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von Bechtolsheim F, Schneider A, Schmidt S, Al-Aqiqi O, Radulova-Mauersberger O, Krause-Jüttler G, Weitz J, Distler M, Oehme F. Satisfaction of surgeons with the current state of training in minimally invasive surgery: a survey among German surgeons. Surg Endosc 2024; 38:1029-1044. [PMID: 38087109 PMCID: PMC10830590 DOI: 10.1007/s00464-023-10584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/04/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Minimally invasive surgery (MIS) requires intense education and training with structured supervision and feedback. However, a standardized training structure is lacking in Germany. This nationwide survey aimed to assess the current state of minimally invasive surgery (MIS) training and factors impacting surgeons' satisfaction. METHODS Between July and October 2021, an online survey was conducted among general, abdominal, and thoracic surgeons in Germany. The survey collected data on department size, individual operative experience, availability of MIS training equipment and curricula, and individual satisfaction with training. A linear regression analysis was conducted to investigate factors influencing the surgeons' satisfaction with the MIS training. RESULTS A total of 1008 surgeons participated in the survey, including residents (26.1%), fellows (14.6%), attendings (43.8%), and heads of departments (15.2%). Of the respondents, 57.4% reported having access to MIS training equipment, 29.8% and 26% had a curriculum for skills lab MIS training and intraoperative MIS training, respectively. In multivariate linear regression analysis, strongest predictors for surgeons' satisfaction with skills lab MIS training and intraoperative training were the availability of respective training curricula (skills lab: β 12.572; p < 0.001 & intraoperative: β 16.541; p < 0.001), and equipment (β 5.246; p = 0.012 & β 4.295; p = 0.037), and experience as a first surgeon in laparoscopy (β 12.572; p < 0.001 & β 3.748; p = 0.007). Additionally, trainees and teachers differed in their satisfaction factors. CONCLUSION Germany lacks standardized training curricula and sufficient access to MIS training equipment. Trainees and teachers have distinct factors influencing their satisfaction with MIS training. Standardized curricula, equipment accessibility, and surgical experience are crucial for improving surgeons' satisfaction with training.
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Affiliation(s)
- Felix von Bechtolsheim
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Alfred Schneider
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sofia Schmidt
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Omar Al-Aqiqi
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Olga Radulova-Mauersberger
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Grit Krause-Jüttler
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Marius Distler
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Florian Oehme
- Department of Visceral-, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Ackermann J, Baumann J, Pape J, Pahls J, Ruchay Z, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Peters G, Willer D, Westermann A, Brügge S, Günther V, Maass N, Mettler L, Alkatout I. Factors influencing surgical performance and learning progress in minimally invasive surgery - results of an interdisciplinary multicenter study. Int J Surg 2023; 109:2975-2986. [PMID: 37462985 PMCID: PMC10583955 DOI: 10.1097/js9.0000000000000590] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. The authors need selection procedures and decision support systems for the recruitment of medical students and young surgeons. The authors aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students. MATERIALS AND METHODS The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting. RESULTS In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multistage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries ( r =0.28-0.45, P <0.001/ r =0.1-0.28, P <0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance ( r =0.18-0.27, P <0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, that is the higher the age, the lower the surgical performance ( r =0.13/ r =0.22, P <0.05/ P <0.001). CONCLUSION Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.
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Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | | | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, Damme
| | - Günter Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, University Hospital of Giessen, Giessen, Germany
| | - Göntje Peters
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Damaris Willer
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
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Jani K. 'Critical circle of fundoplication' - A key concept towards creating identical, replicable and consistent fundoplication wraps. J Minim Access Surg 2023; 19:355-360. [PMID: 36695240 PMCID: PMC10449043 DOI: 10.4103/jmas.jmas_173_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/20/2022] [Indexed: 01/22/2023] Open
Abstract
Background There is a significant learning curve associated with laparoscopic Nissen's fundoplication, during which, complications due to surgical errors are more likely to occur. Moreover, length of the wrap, its situation on the lower esophagus and the points of the fundus brought together to create the wrap are arbitrary and as per the surgeon's judgement and estimation. This leads to a lot of variation in the wraps created, not only from surgeon to surgeon, but also from case to case for each individual surgeon. We propose a new concept of 'Critical Circle of Fundoplication' and the new approach to construct the fundoplication based on this concept, by application of which, a mathematically precise fundoplication can be created which is consistent, accurate and optimum. Patients and Methods A total of 132 patients were operated based on the concept of 'Critical Circle of Fundoplication' between 2015 and 2020, of which 116 patients completed one year of follow-up and are included in the paper. Results The demographic characteristics, intraoperative findings and postoperative are described in detail. An additional average time of 10.5 minutes (range: 8-26 minutes) was required in the precise measurements and markings that were required by this approach. Conclusion By application of the concept of 'Critical Circle of Fundoplication', precise, consistent and optimum wraps can be created. By eliminating the errors of structural construction and placement of the wrap, overall results can be improved.
