procedure effectiveness (PE) in a laparoscopic physical simulator. METHODS Voluntary surgeons and nurses were pretested with the Epworth Sleepiness Scale (ESS) and Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Surgical task was suturing perforated ulcer on a foam stomach in a physical simulator. PQ and PE were measured by accuracy error (AE), tissue damage (TD) leak rate (LR), goal- (GDA) non-goal-directed actions (NGDA), and operating time (OT), respectively. Construct validity was assessed comparing measures when surgeons and nurses performed the surgical task. Inter-rater reliability (IRR) was assessed by Kendall's tau b coefficient. An 80% power parallel block randomization design at alpha = .05 required 60 subjects. RESULTS Thirty-two post-call surgeons and 32 post-work surgeons were well matched for age, gender, practice duration, and ESS and MIST-VR scores. The amount of time slept in the previous 24 hours was 1.5 versus 6.5 hours (P < .05). AE (1.0 mm vs. .5 mm), TD (2.18 mm vs. 2.18 mm), LR (56.2% vs. 65.6%), GDA (33.5 vs. 32.5), NGDA (.56 vs. .31), and OT (381.0 seconds vs. 364.5 seconds) were not significantly different when 32 surgeons in the post-call arm were compared with their 32 counterparts in the post-work arm, respectively. Construct validity was shown by significant improvement in 4 outcome measures (AE 1.0 mm vs. 2.0 mm, P = .00001; GDA 32.5 vs. 39.0, P = .07, NGDA .43 vs. .96, P = .045; and OT 377.5 vs. 557.0, P = .0005) when 64 surgeons performed the task as compared to 64 nurses. Tau b for IRR was 1.0 (P < .0001) for AE, TD, LR, and OT, .75 (P = .325) for GDA, and .77 (P = .305) for NGDA. CONCLUSIONS Sleep deprivation had no impact on the studied outcome measures of a surgical task performed in a laparoscopic simulator.
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Affiliation(s)
- Miroslav Uchal
- Department of Research and Development, Forde Health System, University of Bergen, Forde 6807, Norway
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Katz R, Hoznek A, Salomon L, Antiphon P, de la Taille A, Abbou CC. Skill Assessment of Urological Laparoscopic Surgeons: Can Criterion Levels of Surgical Performance Be Determined Using the Pelvic Box Trainer? Eur Urol 2005; 47:482-7. [PMID: 15774246 DOI: 10.1016/j.eururo.2004.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 12/15/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To correlate between surgeons' experience in urological laparoscopy and their performance of a set of laparoscopic tasks performed on a box trainer in the laparoscopic laboratory. METHODS 44 urologists participated in this study. A self-administrated questionnaire enquired about their experience in laparoscopy and they were divided to 4 categories: no experience, minimal experience, basic and advanced laparoscopists. Tests consisted of 4 tasks: passage of a ligature, intracorporeal knotting, intracorporeal suturing, and cutting a carton circle out of a square. All tests were supervised and time was recorded for each of the tasks. Histograms were plotted showing the mean time for performance of each task in each experience group. The Kruskal-Wallis analysis of variance was used to assess statistical significance. RESULTS Seven participants had no previous experience in laparoscopy and 14 had minimal experience. 15 had basic experience and 8 were advanced laparoscopists. No difference in performance was found between the no experience and minimal experience group and they were united and defined as beginners. A significant difference in performance was noted between the beginners, basic and advanced groups, especially when comparing beginners to advanced. Criterion level values of surgical performance drawn from this data were highly discriminative with sensitivity of 71-85% and specificity of 74.2%-88%. CONCLUSIONS We were able to differentiate between various levels of laparoscopic skills among the participating urologists. Values drawn from such studies could be the basis of criterion level values for technical laparoscopic performance during training programs and before granting laparoscopic privileges to urologists.
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Affiliation(s)
- Ran Katz
- Service d'Urologie, CHU Henri Mondor, Creteil, France.
