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Debes AJ, Aggarwal R, Balasundaram I, Jacobsen MB. Construction of an evidence-based, graduated training curriculum for D-box, a webcam-based laparoscopic basic skills trainer box. Am J Surg 2012; 203:768-75. [DOI: 10.1016/j.amjsurg.2011.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 07/18/2011] [Accepted: 07/18/2011] [Indexed: 01/22/2023]
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A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training. Surg Endosc 2012; 26:3207-14. [DOI: 10.1007/s00464-012-2326-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/26/2012] [Indexed: 01/01/2023]
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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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Thoracic Surgery Skill Proficiency with Chest Wall Tumor Simulator. J Surg Res 2012; 174:250-6. [DOI: 10.1016/j.jss.2011.01.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/28/2010] [Accepted: 01/28/2011] [Indexed: 11/30/2022]
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Loukas C, Nikiteas N, Schizas D, Lahanas V, Georgiou E. A head-to-head comparison between virtual reality and physical reality simulation training for basic skills acquisition. Surg Endosc 2012; 26:2550-8. [DOI: 10.1007/s00464-012-2230-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/24/2012] [Indexed: 11/29/2022]
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Single versus multimodality training basic laparoscopic skills. Surg Endosc 2012; 26:2172-8. [PMID: 22350237 PMCID: PMC3392502 DOI: 10.1007/s00464-012-2184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 01/19/2012] [Indexed: 01/22/2023]
Abstract
Introduction Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality training of basic laparoscopic skills. Methods Thirty-six medical students without laparoscopic experience performed six training sessions of 45 min each, one per day, in which four different basic tasks were trained. Participants in the single-modality group (S) (n = 18) practiced solely on a virtual reality (VR) simulator. Participants in the multimodality group (M) (n = 18) practiced on the same VR simulator (2x), a box trainer (2x), and an augmented reality simulator (2x). All participants performed a pre-test and post-test on the VR simulator (the four basic tasks + one additional basic task). Halfway through the training protocol, both groups performed a salpingectomy on the VR simulator as interim test. Results Both groups improved their performance significantly (Wilcoxon signed-rank, P < 0.05). The performances of group S and group M in the additional basic task and the salpingectomy did not differ significantly (Mann–Whitney U test, P > 0.05). Group S performed the four basic tasks in the post-test on the VR faster than group M (P ≤ 0.05), which can be explained by the fact that they were much more familiar with these tasks. Conclusions Training of basic laparoscopic tasks on single or multiple modalities does not result in different training outcome. Both training methods seem appropriate for the attainment of basic laparoscopic skills in future curricula.
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van Empel PJ, van Rijssen LB, Commandeur JP, Verdam MGE, Huirne JA, Scheele F, Jaap Bonjer H, Jeroen Meijerink W. Validation of a new box trainer-related tracking device: the TrEndo. Surg Endosc 2012; 26:2346-52. [PMID: 22350239 PMCID: PMC3392508 DOI: 10.1007/s00464-012-2187-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 01/05/2012] [Indexed: 01/22/2023]
Abstract
Background There is an increasing demand for structured objective ex vivo training and assessment of laparoscopic psychomotor skills prior to implementation of these skills in practice. The aim of this study was to establish the internal validity of the TrEndo, a motion-tracking device, for implementation on a laparoscopic box trainer. Methods Face validity and content validity were addressed through a structured questionnaire. To assess construct validity, participants were divided into an expert group and a novice group and performed two basic laparoscopic tasks. The TrEndo recorded five motion analysis parameters (MAPs) and time. Results Participants demonstrated a high regard for face and content validity. All recorded MAPs differed significantly between experts and novices after performing a square knot. Overall, the TrEndo correctly assigned group membership in 84.7 and 95.7% of cases based on two laparoscopic tasks. Conclusion Face, content, and construct validities of the TrEndo were established. The TrEndo holds real potential as a (home) training device.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Gavazzi A, Bahsoun AN, Van Haute W, Ahmed K, Elhage O, Jaye P, Khan MS, Dasgupta P. Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot). Ann R Coll Surg Engl 2011; 93:152-6. [PMID: 22041146 DOI: 10.1308/003588411x12851639108358] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool. SUBJECTS AND METHODS The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon's knot. Thirty participants (18 novices, 12 experts) completed the procedures. RESULTS The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon's knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants. CONCLUSIONS The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.