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Affiliation(s)
- Kalpesh Jani
- Department of GI and Laparoscopic Surgery, VIGOS Hospital, Vadodara, Gujarat, India
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Ackermann J, Pahls J, Baumann J, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Laganà AS, Peters G, Pape J, Willer D, Westermann AM, Günther V, Maass N, Mettler L, Alkatout I. The pelvitrainer for training in laparoscopic surgery – A prospective, multicenter, interdisciplinary study: Experimental research. Int J Surg 2022; 101:106604. [DOI: 10.1016/j.ijsu.2022.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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Prudhomme T, Matillon X, Dengu F, de Mazancourt E, Pinar U, Gondran-Tellier B, Freton L, Vallée M, Dominique I, Felber M, Khene ZE, Fortier E, Lannes F, Michiels C, Grevez T, Szabla N, Bardet F, Kaulanjan K, Pradère B, Deschamps JY, Branchereau J. Residents and patients benefit from surgical simulation on a live porcine model, could we consider it as ethical? Prog Urol 2021; 31:618-626. [PMID: 34158220 DOI: 10.1016/j.purol.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model. METHODS A computerized questionnaire (GoogleForm ©) was sent to the members of the French Association of Urologists-in-Training (AFUF) (fellows and residents). Only questionnaires from Urologists-in-training who had participated in surgical training sessions were included. The sessions consisted of performing surgeries such as laparoscopic nephrectomies or laparoscopic cystectomies. RESULTS Overall, 198 met the inclusion criteria. A total of 36.4% (72/198) of the participants were fellows and 63.6% (126/198) were residents. According to the participants, the main interest of sessions was to be able to train for emergency situations. A total of 79.8% (158/198) of the participants wanted surgical simulation to become compulsory. To their opinion, the main advantage of surgical simulation on a live porcine model was: technical progress in 87.4% (173/198) of cases. A total of 13.1% (26/198) of the participants found it was unethical to perform the first technical procedures on live animal models. A total of 65.7% (130/198) of the participants considered that there is currently no system of substitution. CONCLUSION For the participants, surgical training on a live porcine model allows technical progress while training for serious emergency situations. Surgeons and patients could benefit from this risk-free mock surgical scenario. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- T Prudhomme
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - X Matillon
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - F Dengu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - E de Mazancourt
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - U Pinar
- Department of Urology, University Paris Saclay, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - B Gondran-Tellier
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - L Freton
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - I Dominique
- Department of Urology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - M Felber
- Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Z-E Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - E Fortier
- Department of Urology, Montpellier University Hospital, Montpellier, France
| | - F Lannes
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - T Grevez
- Department of Urology, Tours University Hospital, Tours, France
| | - N Szabla
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - K Kaulanjan
- Department of Urology, Pointe à Pitre University Hospital, Guadeloupe, France
| | - B Pradère
- Department of Urology, Tours University Hospital, Tours, France
| | - J-Y Deschamps
- Emergency and Critical Care Unit, ONIRIS, School of Veterinary Medecine, La Chantrerie, Nantes, France
| | - J Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
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Witthaus MW, Farooq S, Melnyk R, Campbell T, Saba P, Mathews E, Ezzat B, Ertefaie A, Frye TP, Wu G, Rashid H, Joseph JV, Ghazi A. Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full-immersion simulation platform for nerve-sparing robot-assisted radical prostatectomy (NS-RARP) utilizing three-dimensional printing and hydrogel casting technology. BJU Int 2019; 125:322-332. [PMID: 31677325 DOI: 10.1111/bju.14940] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). MATERIALS AND METHODS Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into three-dimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. RESULTS The expert group achieved faster task-specific times for nerve-sparing (P = 0.007) and superior surgical margin results (P = 0.011). Nerve forces applied were significantly lower for the expert group with regard to maximum force (P = 0.011), average force (P = 0.011), peak frequency (P = 0.027) and total energy (P = 0.003). Higher force sensitivity (subcategory of GEARS score) and total GEARS score correlated with lower nerve forces (total energy in Joules) applied to NVB during the simulation with a correlation coefficient (r value) of -0.66 (P = 0.019) and -0.87 (P = 0.000), respectively. Both total and force sensitivity GEARS scores were significantly higher in the expert group compared to the novice group (P = 0.003). UVA leak rate highly correlated with total RACE score r value = -0.86 (P = 0.000). Mean RACE scores were also significantly different between novices and experts (P = 0.003). CONCLUSION We present a realistic, feedback-driven, full-immersion simulation platform for the development and evaluation of surgical skills pertinent to NS-RARP. The correlation of validated objective metrics (GEARS and RACE) with our CRPMS suggests their application as a novel method for real-time assessment and feedback during robotic surgery training. Further work is required to assess the ability to predict live surgical outcomes.
