A progressive extended protocol for the basic laparoscopic training using the pelvitrainer

Do 'standard laparoscopic box trainers' represent real-life conditions during transperitoneal laparoscopical interventions of the upper tract?

BACKGROUND

The purpose of this study is to investigate the representativeness of the conventional laparoscopic standard box trainers in terms of real-life circumstances in transperitoneal laparoscopical interventions of the upper tract, using questionnaire inquiries with experienced surgeons.

MATERIALS AND METHODS

The study was conducted with 44 laparoscopists, whose level of renal surgery experience was either high (primary surgeon in >100 cases), moderate (primary surgeon in >50 cases) or basic (primary surgeon in >20 cases). We used the box widely preferred in international training courses, which consists of a 10-mm 30° laparoscope, real endoscopic instruments, light source, monitor and chicken bone materials. Participants were asked whether they represent real-life situations while performing tasks by means of standard box trainers.

RESULTS

The medians of 'restrained body posture of the surgeon', 'position of monitor', 'trocars entry slots', 'tissue distance and region' and 'limited field of movement and restricted working space' were analysed on their difference from the ideal value. All the variables were shown to be significantly different from the ideal value of 5 (p < 0.001). These results suggest that experienced surgeons in our study did not find the box simulation conditions similar to real surgery conditions.

CONCLUSION

Conventional laparoscopic trainer box, which is currently being used, is far from representing for the real situation in transperitoneal laparoscopical interventions of the upper tract.

Validity of a sponge trainer as a simple training model for percutaneous renal access

Objective

To evaluate the efficacy of our simply designed trainer for junior urologists to acquire the initial skills for percutaneous renal access (PRA).

Subjects and methods

Three sponge sheets (60 × 50 × 10 cm) were arranged horizontally over each other. A rectangular groove was made in the middle sheet to accommodate an inflated balloon of a Foley catheter, radio-opaque metal balls, metal rings, or a plastic tube that were sequentially placed for the four training tasks. In each session, 18 trainees were asked to pass a fluoroscopically guided puncture needle from a surface point to the placed object in middle sheet. Clinical impact of training was evaluated by an experience survey on a 5-piont Likert scale (for model usefulness, tactile and fluoroscopic-guidance feedback) and success rate in further mentored practice.

Results

There was a gradual increase in tasks’ and sessions’ scores over the training sessions. According to the experience survey after first clinical practice, the mean (SD) score for overall model usefulness by trainees was 3.8 (0.9) with high fluoroscopic guidance reality [3.6 (1.1)] but poor tactile realism [2.3 (0.9)]. On mentored PRA, the success rate for trainees was 78.3%.

Conclusion

Our early evaluation showed our novel, cost-effective and reproducible sponge trainer could be an effective training model for PRA with a beneficial impact on subsequent clinical practice.