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Cabello R, Bueno-Serrano G, Arteche AH, Villacampa JM, Castilla C, Carnero C, Garranzo Garcia-Ibarrola M, Gonzalez Enguita C. "Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience". ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:451-459. [PMID: 38826693 PMCID: PMC11143445 DOI: 10.2147/amep.s450513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/27/2024] [Indexed: 06/04/2024]
Abstract
Introduction Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Material Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. Results All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Conclusion Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.
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Affiliation(s)
- Ramiro Cabello
- Department Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - José Miguel Villacampa
- Department Otorhinolaryngology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Castilla
- Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Carnero
- Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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García-Formoso N, Ballestero Diego R, Seguí-Moya E, Herrero Blanco E, Mercader Barrull C, González-Padilla DA, Benejam Gual JM. Current status of robotic training during the urology residency: results from a national survey in Spain. Actas Urol Esp 2024:S2173-5786(24)00059-3. [PMID: 38734071 DOI: 10.1016/j.acuroe.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION AND OBJECTIVES The increasing number of robotic urological procedures observed in recent years highlights the need to expand training opportunities in robotic surgery. Our objective is to investigate the state of robotic training during urology residency in Spain in order to identify significant deficiencies. MATERIALS AND METHODS A 20-item online survey was conducted among urology residents in Spain who were registered in the database of the Residents and Young Urologists Group of the Spanish Association of Urology. The survey assessed subjective opinions, institutional aspects, training resources, and experience regarding robotic surgery. A total of 455 email invitations were sent throughout the year 2021. Descriptive analysis of the responses was performed. RESULTS The participation rate reached 30%, with a total of 135 residents. 52% of respondents lacked access to a robotic system in their institution, of which only 48% could compensate for this deficiency through external rotations. Among those with access to a robotic system, 25% and 23% reported having access to theoretical and practical training, respectively. The existence of a formal training program was low (13%). 85% of the respondents considered robotic surgery training in Spain to be deficient. CONCLUSIONS Training for Spanish residents in robotic urological surgery is perceived as inadequate, emphasizing the crucial need for improvement in training programs in this field.
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Affiliation(s)
- N García-Formoso
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Spain; Group of Residents and Young Urologists of the Spanish Urological Association, Madrid, Spain.
| | - R Ballestero Diego
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Spain; Surgery Research and Innovation Group, Valdecilla´s Health Research Institue (IDIVAL), Santander, Spain; Lithiasis and Endourology, Laparoscopy and Robotics Groups of the Spanish Urology Association, Madrid, Spain
| | - E Seguí-Moya
- Group of Residents and Young Urologists of the Spanish Urological Association, Madrid, Spain; Neuro-Urology Department, Royal National Orthopaedic Hospital, London, United Kingdom
| | - E Herrero Blanco
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Spain; Surgery Research and Innovation Group, Valdecilla´s Health Research Institue (IDIVAL), Santander, Spain
| | - C Mercader Barrull
- Group of Residents and Young Urologists of the Spanish Urological Association, Madrid, Spain; Urology department, Clínic Hospital, Barcelona, Spain
| | - D A González-Padilla
- Group of Residents and Young Urologists of the Spanish Urological Association, Madrid, Spain; Urology Department, Navarra University Clinic, Madrid, Spain
| | - J M Benejam Gual
- Lithiasis and Endourology, Laparoscopy and Robotics Groups of the Spanish Urology Association, Madrid, Spain; Urology Department, Manacor Hospital, Manacor, Spain
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Anacleto S, Mota P, Fernandes V, Carvalho N, Morais N, Passos P, Rodrigues R, Cardoso A, Tinoco C, Dias E, Lima E, Correia-Pinto J. Can narration and guidance in video-enhanced learning improve performance on E-BLUS exercises? Cent European J Urol 2021; 74:131-138. [PMID: 33976929 PMCID: PMC8097647 DOI: 10.5173/ceju.2021.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/06/2021] [Accepted: 02/06/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction This study aimed to compare trainees’ laparoscopic performance concerning the peg-transfer (PT) and needle-guidance (NG) exercises after watching the original European Basic Laparoscopic Urologic Skills (E-BLUS) video or after watching a video-mentored tutorial (VMT) with ‘tips and tricks’, narration and didactic illustrations. Material and methods An experimental, unblinded, parallel, 2-intervention, 2-period randomized trial with an allocation ratio of 1:1 was conducted. Forty-two participants were randomized into 2 groups. Prior to task initiation, Group 1 watched the VMT in both trials and Group 2 watched, firstly, the original E-BLUS examination video and, in the second trial, the VMT. Each participant performed 2 trials for each exercise. Outcome measures were task time and total number of errors. Results In the first period, participants who visualized the PT and NG VMT had fewer errors than participants who visualized the E-BLUS video (p = 0.001 and p = 0.014, respectively). In the second period, after watching the VMT, a decrease in the total number of errors in PT and NG exercises was observed in the participants who previously watched the E-BLUS video (p = 0.001 and p = 0.002, respectively). In the second period, a decrease in median task time was observed for Group 1 and 2 after watching the PT VMT (p ≤0.001 and p = 0.003, respectively) and NG VMT (p = 0.005 and p = 0.01, respectively). Conclusions The use of VMT can lead to a smaller number of errors and, if coupled with deliberate practice, could lead to a shorter task time in exercise performance among participants with no previous laparoscopic experience.
