Abstract
ObjectivesTo develop a wet laboratory training model for learning core laparoscopic surgical skills and evaluating learners’ competency level outside the operating room.MethodsParticipants completed three tasks (task 1: tissue dissection around the aorta; task 2: tissue dissection and division of the renal artery; task 3: renal parenchymal closure). Each performance was video recorded and subsequently evaluated by two experts, according to the Global Operative Assessment of Laparoscopic Skills and task‐specific metrics that we developed (Assessment Sheet of Laparoscopic Skills in Wet Lab score). Mean scores were used for analyses. The subjective mental workload was also assessed (NASA Task Load Index).ResultsThe 54 participants included 32 urologists, eight young trainees and 14 medical students. A total of 13 participants were categorized as experts (≥50 laparoscopic surgeries), eight as intermediates (10–49) and 33 as novices (0–9). There were significant differences in the Global Operative Assessment of Laparoscopic Skills and Assessment Sheet of Laparoscopic Skills in Wet Lab scores among the three groups in all three tasks. Higher NASA Task Load Index scores were observed in novices, and there were significant differences in tasks 1 (Kruskal–Wallis test, P = 0.0004) and 2 (P = 0.0002), and marginal differences in task 3 (P = 0.0745) among the three groups.ConclusionsOur training model has good construct validity, and differences in the NASA Task Load Index score reflect previous laparoscopic surgical experiences. Our findings show the ability to assess both laparoscopic surgical skills and mental workloads, which could help educators comprehend trainees’ level outside the operating room. Given the decreasing opportunity to carry out pure laparoscopic surgeries because of the dissemination of robotic surgery, especially in urology, our model can offer practical training opportunities.
Highlights
Because of precise movements of instruments based on tremor filtration and motion scaling, high-definition 3-D vision and better ergonomics of the surgeon’s console, robot-assisted surgery has been widely utilized in various surgical specialties.[1–5] In urology, the numbers of robot-assisted prostatectomies, cystectomies and partial nephrectomies are continuously increasing, resulting in decreasing opportunities for young trainees to carry out pure laparoscopic procedures.[1,6,7] This trend will continue, but we consider that essential laparoscopic surgical skills are still necessary; for example, to cope with intra-abdominal adhesion at the time of port placement or robot-malfunction, and when taking an assistant’s role during robotic surgery
We evaluated the usefulness of our training model to evaluate laparoscopic surgical skill levels and mental workloads of participants outside operating theaters
To help young trainees learn a broad range of techniques in laparoscopic surgery, such as grasping tissue, tissue traction and dissection, applying a Hem-o-lok clip, and suturing/knotting, we started the present wet lab training using the three aforementioned tasks
Summary
Because of precise movements of instruments based on tremor filtration and motion scaling, high-definition 3-D vision and better ergonomics of the surgeon’s console, robot-assisted surgery has been widely utilized in various surgical specialties.[1–5] In urology, the numbers of robot-assisted prostatectomies, cystectomies and partial nephrectomies are continuously increasing, resulting in decreasing opportunities for young trainees to carry out pure laparoscopic procedures.[1,6,7] This trend will continue, but we consider that essential laparoscopic surgical skills are still necessary; for example, to cope with intra-abdominal adhesion at the time of port placement or robot-malfunction, and when taking an assistant’s role during robotic surgery. The numbers of robot-assisted prostatectomies, cystectomies and partial nephrectomies are continuously increasing, resulting in decreasing opportunities for young trainees to carry out pure laparoscopic procedures.[1,6,7]. This trend will continue, but we consider that essential laparoscopic surgical skills are still necessary; for example, to cope with intra-abdominal adhesion at the time of port placement or robot-malfunction, and when taking an assistant’s role during robotic surgery. Angell et al reported that in a laparoscopic and na€ıve cohort (medical students), intensive laparoscopic training in basic laparoscopic skills reduced the time required to carry out the task (pattern cutting) robotically, as well as reduced the number of errors.[8]
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