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Ahmad MA, Watananirun K, De Bie F, Page AS, De Coppi P, Vergote S, Vercauteren T, Vander Poorten E, Joyeux L, Deprest J. High-fidelity, low-cost synthetic training model for fetoscopic spina bifida repair. Am J Obstet Gynecol MFM 2024; 6:101278. [PMID: 38232818 DOI: 10.1016/j.ajogmf.2024.101278] [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: 08/13/2023] [Revised: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Fetoscopic spina bifida repair is increasingly being practiced, but limited skill acquisition poses a barrier to widespread adoption. Extensive training in relevant models, including both ex vivo and in vivo models may help. To address this, a synthetic training model that is affordable, realistic, and that allows skill analysis would be useful. OBJECTIVE This study aimed to create a high-fidelity model for training in the essential neurosurgical steps of fetoscopic spina bifida repair using synthetic materials. In addition, we aimed to obtain a cheap and easily reproducible model. STUDY DESIGN We developed a 3-layered, silicon-based model that resemble the anatomic layers of a typical myelomeningocele lesion. It allows for filling of the cyst with fluid and conducting a water tightness test after repair. A compliant silicon ball mimics the uterine cavity and is fixed to a solid 3-dimensional printed base. The fetal back with the lesion (single-use) is placed inside the uterine ball, which is reusable and repairable to allow for practicing port insertion and fixation multiple times. Following cannula insertion, the uterus is insufflated and a clinical fetoscopic or robotic or prototype instruments can be used. Three skilled endoscopic surgeons each did 6 simulated fetoscopic repairs using the surgical steps of an open repair. The primary outcome was surgical success, which was determined by water tightness of the repair, operation time <180 minutes and an Objective Structured Assessment of Technical Skills score of ≥18 of 25. Skill retention was measured using a competence cumulative sum analysis of a composite binary outcome of surgical success. Secondary outcomes were cost and fabrication time of the model. RESULTS We made a model that can be used to simulate the neurosurgical steps of spina bifida repair, including anatomic details, port insertion, placode release and descent, undermining of skin and muscular layer, and endoscopic suturing. The model was made using reusable 3-dimensional printed molds and easily accessible materials. The 1-time startup cost was €211, and each single-use, simulated myelomeningocele lesion cost €9.5 in materials and 50 minutes of working time. Two skilled endoscopic surgeons performed 6 simulated, 3-port fetoscopic repairs, whereas a third used a Da Vinci surgical robot. Operation times decreased by more than 30% from the first to the last trial. Six experiments per surgeon did not show an obvious Objective Structured Assessment of Technical Skills score improvement. Competence cumulative sum analysis confirmed competency for each surgeon. CONCLUSION This high-fidelity, low-cost spina bifida model allows simulated dissection and closure of a myelomeningocele lesion. VIDEO ABSTRACT.
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Affiliation(s)
- Mirza A Ahmad
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium (Mr Ahmad and Dr Vander Poorten); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Kanokwaroon Watananirun
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Felix De Bie
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Ann-Sophie Page
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Paolo De Coppi
- Institute for Child and Women's Health, University College London, London, United Kingdom (Drs De Coppi and Deprest); National Institute for Health and Care Research Biomedical Research Center, Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom (Dr De Coppi); School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Drs De Coppi and Vercauteren)
| | - Simen Vergote
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Tom Vercauteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Drs De Coppi and Vercauteren)
| | - Emmanuel Vander Poorten
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium (Mr Ahmad and Dr Vander Poorten)
| | - Luc Joyeux
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest)
| | - Jan Deprest
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (Mr Ahmad and Drs Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (Mr Ahmad and Drs, Watananirun, De Bie, Page, Vergote, Vercauteren, Joyeux, and Deprest); Institute for Child and Women's Health, University College London, London, United Kingdom (Drs De Coppi and Deprest).
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Saito S, Endo K, Sakuma Y, Sata N, Lefor AK. Simulator Fidelity Does Not Affect Training for Robot-Assisted Minimally Invasive Surgery. J Clin Med 2023; 12:jcm12072557. [PMID: 37048640 PMCID: PMC10095363 DOI: 10.3390/jcm12072557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
This study was undertaken to compare performance using a surgical robot after training with one of three simulators of varying fidelity. Methods: Eight novice operators and eight expert surgeons were randomly assigned to one of three simulators. Each participant performed two exercises using a simulator and then using a surgical robot. The primary outcome of this study is performance assessed by time and GEARS score. Results: Participants were randomly assigned to one of three simulators. Time to perform the suturing exercise (novices vs. experts) was significantly different for all 3 simulators. Using the da Vinci robot, peg transfer showed no significant difference between novices and experts and all participants combined (mean time novice 2.00, expert 2.21, p = 0.920). The suture exercise had significant differences in each group and all participants combined (novice 3.54, expert 1.90, p = 0.001). ANOVA showed p-Values for suturing (novice 0.523, expert 0.123) and peg transfer (novice 0.742, expert 0.131) are not significantly different. GEARS scores were different (p < 0.05) for novices and experts. Conclusion: Training with simulators of varying fidelity result in similar performance using the da Vinci robot. A dry box simulator may be as effective as a virtual reality simulator for training. Further studies are needed to validate these results.
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Newall N, Khan DZ, Hanrahan JG, Booker J, Borg A, Davids J, Nicolosi F, Sinha S, Dorward N, Marcus H. High fidelity simulation of the endoscopic transsphenoidal approach: Validation of the UpSurgeOn TNS Box. Front Surg 2022; 9:1049685. [PMID: 36561572 PMCID: PMC9764859 DOI: 10.3389/fsurg.2022.1049685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Endoscopic endonasal transsphenoidal surgery is an established technique for the resection of sellar and suprasellar lesions. The approach is technically challenging and has a steep learning curve. Simulation is a growing training tool, allowing the acquisition of technical skills pre-clinically and potentially resulting in a shorter clinical learning curve. We sought validation of the UpSurgeOn Transsphenoidal (TNS) Box for the endoscopic endonasal transsphenoidal approach to the pituitary fossa. Methods Novice, intermediate and expert neurosurgeons were recruited from multiple centres. Participants were asked to perform a sphenoidotomy using the TNS model. Face and content validity were evaluated using a post-task questionnaire. Construct validity was assessed through post-hoc blinded scoring of operative videos using a Modified Objective Structured Assessment of Technical Skills (mOSAT) and a Task-Specific Technical Skill scoring system. Results Fifteen participants were recruited of which n = 10 (66.6%) were novices and n = 5 (33.3%) were intermediate and expert neurosurgeons. Three intermediate and experts (60%) agreed that the model was realistic. All intermediate and experts (n = 5) strongly agreed or agreed that the TNS model was useful for teaching the endonasal transsphenoidal approach to the pituitary fossa. The consensus-derived mOSAT score was 16/30 (IQR 14-16.75) for novices and 29/30 (IQR 27-29) for intermediate and experts (p < 0.001, Mann-Whitney U). The median Task-Specific Technical Skill score was 10/20 (IQR 8.25-13) for novices and 18/20 (IQR 17.75-19) for intermediate and experts (p < 0.001, Mann-Whitney U). Interrater reliability was 0.949 (CI 0.983-0.853) for OSATS and 0.945 (CI 0.981-0.842) for Task-Specific Technical Skills. Suggested improvements for the model included the addition of neuro-vascular anatomy and arachnoid mater to simulate bleeding vessels and CSF leak, respectively, as well as improvement in materials to reproduce the consistency closer to that of human tissue and bone. Conclusion The TNS Box simulation model has demonstrated face, content, and construct validity as a simulator for the endoscopic endonasal transsphenoidal approach. With the steep learning curve associated with endoscopic approaches, this simulation model has the potential as a valuable training tool in neurosurgery with further improvements including advancing simulation materials, dynamic models (e.g., with blood flow) and synergy with complementary technologies (e.g., artificial intelligence and augmented reality).
