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Hiyoshi Y, Miyamoto Y, Akiyama T, Daitoku N, Sakamoto Y, Tokunaga R, Eto K, Nagai Y, Iwatsuki M, Iwagami S, Baba Y, Yoshida N, Baba H. Time trial of dry box laparoscopic surgical training improves laparoscopic surgical skills and surgical outcomes. Asian J Endosc Surg 2021; 14:373-378. [PMID: 33084215 DOI: 10.1111/ases.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The present study assessed the utility of a dry box time trial during laparoscopic surgical training to improve laparoscopic surgical skills and surgical outcomes. METHODS In a monthly time trial, surgeon trainees twice completed a set task that involved grasping a suture, aligning a needle with a needle holder, passing the suture, making three knots, and cutting the two tails of the suture. The mean suturing time was then analyzed. To assess the utility of this time trial, we analyzed the short-term outcomes of patients with stage I to III colon cancer who had undergone laparoscopic colectomy before and after the introduction of the time trial. RESULTS The monthly time trial was introduced in October 2018, and 52 surgeon trainees participated in the trials examined in this study. Within 6 months of the program's introduction, the mean suturing time had significantly declined to less than 70% of the time trial, while the standard deviations had declined to less than 30%. In comparisons of the short-term outcomes of laparoscopic colon cancer surgery before (n = 49) and after (n = 46) the introduction of the time trial, the operative time tended to decline (P = .074) after the introduction of the time trial, and blood loss was significantly reduced (P = .018). The rate of postoperative complications was similar before and after the introduction. CONCLUSION Regular time trials of laparoscopic surgical suture training using a dry box can be useful for improving laparoscopic surgical skills and surgical outcomes. Moreover, time trials can keep trainees motivated.
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Affiliation(s)
- Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobuya Daitoku
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuma Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yohei Nagai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Is the Human Brain Capable of Controlling Seven Degrees of Freedom? J Surg Res 2019; 238:1-9. [PMID: 30721780 DOI: 10.1016/j.jss.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/24/2018] [Accepted: 01/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Conventional rigid laparoscopic instruments offer five degrees of freedom (DOF). Robotic instruments add two independent DOFs allowing unconstrained directional steering. Several nonrobotic instruments have been developed with the additional DOFs, but with these devices, surgeon's wrist movements are not intuitively transmitted into tip movements. In this study, a new articulated instrument has been evaluated. The aim of the study was to compare learning curves and performances of conventional laparoscopic instruments, the da Vinci system and Steerable devices in a crossover study. MATERIALS AND METHODS A total of 16 medical students without any laparoscopic experience were trained for 27 h to operate all of a rigid, a robotic, and a new Steerable instrument in a random order. Learning curves and ultimate experience scores were determined for each instrument. Strain in wrist and shoulders was assessed with a visual analog score. RESULTS Performing the suturing task with rigid and robot instruments required 4 h of training, compared with 6 h to master the Steerable instrument. After 9 h of training with each instrument, completing the complex suturing pattern required 662 ± 308 s with rigid instruments, 279 ± 90 s with the da Vinci system, and 279 ± 53 s with the Steerable instrument. Pain scores were significantly higher after using the rigid instruments compared with the Steerable instruments. CONCLUSIONS Transmission of torque and the presence of additional two DOFs in combination with reduced crosstalk significantly improved the instrument dexterity where the Steerable platform is concerned. Although the learning curve is longer, once mastered, it provides enhanced surgical freedom.
