Neue Perspektiven der laparoskopischen Simulation: Vom Studententrainingslabor bis zur Stressevaluation

Global Curriculum in Surgical Oncology

BACKGROUND

The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden.

MATERIALS AND METHODS

The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology.

RESULTS

A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent.

CONCLUSIONS

A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. © 2016 Society of Surgical Oncology and the European Society of Surgical Oncology. Published by SpringerNature. All rights reserved.

Randomized controlled trial of virtual reality and hybrid simulation for robotic surgical training

OBJECTIVE

To evaluate if two commonly used laparoscopic simulators could be adapted and used successfully for the robotics platform in a laparoscopic and robotic naïve medical student population.

MATERIALS AND METHODS

We identified two widely validated laparoscopic simulation programs, LapSim(®) (Surgical Science Sweden AB), and ProMIS(®) (Haptica, Ireland)for inclusion in the study. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(®) task set was used for ProMIS, and adapted for the DaVinci(®) console (Intuitive Surgical, Inc., Sunnyvale, CA, USA) robotic platform. We then randomized 20 naïve medical students to receive training on either LapSim or ProMIS, both or neither, and evaluated them before and after training.

RESULTS

When the groups were compared at baseline, there were no statistical differences in mean scores amongst the groups in univariate analysis (α= 0.05). When comparing mean scores within groups before and after training sessions, statistically significant performance enhancement in all four robotic tasks were identified in the groups receiving dual training.

CONCLUSION

We have shown that the use of ProMIS hybrid and LapSim virtual reality (VR) simulators in conjunction with each other can considerable improve robotic console performance in novice medical students compared with hybrid and VR simulation alone.

Increased stress levels may explain the incomplete transfer of simulator-acquired skill to the operating room

BACKGROUND

Proficiency-based simulator training in laparoscopic suturing leads to improved operative performance, but the skill transfer is incomplete. The objective of this study was to examine the stress level of trainees during the transition from the simulator to the operating room (OR) and its impact on performance.

METHODS

Novices (n = 20) were randomized into training and control groups. After the training group achieved proficiency in laparoscopic suturing, both groups were tested on a live porcine, laparoscopic Nissen fundoplication model. Participant performance was assessed using an objective score. Stress level was evaluated by recording beat-to-beat heart rate (BBHR) and short-term heart rate variability (STHRV) at baseline, after achieving proficiency (only the training group) and in the OR. Repeated measurement analysis of variance (ANOVA) and t test were used for analysis.

RESULTS

Baseline simulator performance and data for heart rate variability were similar for both groups. After achieving simulator proficiency, the trained group demonstrated the anticipated decrease in performance (mean average + or - SEM) in the OR (524 + or - 17 vs 290 + or - 95; P < .001), and an increase in BBHR (98 + or - 14 vs115 + or - 18; P < .001) but not STHRV (4.1 + or - 0.8 vs 3.7 + or - 0.9; P = .5). A similar but lesser increase of the BBHR was observed in the control group compared to the study group.

CONCLUSION

BBHR was a more sensitive measure of stress level compared with STHRV. The increased BBHR observed in the OR that reflects stress and performance anxiety may explain the incomplete transfer of simulator-acquired skill in novice learners.