Changing the Learning Curve in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program

Comparative Evaluation of Laparoscopic Origami Crane Training With 3D and 2D Laparoscopy: Correlation With Fundamentals of Laparoscopic Surgery Scores

Objective. This prospective comparative study evaluated the efficacy and relationship between laparoscopic origami crane training (LOCT) and the Fundamentals of Laparoscopic Surgery (FLS) score using 3D vs 2D laparoscopy.Methods. From 2020 to 2023, fourth-year medical students at Asahikawa Medical University created 20 origami cranes (1 per day) in a laparoscopic dry box. FLS scores were assessed 5 times, corresponding to every fifth crane. Primary outcomes included LOCT production time, quality, and FLS scores, analyzed using the Mann-Whitney U test and repeated-measures ANOVA.Results. Eighteen participants were divided into 2 groups: 8 in the 3D laparoscopy (3D) group and ten in the 2D laparoscopy (2D) group. At the end of the study, the 3D group (16.5 min) produced cranes significantly faster than the 2D group (27 min, P = 0.02). Repeated-measures ANOVA showed that the production time, origami crane score, and FLS score improved over time. The 3D group had a significantly shorter production time (F (1, 16) = 8, P = 0.01). The origami crane score was not significantly different between the groups (F (1, 7) = 3, P = 0.13) but tended to be higher in the 3D group. No significant differences were found in the FLS scores between the groups for any task. A significant negative correlation between LOCT production time and FLS score in both groups confirmed that shorter production time correlated with higher FLS scores.Conclusions. LOCT is effective for extraclinical laparoscopic training and correlates with FLS scores. 3D laparoscopy may help beginners develop depth perception, improve bimanual and hand-eye coordination, and enhance LOCT effectiveness.

A randomized cohort study on the use of 3D printed models to enhance surgical training in suturing techniques

Three-dimensional (3D) printed surgical models provide an excellent surgical training option to closely mimic real operations to teach medical students who currently rely largely on visual learning aided with simple suturing pads. There is an unmet need to create simple to complex surgical training programs suitable for medical students. A prospective cohort study was conducted on a group of 16 6th year students. They were randomly divided into two groups for suture training on a basic training pad or on unique 3D-printed intestinal anastomosis models. After 4 weeks of open and laparoscopic surgical training, exams were performed on the standardized 3D-printed model at the end of each stage to assess surgical performance including surgical time and scores. Both groups had similar skills before the start of each stage. In stage 1, both groups showed comparable learning performance, but the 3D model group performed better in Exam 1. In stage 2, the 3D model group took more time but showed significant improvements and outperformed the pad group in Exam 2 in both performance scores and time. Post-training questionnaires indicated increased interest in surgery and technical training among students using 3D models. Realistic 3D-printed models benefit surgical training, expected to become integral in teaching operative skills and techniques to medical students.

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization

PURPOSE

Beside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices.

METHODS

48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks "PEG Transfer", "Pattern Cut" and "Intracorporeal Suture" and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance.

RESULTS

In 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group.

CONCLUSION

We could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis

Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.

Using Stereoscopic Virtual Presentation for Clinical Anatomy Instruction and Procedural Training in Medical Education

This chapter begins by exploring the current landscape of virtual and augmented reality technologies in a post-pandemic world and asserting the importance of virtual technologies that improve students' learning outcomes while also reducing costs. Next, the chapter describes clinical anatomy instruction concepts in medical education, including applied anatomy content knowledge, pedagogical anatomy content knowledge, and virtual stereoscopic visualization studies that exemplify these concept areas, respectively. The chapter then explores the concept of procedural training with a specific emphasis on virtual stereoscopic anatomy visualization studies that exemplify or have implications for procedural training in medical education. Subsequently, the chapter discusses the benefits and challenges as well as the potential future positive and negative implications of virtual stereoscopic visualizations in medical education before finally concluding with some pensive considerations for the present and future of anatomy education and training using virtual technologies.

A Systematic Review and Meta-analysis on the Impact of Proficiency-based Progression Simulation Training on Performance Outcomes

OBJECTIVE

To analyze all published prospective, randomized, and blinded clinical studies on the proficiency-based progression (PBP) training using objective performance metrics.

BACKGROUND

The benefit of PBP methodology to learning clinical skills in comparison to conventional training is not settled.

METHODS

Search of PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases, from inception to 1st March 2020. Two independent reviewers extracted the data. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality of included studies. Results were pooled using biased corrected standardized mean difference and ratio-of-means. Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. Secondary outcomes were the number of procedural steps completed and the time to complete the task/procedure.

RESULTS

From the initial pool of 468 studies, 12 randomized clinical studies with a total of 239 participants were included in the analysis. In comparison to the non-PBP training, ratio-of-means results showed that PBP training reduced the number of performance errors by 60% (P < 0.001) and procedural time by 15% (P = 0.003) and increased the number of steps performed by 47% (P < 0.001).