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Affiliation(s)
- Sara Anacleto
- Hospital de Braga, Department of Urology, Braga, Portugal
| | - Paulo Mota
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Vitor Fernandes
- University of Minho, School of Health Sciences, Braga, Portugal
| | - Nuno Carvalho
- University of Minho, School of Health Sciences, Braga, Portugal
| | - Nuno Morais
- Hospital de Braga, Department of Urology, Braga, Portugal
| | - Pedro Passos
- Hospital da Senhora da Oliveira, Department of Urology, Guimarães, Portugal
| | | | | | | | - Emanuel Dias
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Estevão Lima
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Jorge Correia-Pinto
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
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Sánchez-Margallo FM, Durán Rey D, Serrano Pascual Á, Mayol Martínez JA, Sánchez-Margallo JA. Comparative Study of the Influence of Three-Dimensional Versus Two-Dimensional Urological Laparoscopy on Surgeons' Surgical Performance and Ergonomics: A Systematic Review and Meta-Analysis. J Endourol 2020; 35:123-137. [PMID: 32799686 DOI: 10.1089/end.2020.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional systems in laparoscopic urological surgery, analyzing the benefits, limitations, and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics. Methods: A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials, and observational comparative studies were included. Relevant data were extracted and analyzed. Results: A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models, and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills, the results showed no significant differences in execution time using either imaging system. Three-dimensional vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy, and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy. Conclusions: Three-dimensional laparoscopic systems essentially advance surgical performance in less-experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.
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Affiliation(s)
| | - David Durán Rey
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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Aydin A, Ahmed K, Van Hemelrijck M, Ahmed HU, Khan MS, Dasgupta P. Simulation in Urological Training and Education (SIMULATE): Protocol and curriculum development of the first multicentre international randomized controlled trial assessing the transferability of simulation-based surgical training. BJU Int 2020; 126:202-211. [PMID: 32189446 DOI: 10.1111/bju.15056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To report the study protocol for the first international multicentre randomized controlled trial investigating the effectiveness of simulation-based surgical training and the development process for an evidence-based training curriculum, to be delivered as an educational intervention. PARTICIPANTS AND METHODS This prospective, international, multicentre randomized controlled clinical and educational trial will recruit urology surgical trainees who must not have performed ≥10 of the selected index procedure, ureterorenoscopy (URS). Participants will be randomized to simulation-based training (SBT) or non-simulation-based training (NSBT), the latter of which is the current sole standard of training globally. The primary outcome is the number of procedures required to achieve proficiency, where proficiency is defined as achieving a learning curve plateau of 28 or more on an Objective Structured Assessment of Technical Skills (OSATS) assessment scale, for three consecutive operations, without any complications. All participants will be followed up either until they complete 25 procedures or for 18 months. Development of the URS SBT curriculum took place through a two-round Delphi process. RESULTS A total of 47 respondents, consisting of trainees (n = 24) with URS experience and urolithiasis specialists (n = 23), participated in round 1 of the Delphi process. Specialists (n = 10) finalized the content of the curriculum in round 2. The developed interventional curriculum consists of initial theoretic knowledge through didactic lectures followed by select tasks and cases on the URO-Mentor (Simbionix, Lod, Israel) VR Simulator, Uro-Scopic Trainer (Limbs & Things, Bristol, UK) and Scope Trainer (Mediskills, Manchester, UK) models for both semi-rigid and flexible URS. Respondents also selected relevant non-technical skills scenarios and cadaveric simulation tasks as additional components, with delivery subject to local availability. CONCLUSIONS SIMULATE is the first multicentre trial investigating the effect and transferability of supplementary SBT on operating performance and patient outcomes. An evidence-based training curriculum is presented, developed with expert and trainee input. Participants will be followed and the primary outcome, number of procedures required to proficiency, will be reported alongside key clinical secondary outcomes, (ISCRTN 12260261).