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Affiliation(s)
- Michael W Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shamroz Farooq
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Campbell
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Patrick Saba
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Mathews
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Bahie Ezzat
- Hajim School of Engineering, University of Rochester, Rochester, NY, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
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Tokuyasu T, Motodoi K, Endo Y, Iwashita Y, Etoh T, Inomata M. Training System for Endoscopic Surgery Aiming to Provide the Sensation of Forceps Operation. JOURNAL OF ROBOTICS AND MECHATRONICS 2018. [DOI: 10.20965/jrm.2018.p0772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In Japan, a rising number of endoscopic surgery operations have boosted an expectation for the development of a training environment for qualified surgeons. The endoscopic surgery operation requires the operator to operate forceps by hand based on two-dimensional operative field information displayed on the monitor. The characteristics of the operation include a lack of stereoscopic visual field information and movement of the tip of the forceps, which is symmetric about the trocar. These are issues that require an empirical solution from the operator. It is desirable that these issues have already been overcome before the operator starts practicing as an operating surgeon. To this end, it is effective to train the operator in the sensation of forceps operation, which associates the operative field vision with the forceps operation by hand. Therefore, this study includes digitizing the forceps operation by qualified surgeons and providing it to the trainee as visual and force information in order to build a training device that facilitates the cultivation of the sensation of forceps operation.
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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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Eulálio JMR, Ferreira ML, Silva PC, Manso JEF, Nicolau AFC, Carvalho TPD, Silva JRDSPE, Fernandes AR, Schanaider A. A technical note on low cost rat laparoscopy an initial experience. Acta Cir Bras 2018; 33:853-861. [DOI: 10.1590/s0102-865020180090000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022] Open
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Awad M, Awad F, Carter F, Jervis B, Buzink S, Foster J, Jakimowicz J, Francis NK. Consensus views on the optimum training curriculum for advanced minimally invasive surgery: A delphi study. Int J Surg 2018; 53:137-142. [DOI: 10.1016/j.ijsu.2018.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/09/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
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Kowalewski KF, Garrow CR, Proctor T, Preukschas AA, Friedrich M, Müller PC, Kenngott HG, Fischer L, Müller-Stich BP, Nickel F. LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy-results of a randomized controlled trial. Surg Endosc 2018; 32:3830-3838. [PMID: 29435758 DOI: 10.1007/s00464-018-6110-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple training modalities for laparoscopy have different advantages, but little research has been conducted on the benefit of a training program that includes multiple different training methods compared to one method only. This study aimed to evaluate benefits of a combined multi-modality training program for surgical residents. METHODS Laparoscopic cholecystectomy (LC) was performed on a porcine liver as the pre-test. Randomization was stratified for experience to the multi-modality Training group (12 h of training on Virtual Reality (VR) and box trainer) or Control group (no training). The post-test consisted of a VR LC and porcine LC. Performance was rated with the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded experts. RESULTS Training (n = 33) and Control (n = 31) were similar in the pre-test (GOALS: 13.7 ± 3.4 vs. 14.7 ± 2.6; p = 0.198; operation time 57.0 ± 18.1 vs. 63.4 ± 17.5 min; p = 0.191). In the post-test porcine LC, Training had improved GOALS scores (+ 2.84 ± 2.85 points, p < 0.001), while Control did not (+ 0.55 ± 2.34 points, p = 0.154). Operation time in the post-test was shorter for Training vs. Control (40.0 ± 17.0 vs. 55.0 ± 22.2 min; p = 0.012). Junior residents improved GOALS scores to the level of senior residents (pre-test: 13.7 ± 2.7 vs. 18.3 ± 2.9; p = 0.010; post-test: 15.5 ± 3.4 vs. 18.8 ± 3.8; p = 0.120) but senior residents remained faster (50.1 ± 20.6 vs. 25.0 ± 1.9 min; p < 0.001). No differences were found between groups on the post-test VR trainer. CONCLUSIONS Structured multi-modality training is beneficial for novices to improve basics and overcome the initial learning curve in laparoscopy as well as to decrease operation time for LCs in different stages of experience. Future studies should evaluate multi-modality training in comparison with single modalities. TRIAL REGISTRATION German Clinical Trials Register DRKS00011040.