CONCLUSIONS AND RELEVANCE

Our systematic review and meta-analysis confirms that PBP training in comparison to conventional or quality assured training improved trainees' performances, by decreasing procedural errors and procedural time, while increasing the number of correct steps taken when compared to standard simulation-based training.

Laparoscopic skills training: the effects of viewing mode (2D vs. 3D) on skill acquisition and transfer

BACKGROUND

Three-dimensional (3D) visual displays have been suggested to aid laparoscopic skills training by providing the depth cues not present in traditional two-dimensional (2D) displays. However, few studies have robustly investigated the impact of viewing mode (2D vs. 3D) on learning outcomes.

PURPOSE

To examine how viewing mode (2D vs. 3D) impacts the acquisition and transferability of basic laparoscopic skills by comparing performance between transfer and control groups on a complete proficiency-based training program.

METHOD

A counterbalanced between-subjects design was employed. Each participant was randomly allocated to one of four groups, comprising two transfer groups (trained in one viewing mode and tested in the alternate mode: the 2D → 3D and 3D → 2D groups) and two control groups (trained and tested in one viewing mode: the 2D → 2D and 3D → 3D groups). Participants completed proficiency-based training in six laparoscopic training tasks. Testing included two further repetitions of all tasks under test conditions. Objective performance measures included the total number of repetitions to reach proficiency, and total performance scores (i.e. time + error penalties across all repetitions) in training and testing.

RESULTS

The groups trained in 3D demonstrated superior training performance (i.e. less time + errors) and took fewer repetitions to reach proficiency than the groups trained in 2D. The groups tested in 3D also demonstrated superior test performance compared to those tested in 2D. However, training mode did not yield significant test differences between the groups tested in 2D (i.e. 2D → 2D vs. 3D → 2D), or between the groups tested in 3D (i.e. 3D → 3D vs. 2D → 3D).

CONCLUSION

Novices demonstrate superior performance in laparoscopic skills training using a 3D viewing mode compared to 2D. However, this does not necessarily translate to superior performance in subsequent testing or enhanced learning overall. Rather, test performance appears to be dictated by the viewing mode used during testing, not that of prior training.

Stereoscopic versus monoscopic displays: Learning fine manual dexterity skills using a microsurgical task simulator

We investigated the learning of fine manual dexterity with a microsurgical instrument and a new simulator in a context of microsurgery. 30 subjects were divided into two groups. One (3D group) interacted with a stereoscopic and the other (2D group) with a monoscopic display. Visual information for the displays was captured from a surgical stereomicroscope. In 20 trials, both groups performed the repetitive tasks of picking up small rods from a funnel-shaped cavity and placing them outside. In analysing learning curves, we found that the initial learning process for hand-eye coordination is easier with a 3D display, and that performance persists at a higher level of proficiency than with the 2D display option. Thus stereoscopic displays can be especially beneficial for novices, for those learning new procedures, or for providing orientation to operators facing a new or altered spatial situation. Simulators with few reliefs or spatial textures should not be used for comparison between 3D and 2D viewing conditions.

Comparative Analysis of Simulated versus Live Patient-Based FAST (Focused Assessment With Sonography for Trauma) Training

OBJECTIVE

To investigate whether simulated patient (SP)-based training has comparable efficacy as live patient (LP)-based training in teaching Focused Abdominal Sonography for Trauma (FAST) knowledge and skill competencies to surgical residents.

DESIGN

A randomized pretest/intervention/posttest controlled study design was employed to compare the participants' performance in written and practical examinations regarding FAST examination after SP-based versus LP-based training.

SETTING

University-based general residency program at a single institution.

PARTICIPANTS

A total of 29 general surgery residents of various training levels and sonographic experience were recruited by convenience sampling.

RESULTS

There was no correlation between subjects' baseline training level or sonographic experience with either the posttest-pretest score difference or the percentage of subjects getting all 4 windows with adequate quality. There was no significant difference between the improvement in written posttest-pretest scores for SP and LP group, which were 33 ± 9.6 and 31 ± 6.8 (p = 0.40), respectively. With regard to performance-based learning efficacy, a statistically higher proportion of subjects were able to obtain all 4 windows with adequate quality among the LP than the SP group (6/8 vs 1/8, p = 0.01).

CONCLUSION

SP- and LP-based FAST training for surgical residents were associated with similar knowledge-based competency acquisition, but residents receiving LP-based training were better at acquiring adequate FAST windows on live patients. Simulation training appeared to be a valid adjunct to LP practice but cannot replace LP training. Future investigations on how to improve simulation fidelity and its training efficacy for skill-based competencies are warranted.