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Affiliation(s)
- Andrea Gavazzi
- Urology Centre, uy’s Hospital, King’s College London, King’s Health Partners, London, UK
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The influence of a ‘take home’ box trainer on laparoscopic performance for gynaecological surgeons. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0720-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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van Empel PJ, van der Veer WM, van Rijssen LB, Cuesta MA, Scheele F, Bonjer HJ, Meijerink WJ. Mapping the maze of minimally invasive surgery simulators. J Laparoendosc Adv Surg Tech A 2011; 22:51-60. [PMID: 22145607 DOI: 10.1089/lap.2010.0467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Affiliation(s)
- Marshall L Smith
- SimET Center Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.
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Schreuder HWR, van den Berg CB, Hazebroek EJ, Verheijen RHM, Schijven MP. Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG 2011; 118:1576-84. [PMID: 21981275 DOI: 10.1111/j.1471-0528.2011.03146.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To obtain face and construct validity for a new training course to be used in any type of box/video trainer and to give a comprehensive overview of validated exercises for box/video training. DESIGN Cross-sectional study. SETTING University Medical Centre. POPULATION Students, residents and consultants. METHODS Participants (n = 42) were divided into three groups according to their laparoscopic experience: 'Novices' (n = 18), 'Intermediates' (n = 14) and 'Experts' (n = 10). A laparoscopic training course consisting of six exercises was constructed. To emphasise precision, a penalty score was added. Every participant performed two repetitions of the exercises; total score per exercise was calculated. To determine face validity, participants filled in a questionnaire after completion of the exercises. An evidence-based literature search for validated box/video trainer exercises was performed. MAIN OUTCOME MEASURES Face and construct validity. RESULTS The mean score of the 'experts' was set as the training target. Total scores appeared to be positively correlated with individual's laparoscopic experience. The overall score and the score for each exercise were significantly higher in the intermediate and expert groups when compared with the novice group (P ≤ 0.001). All participants completed the questionnaire. The overall assessment of the exercises was considered to be good. The course was found to be most appropriate for training residents year 1-3. CONCLUSION Face and construct validity for an inexpensive course for box/video training was established. A comprehensive and practical overview of all validated and published exercises for box/video trainers is provided to facilitate an inexpensive, but optimal and tailored selection for training purposes.
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Affiliation(s)
- H W R Schreuder
- Department of Gynaecological Oncology Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Stone RT, Watts KP, Zhong P, Wei CS. Physical and cognitive effects of virtual reality integrated training. HUMAN FACTORS 2011; 53:558-572. [PMID: 22046727 DOI: 10.1177/0018720811413389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the cognitive and physical impact of virtual reality (VR) integrated training versus traditional training methods in the domain of weld training. BACKGROUND Weld training is very important in various industries and represents a complex skill set appropriate for advanced training intervention. As such, there has been a long search for the most successful and most cost-effective method for training new welders. METHOD Participants in this study were randomly assigned to one of two separate training courses taught by sanctioned American Welding Society certified welding instructors; the duration of each course was 2 weeks. After completing the training for a specific weld type, participants were given the opportunity to test for the corresponding certification. Participants were evaluated in terms of their cognitive and physical parameters, total training time exposure, and welding certification awards earned. Each of the four weld types taught in this study represented distinct levels of difficulty and required the development of specialized knowledge and skills. RESULTS This study demonstrated that participants in the VR integrated training group (VR50) performed as well as, and in some cases, significantly outperformed, the traditional welding (TW) training group.The VR50 group was found to have a 41.6% increase in overall certifications earned compared with the TW group. CONCLUSION VR technology is a valuable tool for the production of skilled welders in a shorter time and often with more highly developed skills than their traditionally trained counterparts. APPLICATION These findings strongly support the use ofVR integrated training in the welding industry.
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Abstract
INTRODUCTION : Laparoscopic surgery is becoming the main surgical technique in use today. Surgical trainees have to be able to practice these skills in a safe environment. This article describes the design of a novel cheap home laparoscopic trainer using recycled and reusable items. METHODS : This novel home laparoscopic trainer is designed using a mobile phone, torch, and shoe box. Fifteen surgical trainees with variable laparoscopic experience used the device and provided feedback by filling in a Likert scale questionnaire. RESULTS : This is a device that is easy to make and reuse with equipment that is easily accessible in most environments. All the trainees who used the device found it easy to use and helpful for practicing hand-eye coordination. CONCLUSIONS : This is simple and low-cost device allows trainees to practice laparoscopic skills in a safe environment. It provides a design that is accessible and recyclable, hence useful as a low-technology device in places where finances are limited.