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Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, UK.,Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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de Vries AH, Muijtjens AMM, van Genugten HGJ, Hendrikx AJM, Koldewijn EL, Schout BMA, van der Vleuten CPM, Wagner C, Tjiam IM, van Merriënboer JJG. Development and validation of the TOCO–TURBT tool: a summative assessment tool that measures surgical competency in transurethral resection of bladder tumour. Surg Endosc 2018; 32:4923-4931. [DOI: 10.1007/s00464-018-6251-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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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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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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Thinggaard E, Bjerrum F, Strandbygaard J, Gögenur I, Konge L. Ensuring Competency of Novice Laparoscopic Surgeons-Exploring Standard Setting Methods and their Consequences. JOURNAL OF SURGICAL EDUCATION 2016; 73:986-991. [PMID: 27324697 DOI: 10.1016/j.jsurg.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/14/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Simulation-based assessment tools have been developed to allow for proficiency-based simulator training in laparoscopy. However, few studies have examined the consequences of different standard setting methods or examined what level of proficiency is considered adequate for trainees. The objectives of the present study were to explore the consequences of different standard setting methods and to examine the proficiency level that surgical trainees are expected to reach, before performing supervised surgery on patients. DESIGN Study participants undertook the Training and Assessment of Basic Laparoscopic Techniques test. The tests were video-recorded and rated using a simple scoring system based on number of errors and time. Participants were then asked to assess how high a score a novice should reach before performing supervised surgery on a patient. We then compared 3 methods of standard setting: expert performance level, contrasting groups method, and a modified Angoff method. SETTING The study was conducted at the Copenhagen Academy for Medical Education and Simulation. The academy provides surgical simulation training in laparoscopy for trainees at the hospitals in the Capital Region and the Zealand Region of Denmark. PARTICIPANTS Participants were recruited among surgical trainees in their first year of specialty training from surgery, gynecology, and urology departments. A total of 40 participants were included and completed the trial. RESULTS The different standard setting methods resulted in different pass/fail levels. At the expert performance level, the pass/fail level was 474 points-the contrasting groups method resulted in 358 points and the modified Angoff method resulted in 311 points among experienced surgeons, and 386 points among trainees. The different proficiency levels resulted in a failure rate of 0% to 50% of experienced surgeons and a pass rate of 0% to 25% of novices. Novice laparoscopic surgeons set a higher pass/fail level than experienced surgeons did (p = 0.008). CONCLUSION Required proficiency levels varies depending on the standard setting method used, which highlights the importance of using an established standard setting method to set the pass/fail level.
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Affiliation(s)
- Ebbe Thinggaard
- Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark; Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.