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Mariotti ACH, Torricelli FCM, Andrade WS, Mitre AI, Arap MA. Postgraduate course in minimally invasive urological surgery. Transl Androl Urol 2018; 7:274-279. [PMID: 29732287 PMCID: PMC5911530 DOI: 10.21037/tau.2018.03.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Minimally invasive surgeries are increasingly common as the first option for most urological diseases. However, laparoscopic techniques are difficult to master, especially for surgeons who were not trained during their residency programs. Therefore, postgraduate courses are important for such matters. This study aims to evaluate the results of postgraduate courses in minimally invasive urological surgery. Methods A specific questionnaire was used to evaluate the impact of the course on urologists' professional activities. The questionnaire also evaluated demographic data and previous surgical experience. The postgraduate course was divided into 10 monthly modules, each one with 36 hours of activities, from March to December. All students of the laparoscopic postgraduate course from the last five years were enrolled in the study. Results Forty-one students were included in the study. Thirty-nine students were male (95.1%), and the mean age was 39.5 years (range, 30-60 years). Students from all regions of the country were enrolled. Thirty (73.2%) students had minor laparoscopic experience. All students improved their laparoscopic skills and were able to include new procedures in their daily surgical practice. Eleven students (26.8%) had no laparoscopic experience, and all of them started to perform laparoscopic procedures. The median level of impact on professional life was 75 points (range, 0-100 points). Conclusions The postgraduate course is an appropriate way to acquire urological laparoscopic skills. The annual course allowed improvement and initiation of laparoscopic procedures, which significantly impacted urologists' daily activities.
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Affiliation(s)
| | | | - Weslley S Andrade
- Institute of Education and Research, Hospital Sírio Libanês, São Paulo, Brazil
| | - Anuar I Mitre
- Institute of Education and Research, Hospital Sírio Libanês, São Paulo, Brazil
| | - Marco A Arap
- Institute of Education and Research, Hospital Sírio Libanês, São Paulo, Brazil
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Jordan A, El Haloui O, Breaud J, Chevalier D, Antomarchi J, Bongain A, Boucoiran I, Delotte J. Formation des internes de gynécologie obstétrique : évaluation d’un programme pédagogique intégrant cours théoriques et sessions pratiques sur simulateurs. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.gyobfe.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Measurement of the Physical Properties during Laparoscopic Surgery Performed on Pigs by Using Forceps with Pressure Sensors. Adv Urol 2015; 2015:495308. [PMID: 25784932 PMCID: PMC4346692 DOI: 10.1155/2015/495308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/02/2015] [Accepted: 01/16/2015] [Indexed: 11/17/2022] Open
Abstract
Objectives. Here we developed a unique training system, a patient specific virtual reality simulator, for laparoscopic renal surgery. To develop the simulator, it was important to first identify the physical properties of the organ. Methods. We recorded the force measured during laparoscopic surgery performed on pigs by using forceps with pressure sensors. Several sensors, including strain gauges, accelerometers, and a potentiometer, are attached to the forceps. Results. Throughout the experiment, we measured the reaction force in response to the forceps movement in real time. Conclusions. The experiment showed the possibility of digitizing these physical properties in humans as well.
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Uemura M, Tomikawa M, Nagao Y, Yamashita N, Kumashiro R, Tsutsumi N, Ohuchida K, Ieiri S, Ohdaira T, Hashizume M. Significance of metacognitive skills in laparoscopic surgery assessed by essential task simulation. MINIM INVASIV THER 2013; 23:165-72. [DOI: 10.3109/13645706.2013.867273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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[Interest of a structured laparoscopy training in a simulation center: survey of resident's point of view]. ACTA ACUST UNITED AC 2013; 42:238-45. [PMID: 23478044 DOI: 10.1016/j.jgyn.2013.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/02/2013] [Accepted: 01/23/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Assess residents satisfaction within their participation to a short and structured training to laparoscopy, gathering theoretical and practical issues. METHODS This course was divided in two periods of 3days including an individual prospective evaluation. For each period, the residents have answered to three questionnaires trying to evaluate their experience in laparoscopy and their short term and medium term satisfaction. RESULTS Three hundred residents from different French university hospitals have been involved in this study. After 4years, half of them were not satisfied with their chirurgical studies. Thirty-seven percent of them never attended to any surgical procedure as main operator. The training course has answered to their expectation for 95% of the residents and 85% said they now feel more confident about laparoscopy then before. According to 76% of them, it should be a compulsory and systematic training course and for 75%, they should be tested regarding their laparoscopy skills level during the resident studies period. The training on animals is the more efficient for 86% of them. CONCLUSIONS Due to the increasing number of residents and to the legal time for rest, the time spent in the operative room has decreased. People also do not accept easily the training made on true patients. Intensive and tested training are useful and answer to residents needs. They could be systematically integrated in their global curriculum.