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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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Bennett A, Birch DW, Menzes C, Vizhul A, Karmali S. Assessment of medical student laparoscopic camera skills and the impact of formal camera training. Am J Surg 2011; 201:655-9. [PMID: 21545917 DOI: 10.1016/j.amjsurg.2011.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND In laparoscopic surgery, the role of camera holder often falls to untrained medical students. Laparoscopic-naive students can easily acquire laparoscopic camera navigation (LCN) skills, yet it is unclear whether this translates into improved LCN performance in the operating room and whether students retain these skills over time. The purpose of this study was to evaluate whether preclinical laparoscopic camera simulator training would result in improved LCN skills, efficiency, and comfort level over the course of a 6-week surgery clerkship. METHODS A randomized, controlled study was designed to compare students' preclerkship and postclerkship LCN skills on a previously validated box trainer model. The students (n = 70) were randomized via a computer-generated table of random numbers into study and control groups. The study group (n = 36) received a brief laparoscope training session before the clerkship, while the control group (n = 36) did not. All students also completed a preclerkship and postclerkship questionnaire detailing their experience and comfort level. RESULTS Statistical analysis using Wilcoxon's signed-rank test demonstrated that all students improved in skill level (total score, 4 vs 7; P < .0001), efficiency (time, 76 vs 33 seconds; P < .0001), and comfort level (Likert scale score, 2 vs 4; P < .0001), with no statistically significant difference between the control and study groups. CONCLUSIONS This study demonstrates that novice medical students are able to gain laparoscopic camera skills from "hands-on" experience, with no added benefit or retention of skills learned in a preclinical camera simulator training session.
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Affiliation(s)
- Athena Bennett
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Dhariwal AK, Prabhu RY, Dalvi AN, Supe AN. Effectiveness of box trainers in laparoscopic training. J Minim Access Surg 2011; 3:57-63. [PMID: 21124653 PMCID: PMC2980722 DOI: 10.4103/0972-9941.33274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 05/20/2007] [Indexed: 11/04/2022] Open
Abstract
RATIONALE AND OBJECTIVES Various devices are used to aid in the education of laparoscopic skills ranging from simple box trainers to sophisticated virtual reality trainers. Virtual reality system is an advanced and effective training method, however it is yet to be adopted in India due to its cost and the advanced technology required for it. Therefore, box trainers are being used to train laparoscopic skills. Hence this study was undertaken to assess the overall effectiveness of the box-training course. STUDY PROCEDURE: The study was conducted during six-day laparoscopic skills training workshops held during 2006. Twenty five surgeons; age range of 26 to 45 years, of either sex, who had not performed laparoscopic surgery before; attending the workshop were evaluated. Each participant was given a list of tasks to perform before beginning the box-training course on day one and was evaluated quantitatively by rating the successful completion of each test. Evaluation began when the subject placed the first tool into the cannula and ended with task completion. Two evaluation methods used to score the subject, including a global rating scale and a task-specific checklist. After the subject completed all sessions of the workshop, they were asked to perform the same tasks and were evaluated in the same manner. For each task completed by the subjects, the difference in the scores between the second and first runs were calculated and interpreted as an improvement as a percentage of the initial score. STATISTICAL ANALYSIS Wilcoxon matched-paired signed-ranks test was applied to find out the statistical significance of the results obtained. RESULTS The mean percentage improvement in scores for both the tasks, using global rating scale, was 44.5% ± 6.930 (Mean ± SD). For task 1, using the global rating scale mean percentage improvement was 49.4% ± 7.948 (Mean ± SD). For task 2, mean percentage improvement using global rating scale was 39.6% ± 10.4 (Mean ± SD). Using Wilcoxon matched-paired signed-ranks test, 2-tailed P-value<0.0001 which is extremely significant. CONCLUSION This study confirms that a short-term, intensive, focused course does improve laparoscopic skills of trainees. Box-trainers can be used to change the present day didactic training into objective and competency-based. Global rating scale and checklist provide an inexpensive and effective way of objective assessment of performance of laparoscopic skills.