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Affiliation(s)
- K F Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - C R Garrow
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - T Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - A A Preukschas
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Friedrich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P C Müller
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - H G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - L Fischer
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Ueda Y, Shiraishi N, Hirashita T, Etoh T, Inomata M, Kitano S. Surgical Training With Live Animal Models for Laparoscopic Gastrectomy. Surg Innov 2017; 24:533-535. [DOI: 10.1177/1553350617723533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Yoshitake Ueda
- Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Norio Shiraishi
- Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Teijiro Hirashita
- Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Ujiie H, Kato T, Hu HP, Bauer P, Patel P, Wada H, Lee D, Fujino K, Schieman C, Pierre A, Waddell TK, Keshavjee S, Darling GE, Yasufuku K. Development of a novel ex vivo porcine laparoscopic Heller myotomy and Nissen fundoplication training model (Toronto lap-Nissen simulator). J Thorac Dis 2017; 9:1517-1524. [PMID: 28740664 DOI: 10.21037/jtd.2017.05.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgical trainees are required to develop competency in a variety of laparoscopic operations. Developing laparoscopic technical skills can be difficult as there has been a decrease in the number of procedures performed. This study aims to develop an inexpensive and anatomically relevant model for training in laparoscopic foregut procedures. METHODS An ex vivo, anatomic model of the human upper abdomen was developed using intact porcine esophagus, stomach, diaphragm and spleen. The Toronto lap-Nissen simulator was contained in a laparoscopic box-trainer and included an arch system to simulate the normal radial shape and tension of the diaphragm. We integrated the use of this training model as a part of our laparoscopic skills laboratory-training curriculum. Afterwards, we surveyed trainees to evaluate the observed benefit of the learning session. RESULTS Twenty-five trainees and five faculty members completed a survey regarding the use of this model. Among the trainees, only 4 (16%) had experience with laparoscopic Heller myotomy and Nissen fundoplication. They reported that practicing with the model was a valuable use of their limited time, repeating the exercise would be of additional benefit, and that the exercise improved their ability to perform or assist in an actual case in the operating room. Significant improvements were found in the following subjective measures comparing pre- vs. post-training: (I) knowledge level (5.6 vs. 8.0, P<0.001); (II) comfort level in assisting (6.3 vs. 7.6, P<0.001); and (III) comfort level in performing as the primary surgeon (4.9 vs. 7.1, P<0.001). The trainees and faculty members agreed that this model was of adequate fidelity and was a representative simulation of actual human anatomy. CONCLUSIONS We developed an easily reproducible training model for laparoscopic procedures. This simulator reproduces human anatomy and increases the trainees' comfort level in performing and assisting with myotomy and fundoplication.
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Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hsin-Pei Hu
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Patrycja Bauer
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priya Patel
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Daiyoon Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Colin Schieman
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Pierre
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Pantelidis P, Sideris M, Tsoulfas G, Georgopoulou EM, Tsagkaraki I, Staikoglou N, Stagias G, Psychalakis N, Tsitsopoulos P, Athanasiou T, Zografos G, Papalois A. Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education? Ann Med Surg (Lond) 2017; 16:52-56. [PMID: 28413632 PMCID: PMC5385388 DOI: 10.1016/j.amsu.2017.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Essentials Skills in the Management of Surgical Cases - ESMSC is an International Combined Applied Surgical Science and Wet Lab course addressed at the Undergraduate level. Laparoscopic Skills is a fundamental element of Surgical Education and various Simulation-Based Learning (SBL) models have been endorsed. This study aims to explore if there is any significant difference in delegates' performance depending on whether they completed In Vivo module prior to the equivalent in the laparoscopic simulator. MATERIALS AND METHODS 37 Medical Students from various EU countries were divided in 2 groups, and both completed the "Fundamentals in Laparoscopic Surgery" module in the Dry-lab Laparoscopic Simulator as well as the same module "In Vivo" on a swine model. Group A (18 students, 48.6%) completed the "Fundamentals in Laparoscopic Surgery - FLS" module prior to the "In Vivo", whereas group B completed the "In Vivo" module first. Direct Observation of Procedural Skills (DOPS) were used to assess delegates' performance. RESULTS The mean DOPS scores for the "FLS" and "In Vivo" models were 2.27 ± 0.902 and 2.03 ± 0.833, respectively, and the delegates' performance was not statistically significantly different between them (p = 0.128). There was no statistically significant difference in the scores among different gender, year of study, school and handedness groups. The alteration in the sequence between Dry-lab "FLS" and "In Vivo" modules did not affect the performance in neither the "FLS" nor the "In Vivo" models. CONCLUSIONS The inexpensive, but low-fidelity "FLS" model could serve an equal alternative Simulation-Based Learning model for the early undergraduate training. Our study demonstrated that high fidelity In Vivo simulation for laparoscopic skills does not affect significantly the improvement in the delegates' performance at the undergraduate level. Further studies should be conducted to identify at which stage of training should high fidelity simulation be introduced.
