An analysis of the correlation between the efficacy of training using a high-fidelity disease-specific simulator and the clinical outcomes of laparoscopic surgery for congenital biliary dilatation in pediatric patients.

Abstract

The present study clarified the efficacy of repeating laparoscopic surgery training using a disease-specific simulator and investigated the clinical outcomes of laparoscopic surgery for congenital biliary dilatation (CBD) in pediatric patients after training. A high-fidelity laparoscopic hepaticojejunostomy simulator was used. Four pediatric surgeons performed practice laparoscopic hepaticojejunostomy three times using the simulator. The details of forceps manipulation during the task were analyzed. The clinical outcomes of 13 CBD cases treated with laparoscopic surgery in our institution were also evaluated based on medical records. The time required to complete the task became significantly shorter each successive time (1st: 1062.18 ± 346.79s vs. 3rd: 717.44 ± 260.80s, p = 0.039). There were no significant differences in the total path length of the right forceps (1st: 55.56 ± 23.21m vs. 3rd: 28.25 ± 17.01m, p = 0.17), total path length of the left forceps (1st: 47.79 ± 20.79m vs. 3rd: 31.83 ± 17.62m, p = 0.17), average velocity of the right forceps (1st: 58.78 ± 21.29mm/s vs.44.98 ± 10.25mm/s, p = 0.47), or the average velocity of the left forceps (1st: 50.39 ± 19.25mm/s vs. 52.26 ± 19.59mm/s, p = 0.78). Regarding the clinical outcome, all CBD patients underwent laparoscopic surgery performed by practiced pediatric surgeons who had no experience. The operative time was 545.53 ± 91.01min, and the blood loss was 24.2 ± 25.8ml. There were no cases of open conversion, intraoperative adverse events, or anastomotic leakage. Disease-specific simulator training significantly decreased the task performance time by improving the forceps manipulation economy. In addition, simulator training may improve the operative safety and quality of laparoscopic hepaticojejunostomy in pediatric CBD patients.