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Nicolì P, Biffi A, Boca GD, Vitagliano A, Silvestris E, Loizzi V, Naro ED, Cicinelli E, Damiani GR. Four-handed Technique for Total Laparoscopic Hysterectomy: An Italian Experience. Gynecol Minim Invasive Ther 2024; 13:161-167. [PMID: 39184247 PMCID: PMC11343349 DOI: 10.4103/gmit.gmit_50_23] [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] [Received: 04/02/2023] [Revised: 09/23/2023] [Accepted: 11/09/2023] [Indexed: 08/27/2024] Open
Abstract
Objectives In our previous article, we proposed the novel four-handed technique (FHT) for total laparoscopic hysterectomy (TLH), which, according to us, is more helpful compared to the traditional TLH route. The objectives of the study were to analyze the FHT-TLH feasibility and efficiency by comparing some surgical outcomes recorded from 750 FHT-TLH performed in our hospital to literature data about the traditional TLH route and to underline the great opportunity this novel technique offers to the young specialists and residents to be more confident with gynecological laparoscopy. Materials and Methods This was a retrospective analysis carried out by collecting data regarding patient characteristics and surgical outcomes (operative time, blood loss, surgical complications, use of analgesics, and length of hospitalization) from 750 hospital records of women who underwent FHT-TLH (with or without adnexectomy) due to benign or malignant pathology from January 2015 to December 2021 at our hospital. Results We performed a total of 750 FHT-TLH, with or without adnexectomy. The mean skin-to-skin operative time for a FHT-TLH was 50 min, and the mean blood loss was 150 mL. No visceral damage was caused during surgeries. Only two patients underwent exploratory laparotomy with total abdominal hysterectomy due to the inability to proceed laparoscopically. Nonsteroidal anti-inflammatory drugs were administered only twice a day as analgesics, with advantage. The mean length of stay in the hospital after the procedure was 1.5 days, with discharge on the evening of the 1st day after surgery. No major postoperative complications occurred. The only minor postoperative complication described, in just three patients, was cellulitis of the vaginal vault. Conclusion Our FHT-TLH experience represents an alternative to the traditional TLH route, which allows to apply a minimally invasive approach with some advantages for patients compared to the traditional TLH route, such as early recovery and reduced operating time, blood loss, use of analgesics, and hospital stay. Moreover, it allows young specialists and residents to be more confident with gynecological laparoscopy, particularly when operating as the first assistant, to improve their laparoscopic surgical skills faster than the traditional TLH route allows them.
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Affiliation(s)
- Pierpaolo Nicolì
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Anna Biffi
- Department of Obstetrics and Gynecology, Unit of Gynecology and Obstetrics, Leopldo Mandic Hospital, Merate, ASTT, Lecco, Italy
| | - Gregorio Del Boca
- Department of Obstetrics and Gynecology, Unit of Gynecology and Obstetrics, Leopldo Mandic Hospital, Merate, ASTT, Lecco, Italy
| | - Amerigo Vitagliano
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Schützendübel M, Boosz A, Baev E, Häberle L, Müller A. Learning laparoscopic hysterectomy: analysis of different surgeons' individual learning curves. Arch Gynecol Obstet 2023; 307:1065-1072. [PMID: 36580116 DOI: 10.1007/s00404-022-06893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to examine the development of surgical skills among surgeons learning total laparoscopic hysterectomy (TLH), using differences in complication rates between surgeons with different levels of experience and analyzing the development of individual operating times. STUDY DESIGN This retrospective, single-center cohort study included 576 total laparoscopic hysterectomy procedures conducted between January 2015 and December 2019 at the municipal hospital in Karlsruhe, Germany. All TLHs were performed by eight surgeons, two of whom were experienced and six inexperienced. Complications were graded using the Clavien-Dindo classification. RESULTS No differences in complication rates were seen between experienced and inexperienced surgeons. With growing numbers of procedures, most surgeons quickly became faster, leading to reduced operating times. However, experienced surgeons who had performed more than 100 procedures also became faster, not reaching a time plateau after adjustment for weight of the uterus, presurgery score, and adnexal score. CONCLUSIONS Learning laparoscopic hysterectomy in routine practice is safe for patients, and surgeons rapidly become faster as growing numbers of procedures are performed. Operating times for experienced surgeons who have carried out more than 100 operations also improve, and a time plateau is not reached.