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Cacciamani G, De Marco V, Siracusano S, De Marchi D, Bizzotto L, Cerruto MA, Motton G, Porcaro AB, Artibani W. A new training model for robot-assisted urethrovesical anastomosis and posterior muscle-fascial reconstruction: the Verona training technique. J Robot Surg 2016; 11:123-128. [PMID: 27440232 DOI: 10.1007/s11701-016-0626-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/10/2016] [Indexed: 11/28/2022]
Abstract
A training model is usually needed to teach robotic surgical technique successfully. In this way, an ideal training model should mimic as much as possible the "in vivo" procedure and allow several consecutive surgical simulations. The goal of this study was to create a "wet lab" model suitable for RARP training programs, providing the simulation of the posterior fascial reconstruction. The second aim was to compare the original "Venezuelan" chicken model described by Sotelo to our training model. Our training model consists of performing an anastomosis, reproducing the surgical procedure in "vivo" as in RARP, between proventriculus and the proximal portion of the esophagus. A posterior fascial reconstruction simulating Rocco's stitch is performed between the tissues located under the posterior surface of the esophagus and the tissue represented by the serosa of the proventriculus. From 2014 to 2015, during 6 different full-immersion training courses, thirty-four surgeons performed the urethrovesical anastomosis using our model and the Sotelo's one. After the training period, each surgeon was asked to fill out a non-validated questionnaire to perform an evaluation of the differences between the two training models. Our model was judged the best model, in terms of similarity with urethral tissue and similarity with the anatomic unit urethra-pelvic wall. Our training model as reported by all trainees is easily reproducible and anatomically comparable with the urethrovesical anastomosis as performed during radical prostatectomy in humans. It is suitable for performing posterior fascial reconstruction reported by Rocco. In this context, our surgical training model could be routinely proposed in all robotic training courses to develop specific expertise in urethrovesical anastomosis with the reproducibility of the Rocco stitch.
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Affiliation(s)
- G Cacciamani
- Department of Urology, University of Verona, Verona, Italy.
| | - V De Marco
- Department of Urology, University of Verona, Verona, Italy
| | - S Siracusano
- Department of Urology, University of Verona, Verona, Italy
| | - D De Marchi
- Department of Urology, University of Verona, Verona, Italy
| | - L Bizzotto
- Department of Urology, University of Verona, Verona, Italy
| | - M A Cerruto
- Department of Urology, University of Verona, Verona, Italy
| | - G Motton
- Si.F.A.R.V. Centro di Simulazione e Formazione Avanzata della Regione Veneto, Verona, Italy
| | - A B Porcaro
- Department of Urology, University of Verona, Verona, Italy
| | - W Artibani
- Department of Urology, University of Verona, Verona, Italy
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Nickel F, Kowalewski KF, Rehberger F, Hendrie JD, Mayer BFB, Kenngott HG, Bintintan V, Linke GR, Fischer L, Müller-Stich BP. Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy. Surg Endosc 2016; 31:714-722. [PMID: 27317031 DOI: 10.1007/s00464-016-5025-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/06/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The pulsatile organ perfusion (POP) trainer provides training of minimally invasive surgery (MIS) with real instruments and cadaveric organs. It provides training of full procedures with simulation of bleeding. Although widely used, the face validity has not yet been evaluated. This study aimed to establish face validity of the POP trainer for laparoscopic cholecystectomy (LC) and its usefulness compared with other training modalities. MATERIALS AND METHODS During MIS courses, the participants (n = 52) used the POP trainer to perform LC. Face validity was assessed with questionnaires for realism and usefulness on a five-point Likert scale. Participants were divided into two groups: experts (n = 15) who had performed more than 50 laparoscopic procedures and novices (n = 37) with less than 50 procedures. Secondary aims included the ranking of training modalities, as well as exploration of their specific advantages and disadvantages. RESULTS The POP trainer was found to be realistic (3.8 ± 0.9) and useful (4.6 ± 0.9). Differences between experts and novices were only found for "The training modality resembles reality" (3.1 ± 0.8 vs. 3.8 ± 0.7; p = 0.010), "The operation on the POP trainer is realistic" (3.4 ± 1.1 vs. 4.5 ± 0.8; p = 0.003), and "It would be desirable to have a POP trainer at my own hospital" (4.2 ± 1.1 vs. 4.8 ± 0.8; p = 0.040). In the ranking, the animal training (1.1 ± 0.3) placed first, the POP trainer (2.3 ± 0.9) second, and the VR trainer (2.8 ± 0.9) and box trainer (2.8 ± 1.1) third. The realistic simulation of animal training was named as an advantage most often, while the unrealistic simulation of the VR trainer was the most often named disadvantage. CONCLUSIONS The POP trainer was rated a highly realistic and useful training modality with face validity for LC. Differences between experts and novices existed concerning realism and desirability. Future studies should evaluate the POP trainer for more advanced surgical procedures. The POP trainer widens the spectrum of modalities for training of MIS in a safe environment outside the operating room.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Florian Rehberger
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jonathan David Hendrie
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Benjamin Friedrich Berthold Mayer
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes Götz Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Vasile Bintintan
- Department of Surgery, 1st Surgical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georg Richard Linke
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Abstract
Laparoscopy is an evolving field in veterinary medicine, and there is an increased interest in using laparoscopic techniques in nondomestic mammals, including zoo animals, wildlife, and exotic pets. The aim of this article is to summarize the approach to laparoscopic procedures, including instrumentation, patient selection and preparation, and surgical approaches, and to review the current literature on laparoscopy in exotic mammals.
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Affiliation(s)
- Izidora Sladakovic
- Department of Small Animal Medicine and Surgery (Zoological Medicine), University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA
| | - Stephen J Divers
- Department of Small Animal Medicine and Surgery (Zoological Medicine), University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA.
