Toward Optimal Learning of the Gesture in Laparoscopic Surgery: Methodology and Performance.

Marine Cau,Med Amine Laribi,Cyril Breque,Amaël Arguel,Nathalie Huet,Juan Sandoval,Jerome Cau

doi:10.3390/jcm11051398

Abstract

Classical surgical education has to face both a forensic reality and a technical issue: to train a learner in more complex techniques in an increasingly short time. Moreover, surgical training is still based on an empirical hierarchical relationship in which learners must reproduce a sequence of actions in a situation of strong emotional pressure. However, the effectiveness of learning and its quality are linked to the emotional states in which learners find themselves. Among these emotions, epistemic confusion can be found that arises in complex learning situations where there is a cognitive imbalance related to the comprehension of the task, and which results from a rupture between the pre-established patterns of the learner and the new learning task. Although one knows that confusion can have a beneficial or a negative impact on learning, depending on whether it is well regulated or not, the factors that can influence it positively are still poorly understood. Thus, the objective of this experiment is to assess the impact of confusion on the learning of a surgical procedure in an augmented reality context and to determine if this impact varies according to the feedback given to the learners and according to the occurrence of disruptive events. Medical externs were recruited (N = 15) who were required to perform a suturing task on a simulator and whose performance was measured using a Motion Capture (MoCap) system. Even though the statistical analyzes did not allow a conclusion to be reached, the protocol already established makes it possible to consider a longer-term study that will allow (by increasing the number of sessions and the number of participants) more significant results to be obtained in order to develop new surgical learning protocols. This preliminary study opens a new field of research on the influence of epistemic emotions, and more particularly of confusion, which is likely to upset traditional surgical teaching, and is based on negative conditioning and strong emotions with negative valence as well as stress and coercion.

Highlights

The development of new complex surgical techniques such as laparoscopic surgery and robot-assisted surgery is more demanding for trainees and requires specific training [1–3]
There were no statistically significant differences between the control group (CG), NSEB, and Self-Efficacy Belief” (SEB) groups concerning the gesture performance whether it was for the suture score (H (11) = 8, p = 0.2) or the gesture score (H (44) = 44, p = 0.5)
In order to show the effectiveness of using the motion capture and illustrate experimental results

Summary

Introduction

The development of new complex surgical techniques such as laparoscopic surgery and robot-assisted surgery is more demanding for trainees and requires specific training [1–3]. This training, based mainly on simulators, is becoming mandatory to acquire the necessary skills, and to gain security for the patients. If optimizing the acquisition of these technical skills would reduce the learning curve [1], education on simulation does not take into account all the components necessary to react in the context of an operation. If the training on a simulator is fit to acquire new skills for the trainees, it does not allow learning in real situations

Objectives

Results

Discussion

Conclusion