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Tesfai FM, Nagi J, Morrison I, Boal M, Olaitan A, Chandrasekaran D, Stoyanov D, Lanceley A, Francis N. Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review. Acta Obstet Gynecol Scand 2024; 103:1480-1497. [PMID: 38610108 PMCID: PMC11266631 DOI: 10.1111/aogs.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION There is a growing emphasis on proficiency-based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The aim of the present study was to systematically review the literature reporting on available tools for objective assessment of minimally invasive gynecological surgery (simulated) performance and evaluate their reliability and validity. MATERIAL AND METHODS A systematic search (1989-2022) was conducted in MEDLINE, Embase, PubMed, Web of Science in accordance with PRISMA. The trial was registered with the Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022376552. Randomized controlled trials, prospective comparative studies, prospective single-group (with pre- and post-training assessment) or consensus studies that reported on the development, validation or usage of assessment tools of surgical performance in minimally invasive gynecological surgery, were included. Three independent assessors assessed study setting and validity evidence according to a contemporary framework of validity, which was adapted from Messick's validity framework. Methodological quality of included studies was assessed using the modified medical education research study quality instrument (MERSQI) checklist. Heterogeneity in data reporting on types of tools, data collection, study design, definition of expertise (novice vs. experts) and statistical values prevented a meaningful meta-analysis. RESULTS A total of 19 746 titles and abstracts were screened of which 72 articles met the inclusion criteria. A total of 37 different assessment tools were identified of which 13 represented manual global assessment tools, 13 manual procedure-specific assessment tools and 11 automated performance metrices. Only two tools showed substantive evidence of validity. Reliability and validity per tool were provided. No assessment tools showed direct correlation between tool scores and patient related outcomes. CONCLUSIONS Existing objective assessment tools lack evidence on predicting patient outcomes and suffer from limitations in transferability outside of the research environment, particularly for automated performance metrics. Future research should prioritize filling these gaps while integrating advanced technologies like kinematic data and AI for robust, objective surgical skill assessment within gynecological advanced surgical training programs.
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Affiliation(s)
- Freweini Martha Tesfai
- The Griffin InstituteNorthwick Park & St Marks' HospitalLondonUK
- EGA Institute for Women's HealthUniversity College LondonLondonUK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
| | | | - Iona Morrison
- Yeovil District HospitalSomerset Foundation NHS TrustYeovilUK
| | - Matt Boal
- The Griffin InstituteNorthwick Park & St Marks' HospitalLondonUK
- EGA Institute for Women's HealthUniversity College LondonLondonUK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
| | | | - Dhivya Chandrasekaran
- EGA Institute for Women's HealthUniversity College LondonLondonUK
- Department of Gynecological OncologyUniversity College of London HospitalsLondonUK
| | - Danail Stoyanov
- EGA Institute for Women's HealthUniversity College LondonLondonUK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
| | - Anne Lanceley
- EGA Institute for Women's HealthUniversity College LondonLondonUK
| | - Nader Francis
- The Griffin InstituteNorthwick Park & St Marks' HospitalLondonUK
- EGA Institute for Women's HealthUniversity College LondonLondonUK
- Yeovil District HospitalSomerset Foundation NHS TrustYeovilUK
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Azeem Z, Odendaal J, Ghosh D, Tapp A, Hassan I. COVID Recovery Laparoscopic Simulation Program for Gynecological Registrars-Trainee Perceptions of Regional Model. J Minim Invasive Gynecol 2024; 31:688-694. [PMID: 38740127 DOI: 10.1016/j.jmig.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/06/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
STUDY OBJECTIVE The acquisition of gynecological operating skills can be challenging for trainees given the conflicting demands of clinical work. Alternative models of surgical skill training such as laparoscopic simulation is, therefore, required. This study demonstrates the development of a regional gynecological surgery laparoscopic simulation program and trainee perceptions of such an approach. DESIGN An intervention-based cohort study. SETTING A regional model based in West Midlands training region. PATIENTS/PARTICIPANTS Responses from 64 trainees in the training region who participated in this regional program were included. INTERVENTIONS A 3-stream curriculum was developed to deliver key training outcomes as required by the Royal College of Obstetricians and Gynaecologists (RCOG) core curriculum as a component of a COVID Recovery Program. Courses were held in 7 teaching hospitals. Courses consisted of both theory and practical teaching. MEASUREMENTS A structured feedback tool was used to collect trainee perceptions of the program. Trainee satisfaction was measured on the Likert scale of 1 to 3. A qualitative thematic analysis was conducted with rank-order analysis of coded free-text responses. MAIN RESULTS Overall, the majority of trainees 92% (n = 58/64) were very satisfied with the course. Rank-order analysis demonstrated hands-on-practice to be the key perceived benefit of laparoscopic simulation among basic and intermediate trainees, while feedback on procedural skills was felt most useful among advanced trainees. CONCLUSION A regional approach to laparoscopic simulation training is both achievable and acceptable. Trainee perceptions of usefulness are altered by seniority and experience. This should be accounted for in the development of laparoscopic simulation programs.