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Affiliation(s)
- Nicola Newall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom,Correspondence: Nicola Newall
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - James Booker
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joseph Davids
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Siddharth Sinha
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Neil Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
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Hong M, Rozenblit JW. An Adaptive Force Guidance System for Computer-Guided Laparoscopy Training. IEEE TRANSACTIONS ON CYBERNETICS 2022; 52:8019-8031. [PMID: 33600333 DOI: 10.1109/tcyb.2021.3051837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We present an adaptive force guidance system for laparoscopic surgery skills training. This system consists of self-adjusting fuzzy sliding-mode controllers and switching mode controllers to provide proper force feedback. Using virtual fixtures, the proposed system restricts motions or guides a trainee to navigate a surgical instrument in a 3-D space in a manner that mimics a human instructor who would teach the trainees by holding their hands. The self-adjusting controllers incorporate human factors, such as different force sensitivity and proficiency levels. The proposed system was implemented and evaluated using the computer-assisted surgical trainer (CAST). The effects of the force guidance system are presented based on the experimental test results.
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Parente G, De Marziani L, Cordola C, Gargano T, Libri M, Lima M. Training minimally invasive surgery's basic skills: is expensive always better? Pediatr Surg Int 2021; 37:1287-1293. [PMID: 34110478 DOI: 10.1007/s00383-021-04937-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed. MATERIAL AND METHODS The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). RESULTS HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available. CONCLUSION Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy. .,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | - Luca De Marziani
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
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Lefor AK, Harada K, Kawahira H, Mitsuishi M. The effect of simulator fidelity on procedure skill training: a literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:97-106. [PMID: 32425176 PMCID: PMC7246118 DOI: 10.5116/ijme.5ea6.ae73] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the effect of simulator fidelity on procedure skill training through a review of existing studies. METHODS MEDLINE, OVID and EMBASE databases were searched between January 1990 and January 2019. Search terms included "simulator fidelity and comparison" and "low fidelity" and "high fidelity" and "comparison" and "simulator". Author classification of low- and high-fidelity was used for non-laparoscopic procedures. Laparoscopic simulators are classified using a proposed schema. All included studies used a randomized methodology with two or more groups and were written in English. Data was abstracted to a standard data sheet and critically appraised from 17 eligible full papers. RESULTS Of 17 studies, eight were for laparoscopic and nine for other skill training. Studies employed evaluation methodologies, including subjective and objective measures. The evaluation was conducted once in 13/17 studies and before-after in 4/17. Didactic training only or control groups were used in 5/17 studies, while 10/17 studies included two groups only. Skill acquisition and simulator fidelity were different for the level of training in 1/17 studies. Simulation training was followed by clinical evaluation or a live animal evaluation in 3/17 studies. Low-fidelity training was not inferior to training with a high-fidelity simulator in 15/17 studies. CONCLUSIONS Procedure skill after training with low fidelity simulators was not inferior to skill after training with high fidelity simulators in 15/17 studies. Some data suggest that the effectiveness of different fidelity simulators depends on the level of training of participants and requires further study.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Kanako Harada
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kawahira
- Jichi Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Mamoru Mitsuishi
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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Soriero D, Atzori G, Barra F, Pertile D, Massobrio A, Conti L, Gusmini D, Epis L, Gallo M, Banchini F, Capelli P, Penza V, Scabini S. Development and Validation of a Homemade, Low-Cost Laparoscopic Simulator for Resident Surgeons (LABOT). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010323. [PMID: 31906532 PMCID: PMC6981870 DOI: 10.3390/ijerph17010323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022]
Abstract
Several studies have demonstrated that training with a laparoscopic simulator improves laparoscopic technical skills. We describe how to build a homemade, low-cost laparoscopic training simulator (LABOT) and its validation as a training instrument. First, sixty surgeons filled out a survey characterized by 12 closed-answer questions about realism, ergonomics, and usefulness for surgical training (global scores ranged from 1—very insufficient to 5—very good). The results of the questionnaires showed a mean (±SD) rating score of 4.18 ± 0.65 for all users. Then, 15 students (group S) and 15 residents (group R) completed 3 different tasks (T1, T2, T3), which were repeated twice to evaluate the execution time and the number of users’ procedural errors. For T1, the R group had a lower mean execution time and a lower rate of procedural errors than the S group; for T2, the R and S groups had a similar mean execution time, but the R group had a lower rate of errors; and for T3, the R and S groups had a similar mean execution time and rate of errors. On a second attempt, all the participants tended to improve their results in doing these surgical tasks; nevertheless, after subgroup analysis of the T1 results, the S group had a better improvement of both parameters. Our laparoscopic simulator is simple to build, low-cost, easy to use, and seems to be a suitable resource for improving laparoscopic skills. In the future, further studies should evaluate the potential of this laparoscopic box on long-term surgical training with more complex tasks and simulation attempts.
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Affiliation(s)
- Domenico Soriero
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Giulia Atzori
- Department of Surgical Sciences and Integrated Methodologies, University of Genoa, 16132 Genoa, Italy;
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-3349437959
| | - Davide Pertile
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Andrea Massobrio
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Luigi Conti
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Dario Gusmini
- Association of Architects of Bergamo, 24100 Bergamo, Italy
| | - Lorenzo Epis
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
| | - Maurizio Gallo
- Department of Internal Medicine (Di.M.I.), University of Genoa, 16132 Genoa, Italy;
| | - Filippo Banchini
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Patrizio Capelli
- UOC General, Vascular and Thoracic Surgery, G. Da Saliceto Hospital, AUSL, 29121 Piacenza, Italy; (L.C.); (F.B.); (P.C.)
| | - Veronica Penza
- Biomedical Robotics Lab, Advanced Robotics Department, Istituto Italiano di Tecnologia, 16152 Genoa, Italy;
| | - Stefano Scabini
- OU Oncological Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (D.S.); (D.P.); (A.M.); (L.E.); (S.S.)
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Hasnaoui A, Zaafouri H, Haddad D, Bouhafa A, Ben Maamer A. Reliability testing of a modified MISTELS score using a low-cost trainer box. BMC MEDICAL EDUCATION 2019; 19:132. [PMID: 31060548 PMCID: PMC6503379 DOI: 10.1186/s12909-019-1572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Training programs such as the fundamentals of laparoscopic surgery (FLS) that are based on simulation are being currently used in several western countries. FLS allows skill acquisition and evaluation of competency in laparoscopic surgery. On the practical side, evaluation is determined by the MISTELS metrics (MISTELS is the acronym for the McGill inanimate system for training and evaluation of laparoscopic skills). This training program may be modified so that it can be implemented in countries with limited resources using a low-cost trainer box. Would the use of a low-cost trainer box alter the reliability of the MISTELS score? OBJECTIVE OF STUDY The aim of the study was to evaluate the reliability of a modified MISTELS using a low-cost trainer box. METHODS It was a prospective study carried out at Habib Thameur hospital in Tunis (Tunisia), between April 2016 and August 2016. The study involved residents from different surgical specialties in the departments of general surgery and paediatric surgery of the hospital during 2015 and 2016. This study assessed the reliability of a modified MISTELS system (Only three tasks were performed out of the five tasks used in the original MISTELS system). Evaluation was based on Cronbach's alpha and intraclass correlation coefficients (ICC). A low-cost trainer box was designed and constructed. The residents included in the study performed three series of three tasks using this trainer box. The first series was scored by two trained raters to evaluate inter-rater reliability. The two-other series were successively performed to evaluate test-retest reliability. RESULTS The internal consistency, assessed by Cronbach's alpha, was at 0.929 which is an acceptable score. As for inter-rater and test-retest reliabilities that were assessed by ICCs, they yielded excellent scores that were at 1 and 0.95 (95% CI, 0.891-0.978) respectively. CONCLUSIONS The reliability of a modified MISTELS is not altered by the use of a low-cost trainer box. The score of the modified MISTELS is a reliable score for evaluating technical skills of surgical residents using a low-cost trainer box.
