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Ackermann J, Baumann J, Pape J, Pahls J, Ruchay Z, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Peters G, Willer D, Westermann A, Brügge S, Günther V, Maass N, Mettler L, Alkatout I. Factors influencing surgical performance and learning progress in minimally invasive surgery - results of an interdisciplinary multicenter study. Int J Surg 2023; 109:2975-2986. [PMID: 37462985 PMCID: PMC10583955 DOI: 10.1097/js9.0000000000000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. The authors need selection procedures and decision support systems for the recruitment of medical students and young surgeons. The authors aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students. MATERIALS AND METHODS The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting. RESULTS In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multistage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries ( r =0.28-0.45, P <0.001/ r =0.1-0.28, P <0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance ( r =0.18-0.27, P <0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, that is the higher the age, the lower the surgical performance ( r =0.13/ r =0.22, P <0.05/ P <0.001). CONCLUSION Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.
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Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | | | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, Damme
| | - Günter Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dormagen
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, University Hospital of Giessen, Giessen, Germany
| | - Göntje Peters
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Damaris Willer
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Gynaecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel
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Buote NJ, Fransson B, Rishniw M. Comparison of Attempts Needed for Veterinary Students to Reach Proficiency in a Basic and Advanced Robotic Simulator Task. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20220130. [PMID: 36917585 DOI: 10.3138/jvme-2022-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owner's wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables which can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.
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Affiliation(s)
- Nicole J Buote
- ACVS Founding Fellow Minimally Invasive Surgery (Soft Tissue), Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA
| | - Boel Fransson
- ACVS Founding Fellow Minimally Invasive Surgery (Soft Tissue), Department of Clinical Sciences, Washington State University, Pullman, WA 99164-6610
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA
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Sundelin MO, Paltved C, Kingo PS, Kjölhede H, Jensen JB. The transferability of laparoscopic and open surgical skills to robotic surgery. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:26. [PMID: 36064750 PMCID: PMC9446560 DOI: 10.1186/s41077-022-00223-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Within the last decades, robotic surgery has gained popularity. Most robotic surgeons have changed their main surgical activity from open or laparoscopic without prior formal robotic training. With the current practice, it is of great interest to know whether there is a transfer of surgical skills. In visualization, motion scaling, and freedom of motion, robotic surgery resembles open surgery far more than laparoscopic surgery. Therefore, our hypothesis is that open-trained surgeons have more transfer of surgical skills to robotic surgery, compared to surgeons trained in laparoscopy. METHODS Thirty-six surgically inexperienced medical students were randomized into three groups for intensive simulation training in an assigned modality: open surgery, laparoscopy, or robot-assisted laparoscopy. The training period was, for all study subjects, followed by performing a robot-assisted bowel anastomosis in a pig model. As surrogate markers of surgical quality, the anastomoses were tested for resistance to pressure, and video recordings of the procedure were evaluated by two blinded expert robotic surgeons, using a global rating scale of robotic operative performance (Global Evaluative Assessment of Robotic Skills (GEARS)). RESULTS The mean leak pressure of bowel anastomosis was 36.25 (7.62-64.89) mmHg in the laparoscopic training group and 69.01 (28.02-109.99) mmHg in the open surgery group, and the mean leak pressure for the robotic training group was 108.45 (74.96-141.94) mmHg. The same pattern was found with GEARS as surrogate markers of surgical quality. GEARS score was 15.71 (12.37-19.04) in the laparoscopic training group, 18.14 (14.70-21.58) in the open surgery group, and 22.04 (19.29-24.79) in the robotic training group. In comparison with the laparoscopic training group, the robotic training group had a statistically higher leak pressure (p = 0.0015) and GEARS score (p = 0.0023). No significant difference, for neither leak pressure nor GEARS, between the open and the robotic training group. CONCLUSION In our study, training in open surgery was superior to training in laparoscopy when transitioning to robotic surgery in a simulation setting performed by surgically naive study subjects.
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Affiliation(s)
- Maria Ordell Sundelin
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark. .,Corporate MidtSim, Central Denmark Region, Aarhus, Denmark.
| | | | - Pernille Skjold Kingo
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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