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Affiliation(s)
- Zahra Azeem
- Worcester Royal Hospital (Drs. Azeem and Ghosh), Worcester, United Kingdom.
| | - Joshua Odendaal
- University of Warwick (Dr. Odendaal), Coventry, United Kingdom
| | - Donna Ghosh
- Worcester Royal Hospital (Drs. Azeem and Ghosh), Worcester, United Kingdom
| | - Andrew Tapp
- Shrewsbury and Telford Hospital (Dr. Tapp), Shrewsbury, United Kingdom
| | - Ismail Hassan
- Birmingham Women & Children Hospital (Dr. Hassan), Birmingham, United Kingdom
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De Witte B, Barnouin C, Moreau R, Lelevé A, Martin X, Collet C, Hoyek N. A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results. BMC Surg 2021; 21:139. [PMID: 33736639 PMCID: PMC7977247 DOI: 10.1186/s12893-021-01128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/01/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.
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Affiliation(s)
- Benjamin De Witte
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Charles Barnouin
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Richard Moreau
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France
| | - Arnaud Lelevé
- INSA Lyon, Ampère (UMR5005), Univ Lyon, 25 av. Jean Capelle ouest, 69621, Villeurbanne Cedex, France.
| | - Xavier Martin
- Faculty of Medicine, Surgery School, Univ Lyon, University Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Service d'Urologie et de chirurgie de la Transplantation, Hôpital Édouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Christian Collet
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
| | - Nady Hoyek
- Inter-University Laboratory of Human Movement Science (EA 7424), Univ Lyon, University Claude Bernard Lyon 1, 27-29 Boulevard du 11 Novembre 1918, 69622, Villeurbanne Cedex, France
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Crochet P, Netter A, Schmitt A, Garofalo A, Loundou A, Knight S, Rabischong B, Agostini A. Performance Assessment for Total Laparoscopic Hysterectomy in the Operating Room: Validity Evidence of a Procedure-specific Rating Scale. J Minim Invasive Gynecol 2021; 28:1743-1750.e3. [PMID: 33621693 DOI: 10.1016/j.jmig.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE The technical conduct of total laparoscopic hysterectomy (LH) is critical to surgical outcomes. This study explored the validity evidence of an objective scale specific to the assessment of technical skills (H-OSATS) for 7 tasks of an LH with salpingo-oophorectomy procedure performed in the operating room. DESIGN Observational cohort study. SETTING Two academic hospitals in Marseille and Montpellier, France. PATIENTS Three groups of operators (novice, intermediate, and experienced surgeons) were video recorded during their live performances of LH on a simple case. For each group, a dozen unedited videos were obtained for the following tasks: division of the round ligament, division of the infundibulopelvic ligament, creation of the bladder flap, opening of the posterior peritoneum, division of the uterine vessels, colpotomy, and closure of the vault. INTERVENTIONS Two qualified raters blindly assessed each video using the H-OSATS rating scale. Inter-rater reliability and test-retest reliability were calculated as measures of internal structure. In a separate round of evaluations, the raters provided a global competent/noncompetent decision for each performance. As a measure of consequential validity, a pass/fail score was set for each task using the contrasting group method. MEASUREMENTS AND MAIN RESULTS Three tasks (creation of the bladder flap, colpotomy, and closure of the vault) displayed sound validity evidence: a meaningful total score difference among the 3 groups of experience as well as between the intermediate and experienced surgeons, reliability outcomes of >0.7, and a pass/fail score with a theoretical false-positive rate of <10%. CONCLUSION The validity evidence of the H-OSATS rating scale differed for separate evaluations of the 7 tasks. Three tasks (i.e., creation of the bladder flap, colpotomy, and closure of the vault) revealed sound validity evidence, including at the level of the attending surgeon, whereas other tasks were more consistent with low-stakes formative evaluation standards.
