Perceptions of Competition-Based Learning After a Brief Experience at a National Surgical Meeting

BACKGROUND

Competition-based learning (CBL) facilitates learning through competitions. At the 2022 & 2023 Annual SAGES meetings, we evaluated a CBL experience (TOP GUN Shootout) developed from a modified version of the previously validated TOP GUN Laparoscopic Skills and Suturing Program. The project sought to evaluate the TOP GUN Shootout's (TGS) ability to enhance participant engagement in pursuit of laparoscopic surgical skills.

METHODS

Participants competed in the TGS. Their scores (time and errors) were recorded for: Fundamentals of Laparoscopic Surgery Peg Pass, Cup Drop Task, and Intracorporeal Suturing. All participants completed a 10-question satisfaction survey on a 7-point Likert scale, with questions assessing 3 domains: (1) capability/confidence in MIS skill performance prior to the competition; (2) applicability and satisfaction with TGS's capacity to develop MIS skills; and (3) interest in seeking additional MIS training and appropriateness of CBL in MIS training. Descriptive statistics were used to evaluate these areas.

RESULTS

Overall, 121 participants completed the TGS, of whom 84 (69%) completed the satisfaction survey. The average age was 32.9 years, 67% were males. On average (+/- SD), participant satisfaction was 5.04 (+/- 2.08) for Domain 1, 6.20 (+/- 1.28) for Domain 2, and 6.58 (+/- .95) for Domain 3.

CONCLUSION

Participants described an overall lack of confidence in their MIS skills prior to the 2022-2023 Annual SAGES conference. Participants felt that this brief CBL experience, aided in the development of their MIS skills. Furthermore, this brief CBL experience may inspire learners to seek out further training of their MIS skills.

Laparoscopic Myomectomy

Laparoscopic myomectomy is minimally invasive treatment for patients suffering from fibroids, especially those wishing to maintain their fertility sparing potential. While this surgery requires intensive training in surgical skills such as intracorporeal suturing and specimen extraction, patients can also expect less adhesion and a quick return to normal activity. This surgery can be broken into three stages, each presenting its own specific and unique challenges—enucleation, reapproximation of the myoma bed, and specimen extraction. To prepare for the broad spectrum of cases where the size and number of fibroids can differ greatly, we have mastered several techniques for each stage of the procedure. To keep the surgery safe, we train for unexpected scenarios by practicing minimally invasive repair and reconstruction techniques. By following basic tenets and understanding the laparoscopic anatomy, we define the targets and boundaries of our dissection to ensure completeness. In this paper, techniques for the enucleation, reapproximation, and extraction will be presented in detail.

Laparoscopic repair of diaphragmatic defect by total intracorporeal suturing: clinical and technical considerations

OBJECTIVE

The use of laparoscopy in urology is increasing. Tumor of the kidney or adrenal gland and, in some cases, metastatic disease can involve the diaphragm. We describe the application of laparoscopic suturing techniques in the case of diaphragmatic involvement with a renal tumor.

METHODS

After resection of the tumor and a small area of the diaphragm, a chest tube was placed under laparoscopic guidance. The tube was kept clamped until the end of the procedure. Decreasing intraabdominal pneumoperitoneum pressure made suturing easier with less tension on the edges of the diaphragmatic incision. Nonabsorbable interrupted horizontal mattress sutures were placed to close the diaphragmatic defect.

RESULTS

The repair was uneventful; no intraoperative complications occurred. Extubation was done at the end of the procedure in the operating room. The chest tube was removed on postoperative day 2, and the patient was discharged on postoperative day 3.

CONCLUSIONS

Laparoscopic repair of the diaphragm should be commensurate with traditional open surgical principles. In this regard, it is essential that surgeons interested in performing "advanced" laparoscopic oncologic surgery become facile in laparoscopic suturing.

Image rotation and reversal--major obstacles in learning intracorporeal suturing and knot-tying

BACKGROUND AND OBJECTIVES

A major stumbling block to teaching and learning the finer skills of laparoscopy is related to the "optical illusions" the video camera plays on the surgeon's eyes. Until now, the belief was that lack of coordination was the result of depth perception deficiencies resulting from the two dimensional plane of the video monitor. In reality, this is a minor problem that is easily surmounted with practice. A closer analysis of how organ orientation at the operative site compares to the video camera's fields of focus reveals the real problem: the major optical difference between laparotomy and laparoscopy involves rotation of the images received by the brain.

CONCLUSIONS

There are four major operating positions in laparoscopy: camera position, right camera position, left camera position and opposite camera position. The object in front of the camera has two components; the first, a reality image, which results from light reflected off the object as it exists in time and space. The second, a visual image, which represents the actual light entering our eyes. At right camera position the visual image is a 90 degrees counter-clockwise rotation of the reality image. At the left camera position the visual image is a 90 degrees clockwise rotation of the reality image. At opposite camera position, a 180 degrees rotation and complete reversal of the reality image occurs. It is only at camera position that the visual image is equal to the reality image, and we approach a scenario similar to that found in laparotomy. Every other position will be unlike what we were accustomed to in open surgery.