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Affiliation(s)
- Anis Hasnaoui
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia.
| | - Haithem Zaafouri
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Dhafer Haddad
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Ahmed Bouhafa
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib Thameur Hospital, Ali Ben Ayed, Street 2037 Montfleury, Tunis, Tunisia
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9
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Schulz GB, Grimm T, Buchner A, Jokisch F, Casuscelli J, Kretschmer A, Mumm JN, Ziegelmüller B, Stief CG, Karl A. Validation of a High-End Virtual Reality Simulator for Training Transurethral Resection of Bladder Tumors. JOURNAL OF SURGICAL EDUCATION 2019; 76:568-577. [PMID: 30181038 DOI: 10.1016/j.jsurg.2018.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The oncological outcome in patients with bladder cancer (BC) significantly correlates with the quality of transurethral resection of bladder tumors (TUR-BT). Virtual reality (VR) training simulators have been developed to improve surgical skills. We evaluated the advantages and limitations of the novel Uro Trainer (UT) (Karl Storz GmbH, Germany) with respect to training for TUR-BT. DESIGN Participants underwent VR training based on 4 different TUR-BT cases accompanied by self-assessment and evaluation questionnaires. Results were compared between experienced endourologists and novices, and furthermore, correlated with self-rated capabilities for content and construct validity. Student's t tests, Pearson's correlation, and chi-squared tests were performed for statistical evaluation. SETTING The study was performed at the tertiary care urological department of the Ludwig-Maximilians-University, Munich, Germany. PARTICIPANTS A total of 22 urological physicians, including residents and consultants, were included in the study. RESULTS There is a need to improve TUR-BT training as 27.3% of the participants had already experienced overtaxing situations during TUR-BT and only a few reported of high satisfaction with the classical "see one-do one" teaching mode. Construct validity was demonstrated, as consultants achieved significantly higher overall scores (p < 0.001) and safety (p = 0.004) and visualization (p = 0.001) subscores. Interestingly, the self-assessed capability to perform a TUR-BT correlated significantly (p = 0.01) with overall UT scores. Significant progress of self-rated abilities was shown for several parameters, including inspection (p = 0.046) and resection (p = 0.026). Although participants indicated improvements in several procedural skills and overall benefit of the VR training with the UT was rated 4.6 on a 5-point scale by consultants, limitations of the UT were demonstrated predominantly for tissue feedback and authenticity of different tissue layers. CONCLUSIONS The novel VR simulator showed a high face and construct validity, and therefore has a great potential to complement endourological training.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Jan-Niclas Mumm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Abstract
Surgery is traditionally taught by using Halsteadian principle, which includes “see one, do one, teach one”. This principle relies on sheer volume of surgical exposure rather than a specific course structure. Simulation in minimally invasive surgery allows the learner to practice new motor skills in a safe and stress free environment outside the operating room, thereby decreasing the learning curve. A non-structured exhaustive MEDLINE search was done using MeSH words: “Simulation, Urological Training, Training Models, Laparoscopy Urology, Laparoscopic Skill, Endotrainer, Surgical Simulators, Simulator Validation”. The “ Pros and Cons of simulation based training in laparoscopic urology” were studied. Results were discussed along the following lines : 1. How does skill acquisition occur? 2. Factors affecting simulator-based training. 3. Description of types of simulators and models. 4. Validating a simulator. 5. Task analysis after training on a simulator. 6. How effectively does simulation based training, translate into improved surgical performance in real time? Pros: Simulators have the ability to teach a novice basic psychomotor skills. Supervision and feedback enhance learning in a simulation-based training. They are supplements to and not a substitution for traditional method of teaching. These models can be used as a part of most of the surgical training curriculum. Cons: Cost and availability are the key issues. The cost will determine the availability of the simulators at a center and the availability in turn would determine whether a trainee will get the opportunity to use the simulator. Also, teacher training is an important aspect which would help teachers to understand the importance of simulation in student training. The domains in which it would improve and the extent to which simulation will improve surgical skills is dependent on various factors. Most simulators cannot train a surgeon to deal with anatomical and physiological variations. At present, it is not possible to re-validate all the surgeons in terms of their surgical skills, using simulators.
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Affiliation(s)
- Abhishek Gajendra Singh
- Fellow Endourology, Lapro-Robotic Surgery, Consultant Urologist, MPUH, NADIAD, Gujarat, India
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11
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The value of simulation-based training in the path to laparoscopic urological proficiency. Curr Opin Urol 2017; 27:337-341. [DOI: 10.1097/mou.0000000000000400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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12
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Maemura K, Mataki Y, Kurahara H, Kawasaki Y, Mori S, Iino S, Sakoda M, Ueno S, Shinchi H, Natsugoe S. Effect of visual feedback during laparoscopic basic training using a box trainer with a transparent top. Ann Gastroenterol Surg 2017; 1:129-135. [PMID: 29863133 PMCID: PMC5881314 DOI: 10.1002/ags3.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/07/2022] Open
Abstract
Laparoscopic surgical training using a box trainer facilitates mastery of laparoscopic surgery. Few studies have investigated whether visualizing the surgical field in the box trainer improves performance of laparoscopic surgical procedures during laparoscopic training. An original box trainer equipped with a transparent top made of mesh covered with a latticed structure was developed and used for evaluation of novices during laparoscopic training. Three tasks (levels 1 to 3) involving organ handling while setting the surgical field were arranged to evaluate the efficacy of training. Forty-five students were divided into three groups: group A, students without practical training; group B, students trained using the covered box trainer; and group C, students trained using the transparent box trainer. Completion time of each task before and after training was compared. Training significantly reduced the operating time, with a significant difference between the level 1 task and the levels 2 (P<.001) and 3 (P<.0001) tasks. There was no significant difference in operating time between the levels 2 and 3 tasks. Overall time reduction rate in group C was significantly shorter than that in group A, but not in group B. The time reduction rate for the level 3 task was lowest in group C, with a statistically significant difference existing in group A (P<.001). Visual feedback during surgery through the transparent top of the laparoscopic box trainer helped reduce the learning time required to carry out laparoscopic surgery.
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Affiliation(s)
- Kosei Maemura
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Yota Kawasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Shinichirou Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Satoshi Iino
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Masahiko Sakoda
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Shinichi Ueno
- Clinical Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Hiroyuki Shinchi
- Kagoshima University Graduate School of Health Sciences Kagoshima Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
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Franklin BR, Placek SB, Wagner MD, Haviland SM, O'Donnell MT, Ritter EM. Cost Comparison of Fundamentals of Laparoscopic Surgery Training Completed With Standard Fundamentals of Laparoscopic Surgery Equipment versus Low-Cost Equipment. JOURNAL OF SURGICAL EDUCATION 2017; 74:459-465. [PMID: 28011260 DOI: 10.1016/j.jsurg.2016.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/05/2016] [Accepted: 11/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Training for the Fundamentals of Laparoscopic Surgery (FLS) skills test can be expensive. Previous work demonstrated that training on an ergonomically different, low-cost platform does not affect FLS skills test outcomes. This study compares the average training cost with standard FLS equipment and medical-grade consumables versus training on a lower cost platform with non-medical-grade consumables. DESIGN Subjects were prospectively randomized to either the standard FLS training platform (n = 19) with medical-grade consumables (S-FLS), or the low-cost platform (n = 20) with training-grade products (LC-FLS). Both groups trained to proficiency using previously established mastery learning standards on the 5 FLS tasks. The fixed and consumable cost differences were compared. SETTING Training occurred in a surgical simulation center. PARTICIPANTS Laparoscopic novice medical student and resident physician health care professionals who had not completed the national FLS proficiency curriculum and who had performed less than 10 laparoscopic cases. RESULTS The fixed cost of the platform was considerably higher in the S-FLS group (S-FLS, $3360; LC-FLS, $879), and the average consumable training cost was significantly higher for the S-FLS group (S-FLS, $1384.52; LC-FLS, $153.79; p < 0.001). The LC-FLS group had a statistically discernable cost reduction for each consumable (Gauze $9.24 vs. $0.39, p = 0.002; EndoLoop $540.00 vs. $40.60, p < 0.001; extracorporeal suture $216.45 vs. $25.20, p < 0.001; intracorporeal suture $618.83 vs. $87.60, p < 0.001). The annual fixed and consumable cost to train 5 residents is $10,282.60 in the S-FLS group versus $1647.95 in the LC-FLS group. CONCLUSIONS This study shows that the average cost to train a single trainee to proficiency using a lower fixed-cost platform and non-medical-grade equipment results in significant financial savings. A 5-resident program will save approximately $8500 annually. Residency programs should consider adopting this strategy to reduce the cost of FLS training.