| | - Flemming Bjerrum
- Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | | | - Ismail Gögenur
- Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O’Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. GYNECOLOGICAL SURGERY 2016; 13:133-137. [PMID: 27478427 PMCID: PMC4949291 DOI: 10.1007/s10397-016-0957-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills, are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high-stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy, (b) the Minimally Invasive Gynaecological Surgeon (MIGS) and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence, and it counteracts the problem of the traditional surgical apprentice-tutor model. It is seen as a major step toward standardisation of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Arnaud Wattiez
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O’Donovan
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
| | - Yves Van Belle
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
- />University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- />African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- />International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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Enciso S, Díaz-Güemes I, Serrano Á, Bachiller J, Rioja J, Usón J, Sánchez-Margallo F. Initial validation of a training program focused on laparoscopic radical nephrectomy. Actas Urol Esp 2016; 40:237-44. [PMID: 26811021 DOI: 10.1016/j.acuro.2015.11.007] [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: 09/25/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess a training model focused on laparoscopic nephrectomy. MATERIAL AND METHODS 16 residents participated in the study, who attended a training program with a theoretical session (1hour) and a dry (7hours) and a wet lab (13hours). During animal training, the first and last nephrectomies were assessed through the completion time and the global rating scale "Objective and Structured Assessment of Technical Skills" (OSATS). Before and after the course, they performed 3 tasks on the virtual reality simulator LAPMentor (1) eye-hand coordination; 2) hand-hand coordination; and 3) transference of objects), registering time and movement metrics. All participants completed a questionnaire related to the training components on a 5-point rating scale. RESULTS The participants performed the last nephrectomy faster (P<.001) and with higher OSATS scores (P<.001). After the course, they completed the LAPMentor tasks faster (P<.05). The number of movements decreased in all tasks (1) P<.001, 2) P<.05, and 3) P<.05), and the path length in tasks 1 (P<.05) and 2 (P<.05). The movement speeds increased in tasks 2 (P<.001) and 3 (P<.001). With regards to the questionnaire, the usefulness of the animal training and the necessity of training on them prior to their laparoscopic clinical practice were the questions with the highest score (4.92±.28). CONCLUSIONS The combination of physical simulation and animal training constitute an effective training model for improving basic and advanced skills for laparoscopic nephrectomy. The component preferred by the urology residents was the animal training.
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O'Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol 2016; 199:183-6. [PMID: 26946312 DOI: 10.1016/j.ejogrb.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; European Board and College of Obstetrics and Gynaecology, Brussels, Belgium.
| | - Arnaud Wattiez
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O'Donovan
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium.
| | - Yves Van Belle
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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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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Schroeder RPJ, Chrzan RJ, Klijn AJ, Kuijper CF, Dik P, de Jong TPVM. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre. J Pediatr Urol 2015; 11:271.e1-6. [PMID: 26096439 DOI: 10.1016/j.jpurol.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. OBJECTIVE To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). STUDY DESIGN The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. RESULTS Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. DISCUSSION There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. CONCLUSION Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.
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Affiliation(s)
- R P J Schroeder
- Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - R J Chrzan
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - A J Klijn
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - C F Kuijper
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - P Dik
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - T P V M de Jong
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
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de Vries AH, van Luijk SJ, Scherpbier AJJA, Hendrikx AJM, Koldewijn EL, Wagner C, Schout BMA. High acceptability of a newly developed urological practical skills training program. BMC Urol 2015; 15:93. [PMID: 26337054 PMCID: PMC4560076 DOI: 10.1186/s12894-015-0084-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/19/2015] [Indexed: 11/11/2022] Open
Abstract
Background Benefits of simulation training are widely recognized, but its structural implementation into urological curricula remains challenging. This study aims to gain insight into current and ideal urological practical skills training and presents the outline of a newly developed skills training program, including an assessment of the design characteristics that may increase its acceptability. Methods A questionnaire was sent to the urology residents (n = 87) and program directors (n = 45) of all Dutch teaching hospitals. Open- and close-ended questions were used to determine the views on current and ideal skills training and the newly developed skills training program. Eight semi-structured interviews were conducted with 39 residents and 15 program directors. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Results Response was 87.4 % for residents and 86.7 % for program directors. Residents appeared to be still predominantly trained ‘by doing’. Structured practical skills training in local hospitals takes place according to 12 % of the residents versus 44 % of the program directors (p < 0.001). Ideally, residents prefer to practice certain procedures on simulation models first, especially in endourology. The majority of residents (92 %) and program directors (87 %) approved of implementing the newly developed skills training program (p = 0.51). ‘Structured scheduling’, ‘use of peer teaching’ and ‘high fidelity models’ were indicated as design characteristics that increase its acceptability. Conclusions Current urological residency training consists of patient-related ‘learning by doing’, although more practice on simulation models is desired. The acceptability of implementing the presented skills-training program is high. Design characteristics that increase its acceptability are structured scheduling, the use of peer teaching and high fidelity models. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0084-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Scheltus J van Luijk
