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Clanahan JM, Han BJ, Klos CL, Wise PE, Ohman KA. Use of Simulation For Training Advanced Colorectal Procedures. JOURNAL OF SURGICAL EDUCATION 2024; 81:758-767. [PMID: 38508956 DOI: 10.1016/j.jsurg.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Simulation training for minimally invasive colorectal procedures is in developing stages. This study aims to assess the impact of simulation on procedural knowledge and simulated performance in laparoscopic low anterior resection (LLAR) and robotic right colectomy (RRC). DESIGN LLAR and RRC simulation procedures were designed using human cadaveric models. Resident case experience and simulation selfassessments scores for operative ability and knowledge were collected before and after the simulation. Colorectal faculty assessed resident simulation performance using validated assessment scales (OSATS-GRS, GEARS). Paired t-tests, unpaired t-tests, Pearson's correlation, and descriptive statistics were applied in analyses. SETTING Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis, Missouri. PARTICIPANTS Senior general surgery residents at large academic surgery program. RESULTS Fifteen PGY4/PGY5 general surgery residents participated in each simulation. Mean LLAR knowledge score increased overall from 10.0 ± 2.0 to 11.5 ± 1.6 of 15 points (p = 0.0018); when stratified, this increase remained significant for the PGY4 cohort only. Mean confidence in ability to complete LLAR increased overall from 2.0 ± 0.8 to 2.8 ± 0.9 on a 5-point rating scale (p = 0.0013); when stratified, this increase remained significant for the PGY4 cohort only. Mean total OSATS GRS score was 28 ± 6.3 of 35 and had strong positive correlation with previous laparoscopic colorectal experience (r = 0.64, p = 0.0092). Mean RRC knowledge score increased from 9.4 ± 2.2 to 11.1 ± 1.5 of 15 points (p = 0.0030); when stratified, this increase again remained significant for the PGY4 cohort only. Mean confidence in ability to complete RRC increased from 1.9 ± 0.9 to 3.2 ± 1.1 (p = 0.0002) and was significant for both cohorts. CONCLUSIONS Surgical trainees require opportunities to practice advanced minimally invasive colorectal procedures. Our simulation approach promotes increased procedural knowledge and resident confidence and offers a safe complement to live operative experience for trainee development. In the future, simulations will target trainees on the earlier part of the learning curve and be paired with live operative assessments to characterize longitudinal skill progression.
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Affiliation(s)
- Julie M Clanahan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Britta J Han
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Coen L Klos
- Department of Surgery, Veterans Affairs Medical Center, John Cochran Division, St. Louis, Missouri
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kerri A Ohman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Veterans Affairs Medical Center, John Cochran Division, St. Louis, Missouri
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Pandini RV, Pandini LC, Cotti GCC, Spinelli A, Anbar-Neto T, Pupo-Neto JA, Nahas SC. Surgical training in laparoscopic lateral pelvic lymph node dissection: description of an animal model - a video vignette. Colorectal Dis 2020; 22:108-112. [PMID: 31484217 DOI: 10.1111/codi.14843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022]
Affiliation(s)
- R V Pandini
- Colon and Rectum Surgery Department, University of Sao Paulo, Sao Paulo, Brazil.,Minimally Invasive Surgery Center in Araçatuba, Sao Paulo, Brazil
| | - L C Pandini
- Minimally Invasive Surgery Center in Araçatuba, Sao Paulo, Brazil.,FACERES Medical School in Sao Jose do Rio Preto, São Paulo, Brazil
| | - G C C Cotti
- São Paulo Cancer Institute, Sao Paulo, Brazil
| | - A Spinelli
- Division of Colon and Rectum Surgery, Humanitas Research Hospital, Humanitas University Rozzano Milano, Milan, Italy
| | - T Anbar-Neto
- Minimally Invasive Surgery Center in Araçatuba, Sao Paulo, Brazil.,FACERES Medical School in Sao Jose do Rio Preto, São Paulo, Brazil
| | - J A Pupo-Neto
- Minimally Invasive Surgery Center in Araçatuba, Sao Paulo, Brazil.,Colon and Rectum Surgery Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - S C Nahas
- Colon and Rectum Surgery Department, University of Sao Paulo, São Paulo, Brazil