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Affiliation(s)
- Brenton R Franklin
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland.
| | - Sarah B Placek
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland
| | - Mercy D Wagner
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland
| | - Sarah M Haviland
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; Weill Cornell Medical College, Cornell University, New York, New York
| | - Mary T O'Donnell
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland
| | - E Matthew Ritter
- Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland
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14
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Placek SB, Franklin BR, Haviland SM, Wagner MD, O'Donnell MT, Cryer CT, Trinca KD, Silverman E, Matthew Ritter E. Outcomes of Fundamentals of Laparoscopic Surgery (FLS) mastery training standards applied to an ergonomically different, lower cost platform. Surg Endosc 2016; 31:2616-2622. [PMID: 27734202 DOI: 10.1007/s00464-016-5271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Using previously established mastery learning standards, this study compares outcomes of training on standard FLS (FLS) equipment with training on an ergonomically different (ED-FLS), but more portable, lower cost platform. METHODS Subjects completed a pre-training FLS skills test on the standard platform and were then randomized to train on the FLS training platform (n = 20) or the ED-FLS platform (n = 19). A post-training FLS skills test was administered to both groups on the standard FLS platform. RESULTS Group performance on the pretest was similar. Fifty percent of FLS and 32 % of ED-FLS subjects completed the entire curriculum. 100 % of subjects completing the curriculum achieved passing scores on the post-training test. There was no statistically discernible difference in scores on the final FLS exam (FLS 93.4, ED-FLS 93.3, p = 0.98) or training sessions required to complete the curriculum (FLS 7.4, ED-FLS 9.8, p = 0.13). CONCLUSIONS These results show that when applying mastery learning theory to an ergonomically different platform, skill transfer occurs at a high level and prepares subjects to pass the standard FLS skills test.
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Affiliation(s)
- Sarah B Placek
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA. .,National Capital Region Simulation Consortium, Bethesda, MD, USA.
| | - Brenton R Franklin
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
| | - Sarah M Haviland
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
| | - Mercy D Wagner
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
| | - Mary T O'Donnell
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
| | - Chad T Cryer
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kristen D Trinca
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Elliott Silverman
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
| | - E Matthew Ritter
- Division of General Surgery, USU/Walter Reed Department of Surgery, BLD A Room 3020, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,National Capital Region Simulation Consortium, Bethesda, MD, USA
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15
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Montanari E, Schwameis R, Louridas M, Göbl C, Kuessel L, Polterauer S, Husslein H. Training on an inexpensive tablet-based device is equally effective as on a standard laparoscopic box trainer: A randomized controlled trial. Medicine (Baltimore) 2016; 95:e4826. [PMID: 27684813 PMCID: PMC5265906 DOI: 10.1097/md.0000000000004826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of the study was to assess whether an inexpensive tablet-based box trainer (TBT) is at least equally effective compared with a standard box trainer (SBT) to learn basic laparoscopic skills (BLS). BLS training outside the operating room has been shown to be beneficial for surgical residency. However, simulation trainers are expensive and are not consistently available in all training centers. Therefore, TBT and other homemade box trainers were developed. METHODS Medical students were randomized to either a TBT or an SBT and trained 4 fundamentals of laparoscopic surgery (FLS) tasks for 1 hour twice a week for 4 weeks. A baseline test before the training period and a posttraining test were performed. All students then completed a questionnaire to assess their assigned box trainer. The primary outcome measure was the improvement in total test scores. Improvement in the scores for the 4 individual FLS tasks was chosen as a secondary outcome measure. RESULTS Thirty-two medical students were recruited. Baseline test scores did not differ significantly between the groups. BLS improved significantly in both groups for the total score and for all 4 tasks separately. Participants in the TBT group showed a greater improvement of total scores than those in the SBT group, although this did not reach statistical significance; noninferiority of the TBT compared with the SBT concerning the improvement of total scores could be demonstrated. Regarding the individual FLS tasks, noninferiority of the TBT could be shown for the pattern cutting and the suturing with intracorporeal knot-tying task. The acceptance of the TBT by the trainees was very good. CONCLUSION Learning BLS on a homemade TBT is at least equally effective as on an SBT, with the advantage of being very cost saving. Therefore, this readily available box trainer may be used as an effective, flexible training device outside the operating room to improve accessibility to simulation training.
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Affiliation(s)
- Eliana Montanari
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Richard Schwameis
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Marisa Louridas
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Correspondence: Heinrich Husslein, MD, PLLM, Assistant Professor, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (e-mail: )
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16
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Abstract
BACKGROUND Opportunities for surgical skills practice using high-fidelity simulation in the workplace are limited due to cost, time and geographical constraints, and accessibility to junior trainees. An alternative is needed to practise laparoscopic skills at home. Our objective was to undertake a systematic review of low-cost laparoscopic simulators. METHOD A systematic review was undertaken according to PRISMA guidelines. MEDLINE/EMBASE was searched for articles between 1990 and 2014. We included articles describing portable and low-cost laparoscopic simulators that were ready-made or suitable for assembly; articles not in English, with inadequate descriptions of the simulator, and costs >£1500 were excluded. Validation, equipment needed, cost, and ease of assembly were examined. RESULTS Seventy-three unique simulators were identified (60 non-commercial, 13 commercial); 55 % (33) of non-commercial trainers were subject to at least one type of validation compared with 92 % (12) of commercial trainers. Commercial simulators had better face validation compared with non-commercial. The cost ranged from £3 to £216 for non-commercial and £60 to £1007 for commercial simulators. Key components of simulator construction were identified as abdominal cavity and wall, port site, light source, visualisation, and camera monitor. Laptop computers were prerequisite where direct vision was not used. Non-commercial models commonly utilised retail off-the-shelf components, which allowed reduction in costs and greater ease of construction. CONCLUSION The models described provide simple and affordable options for self-assembly, although a significant proportion have not been subject to any validation. Portable simulators may be the most equitable solution to allow regular basic skills practice (e.g. suturing, knot-tying) for junior surgical trainees.
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Affiliation(s)
- Mimi M Li
- Faculty of Medicine, Imperial College London, London, UK.
| | - Joseph George
- Department of Cardiothoracic Surgery, Morriston Hospital, Swansea, UK
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17
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Construction and validation of a low-cost surgical trainer based on iPhone technology for training laparoscopic skills. Surg Laparosc Endosc Percutan Tech 2016; 25:e78-82. [PMID: 25738702 DOI: 10.1097/sle.0000000000000134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this article, we describe the construction and validation of a laparoscopic trainer using an iPhone 5 and a plastic document holder case. The abdominal cavity was simulated with a clear plastic document holder case. On 1 side of the case, 2 holes for entry of laparoscopic instruments were drilled. We added a window to place the camera of the iPhone, which works as our camera of the trainer. Twenty residents carried out 4 tasks using the iPhone Trainer and a physical laparoscopic trainer. The time of all tasks were analyzed with a simple paired t test. The construction of the trainer took 1 hour, with a cost of <US$90. Results showed no significant differences in time for the 4 tasks performed in both the trainers. iPhone Trainer is a reusable and fully functional device that allows surgeons to practice their skills anywhere and at their own pace.