- Academy of Post-graduate Education, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Albert J J A Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Ad J M Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. .,Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. .,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Barbara M A Schout
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. .,Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Thinggaard E, Bjerrum F, Strandbygaard J, Gögenur I, Konge L. Validity of a cross-specialty test in basic laparoscopic techniques (TABLT). Br J Surg 2015; 102:1106-13. [PMID: 26095788 PMCID: PMC4744674 DOI: 10.1002/bjs.9857] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/27/2015] [Accepted: 04/16/2015] [Indexed: 01/22/2023]
Abstract
Background Box trainer systems have been developed that include advanced skills such as suturing. There is still a need for a portable, cheap training and testing system for basic laparoscopic techniques that can be used across different specialties before performing supervised surgery on patients. The aim of this study was to establish validity evidence for the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test, a tablet‐based training system. Methods Laparoscopic surgeons and trainees were recruited from departments of general surgery, gynaecology and urology. Participants included novice, intermediate and experienced surgeons. All participants performed the TABLT test. Performance scores were calculated based on time taken and errors made. Evidence of validity was explored using a contemporary framework of validity. Results Some 60 individuals participated. The TABLT was shown to be reliable, with an intraclass correlation coefficient of 0·99 (P < 0·001). ANOVA showed a difference between the groups with different level of experience (P < 0·001). The Bonferroni correction was used to confirm this finding. A Pearson's r value of 0·73 (P < 0·001) signified a good positive correlation between the level of laparoscopic experience and performance score. A reasonable pass–fail standard was established using contrasting groups methods. Conclusion TABLT can be used for the assessment of basic laparoscopic skills and can help novice surgical trainees in different specialties gain basic laparoscopic competencies. Simple, cheap and valid
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Affiliation(s)
- E Thinggaard
- Centre for Clinical Education, Capital Region of Denmark, Copenhagen, Denmark.,Department of General Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - F Bjerrum
- Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - I Gögenur
- Department of General Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - L Konge
- Centre for Clinical Education, Capital Region of Denmark, Copenhagen, Denmark
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Gómez-Gómez E, Carrasco-Valiente J, Valero-Rosa J, Campos-Hernández J, Anglada-Curado F, Carazo-Carazo J, Font-Ugalde P, Requena-Tapia M. Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gómez-Gómez E, Carrasco-Valiente J, Valero-Rosa J, Campos-Hernández J, Anglada-Curado F, Carazo-Carazo J, Font-Ugalde P, Requena-Tapia M. Impact of 3D vision on mental workload and laparoscopic performance in inexperienced subjects. Actas Urol Esp 2015; 39:229-35. [PMID: 25457567 DOI: 10.1016/j.acuro.2014.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. MATERIALS AND METHODS A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. RESULTS 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3D vision also shows better performance times: "transfer objects" (P = .001), "single knot" (P < .001), "clip and cut" (P < .05), and "needle guidance" (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3D (P < .001). However, 3D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). CONCLUSION The incorporation of 3D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially.
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20
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Are structured curriculums for laparoscopic training useful? A review of current literature. Curr Opin Urol 2015; 25:163-7. [DOI: 10.1097/mou.0000000000000138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wieringa FP, Bouma H, Eendebak PT, van Basten JPA, Beerlage HP, Smits GAHJ, Bos JE. Improved depth perception with three-dimensional auxiliary display and computer generated three-dimensional panoramic overviews in robot-assisted laparoscopy. J Med Imaging (Bellingham) 2014; 1:015001. [PMID: 26158026 DOI: 10.1117/1.jmi.1.1.015001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/15/2014] [Accepted: 04/21/2014] [Indexed: 11/14/2022] Open
Abstract
In comparison to open surgery, endoscopic surgery offers impaired depth perception and narrower field-of-view. To improve depth perception, the Da Vinci robot offers three-dimensional (3-D) video on the console for the surgeon but not for assistants, although both must collaborate. We improved the shared perception of the whole surgical team by connecting live 3-D monitors to all three available Da Vinci generations, probed user experience after two years by questionnaire, and compared time measurements of a predefined complex interaction task performed with a 3-D monitor versus two-dimensional. Additionally, we investigated whether the complex mental task of reconstructing a 3-D overview from an endoscopic video can be performed by a computer and shared among users. During the study, 925 robot-assisted laparoscopic procedures were performed in three hospitals, including prostatectomies, cystectomies, and nephrectomies. Thirty-one users participated in our questionnaire. Eighty-four percent preferred 3-D monitors and 100% reported spatial-perception improvement. All participating urologists indicated quicker performance of tasks requiring delicate collaboration (e.g., clip placement) when assistants used 3-D monitors. Eighteen users participated in a timing experiment during a delicate cooperation task in vitro. Teamwork was significantly (40%) faster with the 3-D monitor. Computer-generated 3-D reconstructions from recordings offered very wide interactive panoramas with educational value, although the present embodiment is vulnerable to movement artifacts.