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Gimm O, Barczyński M, Mihai R, Raffaelli M. Training in endocrine surgery. Langenbecks Arch Surg 2019; 404:929-944. [PMID: 31701231 PMCID: PMC6935392 DOI: 10.1007/s00423-019-01828-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. METHODS A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. RESULTS For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs. CONCLUSIONS Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Clinical and Experimental Medicine (IKE), Linköping University, 58183 Linköping, Sweden
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202 Kraków, Poland
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 7DU United Kingdom
| | - Marco Raffaelli
- U.O. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
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Minimum Number of Required Sessions for Attaining Basic Skills in Laparoscopic Surgery by General Surgery Residents; an Experimental Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e18. [PMID: 31172129 PMCID: PMC6548113 DOI: 10.22114/ajem.v0i0.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Training is the primary route of attaining required skills among residents in general surgery. Objective This study was conducted to evaluate the minimum number of required sessions for attaining basic skills in laparoscopic surgery in a skill-lab among surgical residents. Method This cross-sectional study was conducted in Imam-Khomeini Hospital during 2012. A total of 20 surgical residents were enrolled. There were 45-60 mins sessions weekly, which included the following seven elementary skills: first knot tie, second knot tie, peg exchange, peg drop, rope pass, needle pass, and paper cut. These skills were evaluated weekly, and qualitative evaluations were done every 2 weeks. Results Mean age of the 20 surgical residents was 32.2 ± 4.7 years, and 55.6% of them were males. The median session counts were as follows: six sessions for first knot tie, six sessions for second knot tie, three sessions for peg exchange, eight sessions for needle pass, and five sessions for paper cut. Conclusion Based on the obtained results, it may be concluded that relatively five sessions are required for acquiring basic skills in laparoscopic surgery by surgical residents.
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Educational training in laparoscopic gynecological surgery based on ethanol-glycerol-lysoformin-preserved body donors. Ann Anat 2018; 221:157-164. [PMID: 30312766 DOI: 10.1016/j.aanat.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Educational training of laparoscopic skills performed on body donors is considered the gold standard prior to surgery in living patients. Appropriate, safe, and feasible fixation of body donors, reflecting true-to-life conditions of tissues, is an essential prerequisite for training workshops. MATERIALS AND METHODS Here we describe and evaluate a modified ethanol-glycerol-lysoformin-based fixation technique. Body donors were fixed by perfusion (70% ethanol, 30% glycerol, 0.3% lysoformin; ca. 20l) via femoral artery and stored in a humid atmosphere (1% thymol) at 4°C. Technical equipment included a mobile operating table, endoscopy system with gas insufflation, suction/irrigation pump, standard and electrosurgical instruments. The tissue properties of ethanol-glycerol-lysoformin-fixed body donors and their suitability for laparoscopic surgery were tested and compared to the in vivo situation. RESULTS Modified ethanol-glycerol-lysoformin fixation was a simple, cost-efficient and hazard-free procedure, resulting in near-to-life tissue conditions regarding consistency and flexibility, with moderate discoloration and greater viscosity of organs. Key laparoscopic procedures (trocar handling, pneumoperitoneum, blunt/sharp dissection, partial/total removal of organs, bi- or monopolar electrosurgery, suturing techniques) could be performed without difficulty. Multiple reuse of body donors was feasible over one year. Compared to the in vivo situation, the investigation of body donors required a greater degree of gas insufflation and more energy for electrosurgery. CONCLUSIONS Modified ethanol-glycerol-lysoformin fixation applied to body donors permitted laparoscopic surgery in a realistic and practical manner. Due to its logistic advantages, this technique provides appropriate conditions to train laparoscopic skills and implement novel minimally invasive approaches.