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18
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van der Poel H, Brinkman W, van Cleynenbreugel B, Kallidonis P, Stolzenburg JU, Liatsikos E, Ahmed K, Brunckhorst O, Khan MS, Do M, Ganzer R, Murphy DG, Van Rij S, Dundee PE, Dasgupta P. Training in minimally invasive surgery in urology: European Association of Urology/International Consultation of Urological Diseases consultation. BJU Int 2015; 117:515-30. [DOI: 10.1111/bju.13320] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Henk van der Poel
- Department of Urology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Willem Brinkman
- Department of Urology; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Panagiotis Kallidonis
- Department of Urology; University of Leipzig; Leipzig Germany
- Department of Urology; University of Patras; Patras Greece
| | | | | | - Kamran Ahmed
- MRC Centre for Transplantation; NIHR Biomedical Research Centre; King's College London; London UK
- Department of Urology; Guy's and St. Thomas’ NHS Foundation Trust; King's Health Partners; London UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation; NIHR Biomedical Research Centre; King's College London; London UK
- Department of Urology; Guy's and St. Thomas’ NHS Foundation Trust; King's Health Partners; London UK
| | - Mohammed Shamim Khan
- MRC Centre for Transplantation; NIHR Biomedical Research Centre; King's College London; London UK
- Department of Urology; Guy's and St. Thomas’ NHS Foundation Trust; King's Health Partners; London UK
| | - Minh Do
- Department of Urology; University of Leipzig; Leipzig Germany
| | - Roman Ganzer
- Department of Urology; University of Leipzig; Leipzig Germany
| | - Declan G. Murphy
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
- Epworth Prostate Centre; Epworth Healthcare; Richmond SA Australia
- Royal Melbourne Hospital; Melbourne Vic. Australia
| | - Simon Van Rij
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; University of Melbourne; Melbourne Vic. Australia
| | - Philip E. Dundee
- Epworth Prostate Centre; Epworth Healthcare; Richmond SA Australia
- Royal Melbourne Hospital; Melbourne Vic. Australia
| | - Prokar Dasgupta
- MRC Centre for Transplantation; NIHR Biomedical Research Centre; King's College London; London UK
- Department of Urology; Guy's and St. Thomas’ NHS Foundation Trust; King's Health Partners; London UK
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19
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Acton RD, Chipman JG, Lunden M, Schmitz CC. Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload. JOURNAL OF SURGICAL EDUCATION 2015; 72:522-529. [PMID: 25467731 DOI: 10.1016/j.jsurg.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Using simulation to teach and assess learners represents a powerful approach to training, but one that comes with hidden costs in terms of faculty time, even if programs adopt existing curricula. Some simulators are built to be used independently by learners, but much of the surgical simulation curricula developed for cognitive and psychomotor tasks requires active faculty involvement and low learner-to-faculty teaching ratios to ensure sufficient practice with feedback. The authors hypothesize that the added teaching demands related to simulation have resulted in a significant financial burden to surgery training programs. To date, the effect of simulation-based training on faculty workload has not been estimated objectively and reported in the literature. METHODS To test their hypothesis, the authors analyzed data from 2 sources: (1) changes over time (2006-2014) in formal teaching hours and estimated faculty costs at the University of Minnesota, General Surgery Department and (2) a 2014 online survey of general surgery program directors on their use of simulation for teaching and assessment and their perceptions of workload effects. RESULTS At the University of Minnesota, the total number of hours spent by department faculty in resident and student simulation events increased from 81 in annual year 2006 to 365 in annual year 2013. Estimated full-time equivalent faculty costs rose by 350% during the same period. Program directors (n = 48) of Association of Program Directors in Surgery reported either a slight (60%) or a significant (33%) increase in faculty workload with the advent of simulation, and moderate difficulty in finding enough instructors to meet this increase. Calling upon leadership for support, using diverse instructor types, and relying on "the dedicated few" represent the most common strategies. CONCLUSION To avoid faculty burnout and successfully sustain faculty investment in simulation-based training over time, programs need to be creative in building, sustaining, and managing the instructor workforce.
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Affiliation(s)
- Robert D Acton
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michelle Lunden
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Connie C Schmitz
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Long KL, Spears C, Kenady DE, Roth JS. Implementation of a low-cost laparoscopic skills curriculum in a third-world setting. JOURNAL OF SURGICAL EDUCATION 2014; 71:860-864. [PMID: 24931413 DOI: 10.1016/j.jsurg.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/12/2014] [Accepted: 05/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Training outside the operating room has become a mainstay of surgical education. Laparoscopic training often takes place in a simulation setting. Advanced laparoscopic procedures are now commonplace, even in third-world countries with minimal hospital resources. We sought to implement a low-cost laparoscopic skills curriculum in a general surgery residency program in East Africa. STUDY DESIGN The laparoscopic skills curriculum created and validated at the University of Kentucky was presented to the 10 general surgery residents at Tenwek Hospital. The curriculum and all materials were purchased for approximately $50 (USD). The residents in Kenya had access to laparoscopic trainer boxes and personal laptops to perform the simulations. Residents were timed on their performance at the initiation of the project and after 3 weeks of practice. RESULTS Residents were tested on 3 separate tasks (cannulation drill, peg board, and rope pass). At the initiation of the project, residents were unable to complete the 3 tasks chosen for timing without a critical error (i.e., dropping a peg out of view). After 3 weeks of independent practice, residents were able to successfully complete the tasks, nearing the time limits established in the curriculum manual. Additional practice and testing sessions are scheduled for the remainder of the year. CONCLUSIONS Implementation of a low-cost laparoscopic skills curriculum in a third-world setting is feasible. This approach offers much-needed exposure and opportunities for residents with extremely limited resources and promises to be a vital aspect of the growing surgical residency training in third-world settings.
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Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, Kentucky.
| | - Carol Spears
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - Daniel E Kenady
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - John Scott Roth
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
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A laparoscopic simulator - maybe it is worth making it yourself. Wideochir Inne Tech Maloinwazyjne 2014; 9:380-6. [PMID: 25337161 PMCID: PMC4198645 DOI: 10.5114/wiitm.2014.44139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 01/07/2014] [Accepted: 02/17/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills.
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Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering fidelity in simulation-based training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:387-92. [PMID: 24448038 DOI: 10.1097/acm.0000000000000130] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In simulation-based health professions education, the concept of simulator fidelity is usually understood as the degree to which a simulator looks, feels, and acts like a human patient. Although this can be a useful guide in designing simulators, this definition emphasizes technological advances and physical resemblance over principles of educational effectiveness. In fact, several empirical studies have shown that the degree of fidelity appears to be independent of educational effectiveness. The authors confronted these issues while conducting a recent systematic review of simulation-based health professions education, and in this Perspective they use their experience in conducting that review to examine key concepts and assumptions surrounding the topic of fidelity in simulation.Several concepts typically associated with fidelity are more useful in explaining educational effectiveness, such as transfer of learning, learner engagement, and suspension of disbelief. Given that these concepts more directly influence properties of the learning experience, the authors make the following recommendations: (1) abandon the term fidelity in simulation-based health professions education and replace it with terms reflecting the underlying primary concepts of physical resemblance and functional task alignment; (2) make a shift away from the current emphasis on physical resemblance to a focus on functional correspondence between the simulator and the applied context; and (3) focus on methods to enhance educational effectiveness using principles of transfer of learning, learner engagement, and suspension of disbelief. These recommendations clarify underlying concepts for researchers in simulation-based health professions education and will help advance this burgeoning field.
