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Adnane I, Chahbi M, Elbelhadji M. [Virtual simulation for learning cataract surgery]. J Fr Ophtalmol 2020; 43:334-340. [PMID: 31987677 DOI: 10.1016/j.jfo.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/10/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The training in phacoemulsification cataract surgery in our context requires a long learning curve for a novice surgeon starting from the observation period to the realization of the different operating stages being supervised by a senior surgeon, all under stressful conditions. Topical or locoregional anesthesia limits the communication in the operating room between the novice surgeon and his mentor; thus, increasing the risk of having more operative complications. To reduce the teaching time of cataract surgery, our department has introduced virtual simulator trainings for phacoemulsification. PURPOSE OF THE STUDY To assess the impact of surgical simulator training on residents' performances. MATERIAL AND METHODS We conducted a prospective comparative study in our department in partnership with a private ophthalmology clinic where the simulator is installed. Twelve residents were included in this study, six of them were randomly selected to participate in the phacoemulsification surgical simulator training while the others never used the simulator. The training lasted 30 hours in total. No residents had previous training in phacoemulsification. The parameters studied were: the operating time, the achievement of a circular capsulorhexis of 5-6mm in diameter and well centered, the number of capsular breaks with or without an anterior vitrectomy and finally the accumulated dissipated energy (EDC). The cataract surgery was performed on an Alcon Centurion platform. RESULTS In the operating room, each resident operated 25 cataracts; we compared the two user groups including the simulator and non simulator user and we noticed a statistically significant difference (P<0.05) in terms of average operating time respectively 20 minutes and 37 minutes. Regarding the realization of capsulorhexis; 22 cases of rhexis wandering and 12 poorly centred rhexis on 150 operated cataracts were identified (22.7%) in the group of residents who received no simulator training versus 10 cases in the simulator user group (6.7%). The cumulative dissipated energy (EDC) was significantly lower in the simulator user group (8.1 versus 18.7). The same is true for the rate of posterior capsular rupture, which is higher in the non-user group of simulator 37 cases (24.6%) versus 10 cases (8%) in the second group. DISCUSSION Ophthalmic surgery has benefited from the introduction of endo-ocular surgical simulation tools through simulators of vitreoretinal surgery and phacoemulsification; whose main role is primarily pedagogical because a simulator allows young residents to acquire dexterity and autonomy over a shortened period of time in addition to minimizing the risk of complications. CONCLUSION Initial learning of phacoemulsification cataract surgery should be an integral part of the virtual simulator program before moving to the real conditions of the operating room as it allows for better operative performance with a minimal complication rate.
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Affiliation(s)
- I Adnane
- Service d'ophtalmologie adulte, hôpital du 20-Août-1953, faculté de médecine et de pharmacie, université Hassan II, CHU Ibn Rochd, Casablanca, Maroc
| | - M Chahbi
- Clinique de l'œil de Casablanca, Maroc
| | - M Elbelhadji
- Service d'ophtalmologie adulte, hôpital du 20-Août-1953, faculté de médecine et de pharmacie, université Hassan II, CHU Ibn Rochd, Casablanca, Maroc
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Madec FX, Dariane C, Pradere B, Amadane N, Bergerat S, Gryn A, Lebacle C, Matillon X, Olivier J, Nouhaud FX, Panayotopoulos P, Peyronnet B, Rizk J, Sanson S, Seisen T, Salomon L, Fiard G. [French resident's performance on laparoscopic surgery box trainer: 7-year results of pelvitrainer contests]. Prog Urol 2016; 26:1171-1177. [PMID: 28279367 DOI: 10.1016/j.purol.2016.09.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study objectives were to analyze the resident's laparoscopic surgery performance in order to build a self-assessment data set, to identify discriminatory exercises and to investigate the suturing time changes. METHODS From 2007 to 2014, the French Association of Urologist in Training (AFUF) organized 7 pelvitrainer contests. Participant scores on 11 laparoscopic surgery exercises were evaluated. RESULTS Sixty-six residents participated to these contests and performed 11 exercises each. Twenty-two (33.3 %) participants were beginners, 26 (39.4 %) intermediates et 18 (27.3 %) experienced. The participant scores were gathered into a data set including the average time per exercise. We found a time scoring improvement related to the resident experience for all exercises. A significant decline in time was noted for exercise 8 and 9 between beginners and intermediates (139s [±71]), (173.9s [±118.3]) and between beginners and experienced (80.6s [±26.7]), (94,1s [±42.7]) with a P<0.05. The correlation coefficient for the exercise 11 duration (vesico-uretral anastomosis) was 0.04 over a 7-year period (P=0.44). CONCLUSION The study provided a data set on 11 laparoscopic surgery tasks which can be consulted by all residents as a reference in a self-assessment process. Two exercises (8 and 9) discriminated beginners from intermediates and experienced groups and could be used as a benchmark ahead of an operating room procedure. The vesico-uretral anastomosis duration (exercise 11) did not improve significantly between 2006 and 2014. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F-X Madec
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - C Dariane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Pradere
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - N Amadane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France
| | - S Bergerat
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Gryn
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - C Lebacle
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - X Matillon
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et chirurgie de la transplantation, hôpital Édouard-Herriot, centre hospitalier universitaire de Lyon, 3, place d'Arsonval, 69003 Lyon, France
| | - J Olivier
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - F-X Nouhaud
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rouen Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - P Panayotopoulos
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - B Peyronnet
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - J Rizk
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - S Sanson
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - T Seisen
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, université Pierre-and-Marie-Curie, 75013 Paris, France
| | - L Salomon
- Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - G Fiard
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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