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Affiliation(s)
- Malte Schützendübel
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany.
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexander Boosz
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Lothar Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Ackermann J, Pahls J, Baumann J, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Laganà AS, Peters G, Pape J, Willer D, Westermann AM, Günther V, Maass N, Mettler L, Alkatout I. The pelvitrainer for training in laparoscopic surgery – A prospective, multicenter, interdisciplinary study: Experimental research. Int J Surg 2022; 101:106604. [DOI: 10.1016/j.ijsu.2022.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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Hardon SF, Rahimi AM, Postema RR, Willuth E, Mintz Y, Arezzo A, Dankelman J, Nickel F, Horeman T. Safe implementation of hand held steerable laparoscopic instruments: a survey among EAES surgeons. Updates Surg 2022; 74:1749-1754. [PMID: 35416585 PMCID: PMC9481478 DOI: 10.1007/s13304-022-01258-w] [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] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
Abstract
The complexity of handheld steerable laparoscopic instruments (SLI) may impair the learning curve compared to conventional instruments when first utilized. This study aimed to provide the current state of interest in the use of SLI, the current use of these in daily practice and the type of training which is conducted before using SLI in the operating room (OR) on real patients. An online survey was distributed by European Association of Endoscopic Surgery (EAES) Executive Office to all active members, between January 4th and February 3rd, 2020. The survey consisted of 14 questions regarding the usage and training of steerable laparoscopic instruments. A total of 83 members responded, coming from 33 different countries. Twenty three percent of the respondents using SLI, were using the instruments routinely and of these 21% had not received any formal training in advance of using the instruments in real patients. Of all responding EAES members, 41% considered the instruments to potentially compromise patient safety due to their complexity, learning curve and the inexperience of the surgeons. The respondents reported the three most important aspects of a possible steerable laparoscopic instruments training curriculum to be: hands-on training, safe tissue handling and suturing practice. Finally, a major part of the respondents consider force/pressure feedback data to be of significant importance for implementation of training and assessment of safe laparoscopic and robotic surgery. Training and assessment of skills regarding safe implementation of steerable laparoscopic instruments is lacking. The respondents stressed the need for specific hands-on training during which feedback and assessment of skills should be guaranteed before operating on real patients.
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Affiliation(s)
- S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands. .,Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - A M Rahimi
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - R R Postema
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.,Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - A Arezzo
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - J Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
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Jin C, Dai L, Wang T. The application of virtual reality in the training of laparoscopic surgery: A systematic review and meta-analysis. Int J Surg 2020; 87:105859. [PMID: 33307244 DOI: 10.1016/j.ijsu.2020.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality becomes popular in laparoscopic surgery especially in the training process. An assessment on the learning curve of virtual reality compared to other methods of training or no training needed to be carried out. MATERIALS AND METHODS A systematic literature search between 2000 and 2020 was performed through PubMed, Cochrane library's Central, Embase, Clinicaltrials.gov, and Web of Science. All randomized controlled studies included kept the consistency of participants at the baseline and set the same time or repetitions of training. This systematic review and meta-analysis was under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the methodological quality of systematic reviews(AMSTAR). RESULTS Twenty-three randomized controlled studies and five non-randomized concurrent controlled studies were included among 2692 searched studies. Virtual reality was recommended to be applied among no experience medical students or novice surgeons in the laparoscopic training. It had steeper learning curve compared to no training and traditional trainers. While there was no significant difference between virtual reality and box training or video training in the aspect of learning curve. Moreover, it seemed effective to improve the initial stage of learning curve in actual surgery. CONCLUSION Virtual reality was not the first choice to be applied into laparoscopic training and it had its applicable surgeons or medical students. The superiority of virtual reality in the skill transfer from training room into operating room needed to be confirmed and complemented with further analyses. More importantly, the cost-effectiveness of virtual reality in the training process and patient safety were badly in need of discussion.