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Affiliation(s)
- Patrice Crochet
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini); Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier (Dr. Crochet).
| | - Antoine Netter
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini); Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale, Aix Marseille University, CNRS, IRD, Avignon University (Dr. Netter)
| | - Andy Schmitt
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Anna Garofalo
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Anderson Loundou
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique Hôpitaux de Marseille, Aix Marseille University (Dr. Loundou), Marseille
| | - Sophie Knight
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Benoit Rabischong
- Department of Gynecological Surgery, Clermont-Ferrand University Hospital Estaing, Clermont-Ferrand (Dr. Rabischong), France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
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Netter A, Schmitt A, Agostini A, Crochet P. Video-based self-assessment enhances laparoscopic skills on a virtual reality simulator: a randomized controlled trial. Surg Endosc 2020; 35:6679-6686. [PMID: 33241429 DOI: 10.1007/s00464-020-08170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hysterectomy rates are decreasing in many countries, and virtual reality (VR) simulators bring new training opportunities for residents. As coaching interventions while training on a simulated complex procedure represents a resource challenge, alternative strategies to improve surgical skills must be investigated. We sought to determine whether self-guided learning using a video-based self-assessment (SA) leads to improved surgical skills in laparoscopic hysterectomy (LH) on a VR simulator. METHODS Twenty-four gynecology residents from two university hospitals were randomized into an SA group (n = 12) and a Control group (n = 12). Each participant's baseline performance on a validated VR basic task was assessed. Both groups then performed three virtually simulated LHs during which the participants received no guidance nor feedback. Following each LH, the SA group participants rated the video of their own performance using a generic and a procedure-specific rating scale, while the Control group participants watched an LH video demonstration. The LH videos of both groups' participants were blindly reviewed and rated by expert surgeons, using modified Objective Structured Assessment of Technical Skills scores (OSATS). Objective metrics recorded by the VR simulator were also compared. RESULTS There was no difference between the groups' baseline performances on the VR basic task. For the first LH, the OSATS-derived scores did not differ between SA and Control groups (9 [7-13] versus 9 [8-14]; p = 0.728). For the third LH, the OSATS-derived scores were higher for the SA group than for the Control group (17 [15-21] versus 15 [11-17], p = 0.039). Between the two groups, the objective metrics did not differ from the first to the third LH. CONCLUSIONS The use of a structured video-based SA leads to improved procedural skills in LH on a VR simulator compared to watching benchmark expert performance, in a population of residents with moderate experience in the operating room.
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Affiliation(s)
- Antoine Netter
- Department of Obstetrics and Gynecology, Hôpital de la Conception, Aix Marseille University, 147 Boulevard Baille, 13005, Marseille, France
| | - Andy Schmitt
- Department of Obstetrics and Gynecology, Centre Hospitalier du Pays D'Aix, Aix-en-provence, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital de la Conception, Aix Marseille University, 147 Boulevard Baille, 13005, Marseille, France
| | - Patrice Crochet
- Department of Obstetrics and Gynecology, Hôpital de la Conception, Aix Marseille University, 147 Boulevard Baille, 13005, Marseille, France. .,Department of Obstetrics and Gynecology, Hopital Arnaud de Villeneuve, University of Montpellier, Montpellier, France.
