Current State of Training and Evaluation of Laparoscopic Surgical Skills

Ganni S

doi:10.16966/2470-0991.148

Abstract

__Objective:__ The aim of this study is to understand the current state of training practices and evaluation in laparoscopic surgery in a global context. __Design:__ An open-ended three part questionnaire was designed to gather the opinions about the current state of, adequacy of, and the need for a standard in laparoscopic surgical training. __Participants:__ Members of the European Association for Endoscopic Surgery (EAES), Endoscopic and Laparoscopic Surgeons of Asia (ELSA) and Association of Surgeons of India (ASI) were asked to participate in the survey. __Results:__ Of the 663 responses received, 83.6% were surgeons (64.6% in a teaching position) and 12.6% were surgical residents in training. Most respondents (75.4%) had performed over 200 laparoscopic procedures. Most (72.1%) training programs were approved/endorsed by local surgical associations or government health authorities and of the courses taught by surgical associations the majority had certified trainers (71.1%). In lower Human Development Index (HDI) countries significantly less courses are taught by certified trainers (68.2% versus 54.6%, p<0.001). Only 26.8% stated that their respective government health authorities participated in the certification of laparoscopic surgery; certification was considered important by 63.6%. However, only 17.8% of government health authorities contributed to ensure the quality of laparoscopic training, mostly in very high HDI. Only 3.3% of respondents considered the laparoscopic training and education in their country to be optimal and 51.9% rated it insufficient. Most respondents (86.3%) stated that there is a need for the standardization of laparoscopic training and 88.3% stated that standardization of laparoscopic training is important. __Conclusion:__ Regardless of demographic and experience factors, there was a general consensus that that there is a need for standardisation in mandatory training of laparoscopic surgical skills, although currently not obligatory in most countries.

Highlights

Minimal-access surgery (MAS) has revolutionized the field of surgery over the past few decades; it is considered to be the gold-standard for many surgical procedures, due to the numerous benefits it offers to patients [1,2,3]
The countries were divided in two groups based on their Human Development Indicators ranking, in which the first group had a Very High Human Development Index (HDI), and the remaining were in the second group, those countries with High, Medium or Low HDI (26 countries, n=202 participants) (Figure 2)
26.8% stated that their respective government health authorities participated in the certification of laparoscopic surgery with no difference between the HDI-grouped data with a U leading to p>0.05 in each case

Summary

Introduction

Minimal-access surgery (MAS) has revolutionized the field of surgery over the past few decades; it is considered to be the gold-standard for many surgical procedures, due to the numerous benefits it offers to patients [1,2,3]. Multiple models have been developed to train laparoscopic skills via simulation, including box trainers, animal models, virtual reality (VR) and augmented reality (AR) simulators [7,8,9,10]. The skills acquired by using simulator training have been proven by numerous studies, which show an effective transfer to the operating theatre [11,12,13,14]. Despite this strong evidence that proves the efficacy of training, several reports state the underutilization of simulation and lack of integration within the standard surgical residency training programs [15,16,17]. Chang et al [18], report that simulation based training curricula should be a mandatory part of the residency curricula

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Discussion

Conclusion