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Affiliation(s)
- Chi Jin
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, , China; Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, China
| | - Liuyan Dai
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, , China
| | - Tong Wang
- Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, China.
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Ling JL, Teo SH, Mohamed Al-Fayyadh MZ, Mohamed Ali MR, Ng WM. Low-Cost Self-Made Arthroscopic Training Camera Is Equally as Effective as Commercial Camera: A Comparison Study. Arthroscopy 2019; 35:596-604. [PMID: 30611592 DOI: 10.1016/j.arthro.2018.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effectiveness of a low-cost self-made arthroscopic camera (LAC) in basic arthroscopic skills training compared with a commercial arthroscopic camera (CAC). METHODS One hundred fifty-three orthopaedic residents were recruited and randomly assigned to either the LAC or CAC. They were allocated 2 practice sessions, with 20 minutes each, to practice 4 given arthroscopic tasks: task 1, transferring objects; task 2, stacking objects; task 3, probing numbers; and task 4, stretching rubber bands. The time taken for participants to complete the given tasks was recorded in 3 separate tests; before practice, immediately after practice, and after a period of 3 months. A comparison of the time taken between both groups to complete the given tasks in each test was measured as the primary outcome. RESULTS Significant improvements in time completion were seen in the post-practice test for both groups in all given arthroscopic tasks, each with P < .001. However, there was no significant difference between the groups for task 1 (P = .743), task 2 (P = .940), task 3 (P = .932), task 4 (P = .929), and total (P = .944). The outcomes of the tests (before practice, after practice, and at 3 months) according to repeated measures analysis of variance did not differ significantly between the groups in task 1 (P = .475), task 2 (P = .558), task 3 (P = .850), task 4 (P = .965), and total (P = .865). CONCLUSIONS The LAC is equally as effective as the CAC in basic arthroscopic skills training with the advantage of being cost-effective. CLINICAL RELEVANCE In view of the scarcity in commercial arthroscopic devices for trainees, this low-cost device, which trainees can personally own and use, may provide a less expensive and easily available way for trainees to improve their arthroscopic skills. This might also cultivate more interest in arthroscopic surgery among junior surgeons.
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Affiliation(s)
- Jian Loong Ling
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seow Hui Teo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Mohamed Razif Mohamed Ali
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wuey Min Ng
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Yiasemidou M, de Siqueira J, Tomlinson J, Glassman D, Stock S, Gough M. "Take-home" box trainers are an effective alternative to virtual reality simulators. J Surg Res 2017; 213:69-74. [PMID: 28601335 DOI: 10.1016/j.jss.2017.02.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/17/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practice on virtual reality simulators (VRSs) has been shown to improve surgical performance. However, VRSs are expensive and usually housed in surgical skills centers that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers (BT) are inexpensive and can be used anywhere at anytime. This study assesses "take-home" BTs as an alternative to VRS. METHODS After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT), 25 surgical trainees were randomized to two groups. Trainees were asked to practice three basic laparoscopic tasks for 6 wk (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centers). After the practice period, all performed two laparoscopic cholecystectomy, one on a VRS and one on a BT; (i.e., posttraining assessment). VRS provided metrics (total time [TT], number of movements instrument tip path length), and expert video assessment of cholecystectomy in a BT (Global Operative Assessment of Laparoscopic Skills [GOALS] score) were recorded. Performance during pretraining and posttraining assessment was compared. RESULTS The BT group showed a significant improvement for all VRS metrics (P = 0.008) and the efficiency category of GOALS score (P = 0.03). Only TT improved in the VRS group, and none of the GOALS categories demonstrated a statistically significant improvement after training. Finally, the improvement in VRS metrics in the BT group was significantly greater than in the VR group (TT P = 0.005, number of movements P = 0.042, path length P = 0.031), although there were no differences in the GOALS scores between the groups. CONCLUSIONS This study suggests that a basic "take-home" BT is a suitable alternative to VRS.
