Effect of different warm-up strategies on simulated laparoscopy performance: a randomized controlled trial

Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review

Latest advancements in science lead to drastic improvements in patient health care. Techniques and technology evolved in surgery over the years have resulted in the improvement of patient outcomes by leaps and bounds. Open surgeries previously done for procedures like appendectomy and cholecystectomy evolved into laparoscopic minimally invasive procedures. Such procedures pose few challenges to the surgeons, like lack of tissue feedback and fulcrum effect of the abdominal wall. But training surgeons for such an advanced skill is still following conventional methods. These procedures can be effectively trained using Virtual Reality (VR), which can simulate operations outside the operating room (OR). To maximize the outcomes of VR training, knowledge on various strategies affecting the skills acquisition and retention in VR training is essential. This review collected information from PubMed, EMBASE, Cochrane Library (CENTRAL) databases. Data from the previous ten years are included in the review. This included documents, clinical trials, meta-analysis, randomized controlled trials, reviews, systematic reviews, letters to editors, and grey literature. After an advanced Medical Subject Headings (MeSH) search, we got 59,532 results, and after the application of filters, 189 results showed up. Out of these, studies that were not exclusively relevant to the use of VR in laparoscopic surgery were manually excluded, and a total of 35 articles were included in the study. VR is found to be an excellent training modality with promising outcomes. It helps the surgeons perform the surgery accurately at a faster pace and improves confidence and multitasking ability in OR. Instructor feedback from mentors and deliberate practice of trainees, and early introduction of haptics in VR resulted in the most effective outcomes of the VR training. Box trainers are also compared with VR trainers as they are the cheaper modalities of training. However, this area needs more research to conclude if box trainers can act as a cheaper alternative to VR training providing similar outcomes.

Effect of Rehearsal Modality on Knowledge Retention in Surgical Trainees: A Pilot Study

OBJECTIVE

The operating room is an exciting learning environment. With growing curriculum limitations and increasing complexity of care, existing education opportunities need to be optimized. Rehearsal has benefits for surgeon performance in the operating room, but its role for enhancing operative learning remains unclear. This pilot study aimed to differentiate the effects of physical rehearsal (PR) and cognitive rehearsal (CR) modalities on surgical trainee technical knowledge retention.

DESIGN

Participants took part in a 2-day (sequential Fridays), instructed operative workshop performing midline laparotomy, splenectomy, left nephrectomy, and hand-sewn, side-to-side small bowel anastomosis (SBA). Participants were randomized to 10 minutes of either a (PR; n = 5) or (CR; n = 5) activity each day before operating. PR consisted of practicing SBA on a felt bowel model. CR entailed viewing narrated operative footage detailing the steps of SBA. Participants' technical knowledge of all procedures was assessed at 1 and 12 weeks postworkshop using a 31-question test.

SETTING

Animal operative suites at an academic medical center.

PARTICIPANTS

A total of 10 general surgery postgraduate year 1 interns participated in the workshop; all completed the study. Participants had similar levels of operative exposure at the time of study participation.

RESULTS

At 1-week postworkshop, mean assessment scores for CR were higher than PR (Mean ± Standard Deviation) (CR = 24.7 ± 1.6 vs. PR = 21.8 ± 1.7, p = 0.02). After 12 weeks, there was no difference in mean scores (CR = 23.3 ± 2 vs. PR = 21.7 ± 1.8, p = 0.22). Knowledge decay for the 12-week period was similar between groups (CR = -1.4 ± 1.6 vs. PR = -0.1 ± 2.4, p = 0.36). Study participants performed better on SBA-related questions than unrelated questions (laparotomy, splenectomy, and nephrectomy) at 1-week (related = 81.5% ± 11.3 vs. unrelated = 71.9% ± 6.6, p = 0.03) and 12 weeks (related = 81% ± 13.1 vs. unrelated = 68.6% ± 8.8, p = 0.02).

CONCLUSION

This pilot data suggests the modality of the rehearsal activity may not significantly effect surgical learners' technical knowledge retention. Participants did score higher on questions related to the rehearsal topic, indicating a potential supplementary role for rehearsal activities.