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Affiliation(s)
- Fokko P Wieringa
- Netherlands Org. for Appl. Scientific Research TNO , P.O. Box 6235, 5600 HE Eindhoven, The Netherlands
| | - Henri Bouma
- Netherlands Org. for Appl. Scientific Research TNO , P.O. Box 6235, 5600 HE Eindhoven, The Netherlands
| | - Pieter T Eendebak
- Netherlands Org. for Appl. Scientific Research TNO , P.O. Box 6235, 5600 HE Eindhoven, The Netherlands
| | | | - Harrie P Beerlage
- Jeroen Bosch Hospital , P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | | | - Jelte E Bos
- Netherlands Org. for Appl. Scientific Research TNO , P.O. Box 6235, 5600 HE Eindhoven, The Netherlands ; VU University Amsterdam , De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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Shepherd W, Arora KS, Abboudi H, Shamim Khan M, Dasgupta P, Ahmed K. A review of the available urology skills training curricula and their validation. JOURNAL OF SURGICAL EDUCATION 2014; 71:289-296. [PMID: 24797842 DOI: 10.1016/j.jsurg.2013.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/23/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND The transforming field of urological surgery continues to demand development of novel training devices and curricula for its trainees. Contemporary trainees have to balance workplace demands while overcoming the cognitive barriers of acquiring skills in rapidly multiplying and advancing surgical techniques. This article provides a brief review of the process involved in developing a surgical curriculum and the current status of real and simulation-based curricula in the 4 subgroups of urological surgical practice: open, laparoscopic, endoscopic, and robotic. METHODS An informal literature review was conducted to provide a snapshot into the variety of simulation training tools available for technical and nontechnical urological surgical skills within all subgroups of urological surgery using the following keywords: "urology, surgery, training, curriculum, validation, non-technical skills, technical skills, LESS, robotic, laparoscopy, animal models." Validated training tools explored in research were tabulated and summarized. RESULTS AND CONCLUSIONS A total of 20 studies exploring validated training tools were identified. Huge variation was noticed in the types of validity sought by researchers and suboptimal incorporation of these tools into curricula was noted across the subgroups of urological surgery. The following key recommendations emerge from the review: adoption of simulation-based curricula in training; better integration of dedicated training time in simulated environments within a trainee's working hours; better incentivization for educators and assessors to improvise, research, and deliver teaching using the technologies available; and continued emphasis on developing nontechnical skills in tandem with technical operative skills.
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Affiliation(s)
- William Shepherd
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Karan Singh Arora
- Department of Urology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Hamid Abboudi
- Department of Urology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Mohammed Shamim Khan
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Prokar Dasgupta
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom
| | - Kamran Ahmed
- Department of Urology, MRC Centre for Transplantation, King's College London, Guy's Hospital, London, United Kingdom.
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Brinkman WM, Tjiam IM, Schout BM, Muijtjens AM, Van Cleynenbreugel B, Koldewijn EL, Witjes JA. Results of the European Basic Laparoscopic Urological Skills Examination. Eur Urol 2014; 65:490-6. [DOI: 10.1016/j.eururo.2013.10.036] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/22/2013] [Indexed: 11/28/2022]
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Valdivieso RF, Zorn KC. Surgery: Urological laparoscopic training--practice makes perfect. Nat Rev Urol 2014; 11:138-9. [PMID: 24473415 DOI: 10.1038/nrurol.2014.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roger F Valdivieso
- University of Montreal Hospital Centre (CHUM), 235 René-Levesque Est, Suite 301, Montreal, QC H2X 1N8, Canada
| | - Kevin C Zorn
- University of Montreal Hospital Centre (CHUM), 235 René-Levesque Est, Suite 301, Montreal, QC H2X 1N8, Canada
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Autorino R, Cicione A, Rassweiler J, Lima E. Re: Willem M. Brinkman, Irene M. Tjiam, Barbara M.A. Schout, et al. Results of the European basic laparoscopic urological skills examination. Eur Urol 2014;65:490-6. Eur Urol 2013; 65:e38-9. [PMID: 24331153 DOI: 10.1016/j.eururo.2013.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Unit, Second University of Naples, Naples, Italy.