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Affiliation(s)
- Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | | | - James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
| | - Simon Stock
- World Mate Emergency Hospital, Battambang, Cambodia
| | - Michael Gough
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, UK
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Yiasemidou M, Glassman D, Tomlinson J, Song D, Gough MJ. Perceptions About the Present and Future of Surgical Simulation: A National Study of Mixed Qualitative and Quantitative Methodology. JOURNAL OF SURGICAL EDUCATION 2017; 74:108-116. [PMID: 27617919 DOI: 10.1016/j.jsurg.2016.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/17/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Assess expert opinion on the current and future role of simulation in surgical education. DESIGN Expert opinion was sought through an externally validated questionnaire that was disseminated electronically. PARTICIPANTS Heads of Schools of Surgery (HoS) (and deputies) and Training Program Directors (TPD) (and deputies). RESULTS Simulation was considered a good training tool (HoS: 15/15, TPD: 21/21). The concept that simulation is useful mostly to novices and for basic skills acquisition was rejected (HoS: 15/15, TPDs: 21/21; HoS: 13/15, TPDs: 18/21). Further, simulation is considered suitable for teaching nontechnical skills (HoS: 13/15, TPDs: 20/21) and re-enacting stressful situations (HoS: 14/15, TPDs: 15/21). Most respondents also felt that education centers should be formally accredited (HoS: 12/15, TPDs: 16/21) and that consultant mentors should be appointed by every trust (HoS: 12/15, TPDs: 19/21). In contrast, there were mixed views on its use for trainee assessment (HoS: 6/15, TPDs: 14/21) and whether it should be compulsory (HoS: 8/15, TPDs: 11/21). CONCLUSION The use of simulation for the acquirement of both technical and nontechnical skills is strongly supported while views on other applications (e.g., assessment) are conflicting. Further, the need for center accreditation and supervised, consultant-led teaching is highlighted.
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Affiliation(s)
- Marina Yiasemidou
- School of Surgery, Health Education Yorkshire and Humber, Leeds Institute of Biomedical and Clinical Sciences, Leeds, West Yorkshire, United Kingdom.
| | - Daniel Glassman
- Leeds Teaching Hospitals, Leeds, West Yorkshire, United Kingdom
| | - James Tomlinson
- School of Surgery, Health Education Yorkshire and the Humber, Leeds Teaching Hospitals, Leeds, West Yorkshire, United Kingdom
| | - David Song
- Medical School, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Michael J Gough
- School of Surgery, Health Education Yorkshire and the Humber, Leeds, West Yorkshire, United Kingdom
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Fransson BA. Advances in Laparoscopic Skills Training and Management. Vet Clin North Am Small Anim Pract 2016; 46:1-12. [DOI: 10.1016/j.cvsm.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee M, Savage J, Dias M, Bergersen P, Winter M. Box, cable and smartphone: a simple laparoscopic trainer. CLINICAL TEACHER 2015; 12:384-8. [PMID: 26135242 DOI: 10.1111/tct.12380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic surgery requires different abilities to open surgery, and is challenging to learn within the confines of the operating theatre. With the development of laparoscopic surgery in modern surgery, the importance in improving these skills is becoming an increasing focus of surgical training programmes. CONTEXT The assembly of the laparoscopic trainer and exercises was performed at the University of Sydney Clinical School located at Hornsby Hospital in Sydney, Australia. The objective was to design and construct a new concept smartphone box laparoscopic trainer that is affordable and replicable, and to demonstrate its usefulness in practising laparoscopic techniques to improve skills outside of the operating theatre. INNOVATION The trainer was constructed using a personal smartphone, cardboard box, video graphics array (VGA) adaptor, VGA cable and a computer screen. Laparoscopic instruments and materials used for simulated task exercises were obtained from the operating theatre. Simulated demonstrations of simple laparoscopic tasks included suture handling, instrument knot-tying and anastomotic suture techniques. IMPLICATIONS The smartphone box trainer is inexpensive (approximately $60) and took less than 20 minutes to build. The cost was almost entirely for the VGA adaptor. The box trainer was light, portable and easily transported to any setting that provided a computer screen. It is an inexpensive, easy-to-assemble, replicable model that benefits from the advanced technology of personal smartphones, and can be easily accessed as a useful tool in learning and improving laparoscopic techniques. Laparoscopic surgery requires different abilities to open surgery.