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Affiliation(s)
- Stanley J Hamstra
- Dr. Hamstra is professor, Departments of Medicine, Anesthesia and Surgery; research director, University of Ottawa Skills and Simulation Centre; and director, Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Brydges is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Zendejas is resident, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Dr. Cook is professor of medicine and medical education, Department of Medicine, Mayo Clinic College of Medicine, and director, Office of Education Research, Mayo Medical School, Rochester, Minnesota
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Nagendran M, Toon CD, Davidson BR, Gurusamy KS. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Cochrane Database Syst Rev 2014; 2014:CD010479. [PMID: 24442763 PMCID: PMC10875404 DOI: 10.1002/14651858.cd010479.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator - either a video box or a mirrored box - is an option to supplement standard training. However, the impact of this modality on trainees with no prior laparoscopic experience is unknown. OBJECTIVES To compare the benefits and harms of box model training versus no training, another box model, animal model, or cadaveric model training for surgical trainees with no prior laparoscopic experience. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013. SELECTION CRITERIA We included all randomised clinical trials comparing box model trainers versus no training in surgical trainees with no prior laparoscopic experience. We also included trials comparing different methods of box model training. DATA COLLECTION AND ANALYSIS Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager for analysis. For each outcome, we calculated the standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible. MAIN RESULTS Twenty-five trials contributed data to the quantitative synthesis in this review. All but one trial were at high risk of bias. Overall, 16 trials (464 participants) provided data for meta-analysis of box training (248 participants) versus no supplementary training (216 participants). All the 16 trials in this comparison used video trainers. Overall, 14 trials (382 participants) provided data for quantitative comparison of different methods of box training. There were no trials comparing box model training versus animal model or cadaveric model training. Box model training versus no training: The meta-analysis showed that the time taken for task completion was significantly shorter in the box trainer group than the control group (8 trials; 249 participants; SMD -0.48 seconds; 95% CI -0.74 to -0.22). Compared with the control group, the box trainer group also had lower error score (3 trials; 69 participants; SMD -0.69; 95% CI -1.21 to -0.17), better accuracy score (3 trials; 73 participants; SMD 0.67; 95% CI 0.18 to 1.17), and better composite performance scores (SMD 0.65; 95% CI 0.42 to 0.88). Three trials reported movement distance but could not be meta-analysed as they were not in a format for meta-analysis. There was significantly lower movement distance in the box model training compared with no training in one trial, and there were no significant differences in the movement distance between the two groups in the other two trials. None of the remaining secondary outcomes such as mortality and morbidity were reported in the trials when animal models were used for assessment of training, error in movements, and trainee satisfaction. Different methods of box training: One trial (36 participants) found significantly shorter time taken to complete the task when box training was performed using a simple cardboard box trainer compared with the standard pelvic trainer (SMD -3.79 seconds; 95% CI -4.92 to -2.65). There was no significant difference in the time taken to complete the task in the remaining three comparisons (reverse alignment versus forward alignment box training; box trainer suturing versus box trainer drills; and single incision versus multiport box model training). There were no significant differences in the error score between the two groups in any of the comparisons (box trainer suturing versus box trainer drills; single incision versus multiport box model training; Z-maze box training versus U-maze box training). The only trial that reported accuracy score found significantly higher accuracy score with Z-maze box training than U-maze box training (1 trial; 16 participants; SMD 1.55; 95% CI 0.39 to 2.71). One trial (36 participants) found significantly higher composite score with simple cardboard box trainer compared with conventional pelvic trainer (SMD 0.87; 95% CI 0.19 to 1.56). Another trial (22 participants) found significantly higher composite score with reverse alignment compared with forward alignment box training (SMD 1.82; 95% CI 0.79 to 2.84). There were no significant differences in the composite score between the intervention and control groups in any of the remaining comparisons. None of the secondary outcomes were adequately reported in the trials. AUTHORS' CONCLUSIONS The results of this review are threatened by both risks of systematic errors (bias) and risks of random errors (play of chance). Laparoscopic box model training appears to improve technical skills compared with no training in trainees with no previous laparoscopic experience. The impacts of this decreased time on patients and healthcare funders in terms of improved outcomes or decreased costs are unknown. There appears to be no significant differences in the improvement of technical skills between different methods of box model training. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the impacts of box model training on surgical skills in both the short and long term, as well as clinical outcomes when the trainee becomes competent to operate on patients.
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Affiliation(s)
- Myura Nagendran
- Department of SurgeryUCL Division of Surgery and Interventional Science9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Clare D Toon
- West Sussex County CouncilPublic Health1st Floor, The GrangeTower StreetChichesterWest SussexUKPO19 1QT
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
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Xiao D, Albayrak A, Jakimowicz JJ, Goossens RHM. A newly designed portable ergonomic laparoscopic skills Ergo-Lap simulator. MINIM INVASIV THER 2013; 22:337-45. [PMID: 23992382 DOI: 10.3109/13645706.2013.821997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The cost of laparoscopic simulators restricts the wide use of simulation for training of basic psychomotor skills. This paper describes the scientifically-based development of an inexpensive and portable Ergonomic Laparoscopic Skills (Ergo-Lap) simulator with multiple tasks. MATERIAL AND METHODS The design of this Ergo-Lap simulator and related training task panel was based on scientific research regarding the representative skills and the ergonomic guidelines for laparoscopic surgery. A user-centred design approach was followed. Fifty-three surgical participants with variable laparoscopic experience (14 medical students, 27 surgeons in training, and 12 experienced laparoscopic surgeons) performed several tasks on the prototype and gave their feedback by filling out a 5-point scale Likert scale questionnaire. RESULTS The results of the usability evaluation showed that the participants regarded the Ergo-Lap simulator as a useful device to practice the basic and advanced skills effectively. Forty-three of the 53 participants indicated they would like to purchase this simulator since it is easy to use and challenges their laparoscopic skills. CONCLUSIONS For laparoscopic skills training, this inexpensive Ergo-Lap simulator with diverse task choices offers a simple training opportunity for trainees who want to practice laparoscopic skills at home or at the office.
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Affiliation(s)
- Dongjuan Xiao
- Faculty of Industrial Design Engineering, Delft University of Technology , Delft , The Netherlands
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Nguyen T, Braga LH, Hoogenes J, Matsumoto ED. Commercial Video Laparoscopic Trainers versus Less Expensive, Simple Laparoscopic Trainers: A Systematic Review and Meta-Analysis. J Urol 2013; 190:894-9. [DOI: 10.1016/j.juro.2013.03.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Nguyen
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
| | - Luis H. Braga
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
| | - Jen Hoogenes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Edward D. Matsumoto
- Department of Surgery (Division of Urology), McMaster University, Hamilton, Ontario, Canada
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Blackmur JP, Clement RG, Brady RR, Oliver CW. Surgical training 2.0: How contemporary developments in information technology can augment surgical training. Surgeon 2013; 11:105-12. [DOI: 10.1016/j.surge.2012.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 11/16/2022]
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Bahsoun AN, Malik MM, Ahmed K, El-Hage O, Jaye P, Dasgupta P. Tablet based simulation provides a new solution to accessing laparoscopic skills training. JOURNAL OF SURGICAL EDUCATION 2013; 70:161-3. [PMID: 23337687 DOI: 10.1016/j.jsurg.2012.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/09/2012] [Accepted: 08/20/2012] [Indexed: 05/17/2023]
Abstract
AIM Access to facilities that allow trainees to develop their laparoscopic skills is very limited in the hospital environment and courses can be very expensive. We set out to build an inexpensive yet effective trainer to allow laparoscopic skill acquisition in the home or classroom environment based on using a tablet as a replacement for the laparoscopic stack and camera. METHODS The cavity in which to train was made from a cardboard box; we left the sides and back open to allow for natural light to fill the cavity. An iPad 2 (Apple Inc.) was placed over the box to act as our camera and monitor. We provided 10 experienced laparoscopic surgeons with the task of passing a suture needle through 3 hoops; then they filled in a questionnaire to assess Face (training capacity) and Content (performance) validity. RESULTS On a 5-point Likert scale, the tablet-based laparoscopic trainer scored a mean 4.2 for training capacity (hand eye coordination, development, and maintenance of lap skills) and for performance (graphics, video, and lighting quality) it scored a mean 4.1. CONCLUSIONS The iPad 2-based laparoscopic trainer was successfully validated for training. It allows students and trainees to practice at their own pace and for inexpensive training on the go. Future "app-"based skills are planned.