| | - Antonio Cicione
- Urology Unit, Magna Graecia University, Catanzaro, Italy; Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Jens Rassweiler
- Department of Urology, SLK Klinken Heilbronn, Heilbronn, Germany
| | - Estevao Lima
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
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Cicione A, Autorino R, Breda A, De Sio M, Damiano R, Fusco F, Greco F, Carvalho-Dias E, Mota P, Nogueira C, Pinho P, Mirone V, Correia-Pinto J, Rassweiler J, Lima E. Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic urologic skills. Urology 2013; 82:1444-50. [PMID: 24094658 DOI: 10.1016/j.urology.2013.07.047] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/09/2013] [Accepted: 07/18/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare the last generation of 3-dimensional imaging (3D) vs standard 2-dimensional imaging (2D) laparoscopy. MATERIALS AND METHODS A prospective observational study was conducted during the 4th Minimally Invasive Urological Surgical Week Course held in Braga (Portugal) in April 2013. The course participants and faculty were asked to perform standardized tasks in the dry laboratory setting and randomly assigned into 2 study groups; one starting with 3D, the other with 2D laparoscopy. The 5 tasks of the European Training in Basic Laparoscopic Urological Skills were performed. Time to complete each task and errors made were recorded and analyzed. An end-of-study questionnaire was filled by the participants. RESULTS Ten laparoscopic experts and 23 laparoscopy-naïve residents were included. Overall, a significantly better performance was obtained using 3D in terms of time (1115 seconds, interquartile range [IQR] 596-1469 vs 1299 seconds, IQR 620-1723; P = .027) and number of errors (2, IQR 1-3 vs 3, IQR 2-5.5; P = .001). However, the experts were faster only in the "peg transfer" task when using the 3D, whereas naïves improved their performance in 3 of the 5 tasks. A linear correlation between level of experience and performance was found. Three-dimensional imaging was perceived as "easier" by a third of the laparoscopy-naïve participants (P = .027). CONCLUSION Three-dimensional imaging seems to facilitate surgical performance of urologic surgeons without laparoscopic background in the dry laboratory setting. The advantage provided by 3D for those with previous laparoscopic experience remains to be demonstrated. Further studies are needed to determine the actual advantage of 3D over standard 2D laparoscopy in the clinical setting.
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Affiliation(s)
- Antonio Cicione
- Life and Health Sciences Research Institute, Universidade do Minho, Braga, Portugal; Urology Unit, Magna Graecia University, Catanzaro, Italy
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Brinkman WM, Tjiam IM, Buzink SN. Assessment of basic laparoscopic skills on virtual reality simulator or box trainer. Surg Endosc 2013; 27:3584-90. [DOI: 10.1007/s00464-013-2930-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/08/2013] [Indexed: 01/22/2023]
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Thiel DD, Lannen A, Richie E, Dove J, Gajarawala NM, Igel TC. Simulation-Based Training for Bedside Assistants Can Benefit Experienced Robotic Prostatectomy Teams. J Endourol 2013; 27:230-7. [DOI: 10.1089/end.2012.0382] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David D. Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
- Multidisciplinary Simulation Center, Mayo Clinic, Jacksonville, Florida
| | - Amy Lannen
- Multidisciplinary Simulation Center, Mayo Clinic, Jacksonville, Florida
| | - Eugene Richie
- Multidisciplinary Simulation Center, Mayo Clinic, Jacksonville, Florida
| | - Jesse Dove
- Multidisciplinary Simulation Center, Mayo Clinic, Jacksonville, Florida
| | | | - Todd C. Igel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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