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Affiliation(s)
- Migie Lee
- Department of Urology, Hornsby Ku-ring-Gai Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Jason Savage
- Department of Urology, Hornsby Ku-ring-Gai Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Maxwell Dias
- Department of Urology, Hornsby Ku-ring-Gai Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Philip Bergersen
- Department of Urology, Hornsby Ku-ring-Gai Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Matthew Winter
- Department of Urology, Hornsby Ku-ring-Gai Hospital, Northern Sydney Local Health District, Sydney, Australia
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Lahanas V, Loukas C, Smailis N, Georgiou E. A novel augmented reality simulator for skills assessment in minimal invasive surgery. Surg Endosc 2014; 29:2224-34. [PMID: 25303925 DOI: 10.1007/s00464-014-3930-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/27/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Over the past decade, simulation-based training has come to the foreground as an efficient method for training and assessment of surgical skills in minimal invasive surgery. Box-trainers and virtual reality (VR) simulators have been introduced in the teaching curricula and have substituted to some extent the traditional model of training based on animals or cadavers. Augmented reality (AR) is a new technology that allows blending of VR elements and real objects within a real-world scene. In this paper, we present a novel AR simulator for assessment of basic laparoscopic skills. METHODS The components of the proposed system include: a box-trainer, a camera and a set of laparoscopic tools equipped with custom-made sensors that allow interaction with VR training elements. Three AR tasks were developed, focusing on basic skills such as perception of depth of field, hand-eye coordination and bimanual operation. The construct validity of the system was evaluated via a comparison between two experience groups: novices with no experience in laparoscopic surgery and experienced surgeons. The observed metrics included task execution time, tool pathlength and two task-specific errors. The study also included a feedback questionnaire requiring participants to evaluate the face-validity of the system. RESULTS Between-group comparison demonstrated highly significant differences (<0.01) in all performance metrics and tasks denoting the simulator's construct validity. Qualitative analysis on the instruments' trajectories highlighted differences between novices and experts regarding smoothness and economy of motion. Subjects' ratings on the feedback questionnaire highlighted the face-validity of the training system. CONCLUSIONS The results highlight the potential of the proposed simulator to discriminate groups with different expertise providing a proof of concept for the potential use of AR as a core technology for laparoscopic simulation training.
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Affiliation(s)
- Vasileios Lahanas
- Medical Physics Laboratory Simulation Centre, School of Medicine, University of Athens, Mikras Asias St. 75, 11527, Athens, Greece,
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Akdemir A, Zeybek B, Ergenoglu AM, Yeniel AO, Sendag F. Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills. Int J Gynaecol Obstet 2014; 127:309-13. [DOI: 10.1016/j.ijgo.2014.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 06/24/2014] [Accepted: 08/05/2014] [Indexed: 11/17/2022]
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Furriel FTG, Laguna MP, Figueiredo AJC, Nunes PTC, Rassweiler JJ. Training of European urology residents in laparoscopy: results of a pan-European survey. BJU Int 2014; 112:1223-8. [PMID: 24053711 DOI: 10.1111/bju.12410] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments. MATERIALS AND METHODS A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012. Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated. Data was analysed with descriptive statistics. RESULTS In all, 219 European urology residents answered the survey. Conventional laparoscopy was available in 74% of the respondents' departments, while robotic surgery was available in 17% of the departments. Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least 'satisfactory'; 32% of the residents did not attend any course or fellowship on laparoscopy. Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory. The motivation to perform laparoscopy was rated as 'high' or 'very high' by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy. CONCLUSIONS Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor. Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged.