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Rashid P, Gianduzzo TR. Urology technical and non-technical skills development: the emerging role of simulation. BJU Int 2015; 117 Suppl 4:9-16. [DOI: 10.1111/bju.13259] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Prem Rashid
- Department of Urology; Rural Clinical School; The University of New South Wales; Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Troy R.J. Gianduzzo
- Department of Urology; School of Medicine; The University of Queensland; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
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Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Müller-Stich BP. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 2015; 94:e764. [PMID: 25997044 PMCID: PMC4602875 DOI: 10.1097/md.0000000000000764] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.
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Affiliation(s)
- Felix Nickel
- From the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (FN, JAB, HMR, JC, HGK, GRL, MK, LF, BPM-S); and Department of Psychology, University of Copenhagen, Copenhagen, Denmark (MG)
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Van Bruwaene S, Schijven MP, Napolitano D, De Win G, Miserez M. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial. JOURNAL OF SURGICAL EDUCATION 2015; 72:483-90. [PMID: 25555673 DOI: 10.1016/j.jsurg.2014.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/30/2014] [Accepted: 11/30/2014] [Indexed: 05/26/2023]
Abstract
OBJECTIVES As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial. DESIGN After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training. SETTING All research was performed in the Center for Surgical Technologies, Leuven, Belgium. PARTICIPANTS In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium). RESULTS The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p < 0.01). There were no significant differences between groups at retention testing. The virtual trainer group did not outperform the control group at any time. CONCLUSIONS For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven.
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Affiliation(s)
- Siska Van Bruwaene
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Marlies P Schijven
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | | | - Gunter De Win
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, University Hospitals Antwerp, Edegem, Belgium
| | - Marc Miserez
- Center for Surgical Technologies, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Postoperative pain in Sprague Dawley rats after liver biopsy by laparotomy versus laparoscopy. Lab Anim (NY) 2015; 44:174-8. [DOI: 10.1038/laban.731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/22/2014] [Indexed: 12/15/2022]
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Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K. Simulation-based training for prostate surgery. BJU Int 2015; 116:665-74. [DOI: 10.1111/bju.12721] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Raheej Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
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Shepherd W, Arora KS, Abboudi H, Shamim Khan M, Dasgupta P, Ahmed K. A review of the available urology skills training curricula and their validation. JOURNAL OF SURGICAL EDUCATION 2014; 71:289-296. [PMID: 24797842 DOI: 10.1016/j.jsurg.2013.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/23/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND The transforming field of urological surgery continues to demand development of novel training devices and curricula for its trainees. Contemporary trainees have to balance workplace demands while overcoming the cognitive barriers of acquiring skills in rapidly multiplying and advancing surgical techniques. This article provides a brief review of the process involved in developing a surgical curriculum and the current status of real and simulation-based curricula in the 4 subgroups of urological surgical practice: open, laparoscopic, endoscopic, and robotic. METHODS An informal literature review was conducted to provide a snapshot into the variety of simulation training tools available for technical and nontechnical urological surgical skills within all subgroups of urological surgery using the following keywords: "urology, surgery, training, curriculum, validation, non-technical skills, technical skills, LESS, robotic, laparoscopy, animal models." Validated training tools explored in research were tabulated and summarized. RESULTS AND CONCLUSIONS A total of 20 studies exploring validated training tools were identified. Huge variation was noticed in the types of validity sought by researchers and suboptimal incorporation of these tools into curricula was noted across the subgroups of urological surgery. The following key recommendations emerge from the review: adoption of simulation-based curricula in training; better integration of dedicated training time in simulated environments within a trainee's working hours; better incentivization for educators and assessors to improvise, research, and deliver teaching using the technologies available; and continued emphasis on developing nontechnical skills in tandem with technical operative skills.
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Affiliation(s)
- William Shepherd
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Karan Singh Arora
- Department of Urology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Hamid Abboudi
- Department of Urology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Mohammed Shamim Khan
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Prokar Dasgupta
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Kamran Ahmed
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom.
