The influence of a ‘take home’ box trainer on laparoscopic performance for gynaecological surgeons

Abstract

Laparoscopic surgery requires a unique set of technical skills. There is emphasis on increasing patient safety, and therefore, a growing need to improve laparoscopic training. The aim of this study is to determine if the use of a ‘take-home’ box trainer would improve gynaecological surgeon performance. Thirteen obstetricians and gynaecologists (consultants and registrars) were enrolled to receive 6 months formal laparoscopic training using a ‘take-home’ box trainer. Laparoscopic skills were objectively assessed using a virtual reality haptic-enhanced simulator prior to commencement and at the completion of the course utilising three defined exercises (locating and coordinating, tissue manipulation and object positioning) where task duration, path length, economy of movement, hand dominance and overall score were assessed. Data is presented as mean ± SEM and differences between groups evaluated with ANOVA. All 13 gynaecologists completed the programme. For tissue manipulation, laparoscopic training using the box trainer reduced the task duration (214.8 ± 16.5 s vs. 147.7 ± 12.6 s, P = 0.04) and increased economy of movement (22 ± 7.1% vs. 78.9 ± 2.3%, P < 0.001) and overall score (11.7 ± 3.1% vs. 33.7 ± 1.8%, P < 0.001). For object positioning, laparoscopic training with the box trainer reduced task duration (280.1 ± 40.3 s vs. 106.6 ± 5.1 s, P < 0.001) and path length (825.3 ± 48.3 cm vs. 463.4 ± 16.8 cm, P < 0.001) and increased overall score (4.15 ± 1.7% vs. 15.2 ± 2%, P < 0.001). The box trainer did not significantly affect laparoscopic locating and coordinating or change hand dominance. Formal training and continuous practice using the box trainer model improves surgical skills required for laparoscopic surgery. The box trainer could be a more accessible and preferred tool for those training to become laparoscopic surgeons.