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Affiliation(s)
- Anender Kaur Dhariwal
- Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Parel, Mumbai - 400 012, India
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Diesen DL, Erhunmwunsee L, Bennett KM, Ben-David K, Yurcisin B, Ceppa EP, Omotosho PA, Perez A, Pryor A. Effectiveness of laparoscopic computer simulator versus usage of box trainer for endoscopic surgery training of novices. JOURNAL OF SURGICAL EDUCATION 2011; 68:282-289. [PMID: 21708364 DOI: 10.1016/j.jsurg.2011.02.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Teaching of laparoscopic skills is a challenge in surgical training programs. Because of the highly technical nature and the steep learning curve, students and residents must learn laparoscopic skills before performing them in the operating room. To improve efficiency of learning and patient safety, research in simulation is essential. Two types of simulators currently in use include virtual reality and box trainers. Our study examined which simulator technique was most effective in teaching novice trainees laparoscopic techniques. DESIGN This is a prospective, randomized, blinded, controlled trial that enrolled fourth-year medical students and surgical interns to participate in a supervised 6-month laparoscopic training program with either computer simulators or box trainers. Subjects were randomized and trained on appropriate laparoscopic camera skills, instrument handling, object positioning, dissection, ligation, suturing, and knot tying. Students within one group were not allowed to practice, learn or train on the opposing trainers. At time points 0, 2, and 6 months all subjects completed a series of laparoscopic exercises in a live porcine model, which were captured on DVD and scored by blinded expert investigators. RESULTS Scores improved overall from the pretest to subsequent tests after training with no difference between the virtual reality and box simulator groups. In the medical students specifically, there was overall improvement, and improvement in the needle-transfer and knot-tying skills specifically, with no difference between the box simulator and virtual reality groups. For the interns, both groups showed significant overall improvement with no difference between the virtual reality and box simulator groups or on individual skills. CONCLUSIONS We conclude that laparoscopic simulator training improves surgical skills in novice trainees. We found both the box trainers and the virtual reality simulators are equally effective means of teaching laparoscopic skills to novice learners.
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Affiliation(s)
- Diana L Diesen
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Rossitto C, Gagliardi ML, Fagotti A, Fanfani F, Gallotta V, Scambia G. Teaching and training in laparoscopic surgery: experience of Catholic Laparoscopy Advanced Surgery School in the basic gynecological surgery. Arch Gynecol Obstet 2011; 285:155-60. [PMID: 21667165 DOI: 10.1007/s00404-011-1940-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/26/2011] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the effectiveness of our training method for basic "hands-on" laparoscopic courses. METHODS A prospective observational study between September 2008 and December 2010 at Catholic Laparoscopy Advanced Surgery School of the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Sacred Heart-Rome, was conducted. Each course lasted for 3 days, divided into theoretical and practical parts, ending with a live surgery. Gynecologists who attended our 'hands-on' laparoscopic courses had no or minimum experience with laparoscopic technique. The teachers were expert laparoscopists of our Division, and every single group of participants had the same tutor for the entire course. Trainees completed self-assessment anonymous questionnaire of laparoscopic knowledge, before and immediately after the course. RESULTS During the study period, we performed 20 basic courses, enrolling 120 consecutive gynecologists. Among them, 114 (95%) decided to participate. Average age was 41 years (range 35-60 years) and 108 (94.7%) trainees were Italian. The subjective assessment showed an immediate improvement of motor skills. CONCLUSIONS Laparoscopic training course can improve both theoretical knowledge and motor skills. Such courses result in a short-term subjective improvement.
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Affiliation(s)
- Cristiano Rossitto
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168, Rome, Italy
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Abstract
Surgical simulation offers a safe opportunity to develop the skills required for the operating room. Box trainers are an excellent low-cost training option but there are limited options for teaching laparoscopic ventral hernia repair. We developed a realistic and cost-effective box system for laparoscopic ventral herniorrhaphy that will enhance training experience before entering the operating theater.
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Islam A, Castellvi AO, Tesfay ST, Castellvi AD, Wright AS, Scott DJ. Early surgeon impressions and technical difficulty associated with laparoendoscopic single-site surgery: a Society of American Gastrointestinal and Endoscopic Surgeons Learning Center study. Surg Endosc 2011; 25:2597-603. [PMID: 21359887 DOI: 10.1007/s00464-011-1594-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/24/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Interest in laparoendoscopic single-site surgery (LESS) is growing rapidly among surgeons. This study aimed to characterize current surgeon impressions about LESS and to determine the relative difficulty of performing a simulated LESS task using a multiport access device. METHODS This study was conducted at the 2009 Society of Gastrointestinal Endoscopic Surgeons (SAGES) Learning Center. The 56 study participants were asked to complete pre- and post-test questionnaires regarding their level of training, prior clinical experience, and opinions about LESS. Technical skill performance was evaluated using the standardized fundamentals of laparoscopic surgery Peg Transfer task scored according to time and error metrics. The participants completed three repetitions: conventional laparoscopy (LAP), LESS with nonarticulated instruments (LESS Straight), and LESS with articulated instruments (LESS Articulating). RESULTS Complete data were collected for 45 (80%) of the 56 participants, which included 27 practicing surgeons, nine minimally invasive surgery (MIS) fellows, seven residents, and two allied health professionals. Five surgeons (LESS experienced) had managed at least one LESS case in the preceding 6 months. Participants rated their comfort with LESS as 2.0 ± 1.2 (5-point scale, 1 = very uncomfortable). Compared with conventional laparoscopy, the participants indicated that LESS had 97% better cosmesis, 25% decreased postoperative pain, 18% faster recovery, 97% more demanding, 73% increased rate of complications, and 82% anticipated wide adoption. They all indicated a readiness to offer LESS to their patients if appropriately trained. Peg Transfer performance was significantly worse for LESS than for LAP (40-65% performance decline), and for LESS Articulating than for LESS Straight (44% performance decline). Construct validity for the LESS simulated tasks was supported because the LESS-experienced scores were significantly better than the LESS-nonexpert scores. CONCLUSION Despite the increased technical difficulty associated with the LESS approach, surgeons are enthusiastic about offering these techniques and seeking additional training. Robust simulation-based methods that foster skill acquisition through repetitive practice and verification of proficiency are needed such that safe adoption may be fostered.
