Value of orientation training in laparoscopic cholecystectomy

Abstract

It is well established that disorientation during laparoscopic operations such as cholecystectomy is associated with increased morbidity and mortality. The aim of the present study was to evaluate whether high-performance orientation strategies could be taught to a cohort without relevant experience of laparoscopic cholecystectomy, resulting in improved performance and spatial awareness, thereby reducing the need for operative experience to command this skill. Thirty medical students participated in a randomized controlled trial, with half randomized to a tutorial teaching orientation strategies at specific stages of laparoscopic cholecystectomy and half to a control group without any teaching. Attention as represented by gaze was captured using eye tracking as subjects were presented with 12 images of various stages of the operation, with the task of interpreting the orientation of the image. The primary outcome measure was subject performance in orientation. Secondary outcome measures were gaze dwell time on relevant anatomical structures within the images and comparison of individual behaviour using a visual behaviour profiling algorithm. The intervention group was significantly more likely to orientate correctly than the control group (mean 75·6 versus 56·1 per cent; P = 0·019). A difference in visual attention behaviour between the two groups was apparent for the majority of images when examining the output of the visual profiling algorithm, in the form of increased homogeneity of visual behaviour and/or an overall difference in orientation strategy. The mean orientation rate of all surgeons under identical conditions in a previously published study was 78·6 per cent. Training novices in orientation strategies improved their performance significantly and it could reach the level of a surgeon with several years of experience in laparoscopic surgery.