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Teber D, Dekel Y, Frede T, Klein J, Rassweiler J. The Heilbronn Laparoscopic Training Program for Laparoscopic Suturing: Concept and Validation. J Endourol 2005; 19:230-8. [PMID: 15798424 DOI: 10.1089/end.2005.19.230] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE More than a decade after the first description of laparoscopic nephrectomy, an increasing number of laparoscopic procedures are being performed worldwide. Nevertheless, there still exists a significant lack of standardized training programs to teach ablative and, most important, reconstructive laparoscopic operations (i.e., pyeloplasty, radical prostatectomy). We evaluated and validated a new standardized step-by-step program to improve laparoscopic skills and enable trainees not experienced in laparoscopy to perform a urethrovesical anastomosis. MATERIALS AND METHODS In an inanimate model (pelvic trainer) with defined trocar positions, the 10 participants were exposed to six reconstructive exercises. The steps consist of improvement of hand-eye coordination (two-row metal-pin model; step I), linear and curved suturing with changing angles of the needle (chicken leg and catheter model; steps II-V), and performance of an anastomosis in a porcine bladder (step VI). Times of 3, 15, 15, 10, 20, and 30 minutes for steps I, II, III, IV,V, and VI, respectively, were defined as the goal before proceeding to the next stage. The time required to succeed in each step and the increase in the speed of suturing and knotting activities were analyzed with the Wilcoxon signed-rank test. RESULTS After a mean of 40 hours of training, all participants were able to perform all steps within the specified times and complete an accurate urethrovesical anastomosis in 30 minutes. The time required to succeed before and after training showed a significant decrease (P < 0.05). Continual training in reconstructive procedures decreased the time needed for suturing activities by between 66.3% and 72.2%. The time needed for the knotting activities decreased by between 34.3% and 38.3%. CONCLUSIONS Our program enabled participants not experienced in laparoscopy to increase reproducible performance in reconstructive laparoscopy. These results indicate that the challenging parts of reconstructive laparoscopy such as intracorporeal suturing can be taught using a standardized concept. This experience could be incorporated easily by every department developing a laparoscopic training program.
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Affiliation(s)
- Dogu Teber
- Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany
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Valentine RJ, Rege RV. Integrating technical competency into the surgical curriculum: doing more with less. Surg Clin North Am 2004; 84:1647-67, xi-xii. [PMID: 15501280 DOI: 10.1016/j.suc.2004.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- R James Valentine
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9031, USA.
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Uchal M, Raftopoulos Y, Tjugum J, Bergamaschi R. Validation of a six-task simulation model in minimally invasive surgery. Surg Endosc 2004; 19:109-16. [PMID: 15531971 DOI: 10.1007/s00464-004-8145-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 07/27/2004] [Indexed: 01/22/2023]
Abstract
BACKGROUND The content validity of currently available inanimate simulation models is questionable, because some tasks seem too far from clinical reality. The aim of this study was to validate a simulation model with six tasks commonly used in clinical practice (6-TSM) for the acquisition of psychomotor skills in minimally invasive surgery (MIS). METHODS This was a prospective randomized trial comparing the 6-TSM to a previously described three-task training method (3-TTM). All first, second, and third postgraduate year surgical residents were eligible. The 6-TSM included clipping and dividing of a vessel, excision of lesion, appendectomy, mesh repair, suturing perforation, and hand-sewn anastomosis. The outcome measures of 6-TSM included accuracy error, tissue damage, sliding knot, leak, operating time, and dangerous movements. After completion of training, 6-TSM and 3-TTN residents were tested by the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Criterion-related and construct validity, responsiveness, test-retest, and interrater reliability were assessed. RESULTS During six months, 17 residents underwent training with the 6-TSM or the 3-TTM as allocated. The mean duration of training with 6-TSM and 3-TTM was similar (7.8 vs 8.1 h). The criterion-related validity of the 6-TSM was shown by significantly increased skill improvement in the 6-TSM residents, as compared with the 3-TTM residents at MIST-VR. Construct validity the of 6-TSM was shown by the finding that the experts' baseline was superior to the residents' baseline. The responsiveness of the 6-TSM was shown by the significantly increased skill improvement of the 6-TSM residents in sliding knot, leak, and operating time. The test-retest reliability of the 6-TSM was good (> 0.80), except for accuracy error and dangerous movements (Cronbach's intraclass correlation coefficient alpha: 0.57, p < 0.0001; 0.62, p < 0.0001, respectively). The interrater reliability of the 6-TSM was good (>0.80) except for leak (Kendall's concordance coefficient tau_b:0.76, p = 0.06 for hand-sewn anastomosis) and dangerous movements (tau_b:0.72, p = 0.08 for suturing perforation and tau_b:0.68, p = 0.10 for hand-sewn anastomosis). The perresident cost for 6-TSM was 769 dollars. CONCLUSIONS The 6-TSM is a valid and reliable learning tool for surgical residents' acquisition of laparoscopic motor skills.