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Mentor Tutoring: An Efficient Method for Teaching Laparoscopic Colorectal Surgical Skills in a General Hospital. Surg Laparosc Endosc Percutan Tech 2018; 27:479-484. [PMID: 29049081 DOI: 10.1097/sle.0000000000000487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We retrospectively assessed the efficacy of our mentor tutoring system for teaching laparoscopic colorectal surgical skills in a general hospital. MATERIALS AND METHODS A series of 55 laparoscopic colectomies performed by 1 trainee were evaluated. Next, the learning curves for high anterior resection performed by the trainee (n=20) were compared with those of a self-trained surgeon (n=19). RESULTS Cumulative sum analysis and multivariate regression analyses showed that 38 completed cases were needed to reduce the operative time. In high anterior resection, the mean operative times were significantly shorter after the seventh average for the tutored surgeon compared with that for the self-trained surgeon. In cumulative sum charting, the curve reached a plateau by the seventh case for the tutored surgeon, but continued to increase for the self-trained surgeon. CONCLUSIONS Mentor tutoring effectively teaches laparoscopic colorectal surgical skills in a general hospital setting.
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Cruz JASD, Miranda AF, Costa LED, Azevedo RUD, Reis STD, Srougi M, Passerotti CC. Assessment of a new kind of surgical simulator. The physical surgical simulator. Acta Cir Bras 2018; 33:86-94. [PMID: 29412236 DOI: 10.1590/s0102-865020180010000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. METHODS Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. RESULTS There was no difference in any of the evaluated parameters. CONCLUSION We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.
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Affiliation(s)
- José Arnaldo Shiomi da Cruz
- MD, MSc, Laboratory of Medical Research, Urology - LIM 55, Medical School, Universidade de São Paulo (USP), Brazil. Conception, design and scientific content of the study; manuscript preparation; critical revision; final approval
| | - André Filipe Miranda
- MD, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Technical procedures, interpretation of data, manuscript preparation
| | - Lucas Evangelista da Costa
- MD, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Technical procedures, interpretation of data, manuscript preparation
| | - Rafael Ulysses de Azevedo
- MD, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Technical procedures, interpretation of data, manuscript preparation
| | - Sabrina Thalita Dos Reis
- PhD, Associate Professor, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Manuscript preparation, critical revision, final approval
| | - Miguel Srougi
- PhD, Full Professor, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Manuscript preparation, critical revision, final approval
| | - Carlo Camargo Passerotti
- PhD, Associate Professor, Laboratory of Medical Research, Urology - LIM 55, Medical School, USP, Sao Paulo-SP, Brazil. Manuscript preparation, critical revision, final approval
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Torricelli FCM, Barbosa JABA, Marchini GS. Impact of laparoscopic surgery training laboratory on surgeon's performance. World J Gastrointest Surg 2016; 8:735-743. [PMID: 27933135 PMCID: PMC5124702 DOI: 10.4240/wjgs.v8.i11.735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/02/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.