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Affiliation(s)
- Frederico T G Furriel
- Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal
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Ju R, Chang PL, Buckley AP, Wang KC. Comparison of Nintendo Wii and PlayStation2 for enhancing laparoscopic skills. JSLS 2013; 16:606-11. [PMID: 23484573 PMCID: PMC3558901 DOI: 10.4293/108680812x13462882737294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The authors suggest that these video games may be an inexpensive alternative to laparoscopic training simulators. Background and Objective: The increase in laparoscopic surgery has led to a growing need to train residents in this skill. Virtual reality simulators and box trainers have been used as educational tools outside of the operating room, but both approaches have advantages and disadvantages. Video games have been an area of interest in the search for other modalities to train residents. Experience with the traditional single controller unit video games have been correlated with better surgical skill acquisition. In 2006, Nintendo introduced the Wii, a novel gaming modality that mimics movements in laparoscopy better than traditional games do. Our objective was to compare the Nintendo Wii and PlayStation2 for enhancing laparoscopy skills. Methods: The study included stratified randomization of 23 less experienced (<12 laparoscopy cases per year) and 19 more experienced (>12 per year) physicians, residents, and medical students to 30 min of Wii versus PlayStation2 in a university-affiliated hospital Department of Obstetrics and Gynecology. Pre- and posttest bead transfer and suturing scores were obtained. Results: Baseline characteristics were similar for both video game groups. Participants assigned to Wii and PlayStation2 both demonstrated significant improvement in bead transfer. Neither Wii nor PlayStation2 participants improved in suturing scores. The Wii group improved more in bead transfer scores when compared to the PlayStation2 group (60 points vs. 40 points, respectively), but this difference was not statistically significant. Conclusions: Both Wii and PlayStation2 significantly improved laparoscopic skills in bead transfer. These video games may be inexpensive alternatives to laparoscopy training simulators.
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Affiliation(s)
- Rujin Ju
- Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC 27514, USA.
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Loukas C, Nikiteas N, Schizas D, Lahanas V, Georgiou E. A head-to-head comparison between virtual reality and physical reality simulation training for basic skills acquisition. Surg Endosc 2012; 26:2550-8. [DOI: 10.1007/s00464-012-2230-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/24/2012] [Indexed: 11/29/2022]
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Mulla M, Sharma D, Moghul M, Kailani O, Dockery J, Ayis S, Grange P. Learning basic laparoscopic skills: a randomized controlled study comparing box trainer, virtual reality simulator, and mental training. JOURNAL OF SURGICAL EDUCATION 2012; 69:190-5. [PMID: 22365864 DOI: 10.1016/j.jsurg.2011.07.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The objectives of this study were (1) to compare different methods of learning basic laparoscopic skills using box trainer (BT), virtual reality simulator (VRS) and mental training (MT); and (2) to determine the most effective method of learning laparoscopic skills. DESIGN Randomized controlled trial. SETTING King's College, London. METHODS 41 medical students were included in the study. After randomization, they were divided into 5 groups. Group 1 was the control group without training; group 2 was box trained; group 3 was also box trained with an additional practice session; group 4 was VRS trained; and group 5 was solely mentally trained. The task was to cut out a circle marked on a stretchable material. All groups were assessed after 1 week on both BT and VRS. Four main parameters were assessed, namely time, precision, accuracy, and performance. RESULTS Time: On BT assessment, the box-trained group with additional practice group 3 was the fastest, and the mental-trained group 5 was the slowest. On VRS assessment, the time difference between group 3 and the control group 1 was statistically significant. Precision: On BT assessment, the box-trained groups 2 and 3 scored high, and mental trained were low on precision. On VRS assessment, the VRS-trained group ranked at the top, and the MT group was at the bottom on precision. Accuracy: On BT assessment, the box-trained group 3 was best and the mental-trained group was last. On VRS assessment, the VRS-trained group 4 scored high closely followed by box-trained groups 2 and 3. Performance: On BT assessment, the box-trained group 3 ranked above all the other groups, and the mental-trained group ranked last. On VRS assessment, the VRS group 4 scored best, followed closely by box-trained groups 2 and 3. CONCLUSIONS The skills learned on box training were reproducible on both VRS and BT. However, not all the skills learned on VRS were transferable to BT. Furthermore, VRS was found to be a reliable and the most convenient method of assessment. MT alone cannot replace conventional training.