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Affiliation(s)
- M Uchal
- Minimally Invasive Surgery Center, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Bimodal assessment of laparoscopic suturing skills. Surg Endosc 2004. [DOI: 10.1007/bf02637130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moorthy K, Munz Y, Dosis A, Bello F, Chang A, Darzi A. Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity. Surg Endosc 2004; 18:1608-12. [PMID: 15931486 DOI: 10.1007/s00464-003-9312-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2003] [Accepted: 05/27/2004] [Indexed: 01/08/2023]
Abstract
BACKGROUND The assessment of technical skills should provide objective feedback and judge suitability of progress during training. The aim of this study was to validate two objective assessment techniques for laparoscopic suturing and demonstrate a correlation between them. METHODS Six experts, seven surgeons skilled in laparoscopic suturing, and 13 with no laparoscopic suturing skills were asked to place two or three intracorporeal sutures on a synthetic suture pad. The latter group was given video-based instructions prior to the execution of the sutures. Ergonomic conditions were standardized for all subjects. The procedures were recorded on videotape and two blinded observers rated the first suture of each subject on a 29-point checklist. A motion analysis system, Imperial College Surgical Assessment Device, was used to assess psychomotor skills. RESULTS There was a significant difference in the time taken (p = 0.000) and total path length (p = 0.000) per suture across the groups. There were also a significant difference in the total checklist score (p = 0.000) and its individual categories. The was a strong correlation between the total path length and the total checklist score (coefficient, 0.78; p < 0.001). CONCLUSIONS A combination of the motion analysis system and the checklist would make the process of formative feedback during the learning of intracorporeal suturing objective and comprehensive.
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Affiliation(s)
- K Moorthy
- Department of Surgical Oncology and Technology, Imperial College, St. Mary's Hospital, W2 1NY, London.
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Mayooran Z, Rombauts L, Brown TIH, Tsaltas J, Fraser K, Healy DL. Reliability and validity of an objective assessment instrument of laparoscopic skill. Fertil Steril 2004; 82:976-8. [PMID: 15482787 DOI: 10.1016/j.fertnstert.2004.05.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 05/26/2004] [Accepted: 05/26/2004] [Indexed: 11/26/2022]
Abstract
A novel objective assessment method in reproductive endoscopic surgery could advance surgical education.
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Affiliation(s)
- Zorana Mayooran
- Department of Electrical and Computer Systems Engineering, Monash University, Clayton, Victoria, Australia
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Jensen A, Milner R, Fisher C, Gaughan J, Rolandelli R, Grewal H. Short-term sleep deficits do not adversely affect acquisition of laparoscopic skills in a laboratory setting. Surg Endosc 2004; 18:948-53. [PMID: 15095080 DOI: 10.1007/s00464-003-8225-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 01/13/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Residents often are sleep deprived after being on call. This study evaluated the effects of these sleep deficits on the acquisition of laparoscopic skills in the laboratory setting. METHODS The amount of sleep on the preceding night was recorded for 40 residents undergoing surgical skills training. The residents underwent a pretest, training, practice, and a posttest using basic (pegboard, cup drop, rope pass) and task-specific (pattern cutting, clip application, loop application) drills. Time to completion, penalty score, and total score were assessed. RESULTS Significant improvements were seen in the time and total score for all six drills, with a significant decrease in penalty scores noted for the pegboard and rope pass drills. No significant differences in skill acquisition were attributable to amount of sleep. CONCLUSION Training in the laboratory results in significant improvement of basic laparoscopic skills. Because short-term sleep deficits do not appear to hinder the acquisition of these skills, this model can be effectively applied, even after residents correct have been on call.