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Affiliation(s)
- Arsalla Islam
- Department of Surgery, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA
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Torricelli FCM, Guglielmetti G, Duarte RJ, Srougi M. Laparoscopic skill laboratory in urological surgery: tools and methods for resident training. Int Braz J Urol 2011; 37:108-11; discussion 112. [DOI: 10.1590/s1677-55382011000100014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2010] [Indexed: 11/22/2022] Open
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Mohammadi Y, Lerner MA, Sethi AS, Sundaram CP. Comparison of laparoscopy training using the box trainer versus the virtual trainer. JSLS 2010; 14:205-12. [PMID: 20932370 PMCID: PMC3043569 DOI: 10.4293/108680810x12785289144115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The virtual reality trainer was found to be a reasonable alternative to the box trainer for laparoscopic skills training. Background and Objectives: To evaluate whether training on a virtual reality laparoscopic simulator improves the performance on a laparoscopic box trainer. Methods: Twenty-six subjects were trained using a box trainer, and 17 participants were trained using a virtual simulator. Participants in the experimental group completed 1 session of 5 exercises on the box trainer, 4 sessions on the virtual simulator, and a final session on the box trainer. Participants in the control group completed 6 sessions of 5 exercises on the box trainer alone. Exercises were monitored and scored for time and accuracy. Participants completed a self-evaluation survey after each session and a user satisfaction questionnaire at the end of the training. Results: No significant difference existed between the 2 groups in improvement of accuracy. Pegboard time (P=0.0110) and pattern cutting time (P=0.0229) were the only exercise parameters that improved significantly more in the control group compared with the experimental group. The experimental group developed more interest in a surgical field as a result of their experience than the control group did (70.6% vs 53.8%, respectively). Conclusion: The virtual simulator is a reasonable alternative to the box trainer for laparoscopic skills training.
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Affiliation(s)
- Yousef Mohammadi
- Department of Public Health, Indiana University, Indianapolis, Indiana, USA
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The LapSim virtual reality simulator: promising but not yet proven. Surg Endosc 2010; 25:343-55. [PMID: 20614142 DOI: 10.1007/s00464-010-1181-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
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127
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Review of methods for objective surgical skill evaluation. Surg Endosc 2010; 25:356-66. [DOI: 10.1007/s00464-010-1190-z] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 06/14/2010] [Indexed: 01/15/2023]
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128
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Augmented reality haptic (ARH): an approach of electromagnetic tracking in minimally invasive surgery. Int J Comput Assist Radiol Surg 2010; 6:257-63. [DOI: 10.1007/s11548-010-0501-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/01/2010] [Indexed: 11/26/2022]
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Fransson BA, Ragle CA. Assessment of laparoscopic skills before and after simulation training with a canine abdominal model. J Am Vet Med Assoc 2010; 236:1079-84. [DOI: 10.2460/javma.236.10.1079] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Vanessa N Palter
- Department of Surgery, University of Toronto, and Division of General Surgery, St. Michael's Hospital, Toronto, Ontario.