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Training model for laparoscopic Heller and Dor fundoplication: a tool for laparoscopic skills training and assessment—construct validity using the GOALS score. Surg Endosc 2015; 30:3654-60. [DOI: 10.1007/s00464-015-4617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
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Valinluck Lao V, Steele SR. The role of simulation in colon and rectal surgery training. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Narayanan SK, Cohen RC, Shun A. Technical tips and advancements in pediatric minimally invasive surgical training on porcine based simulations. Pediatr Surg Int 2014; 30:655-61. [PMID: 24748108 DOI: 10.1007/s00383-014-3502-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimal access techniques have transformed the way pediatric surgery is practiced. Due to various constraints, surgical residency programs have not been able to tutor adequate training skills in the routine setting. The advent of new technology and methods in minimally invasive surgery (MIS), has similarly contributed to the need for systematic skills' training in a safe, simulated environment. To enable the training of the proper technique among pediatric surgery trainees, we have advanced a porcine non-survival model for endoscopic surgery. MATERIALS AND METHODS The technical advancements over the past 3 years and a subjective validation of the porcine model from 114 participating trainees using a standard questionnaire and a 5-point Likert scale have been described here. Mean attitude scores and analysis of variance (ANOVA) were used for statistical analysis of the data. RESULTS Almost all trainees agreed or strongly agreed that the animal-based model was appropriate (98.35%) and also acknowledged that such workshops provided adequate practical experience before attempting on human subjects (96.6%). Mean attitude score for respondents was 19.08 (SD 3.4, range 4-20). Attitude scores showed no statistical association with years of experience or the level of seniority, indicating a positive attitude among all groups of respondents. CONCLUSIONS Structured porcine-based MIS training should be an integral part of skill acquisition for pediatric surgery trainees and the experience gained can be transferred into clinical practice. We advocate that laparoscopic training should begin in a controlled workshop setting before procedures are attempted on human patients.
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Affiliation(s)
- Sarath Kumar Narayanan
- Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia,
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Golriz M, Hafezi M, Garoussi C, Fard N, Arvin J, Fonouni H, Nickkholgh A, Kulu Y, Frongia G, Schemmer P, Mehrabi A. Do we need animal hands-on courses for transplantation surgery? Clin Transplant 2014; 27 Suppl 25:6-15. [PMID: 23909497 DOI: 10.1111/ctr.12155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transplantation surgery requires many years of training. This study evaluates and presents the results of our recent four-yr animal hands-on courses of transplantation surgery on participants' training. METHODS Since 2008, five two-d hands-on courses of transplantation surgery were performed on swine models at our department. Sixty-one participants were asked to answer three questionnaires (pre-course, immediate post-course, subsequent post-course). The questions pertained to their past education, expectations, and evaluation of our courses, as well as our course's effectiveness in advancing their surgical abilities. The results were analyzed, compared and are presented herein. RESULTS On average, 1.8 multiorgan procurements, 2.3 kidney, 1.5 liver, and 0.7 pancreas transplantations were performed by each participant. 41.7% of participants considered their previous practical training only satisfactory; 85% hoped for more opportunities to practice surgery; 73.3% evaluated our courses as very good; and 95.8% believed that our courses had fulfilled their expectations. 66% found the effectiveness of our course in advancing their surgical abilities very good; 30% good, and 4% satisfactory. CONCLUSION Animal hands-on courses of transplantation surgery are one of the best options to learn and practice different operations and techniques in a near to clinical simulated model. Regular participation in such courses with a focus on practical issues can provide optimal opportunities for trainees with the advantage of direct mentoring and feedback.
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Affiliation(s)
- Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Abstract
BACKGROUND AND AIM Laparoscopic surgery is recognized as an established technique for several abdominal disorders. Aim of the present investigation was to assess the level of expertise of senior residents and to evaluate the role of the animal model on advanced laparoscopic training. METHODS Overall, 60 residents underwent a training session on a porcine model under the guidance of experienced laparoscopic surgeons. Of these, 30 residents underwent a box-trainer preparation before starting the surgical procedure on the animal model, while a group of 20 repeated the course 3 months after the first session. Global Operative Assessment of Laparoscopic Skills (GOALS) was used to evaluate technical proficiency. RESULTS Senior residents presented low mean scores for all the GOALS domains for both for the minor and major surgical procedure. The box-trainer led to an improvement in suturing skills (P<0.001). Comparison of the mean GOALS scores from the first to the second laparoscopic session demonstrated a significant improvement on the duration of the procedures (P<0.05), onset of major complications (P=0.01), need of the tutor (P=0.08), and confidence in treating intraoperative bleeding (P=0.01). CONCLUSIONS National Resident Training Programs should take into consideration the present quality of training and attempt to develop alternative methods of training for laparoscopic surgery, such as, the animal model laboratory.
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