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Vaidya A, Aydin A, Ridgley J, Raison N, Dasgupta P, Ahmed K. Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review. J Surg Res 2020; 246:342-378. [DOI: 10.1016/j.jss.2019.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
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Lamblin G, Thiberville G, Druette L, Moret S, Couraud S, Martin X, Dubernard G, Chene G. Virtual reality simulation to enhance laparoscopic salpingectomy skills. J Gynecol Obstet Hum Reprod 2020; 49:101685. [PMID: 31931145 DOI: 10.1016/j.jogoh.2020.101685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 11/29/2019] [Accepted: 01/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND To assess skill enhancement and maintenance by virtual-reality simulation of laparoscopic salpingectomy in gynecologic surgery fellows. Skill acquisition by virtual-reality surgical simulation is an active field of research and technological development. Salpingectomy is one of the first gynecologic surgery techniques taught to fellows that requires accompanied learning. METHODS A single-center prospective study was performed in the University of Lyon, France, including 26 junior fellows (≤ 3 semesters' internship) performing laparoscopic salpingectomy exercises on a LapSim® virtual reality simulator. Salpingectomy was performed and timed on 3 trials in session 1 and 3 trials in session 2, at a 3-month interval. Analysis was based on students' subjective assessments and a senior surgeon's objective assessment of skill. Progress between the 2 sessions was assessed on McNemar test and Wilcoxon test for matched series. RESULTS 26 junior specialist trainees performed all trials. Most performed anterograde salpingectomy, both in session 1 (69 %) and session 2 (86 %). Mean procedure time was significantly shorter in session 2: 6.10min versus 7.82min (p=0.0003). There was a significant decrease in blood loss between the first trial in session 1 and the last trial in session 2: 167ml versus 70.3ml (p=0.02). Subjective assessment showed a significant decrease in anxiety and significant increase in perceived efficacy, eye-hand coordination and ergonomics. Efficacy, performance quality and speed of execution as assessed by the senior surgeon all improved significantly from trial to trial, while hesitation significantly decreased. CONCLUSIONS The study showed that junior trainees improved their surgical skills on a short laparoscopic exercise using a virtual reality simulator. Virtual reality simulation is useful in the early learning curve, accelerating the acquisition of reflexes. Maintaining skill requires simulation sessions at shorter intervals.
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Affiliation(s)
- Gery Lamblin
- Department of Gynecology Surgery and Urogynecology, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Lyon-Bron, France; Claude Bernard Lyon 1 Medical Faculty, Lyon 1 University, 69008 Lyon, France; Surgery School, Claude Bernard Lyon 1 University, IDEFI Program, SAMSEI (ANR 11 IDFI 0034), Lyon, France.
| | - Gabriel Thiberville
- Department of Gynecology Surgery and Urogynecology, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Lyon-Bron, France
| | - Loic Druette
- Surgery School, Claude Bernard Lyon 1 University, IDEFI Program, SAMSEI (ANR 11 IDFI 0034), Lyon, France
| | - Stéphanie Moret
- Department of Gynecology Surgery and Urogynecology, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Lyon-Bron, France
| | | | - Xavier Martin
- Surgery School, Claude Bernard Lyon 1 University, IDEFI Program, SAMSEI (ANR 11 IDFI 0034), Lyon, France
| | - Gil Dubernard
- Department of Gynecology Surgery, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Gautier Chene
- Department of Gynecology Surgery and Urogynecology, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Lyon-Bron, France; Claude Bernard Lyon 1 Medical Faculty, Lyon 1 University, 69008 Lyon, France
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Jokinen E, Mikkola TS, Härkki P. Simulator training and residents' first laparoscopic hysterectomy: a randomized controlled trial. Surg Endosc 2019; 34:4874-4882. [PMID: 31768724 PMCID: PMC7572324 DOI: 10.1007/s00464-019-07270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hysterectomy rates are decreasing in many countries, and virtual reality simulators bring new opportunities into residents' surgical education. The objective of this study was to evaluate the effect of training in laparoscopic hysterectomy module with virtual reality simulator on surgical outcomes among residents performing their first laparoscopic hysterectomy. METHODS This randomized study was carried out at the Department of Obstetrics and Gynecology in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty residents and randomly signed half of them to train ten times with the laparoscopic hysterectomy module on a virtual reality simulator, while the rest represented the control group. Their first laparoscopic hysterectomy was video recorded and assessed later by using the Objective Structured Assessment of Technical Skills (OSATS) forms and Visual Analog Scale (VAS). The scores and surgical outcomes were compared between the groups. RESULTS The mean OSATS score for the Global Rating Scale (GRS) was 17.0 (SD 3.1) in the intervention group and 11.2 (SD 2.4) in the control group (p = 0.002). The mean procedure-specific OSATS score was 20.0 (SD 3.3) and 16.0 (SD 2.8) (p = 0.012), and the mean VAS score was 55.0 (SD 14.8) and 29.9 (SD 14.9) (p = 0.001). Operative time was 144 min in the intervention group and 165 min in the control group, but the difference did not reach statistical significance (p = 0.205). There were no differences between the groups in blood loss or direct complications. CONCLUSION Residents training with a virtual reality simulator prior to the first laparoscopic hysterectomy seem to perform better in the actual live operation. Thus, a virtual reality simulator hysterectomy module could be considered as a part of laparoscopic training curriculum.