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131
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Debes AJ, Aggarwal R, Balasundaram I, Jacobsen MB. A tale of two trainers: virtual reality versus a video trainer for acquisition of basic laparoscopic skills. Am J Surg 2010; 199:840-5. [PMID: 20079480 DOI: 10.1016/j.amjsurg.2009.05.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 04/28/2009] [Accepted: 05/04/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aimed to assess the transferability of basic laparoscopic skills between a virtual reality simulator (MIST-VR) and a video trainer box (D-Box). METHODS Forty-six medical students were randomized into 2 groups, training on MIST-VR or D-Box. After training with one modality, a crossover assessment on the other was performed. RESULTS When tested on MIST-VR, the MIST-VR group showed significantly shorter time (90.3 seconds vs 188.6 seconds, P <.001), better economy of movements (4.40 vs 7.50, P <.001), and lower score (224.7 vs 527.0, P <.001). However, when assessed on the D-Box, there was no difference between the groups for time (402.0 seconds vs 325.6 seconds, P = .152), total hand movements (THC) (289 vs 262, P = .792), or total path length (TPL) (34.9 m vs 34.6 m, P = .388). CONCLUSION Both simulators provide significant improvement in performance. Our results indicate that skills learned on the MIST-VR are transferable to the D-Box, but the opposite cannot be demonstrated.
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Affiliation(s)
- Anders J Debes
- Department of Surgery, Oestfold Hospital Trust, Oestfold Hospital Trust, N-1603 Fredrikstad, Norway.
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132
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Morandeira Rivas A, Cabrera Vilanova A, Sabench Pereferrer F, Hernández González M, del Castillo Déjardin D. Simulador de bajo coste para el entrenamiento de habilidades laparoscópicas básicas. Cir Esp 2010; 87:26-32. [DOI: 10.1016/j.ciresp.2009.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/10/2009] [Indexed: 11/16/2022]
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Yee KA, Karmali S, Sherman V. Validation of a simple camera navigation trainer. J Am Coll Surg 2009; 209:753-7. [PMID: 19959045 DOI: 10.1016/j.jamcollsurg.2009.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/27/2009] [Accepted: 09/01/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND One laparoscopic skill that is rarely addressed is proper use of the 30-degree laparoscope. Lack of knowledge and training with an angled laparoscope can result in less than optimal visualization. The purpose of this study is to validate a simple and efficient camera navigation trainer. STUDY DESIGN Thirty-four medical students from Baylor College of Medicine participated. Their use of a 30-degree laparoscope was assessed. In task A, subjects were asked to demonstrate a series of views corresponding to the position of the light cord. In task B, subjects had to correctly demonstrate views of a three-dimensional model of a liver, intestines, and abdominal wall. Subjects then underwent a brief training session, followed by a self-directed, 10-minute practice session. Last, they were retested in tasks A and B. RESULTS Sixteen students (47.1%) had prior experience using a laparoscope. At baseline testing, 0 of 34 novices were able to demonstrate the intended views in task A, but at posttraining the mean success rate was 99.5% (p < 0.0001). There was also significant improvement in performance of task B, where pretest success was 5.9% and posttest success was 98.5% (p < 0.0001). CONCLUSIONS After a simple and brief training session, novices were able to effectively use the 30-degree laparoscope using the established verbal cues. The simplicity of this training module provides an efficient method of training novice camera operators both within and outside the operating room.
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Affiliation(s)
- Kimberly A Yee
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: Use of fresh cadavers in vascular surgery training. Surgery 2009; 146:757-62; discussion 762-3. [DOI: 10.1016/j.surg.2009.06.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 06/06/2009] [Indexed: 01/22/2023]
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King RC, Atallah L, Lo BPL, Yang GZ. Development of a Wireless Sensor Glove for Surgical Skills Assessment. ACTA ACUST UNITED AC 2009; 13:673-9. [PMID: 19726263 DOI: 10.1109/titb.2009.2029614] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rachel C King
- Department of Computing, Imperial College London, London SW7 2AZ, UK.