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Nickel F, Bintintan VV, Gehrig T, Kenngott HG, Fischer L, Gutt CN, Müller-Stich BP. Virtual reality does not meet expectations in a pilot study on multimodal laparoscopic surgery training. World J Surg 2013; 37:965-73. [PMID: 23430004 DOI: 10.1007/s00268-013-1963-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of the present study was to determine the value of virtual reality (VR) training for a multimodality training program of basic laparoscopic surgery. MATERIALS AND METHODS Participants in a two-day multimodality training for laparoscopic surgery used box trainers, live animal training, and cadaveric training on the pulsating organ perfusion (POP) trainer in a structured and standardized training program. The participants were divided into two groups. The VR group (n = 13) also practiced with VR training during the program, whereas the control group (n = 14) did not use VR training. The training modalities were assessed using questionnaires with a five-point Likert scale after the program. Concerning VR training, members of the control group assessed their expectations, whereas the VR group assessed the actual experience of using it. Skills performance was evaluated with five standardized test tasks in a live porcine model before (pre-test) and after (post-test) the training program. Laparoscopic skills were measured by task completion time and a general performance score for each task. Baseline tests were compared with laparoscopic experience of all participants for construct validity of the skills test. RESULTS The expected benefit from VR training of the control group was higher than the experienced benefit of the VR group. Box and POP training received better ratings from the VR group than from the control group for some purposes. Both groups improved their skill parameters significantly from pre-training to post-training tests [score +17 % (P < 0.01), time -29 % (P < 0.01)]. No significant difference was found between the two groups for laparoscopic skills improvement except for the score in the instrument coordination task. Construct validity of the skills test was significant for both time and score. CONCLUSIONS At its current level of performance, VR training does not meet expectations. No additional benefit was observed from VR training in our multimodality training program.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Klein J, Teber D, Frede T, Stock C, Hruza M, Gözen A, Seemann O, Schulze M, Rassweiler J. Development, Validation and Operating Room-Transfer of a Six-Step Laparoscopic Training Program for the Vesicourethral Anastomosis. J Endourol 2013; 27:349-54. [DOI: 10.1089/end.2012.0209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan Klein
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Tom Frede
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Marcel Hruza
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Ali Gözen
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Othmar Seemann
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Michael Schulze
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
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Díaz-Güemes Martín-Portugués I, Hernández-Hurtado L, Usón-Casaús J, Sánchez-Hurtado MA, Sánchez-Margallo FM. Ureteral obstruction swine model through laparoscopy and single port for training on laparoscopic pyeloplasty. Int J Med Sci 2013; 10:1047-52. [PMID: 23801892 PMCID: PMC3691804 DOI: 10.7150/ijms.6099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/06/2013] [Indexed: 11/29/2022] Open
Abstract
This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists. Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire. Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale. Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred.
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Bidarkar SS, Deshpande A, Kaur M, Cohen RC. Porcine Models for Pediatric Minimally Invasive Surgical Training—A Template for the Future. J Laparoendosc Adv Surg Tech A 2012; 22:117-22. [DOI: 10.1089/lap.2011.0057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sandeep S. Bidarkar
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Aniruddh Deshpande
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Mandeep Kaur
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ralph C. Cohen
- Department of Surgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Simforoosh N, Khazaeli M, Nouralizadeh A, Soltani MH, Samzadeh M, Saffarian O, Rahmani J. Laparoscopic animal surgery for training without sacrificing animals; introducing the rabbit as a model for infantile laparoscopy. J Laparoendosc Adv Surg Tech A 2011; 21:929-33. [PMID: 22011278 DOI: 10.1089/lap.2011.0308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Improvement in laparoscopic skills requires practicing, and it is mostly beneficial when live animal models are considered for use. Apart from pelvic trainer, dogs and rabbits are used as the animal models for training laparoscopic surgeries at our center. Every effort is made to keep the animals alive after surgery. MATERIALS AND METHODS From January 2007 to January 2010, German shepherd dogs and Angora rabbits were selected as the animal models for laparoscopic skill training. Under general anesthesia, trainees performed several laparoscopic surgeries under the supervision of experienced surgeons. RESULTS A total number of 72 animals including 54 dogs and 18 rabbits were used for training laparoscopy. In total, some 107 different laparoscopic procedures were performed by trainees including nephrectomy, nephropexy, vesicotomy and vesicorrhaphy, vasectomies, spermatic cord ligation, and unilateral oophrectomy. There were one vascular and two visceral injuries in the rabbit model that were laparoscopically controlled, and conversion to open surgery happened in one case due to the failure in extracting the specimen from the abdominal cavity. Three visceral and six vascular injuries occurred in the canine model. Total mortality was five including three rabbits and two dogs. CONCLUSIONS The sacrifice of the animal is important to be avoided from both ethical and technical stand points. Dogs and rabbits are good models for laparoscopic training in urology, and it is possible to keep the animals alive after surgery by close monitoring. We also found the rabbit to be a good model for practicing infantile laparoscopic surgery, as it simulates the real surgery in this difficult age group.
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Affiliation(s)
- Nasser Simforoosh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University, M.C., Tehran, Islamic Republic of Iran.
