The Importance of Stressing the Use of Laparoscopic Instruments in the Initial Training for Laparoscopic Surgery Using Box Trainers: A Randomized Control Study

Conscientiousness Counts: How Personality Traits Impact Laparoscopic Surgical Skill Improvement in Medical Students

OBJECTIVE

Studies have shown that personality traits affect cognitive performance; however, little is known about their influence on surgical performance. This study aimed to assess the impact of the Big Five personality traits on medical students' laparoscopic surgical skills.

DESIGN

In this prospective study, medical students' laparoscopic surgical skills were assessed using the Hiroshima University Laparoscopic Surgical Assessment Device (HUESAD). The participants performed the HUESAD tasks 10 times before they underwent training. After completing the simulator training, they performed the tasks 10 times. Thereafter, they answered Big Five personality trait questionnaires (Extraversion, Neuroticism, Openness to experience, Conscientiousness, and Agreeableness).

SETTING

Academic medical centers.

PARTICIPANTS

Forty medical students (10 women) were recruited. The selection criterion was a lack of simulations or clinical experience in laparoscopic procedures.

RESULTS

No significant correlations were found between personality traits and HUESAD assessment scores before training. Laparoscopic surgical skills improved significantly after the training (p < 0.001). The Big Five personality traits were correlated with improved laparoscopic surgical performance after training (r = -0.44, p < 0.05). Moreover, statistically significant positive correlations were observed between Conscientiousness and improvement rates (r = 0.36, p < 0.05).

CONCLUSIONS

The results suggest that medical students scoring high on Conscientiousness were more likely to have improved laparoscopic surgical skills, regardless of their initial skills. The ability to predict laparoscopic surgical skills would be useful in designing tailor-made training programs for safe and high-quality operations.

Origami Box Folding Exercise: A laparoscopic box simulation training and assessment method in facilitating laparoscopic psychomotor skills with minimal preparation

OBJECTIVE

Laparoscopic box simulation training is widely recognized as an assessment tool to facilitate psychomotor skills especially for novice surgeons. However, current commercialized training modules including pegs, gauze, clips, pins etc. are generally costly and relatively inaccessible. We introduce a simple and pioneer surgical training drill, the Origami Box Folding Exercise (OBFE), based on the validated evaluating system of objective structured assessment of technical skills (OSATS) constructed with the scoring system of procedure-specific checklist (PSC) and global rating scale (GRS).

MATERIALS AND METHODS

Face and content validation of the OBFE and OSATS are evaluated by five endoscopic experts from two medical centers in Taiwan. This is a prospective observational study analyzing the pre-test/post-test result of OBFE from 37 participants in two individual workshops as training and evaluating method for laparoscopic psychomotor skills. Both the pre and post tests are video recorded with a time limit of 5 min graded by two independent evaluators based on the OSATS scoring system.

RESULTS

The reliability of PSC, GRS, and intergroup value between PSC and GRS were 0.923, 0.926 and 0.933, respectively. Inter-rater reliability of PSC, GRS, and both were 0.985, 0.932 and 0.977, respectively. Construct validity of PSC and GRS were statistically significant, with p-value 0.006 and 0.001, respectively.

CONCLUSION

OBFE enhances laparoscopic psychomotor skills with requirement of a single piece of paper. The associated OSATS tool for a 5-min OBFE test was validated. OBFE training is an efficient training and assessment system to promote psychomotor skills in laparoscopic box simulation drill which requires simple and economical preparation.

Improving performance under mirror-image conditions during laparoscopic surgery using the Broadview camera system

INTRODUCTION

Under mirror-image conditions, surgeons often become confused and their task performance may deteriorate. This study aimed to quantitatively investigate the difficulty of performing laparoscopic surgery based on a mirror image and to find methods to improve performance under these conditions.

METHODS

Twelve medical students with no prior endoscopic surgical experience and 10 surgical residents, each with over 50 laparoscopic surgery experiences, participated in this study. Three measures were assessed using the Hiroshima University Endoscopic Surgical Assessment Device: the deviation with integrated time, the approaching time, and the peak velocity. The scope was placed at 0° (coaxial position), 180° (mirror-image condition), and 180° using the Broadview camera system. Each participant performed the Hiroshima University Endoscopic Surgical Assessment Device task 10 times.