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Affiliation(s)
- Ali Nehme Bahsoun
- Medical Research Council (MRC) Center for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College London, King's Health Partners, London, United Kingdom
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El-Enen MA, El-Gamal OM, Elashry OM, Elbahnasy AM, Ghiaty A, Rasheed M. A progressive extended protocol for the basic laparoscopic training using the pelvitrainer. J Endourol 2012; 27:86-91. [PMID: 22891798 DOI: 10.1089/end.2012.0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Abstract Purpose: We describe an extended training program using the pelvitrainer to improve the basic laparoscopic skills of the junior urologists. MATERIALS AND METHODS Ten junior residents were involved in our program that consisted of an hour of training every other day; every 3 hours represented one training session. This curriculum started with 4 inanimate tasks that included peg transfer, disc cutout, extracorporeal, and intracorporeal knot tying. Each task was practiced for one training session with an objective evaluation at the initial attempt and at the end of its session. Thereafter, the participants began to perform an anastomosis using a latex glove model of the laparoscopic urethrovesical anastmosis (L-UVA) (5 experiments). This was followed by 10 experiments of the sheep intestine model of the L-UVA. The performance in these models was evaluated by both the amount of leakage of the injected saline and the time required for completing it. Lastly, another sheep intestine model was performed 3 weeks after the end of the training program. RESULTS The continuous evaluation of these trainees showed that there was a significant decrease in the time required to perform each of the first 4 tasks at the end of their corresponding sessions compared to the base line values (p=0.000). We also detected a significant decrease in the time and the amount of leakage in sheep intestine models in the 10th attempt compared to the first one (p=0.000). However, there was no significant difference between the results at the 10th model and those of the 3 weeks retest regarding both the time (p=0.198) and the amount of leakage (p=0.076). CONCLUSIONS The use of the two described models of the L-UVA after the inanimate tasks in the pelvitrainer distributed course of training could help in the improvement and in the retention of the basic laparoscopic skills of the junior urologists.
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Moreira-Pinto J, Silva JG, Ribeiro de Castro JL, Correia-Pinto J. Five really easy steps to build a homemade low-cost simulator. Surg Innov 2012; 20:95-9. [PMID: 22434377 DOI: 10.1177/1553350612440508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to evaluate how simple it is to build a homemade low-cost simulator using a simple 5-step scheme. METHODS A scheme explaining how to build an endoscopic surgery simulator in 5 easy steps was presented to 26 surgeons. The simulator required a pair of scissors and easy-to-find materials. Its total cost was less than €35. The participants assessed the simulator using common endoscopic training toys or ex vivo tissue and completed an anonymous query comparing it with other commercial simulators that they had experienced before. RESULTS In all, 84.6% found the simulator really easy to build. Every participant felt that he or she could do the same simulator themselves. Comparing with other commercial available box simulators, the majority of participants found the homemade simulator easier to (a) mount and dismount, (b) transport, (c) clean, and (d) use when practicing alone. CONCLUSIONS Anyone can build its own simulator for a small amount of money.
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Affiliation(s)
- João Moreira-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
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Nakamura LY, Martin GL, Fox JC, Andrews PE, Humphreys M, Castle EP. Comparing the portable laparoscopic trainer with a standardized trainer in surgically naïve subjects. J Endourol 2011; 26:67-72. [PMID: 21999424 DOI: 10.1089/end.2011.0335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of the portable laparoscopic trainer in improving skills in subjects who have had no previous laparoscopic experience. MATERIALS AND METHODS Twenty-nine medical students were given a pretest of three tasks on a standardized laparoscopic trainer. Subjects were evaluated objectively and subjectively. Fifteen subjects were randomized to receive a portable laparoscopic trainer and 14 subjects were assigned to the standardized laparoscopic trainers at our facility. The portable trainer group subjects were advised but not required to complete at least 3 hours of training. The group at the facility had a proctored 1-hour session each week for 3 weeks. Each subject was then retested and evaluated with the same pretest tasks. Objective and subjective improvements between the groups were compared. RESULTS Baseline demographics and pretest scores were similar between both groups. All students in the facility group completed the three 1-hour proctored sessions. The portable trainer group reported an average 204 minutes of practice. The facility group did objectively better on the post-test in overall time, and in two exercises. Subjectively, the facility group had a significant improvement compared with the portable trainer group (4.6 vs 2.4 point average increase, P=0.03). CONCLUSIONS Both groups showed objective and subjective improvement after a 3-week period of training. The portable trainer group did report longer average practice time, but this made no significant difference in subjective or objective improvement. The portable laparoscopic trainer is comparable to the standard trainer for improvement of basic laparoscopic skills.
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Affiliation(s)
- Leah Y Nakamura
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA.
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Abstract
INTRODUCTION : Laparoscopic surgery is becoming the main surgical technique in use today. Surgical trainees have to be able to practice these skills in a safe environment. This article describes the design of a novel cheap home laparoscopic trainer using recycled and reusable items. METHODS : This novel home laparoscopic trainer is designed using a mobile phone, torch, and shoe box. Fifteen surgical trainees with variable laparoscopic experience used the device and provided feedback by filling in a Likert scale questionnaire. RESULTS : This is a device that is easy to make and reuse with equipment that is easily accessible in most environments. All the trainees who used the device found it easy to use and helpful for practicing hand-eye coordination. CONCLUSIONS : This is simple and low-cost device allows trainees to practice laparoscopic skills in a safe environment. It provides a design that is accessible and recyclable, hence useful as a low-technology device in places where finances are limited.
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Salin A, Gaujoux S, Sarnacki S, Hardy P, Frileux P. Teaching laparoscopic techniques: The Surgical School of Paris experience. J Visc Surg 2010; 147:e385-8. [DOI: 10.1016/j.jviscsurg.2010.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Autorino R, Haber GP, Stein RJ, Rane A, De Sio M, White MA, Yang B, de la Rosette JJ, Kaouk JH, Laguna MP. Laparoscopic Training in Urology: Critical Analysis of Current Evidence. J Endourol 2010; 24:1377-90. [DOI: 10.1089/end.2010.0005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Urology Clinic, Second University of Naples, Naples, Italy
| | - Georges-Pascal Haber
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Marco De Sio
- Urology Clinic, Second University of Naples, Naples, Italy
| | - Michael A. White
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Yang
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jean J. de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jihad H. Kaouk
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - M. Pilar Laguna
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Administrative considerations when implementing ACS/APDS Skills Curriculum. Surgery 2010; 147:614-21. [DOI: 10.1016/j.surg.2009.10.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/26/2009] [Indexed: 11/19/2022]
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Ai X, Wang BJ, Wu Z, Zhang GX, Ju ZH, Shi TP, Fu B, Li HZ, Ma X, Zhang X. New porcine model for training for laparoscopic ureteral reimplantation with horn of uterus to mimic enlarged ureter. J Endourol 2009; 24:103-7. [PMID: 19852721 DOI: 10.1089/end.2009.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To develop a new porcine model with horn of the uterus to mimic an enlarged ureter for training for laparoscopic ureteral reimplantation (LUR) and to evaluate its feasibility. MATERIALS AND METHODS Ten female pigs were used in the training. The pig was placed to a dorsal position after an anesthetic was administered. The horn of the uterus near the bladder was dissected, then spatulated and trimmed to replace the enlarged ureter. LUR was performed according to standard operation steps. Four trainees completed the LUR procedure based on a mentor-trainee model to guarantee the success of the procedure and the quality of the anastomoses. The learning curve of operative time was analyzed. The anastomotic stoma was cut off postoperatively and checked extracorporeally. After the course, questionnaire surveys were sent to the trainees to investigate satisfaction of the training and assess the impact of the training on their learning of "real" LUR in future practice. RESULTS This model reproduced the key technique steps of LUR. Four LUR procedures were performed on each pig. The operative time declined from 170.0 +/- 10.3 minutes to 90.3 +/- 3.7 minutes (P < 0.01) after the trainees had performed 10 LURs. There was proper stitching in each "ureterovesical" anastomosis. At the end of training, all trainees could accomplish a LUR procedure skillfully on the model; they were satisfied after the course and thought the training was helpful to future practice of LUR. CONCLUSION The new model was feasible and cost-effective for training in the basic skills of laparoscopic ureteral reconstruction procedures.