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Training for laparoscopic Nissen fundoplication with a newly designed model: a replacement for animal tissue models? Surg Endosc 2010; 24:3134-40. [PMID: 20526629 PMCID: PMC2982997 DOI: 10.1007/s00464-010-1104-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 08/14/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND To bridge the early learning curve for laparoscopic Nissen fundoplication from the clinical setting to a safe environment, training models can be used. This study aimed to develop a reusable, low-cost model to be used for training in laparoscopic Nissen fundoplication procedure as an alternative to the use of animal tissue models. METHODS From artificial organs and tissue, an anatomic model of the human upper abdomen was developed for training in performing laparoscopic Nissen fundoplication. The 20 participants and tutors in the European Association for Endoscopic Surgery (EAES) upper gastrointestinal surgery course completed four complementary tasks of laparoscopic Nissen fundoplication with the artificial model, then compared the realism, haptic feedback, and training properties of the model with those of animal tissue models. RESULTS The main difference between the two training models was seen in the properties of the stomach. The wrapping of the stomach in the artificial model was rated significantly lower than that in the animal tissue model (mean, 3.6 vs. 4.2; p = 0.010). The main criticism of the stomach of the artificial model was that it was too rigid for making a proper wrap. The suturing of the stomach wall, however, was regarded as fairly realistic (mean, 3.6). The crura on the artificial model were rated better (mean, 4.3) than those on the animal tissue (mean, 4.0), although the difference was not significant. The participants regarded the model as a good to excellent (mean, 4.3) training tool. CONCLUSION The newly developed model is regarded as a good tool for training in laparoscopic Nissen fundoplication procedure. It is cheaper, more durable, and more readily available for training and can therefore be used in every training center. The stomach of this model, however, still needs improvement because it is too rigid for making the wrap.
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Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0594-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hishikawa S, Kawano M, Tanaka H, Konno K, Yasuda Y, Kawano R, Kobayashi E, Lefor AT. Mannequin Simulation Improves the Confidence of Medical Students Performing Tube Thoracostomy: A Prospective, Controlled Trial. Am Surg 2010. [DOI: 10.1177/000313481007600115] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was undertaken to determine the educational benefits of mannequin simulation for performance of tube thoracostomy in a porcine model by medical students. Thirty medical students were randomized into two groups; the first performed tube thoracostomy on a mannequin simulator and then a porcine model; the second used only the porcine model. Performance measures included completion of subtasks, time to perform the procedure, a global score assigned by faculty raters, and a self-evaluation survey. Subtask completion rate was similar in both groups ( P > 0.05). Mean time to perform the procedure was 9.8 minutes (±0.9, simulator), and 9.3 minutes (± 1.0, nonsimulator, P > 0.05). Global scores were 12.3 (±1.3, simulator) and 11.0 (±1.4, non-simulator, P > 0.05). Self-evaluation of confidence (1= “very”, 7= “not at all”) showed the simulator group was significantly more confident (3.4 ± 0.42) than the nonsimulator group (4.7 ± 0.49, P < 0.05). All students met basic competencies to perform tube thoracostomy. The simulator group felt significantly more confident to subsequently perform the procedure on a patient, whereas performance was not statistically significantly different for the two groups. Further trials may be needed to delineate the optimal role for these simulators in teaching tube thoracostomy.
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Affiliation(s)
- Shuji Hishikawa
- Center for Experimental Medicine, Jichi Medical University, Tochigi Japan
| | - Masaki Kawano
- Department of Emergency Medicine, Jichi Medical University, Tochigi Japan
| | - Hozumi Tanaka
- Center for Experimental Medicine, Jichi Medical University, Tochigi Japan
| | - Kenjiro Konno
- Center for Experimental Medicine, Jichi Medical University, Tochigi Japan
| | - Yoshikazu Yasuda
- Department of Surgery, and Jichi Medical University, Tochigi Japan
| | - Ryutaro Kawano
- Medical Simulation Center, Jichi Medical University, Tochigi Japan
| | - Eiji Kobayashi
- Center for Experimental Medicine, Jichi Medical University, Tochigi Japan
- Department of Surgery, and Jichi Medical University, Tochigi Japan
| | - Alan T. Lefor
- Medical Simulation Center, Jichi Medical University, Tochigi Japan
- Center for Experimental Medicine, Jichi Medical University, Tochigi Japan
- Department of Surgery, and Jichi Medical University, Tochigi Japan
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van Velthoven RF, Piechaud PT. Training centers: An essential step to developing skills in urolaparoscopy. Curr Urol Rep 2009; 10:93-6. [DOI: 10.1007/s11934-009-0018-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sotelo R, Sanchez-Salas R, Clavijo R. Endoscopic inguinal lymph node dissection for penile carcinoma: the developing of a novel technique. World J Urol 2009; 27:213-9. [DOI: 10.1007/s00345-009-0372-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 01/13/2009] [Indexed: 02/05/2023] Open
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Jiang C, Lin T, Zhang C, Guo Z, Xu K, Dong W, Han J, Huang H, Yin X, Huang J. A Training Model for Laparoscopic Urethrovesical Anastomosis. J Endourol 2008; 22:1541-5. [PMID: 18620485 DOI: 10.1089/end.2008.0143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chun Jiang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Endourological Training Center of Southern China, Guangzhou, China
| | - Tianxin Lin
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Endourological Training Center of Southern China, Guangzhou, China
| | - Caixia Zhang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenghui Guo
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kewei Xu
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Endourological Training Center of Southern China, Guangzhou, China
| | - Wen Dong
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinli Han
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Huang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinbao Yin
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, the Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Endourological Training Center of Southern China, Guangzhou, China
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Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R. Feasibility and construct validity of a novel laparoscopic skills testing and training model. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0391-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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