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Affiliation(s)
- Ewa Jokinen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland.
| | - Tomi S Mikkola
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - Päivi Härkki
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland
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A scoping review of assessment tools for laparoscopic suturing. Surg Endosc 2018; 32:3009-3023. [PMID: 29721749 DOI: 10.1007/s00464-018-6199-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions. METHODS Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills. RESULTS Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences. CONCLUSION Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.
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Schmitt F, Mariani A, Eyssartier E, Granry JC, Podevin G. Skills improvement after observation or direct practice of a simulated laparoscopic intervention. J Gynecol Obstet Hum Reprod 2018; 47:101-106. [DOI: 10.1016/j.jogoh.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 01/22/2023]
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Knight S, Aggarwal R, Agostini A, Loundou A, Berdah S, Crochet P. Development of an objective assessment tool for total laparoscopic hysterectomy: A Delphi method among experts and evaluation on a virtual reality simulator. PLoS One 2018; 13:e0190580. [PMID: 29293635 PMCID: PMC5749811 DOI: 10.1371/journal.pone.0190580] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Total Laparoscopic hysterectomy (LH) requires an advanced level of operative skills and training. The aim of this study was to develop an objective scale specific for the assessment of technical skills for LH (H-OSATS) and to demonstrate feasibility of use and validity in a virtual reality setting. MATERIAL AND METHODS The scale was developed using a hierarchical task analysis and a panel of international experts. A Delphi method obtained consensus among experts on relevant steps that should be included into the H-OSATS scale for assessment of operative performances. Feasibility of use and validity of the scale were evaluated by reviewing video recordings of LH performed on a virtual reality laparoscopic simulator. Three groups of operators of different levels of experience were assessed in a Marseille teaching hospital (10 novices, 8 intermediates and 8 experienced surgeons). Correlations with scores obtained using a recognised generic global rating tool (OSATS) were calculated. RESULTS A total of 76 discrete steps were identified by the hierarchical task analysis. 14 experts completed the two rounds of the Delphi questionnaire. 64 steps reached consensus and were integrated in the scale. During the validation process, median time to rate each video recording was 25 minutes. There was a significant difference between the novice, intermediate and experienced group for total H-OSATS scores (133, 155.9 and 178.25 respectively; p = 0.002). H-OSATS scale demonstrated high inter-rater reliability (intraclass correlation coefficient [ICC] = 0.930; p<0.001) and test retest reliability (ICC = 0.877; p<0.001). High correlations were found between total H-OSATS scores and OSATS scores (rho = 0.928; p<0.001). CONCLUSION The H-OSATS scale displayed evidence of validity for assessment of technical performances for LH performed on a virtual reality simulator. The implementation of this scale is expected to facilitate deliberate practice. Next steps should focus on evaluating the validity of the scale in the operating room.
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Affiliation(s)
- Sophie Knight
- Department of Obstetrics and Gynecology, Assistance Publique—Hôpitaux de Marseille, La Conception Hospital, Marseille, Aix Marseille Université, France
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University,Philadelphia, Pennsylvania, United States of America
- Office of Strategic Business Development and Partnerships, Jefferson Health, Philadelphia, Pennsylvania, United States of America
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Assistance Publique—Hôpitaux de Marseille, La Conception Hospital, Marseille, Aix Marseille Université, France
| | - Anderson Loundou
- Public Health Laboratory, Aix-Marseille University, Marseille, France
| | - Stéphane Berdah
- Aix Marseille Université, CERC, IFSTTAR, LBA UMR_T 24, Marseille, France
| | - Patrice Crochet
- Department of Obstetrics and Gynecology, Assistance Publique—Hôpitaux de Marseille, La Conception Hospital, Marseille, Aix Marseille Université, France
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