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Affiliation(s)
- Xing Ai
- Department of Urology, China PLA General Hospital, Beijing, China
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Heesakkers JPFA, Costantini E, Oelke M. Should we train urologists in female urology? A European view. Curr Opin Urol 2009; 19:353-7. [DOI: 10.1097/mou.0b013e32832ae1a4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang X, Wang B, Ma X, Zhang G, Shi T, Ju Z, Wang C, Li H, Ai X, Fu B. Laparoscopic adrenalectomy for beginners without open counterpart experience: initial results under staged training. Urology 2009; 73:1061-5. [PMID: 19394504 DOI: 10.1016/j.urology.2008.11.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 10/18/2008] [Accepted: 11/15/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To develop a staged laparoscopic training program for beginners to perform laparoscopic adrenalectomy (LA) and to determine its safety and feasibility. METHODS From January 2002 to October 2007, 5 beginners (postgraduate years 1-5) without previous experience in open adrenalectomy were selected randomly to receive the staged laparoscopic training, including box-trainer, animal model, and mentor-initiated clinical training. During the clinical training, the trainees acted as the camera holder first, and then selectively performed simple operations, such as laparoscopic renal cyst unroofing. Finally, they performed 30 LAs independently under the mentor's supervision using the technique of anatomic retroperitoneoscopic adrenalectomy. The clinical data of the 30 LAs performed by each the trainees (150 LAs total) were collected and compared with the data from the initial 30 LAs of the mentor. RESULTS All LAs were completed successfully. No procedure required conversion to open surgery. The median operative time of the trainees was 82.3 minutes (range 59-133), which was obviously shorten than the mentor's (median operative time 131.5 minutes, range 73-230, P < .001). The learning curve among the trainees was shorter compared with that of the mentor. No major complications were observed. The minor intraoperative and postoperative complication rate for the trainees was 0.67% and 6.7%, respectively, not significantly different from those of the mentor (0% and 3.3%, respectively; both P > .05). All complications developing in patients treated by the trainees required only conservative therapy. CONCLUSIONS It was safe and feasible for beginners without previous open counterpart experience to perform LA using staged training.
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Affiliation(s)
- Xu Zhang
- Department of Urology, Clinical Division of Surgery, Chinese PLA General Hospital, Hai Dian District, Beijing, People's Republic of China.
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Arden D, Hacker MR, Jones DB, Awtrey CS. Description and validation of the Pelv-Sim: a training model designed to improve gynecologic minimally invasive suturing skills. J Minim Invasive Gynecol 2009; 15:707-11. [PMID: 18971133 DOI: 10.1016/j.jmig.2008.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/25/2008] [Accepted: 08/01/2008] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To describe and validate the Pelv-Sim trainer, an innovative training model for gynecologic laparoscopic suturing with 4 laparoscopic exercises: closing an open vaginal cuff, transposing an ovary to the pelvic sidewall, ligating an infundibulopelvic ligament, and closing a port-site fascial incision. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Academic medical center. PARTICIPANTS Obstetrics and gynecology residents (n = 19) and third-year medical students (n = 10). INTERVENTIONS To test the Pelv-Sim model for construct validity, all participants were timed as they completed the 4 tasks, and their performances were compared. The residents were then randomized to a study group asked to train with the Pelv-Sim for 1 hour/week for 10 weeks, or to a control group. To evaluate the effectiveness of training with the Pelv-Sim model, both groups of residents were retested at the end of the 10-week study period. Pretraining and posttraining performances were compared within each group. MEASUREMENTS AND MAIN RESULTS Before the intervention, the residents completed all 4 tasks in significantly less time than the medical students (all p values <or=.012). When retested after the 10-week study period, the control group showed no significant performance improvements. The trained group showed significant improvement in performance for the vaginal cuff closure task (p = .004) and the ovary transposition task (p = .047), but not for the infundibulopelvic ligament ligation or the fascial closure tasks. CONCLUSION Construct validity was shown for all 4 Pelv-Sim simulation tasks. Resident training improves performance on the vaginal cuff closure and ovary transposition tasks. The Pelv-Sim has the potential to be a valuable tool in laparoscopic training for gynecology residents.
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Affiliation(s)
- Deborah Arden
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Galfano A. Editorial comment on: Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 2008; 56:873. [PMID: 18922624 DOI: 10.1016/j.eururo.2008.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 2008; 56:865-72. [PMID: 18922627 DOI: 10.1016/j.eururo.2008.09.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 09/19/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been acknowledged that standardised training programmes are needed to improve laparoscopic training of urologic trainees. Previous studies have suggested that simulator-based laparoscopic training can improve performance during real laparoscopic procedures. OBJECTIVE To determine if there are performance differences for the completion of a simulated laparoscopic suturing task among urology residents based on their postgraduate year of training (PGY). DESIGN, SETTING, AND PARTICIPANTS Using a validated scoring checklist, two independent observers objectively scored the completion of a standardised laparoscopic suturing task in a bench-top laparoscopic box trainer. PGY and previous exposure to laparoscopic surgery and laparoscopic simulated training was obtained from self-administered questionnaires. Data acquisition was undertaken at the European Urological Residents Education Programme (EUREP) 2007, run by the European School of Urology, and included a pan-European cohort of 201 urology residents. MEASUREMENTS Reliability among those rating the suturing tasks was excellent (Cronbach's α=0.83). Each resident was scored for the suturing task. Residents were categorised into three groups based on their PGY status (junior [n=8]; intermediate [n=37]; senior [n=156]). The Kruskal-Wallis test was used to measure trend across the PGY; the Mann-Whitney U test was used to determine variation among categorised PGY groups. RESULTS AND LIMITATIONS Laparoscopic suturing skill was significantly different across PGY levels (p=0.032), and between junior residents and both intermediate and senior residents (p=0.008 and p=0.012, respectively). There was no significant difference between intermediate and senior residents (p=0.697). Only 12% of participants rated their existing volume of laparoscopic operative cases as sufficient, while 55% of participants had no regular opportunities, and 32% of participants had not performed laparoscopic procedures as primary surgeon. Most residents (96%) reported the use of laparoscopic simulators to be beneficial in training, although current European training programmes appear to provide <50% of residents with the opportunity to train with them. CONCLUSIONS A discernable relationship existed between the score obtained for a laparoscopic suturing task and year of resident training. Modular simulator training as part of a formal training programme may help to overcome some of the shortfall in residents' exposure to laparoscopic procedures as primary surgeon.
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Park SY, Soh BH, Rha KH, Yang SC, Han WK. The Impact of Using a Porcine Model in Laparoscopic Partial Nephrectomy Training. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.10.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Yul Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hyun Soh
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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