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Jain M, Tantia O, Khanna S, Sen B, Kumar Sasmal P. Hernia Endotrainer: Results of Training on Self-Designed Hernia Trainer Box. J Laparoendosc Adv Surg Tech A 2009; 19:535-40. [DOI: 10.1089/lap.2008.0384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Mayank Jain
- Department of Minimal Access Surgery, ILS Multispecialty Clinic, Kolkata, India
| | - Om Tantia
- Department of Minimal Access Surgery, ILS Multispecialty Clinic, Kolkata, India
| | - Shashi Khanna
- Department of Minimal Access Surgery, ILS Multispecialty Clinic, Kolkata, India
| | - Bimalendu Sen
- Department of Minimal Access Surgery, ILS Multispecialty Clinic, Kolkata, India
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Stelzer MK, Abdel MP, Sloan MP, Gould JC. Dry Lab Practice Leads to Improved Laparoscopic Performance in the Operating Room. J Surg Res 2009; 154:163-6. [PMID: 19101694 DOI: 10.1016/j.jss.2008.06.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 05/26/2008] [Accepted: 06/05/2008] [Indexed: 11/27/2022]
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Training the Next Generation of Minimally Invasive Surgeons. J Minim Invasive Gynecol 2009; 16:136-41. [PMID: 19249701 DOI: 10.1016/j.jmig.2008.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/15/2008] [Accepted: 11/20/2008] [Indexed: 01/22/2023]
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Evaluation of skills in arthroscopic training based on trajectory and force data. Clin Orthop Relat Res 2009; 467:546-52. [PMID: 18791774 PMCID: PMC2628523 DOI: 10.1007/s11999-008-0497-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
Objective evaluation of surgical skills is essential for an arthroscopic training system. We asked whether a quantitative assessment of arthroscopic skills using scores, time to completion, instrument tip trajectory data, and force data was valid. We presumed more experienced surgeons would perform better on a simulated arthroscopic procedure than novices, therefore validating the quantitative assessment. Surgical trainees (n = 12), orthopaedic residents (n = 12), and experienced arthroscopic surgeons (n = 6) were tested on a Sawbones knee simulator. Subjects performed a joint inspection and probing task and a partial meniscectomy task. The trajectory data were measured using an electromagnetic motion tracking system and the force data were measured using a force sensor. The experienced group performed both tasks with higher scores and more quickly than the less experienced groups. The path length of the probe and the scissors was substantially shorter and the probe velocity was considerably faster in the experienced group. The trainee group applied substantially stronger forces to the joint during the joint inspection and probing task. Our data suggest a performance assessment using an electromagnetic motion tracking system and a force sensor provides an objective means of evaluating surgical skills in an arthroscopic training system.
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141
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Retention of basic laparoscopic skills after a structured training program. ACTA ACUST UNITED AC 2009; 6:229-235. [PMID: 20234837 PMCID: PMC2837243 DOI: 10.1007/s10397-008-0458-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 12/29/2008] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer. Scores were calculated by adding up the time to completion of the task with penalty points, consequently rewarding speed and precision. The sum score was the sum of the five scores. One year later, seven of them underwent retention testing for the current study. The final test results were compared with retention test results as a measure of durability of acquired skills. Novices’ scores did not worsen significantly for four out of five tasks (i.e., placing a pipe cleaner p = 0.46, placing beads p = 0.24, cutting a circle p = 0.31, and knot tying p = 0.13). However, deterioration was observed in the performance on stretching a rubber band (p < 0.05), as well as in the sum score (p < 0.05). Nevertheless, all retention scores remained better than the baseline results. In conclusion, basic laparoscopic skills acquired during a short training program merely sustain over time. However, ongoing practice is advisable, especially to preserve tissue-handling skills, since these may be the first to deteriorate.
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142
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Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [PMID: 19160288 DOI: 10.1002/14651858.cd006575] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [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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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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144
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Predictors of technical skill acquisition among resident trainees in a laparoscopic skills education program. World J Surg 2009; 32:1917-21. [PMID: 18553192 DOI: 10.1007/s00268-008-9643-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Administrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four-week laparoscopic skills development program. METHODS Laparoscopic skills in 35 first-year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four-week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson's correlation and paired t-test studies. RESULTS Intake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04). CONCLUSIONS A laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.
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145
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146
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Logan-Collins JM, Barnes SL, Huezo KL, Pritts TA. Management of common postoperative emergencies: are July interns ready for prime time? JOURNAL OF SURGICAL EDUCATION 2008; 65:453-459. [PMID: 19059177 DOI: 10.1016/j.jsurg.2008.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 04/21/2008] [Indexed: 05/27/2023]
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147
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Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 2008; 56:865-72. [PMID: 18922627 DOI: 10.1016/j.eururo.2008.09.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 09/19/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been acknowledged that standardised training programmes are needed to improve laparoscopic training of urologic trainees. Previous studies have suggested that simulator-based laparoscopic training can improve performance during real laparoscopic procedures. OBJECTIVE To determine if there are performance differences for the completion of a simulated laparoscopic suturing task among urology residents based on their postgraduate year of training (PGY). DESIGN, SETTING, AND PARTICIPANTS Using a validated scoring checklist, two independent observers objectively scored the completion of a standardised laparoscopic suturing task in a bench-top laparoscopic box trainer. PGY and previous exposure to laparoscopic surgery and laparoscopic simulated training was obtained from self-administered questionnaires. Data acquisition was undertaken at the European Urological Residents Education Programme (EUREP) 2007, run by the European School of Urology, and included a pan-European cohort of 201 urology residents. MEASUREMENTS Reliability among those rating the suturing tasks was excellent (Cronbach's α=0.83). Each resident was scored for the suturing task. Residents were categorised into three groups based on their PGY status (junior [n=8]; intermediate [n=37]; senior [n=156]). The Kruskal-Wallis test was used to measure trend across the PGY; the Mann-Whitney U test was used to determine variation among categorised PGY groups. RESULTS AND LIMITATIONS Laparoscopic suturing skill was significantly different across PGY levels (p=0.032), and between junior residents and both intermediate and senior residents (p=0.008 and p=0.012, respectively). There was no significant difference between intermediate and senior residents (p=0.697). Only 12% of participants rated their existing volume of laparoscopic operative cases as sufficient, while 55% of participants had no regular opportunities, and 32% of participants had not performed laparoscopic procedures as primary surgeon. Most residents (96%) reported the use of laparoscopic simulators to be beneficial in training, although current European training programmes appear to provide <50% of residents with the opportunity to train with them. CONCLUSIONS A discernable relationship existed between the score obtained for a laparoscopic suturing task and year of resident training. Modular simulator training as part of a formal training programme may help to overcome some of the shortfall in residents' exposure to laparoscopic procedures as primary surgeon.