RESULTS

The deviation with integrated time, the approaching time, and the peak velocity were better for surgical residents than for novices at 0° (P < 0.001, P = 0.001, P = 0.011). The deviation with integrated time, the approaching time, and the peak velocity at 180° were significantly worse than the corresponding values at 0° (P < 0.0001) for both surgical residents and novices. All three types of Hiroshima University Endoscopic Surgical Assessment Device assessment at 180° were significantly better when the Broadview camera system was used than when it was not (P < 0.0001).

CONCLUSION

This study showed quantitatively the difficulty in manipulating laparoscopic instruments in mirror-image conditions. Using the Broadview camera system improved surgeons' performance under mirror-image conditions during laparoscopic surgery.

Effects of open versus laparoscopic nephrectomy techniques on oxidative stress markers in patients with renal cell carcinoma

The aim of the study was to determine the concentration of lipid peroxidation products, the activity of selected antioxidant and lysosomal enzymes, and protease inhibitor in patients with renal cell carcinoma who underwent radical nephrectomy. The studied group included 44 patients: 21 of them underwent open surgery, while 23 underwent laparoscopy. Blood samples were collected three times: before treatment and 12 hours and five days after nephrectomy. In blood of participants, the concentration of thiobarbituric acid reactive substances (TBARS), the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx), and the activity of acid phosphatase (AcP), arylsulfatase (ASA), cathepsin D (CTSD), and α 1-antitrypsin (AAT) were assayed. No statistically significant differences in investigated parameters were found between studied groups. Moreover, TBARS concentration and CAT, SOD, and GPx activity were not altered in the course of both types of surgery. Five days after both open and laparoscopic nephrectomy techniques, AAT activity was higher than its activity 12 hours after the procedure. The obtained results suggest that laparoscopy may be used for nephrectomy as effectively as open surgery without creating greater oxidative stress. Reduced period of convalescence at patients treated with laparoscopy may be due to less severe response of acute-phase proteins.

Training to acquire psychomotor skills for endoscopic endonasal surgery using a personal webcam trainer

OBJECT

Existing training methods for neuroendoscopic surgery have mainly emphasized the acquisition of anatomical knowledge and procedures for operating an endoscope and instruments. For laparoscopic surgery, various training systems have been developed to teach handling of an endoscope as well as the manipulation of instruments for speedy and precise endoscopic performance using both hands. In endoscopic endonasal surgery (EES), especially using a binostril approach to the skull base and intradural lesions, the learning of more meticulous manipulation of instruments is mandatory, and it may be necessary to develop another type of training method for acquiring psychomotor skills for EES. Authors of the present study developed an inexpensive, portable personal trainer using a webcam and objectively evaluated its utility.

METHODS

Twenty-five neurosurgeons volunteered for this study and were divided into 2 groups, a novice group (19 neurosurgeons) and an experienced group (6 neurosurgeons). Before and after the exercises of set tasks with a webcam box trainer, the basic endoscopic skills of each participant were objectively assessed using the virtual reality simulator (LapSim) while executing 2 virtual tasks: grasping and instrument navigation. Scores for the following 11 performance variables were recorded: instrument time, instrument misses, instrument path length, and instrument angular path (all of which were measured in both hands), as well as tissue damage, max damage, and finally overall score. Instrument time was indicated as movement speed; instrument path length and instrument angular path as movement efficiency; and instrument misses, tissue damage, and max damage as movement precision.

RESULTS

In the novice group, movement speed and efficiency were significantly improved after the training. In the experienced group, significant improvement was not shown in the majority of virtual tasks. Before the training, significantly greater movement speed and efficiency were demonstrated in the experienced group, but no difference in movement precision was shown between the 2 groups. After the training, no significant differences were shown between the 2 groups in the majority of the virtual tasks. Analysis revealed that the webcam trainer improved the basic skills of the novices, increasing movement speed and efficiency without sacrificing movement precision.

CONCLUSIONS

Novices using this unique webcam trainer showed improvement in psychomotor skills for EES. The authors believe that training in terms of basic endoscopic skills is meaningful and that the webcam training system can play a role in daily off-the-job training for EES.