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Mereu L, Carri G, Albis Florez ED, Cofelice V, Pontis A, Romeo A, Mencaglia L. Three-step model course to teach intracorporeal laparoscopic suturing. J Laparoendosc Adv Surg Tech A 2012; 23:26-32. [PMID: 23216448 DOI: 10.1089/lap.2012.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopy requires a set of skills such as intracorporeal stitching and knotting. The aim of this study is to present an effective specialized training course for the laparoscopic suturing technique. MATERIALS AND METHODS We designed a specialized 5-day training course for laparoscopic suturing skills with theoretical and practical sessions on inanimate pelvic training. The "gladiator rule" was the method used to teach intracorporeal suturing using the right and left hand from a lateral and suprapubic access. Data on sense of depth, coordination, dexterity, traction power, and posture at the beginning and at the end of the course were compiled. Three practical evaluations were performed by each course participant. Follow-up on subsequent live laparoscopic application of intracorporeal suturing was obtained. RESULTS We enrolled 44 consecutive trainees: 33 men and 11 women. We found a significant statistical improvement during the course in coordination (P=.001), dexterity (P=.000), traction power (P=.002), and posture (P=.003). Men were better than women in coordination (P=.002), dexterity (P=.000), and traction power (P=.014). No significant statistical difference in suturing skill was found in relation to age, gender, previous courses, surgical training (surgeon or resident), and dominant hand. Twenty-nine of 40 (72.5%) trainees after the course began to apply intracorporeal sutures in vivo. CONCLUSIONS The present study demonstrates the utility of a 5-day suturing course in teaching laparoscopic suturing technique. The "gladiator rule" is a useful and reproducible theory to teach intracorporeal knotting. The three-step model allows the majority of the trainees to apply laparoscopic suturing in vivo.
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Affiliation(s)
- Liliana Mereu
- Department of Gynecology, Fiorentino Oncology Center, Sesto Fiorentino, Italy.
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Makiyama K, Nagasaka M, Inuiya T, Takanami K, Ogata M, Kubota Y. Development of a patient-specific simulator for laparoscopic renal surgery. Int J Urol 2012; 19:829-35. [DOI: 10.1111/j.1442-2042.2012.03053.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ishida M, Miyajima A, Takeda T, Hasegawa M, Kikuchi E, Oya M. Technical difficulties of transumbilical laparoendoscopic single-site adrenalectomy: comparison with conventional laparoscopic adrenalectomy. World J Urol 2010; 31:199-203. [PMID: 21188386 DOI: 10.1007/s00345-010-0636-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/10/2010] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Interest in laparoendoscopic single-site (LESS) surgery has increased in recent years. The aim of this study was to evaluate the feasibility and safety of transumbilical LESS adrenalectomy and to elucidate the technical differences between LESS and conventional laparoscopic surgery. METHODS This study was comparing 10 consecutive transumbilical LESS adrenalectomies and 10 conventional laparoscopic adrenalectomies performed between March 2006 and April 2010 for benign adrenal tumors. Perioperative parameters were compared, and we reviewed our surgical videos and analyzed technical characteristics of the surgeries. RESULTS There was no open conversion in laparoscopic group, no additional port placement in LESS group, and no perioperative complications in either group. No significant differences in operative time, estimated blood loss, or resumption of oral intake were observed between two groups. Pneumoperitoneum time did not differ between LESS and laparoscopic groups (91.2 vs. 74.3 min, P = 0.257). In LESS group only, time was needed for adjustment of roticulator (14.5 ± 8.1 min). After subtracting the time needed for adjustment, operative time between two groups was more comparable (76.7 vs. 74.3 min, P = 0.880). One-handed manipulation time in LESS group decreased in a time-dependent manner (r = -0.806, P < 0.0049). Tissue re-grasping during operation was more frequently observed in LESS group (16.2 vs. 2.2 times, P < 0.001). CONCLUSIONS Transumbilical LESS adrenalectomy is feasible and comparable to conventional laparoscopic adrenalectomy. There are still obvious technical difficulties associated with LESS surgery, and it is essential that these be overcome in order to improve this surgical technique.
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Affiliation(s)
- Masaru Ishida
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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