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Affiliation(s)
- Mubashir Mulla
- King's College Hospital, Denmark Hill, London, United Kingdom.
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Bonrath EM, Weber BK, Fritz M, Mees ST, Wolters HH, Senninger N, Rijcken E. Laparoscopic simulation training: Testing for skill acquisition and retention. Surgery 2012; 152:12-20. [PMID: 22341719 DOI: 10.1016/j.surg.2011.12.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 12/23/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Simulation in laparoscopy leads to skill acquisition. Although many curricula for simulation training have been described, the nature of skill deterioration remains unclear. We evaluated skill acquisition and retention after laparoscopic simulation training. METHODS Thirty-six novices in surgery (medical students) underwent a 5-day curriculum consisting of 9 skills of increasing complexity. Each subject underwent baseline and post-training evaluation after completion of the course. Skill retention testing was measured after 6 weeks (group 1; n = 18) and after 11 weeks (group 2; n = 18). Neither group had access to a training facility during this interval. Task completion was measured in time (s) with penalties for inaccurate performance. RESULTS Comparison of the baseline and post-training values revealed a significant learning outcome for all exercises in both groups (P < .001). In group 1, skill retention testing found no significant decrease in skill level when compared to post-training values in all but 1 task (extracorporeal knot tying; P = .007). In group 2, differences between skill retention and post-training evaluation were observed for 5 of the 9 tasks (transfer task, positioning, loop tie, extracorporeal knot, and intracorporeal knot; P ≤ .05 for each). CONCLUSION Basic laparoscopic skills can be learned successfully by novices in surgery using a compact curriculum. These skills are retained for at least 6 weeks. Eleven weeks after initial training, skill deterioration is likely, and therefore an opportunity for practice and repetition is desirable.
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Affiliation(s)
- Esther M Bonrath
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
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Current world literature. Curr Opin Urol 2011; 22:78-82. [PMID: 22143440 DOI: 10.1097/mou.0b013e32834ec873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks. Wideochir Inne Tech Maloinwazyjne 2011; 7:27-32. [PMID: 23255997 PMCID: PMC3516962 DOI: 10.5114/wiitm.2011.25666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 09/14/2011] [Accepted: 10/12/2011] [Indexed: 01/22/2023] Open
Abstract
Introduction In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. Material and methods The study included 34 students who completed the authors‘ laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. Results The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. Conclusions Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress.
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Paige JT, Yang T, Suleman R, Chauvin S, Alleyn J, Brewer M, Hoxsey R. Role of Instruction Method in Novices' Acquisition of Minimally Invasive Surgical Basic Skills. J Laparoendosc Adv Surg Tech A 2011; 21:711-5. [DOI: 10.1089/lap.2010.0392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John T. Paige
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tong Yang
- Office of Medical Education, Research and Development, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Rabiya Suleman
- Specialists in Women Care, HCA Midwest Physicians, Shawnee, Kansas
| | - Sheila Chauvin
- Office of Medical Education, Research and Development, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jaime Alleyn
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Martha Brewer
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Rodney Hoxsey
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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