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148
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Mir IS, Mohsin M, Malik A, Shah AQ, Majid T. A structured training module using an inexpensive endotrainer for improving the performance of trainee surgeons. Trop Doct 2008; 38:217-8. [DOI: 10.1258/td.2008.070359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Training in minimal access surgery has always been difficult in developing countries with limited resources, non availability of formal animal labs, inaffordability of conventional endotrainers and lack of trained endosurgeons to help the amateurs. It is always difficult to start a new procedure in such places where not only the patients but the orthodox surgical fraternity are reluctant to accept new ideas and newer trends in surgery. After thorough discussions with senior surgeons, the author (who was the only trained endosurgeon to begin with) developed a training policy to train the surgeons over a period of time through various exercises before allowing them to assist him in the actual surgeries. A homemade, inexpensive endotrainer was designed for these exercises. Audio-visual seminars were held in between the training sessions. This training module can be employed by other rural hospitals to improve the skills of surgeons who are new to the art of endosurgery.
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Affiliation(s)
- Iqbal Saleem Mir
- Minimal Access Surgery Unit, Government Gousia Hospital, Khanyar
| | - Mir Mohsin
- Minimal Access Surgery Unit, Government Gousia Hospital, Khanyar
| | | | - Abdul Qayoom Shah
- Minimal Access Surgery Unit, Government District Hospital, Baramulla, Kashmir, India, 190010
| | - Tafazul Majid
- Minimal Access Surgery Unit, Government Gousia Hospital, Khanyar
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Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 2008; 95:1088-97. [DOI: 10.1002/bjs.6344] [Citation(s) in RCA: 297] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Abstract
Background
Surgical training has traditionally been one of apprenticeship. The aim of this review was to determine whether virtual reality (VR) training can supplement and/or replace conventional laparoscopic training in surgical trainees with limited or no laparoscopic experience.
Methods
Randomized clinical trials addressing this issue were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded, grey literature and reference lists. Standardized mean difference was calculated with 95 per cent confidence intervals based on available case analysis.
Results
Twenty-three trials (mostly with a high risk of bias) involving 622 participants were included in this review. In trainees without surgical experience, VR training decreased the time taken to complete a task, increased accuracy and decreased errors compared with no training. In the same participants, VR training was more accurate than video trainer (VT) training. In participants with limited laparoscopic experience, VR training resulted in a greater reduction in operating time, error and unnecessary movements than standard laparoscopic training. In these participants, the composite performance score was better in the VR group than the VT group.
Conclusion
VR training can supplement standard laparoscopic surgical training. It is at least as effective as video training in supplementing standard laparoscopic training.
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Affiliation(s)
- K Gurusamy
- Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, University College London and Royal Free Hospital NHS Trust, London NW3 2QG, UK
| | - R Aggarwal
- Department of Biosurgery and Surgical Technology, Imperial College, London, UK
| | - L Palanivelu
- Department of Obstetrics and Gynaecology, Milton Keynes General NHS Trust, Milton Keynes, UK
| | - B R Davidson
- Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, University College London and Royal Free Hospital NHS Trust, London NW3 2QG, UK
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Geoffrion R. Standing on the Shoulders of Giants: Contemplating a Standard National Curriculum for Surgical Training in Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:684-695. [DOI: 10.1016/s1701-2163(16)32917-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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