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Affiliation(s)
- A Jensen
- Department of Surgery, Temple University School of Medicine, 3400 North Broad Street, Philadelphia, PA 19140, USA
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Malzoni M, Perniola G, Perniola F, Imperato F. Optimizing the Total Laparoscopic Hysterectomy Procedure for Benign Uterine Pathology. ACTA ACUST UNITED AC 2004; 11:211-8. [PMID: 15200777 DOI: 10.1016/s1074-3804(05)60201-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To evaluate the influence of the learning curve in total laparoscopic hysterectomy on short- and long-term clinical results. DESIGN Retrospective comparative analysis (Canadian Task Force classification II-2). SETTING Malzoni Medical Center of Avellino, university-affiliated hospital. PATIENTS Three hundred and ninety-six women in the first time period (1997-1999) and 624 women in the second time period (2000-2002) were treated, using different techniques, by the same surgeon. Patients suffered from symptomatic myomas and uterine fibromatosis. No case was considered suitable for a vaginal procedure. INTERVENTION Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS No statistical differences were found between the two groups for patient age, parity, body mass index, and indications for surgery (p = NS), except for uterine weight (395 g vs. 408 g; p <.01). In the first time period, the average operating time was 105 +/- 27 minutes (range, from 65-190). In the second time period, the average operating time was 80 +/- 21 minutes (range, 45-170) (p <.001). The postoperative hemoglobin drop was 1.44 g/dL (range, 0.8-6.1) and 1.39 g/d (range, 0.7-4.3) in the first series and second series, respectively (p = NS). In the first series, the mean postoperative hospital stay was 2.4 +/- 1 days (range, 2-7). In the second series, the mean postoperative hospital stay was 2.3 +/- 1 days (range, 2-6). A significant decrease in short-term complications occurred between the first and second time period, 7.7% and 5.55% respectively (p <.03). We performed three (0.75%) and four (0.6%) conversion to laparotomy procedures, respectively, in the first and second groups (p = NS). During the first period, two reoperations were necessary; in the second period, one patient (0.15%) required a reoperation (p = NS). The rate of postoperative blood transfusion was 0.5% (n = 2) in the first period versus 0.15% (n = 1) in the second period (p = NS). Significant decrease of long-term complications occurred between first and second series, 2.0% and 0.45% respectively (p <.05). There were no differences between the two groups regarding sexual symptoms p = NS). CONCLUSION Laparoscopic hysterectomy is a safe, effective, and reproducible technique after completion of a period of training necessary to standardize the procedure. The results support the importance of optimizing some steps of the surgical technique to reduce severe complications.
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Affiliation(s)
- Mario Malzoni
- Malzoni Medical Center, Villa dei Platani, University of Rome La Sapienza, Avellino, Italy
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Taylor JD, Hammond IG. The freshly killed pig: A model for surgical training in gynaecological oncology. Aust N Z J Obstet Gynaecol 2004; 44:146-8. [PMID: 15089839 DOI: 10.1111/j.1479-828x.2004.00219.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical training in gynaecological oncology is complex and alternatives to the 'apprenticeship' model are being explored. Animate and inanimate simulation may be useful, allowing trainees to gain experience without the risk of harm to patients. Live animal models and ex vivo isolated material is commonly used. We present the use of a freshly killed pig (FKP) for training in the urological and gastrointestinal surgery pertinent to gynaecological oncology. METHODS An Anatomy of Complications Workshop was held for 12 specialists and subspecialty Trainees in gynaecological oncology. Seven freshly killed pigs were used for surgical training in a range of urological and intestinal operations including repair of a transected ureter, ureteric reimplantation, Boari flap, ileal conduit, bowel resection and anastomosis and stoma formation. A pre-workshop instructional video was sent to all participants. A live demonstration of each procedure preceded the participant's own closely supervised performance. EVALUATION All participants completed the procedures in the allocated time. The tissues felt 'live' throughout the 4 h session and were kept moist with a fine water spray. The use of sutures, ligatures and stapling instruments felt realistic. Formal participant feedback evaluation was enthusiastic about the FKP model. CONCLUSION We have demonstrated that the FKP can be successfully used for training in urological and gastrointestinal procedures. The range of operations described in the present paper could be expanded for other surgical disciplines. This simulation is recommended to Trainees as a valuable addition to their training and development.
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Affiliation(s)
- John D Taylor
- Department of Urology and Urogynaecology, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
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Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A. Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc 2004; 18:485-94. [PMID: 14752633 DOI: 10.1007/s00464-003-9043-7] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 09/02/2003] [Indexed: 12/22/2022]
Abstract
BACKGROUND Virtual reality (VR) simulators now have the potential to replace traditional methods of laparoscopic training. The aim of this study was to compare the VR simulator with the classical box trainer and determine whether one has advantages over the other. METHODS Twenty four novices were tested to determine their baseline laparoscopic skills and then randomized into the following three group: LapSim, box trainer, and no training (control). After 3 weekly training sessions lasting 30-min each, all subjects were reassessed. Assessment included motion analysis and error scores. Nonparametric tests were applied, and p < 0.05 was deemed significant. RESULTS Both trained groups made significant improvements in all parameters measured ( p < 0.05). Compared to the controls, the box trainer group performed significantly better on most of the parameters, whereas the LapSim group performed significantly better on some parameters. There were no significant differences between the LapSim and box trainer groups. CONCLUSIONS LapSim is effective in teaching skills that are transferable to a real laparoscopic task. However, there appear to be no substantial advantages of one system over the other.
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Affiliation(s)
- Y Munz
- Department of Surgical Oncology and Technology, Imperial College of Science, Technology, and Medicine, St. Mary's Hospital, QEQM Wing, London W2 1NY, England, United Kingdom.
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