Abstract
To analyze the applicability and efficiency of a multi-approach laparoscopic training in improving basic laparoscopic skills of obstetrics and gynecology (OBGYN) residents. Cross-sectional, observational and descriptive study, developed at the Experimentation and Surgery Training Center (CETEC, in the Portuguese acronym) of the Hospital Israelita Albert Einstein with OBGYN residents. Theoretical and practical tests were applied to 24 OBGYN residents to assess their laparoscopic skills before and after their participation in an 8-week course. The course involved theoretical lectures and practical laparoscopic surgery exercises developed using rubber models, black boxes, virtual simulators and animal models (pigs). There was an overall improvement in the ability of the residents, with an increase in the number of correct answers in the theoretical evaluation and decrease in the time needed to perform practical tests (needle holder assembly and laparoscopic node). The course was evaluated by the students as highly relevant for both improving their surgical skills and motivating them to continue practicing. Laparoscopic training using multiple approaches resulted in significant improvement of surgical skills with a high satisfaction level of the participants. Further studies are still needed to measure the long-term retention of these acquired skills.
Highlights
Throughout past decades, laparoscopy (LP) became the first access choice for different procedures and specialties, as it provides, among other advantages, faster recovery, less pain and lower hospitalization length to the patients, in a way that there has been an increase in the use of minimally invasive access routes in surgery.[1,2]To be able to perform a laparoscopic surgery, a learning curve is required, as there is a need to develop and improve nonintuitive psychomotor functions, such as performing tasks under indirect vision and proprioception and handling with laparoscopic graspers.[3,4] It is crucial to all learning surgeons to practice these basic abilities before applying them to their patients
Laparoscopic training using multiple approaches resulted in significant improvement of surgical skills with a high satisfaction level of the participants
24 students were included in the study and answered the tests, but 3 of them were posteriorly excluded, 1 for being one of the authors of the study, and 2 students due to absence in the post-course test; the final analysis was conducted with a total of 21 participants, as shown in the workflow of selection (►Fig. 3)
Summary
Throughout past decades, laparoscopy (LP) became the first access choice for different procedures and specialties, as it provides, among other advantages, faster recovery, less pain and lower hospitalization length to the patients, in a way that there has been an increase in the use of minimally invasive access routes in surgery.[1,2]To be able to perform a laparoscopic surgery, a learning curve is required, as there is a need to develop and improve nonintuitive psychomotor functions, such as performing tasks under indirect vision and proprioception and handling with laparoscopic graspers.[3,4] It is crucial to all learning surgeons to practice these basic abilities before applying them to their patients. Different models are used during practice and some of them are low-cost models, such as rubber models and indirect vision boxes; others have higher cost, such as animals, virtual simulators and human cadavers. It seems to be consensus in the literature that the most technological or complex ones are as effective as simpler models, when the main objective is the development of the majority of the tasks, except for transferring objects between graspers or reproducing realistic scenarios.[5,6,7]
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