Acquisition Of Laparoscopic Skills Research Articles

SP1.13 - An Overview of Laparoscopic Surgical Training Modalities – How Does Augmented Reality Simulation Compare?

Abstract Background Laparoscopic surgery is known to require intensive training to gain the required skills and with the increasing popularity of laparoscopic surgery over open surgery requires novel and efficient ways of training. AR is a novel introduction to laparoscopic surgical training and can superimpose digital images and physical models with the unique advantage of combining visual realism with true-to-life haptic feedback. Methods Compare different types of laparoscopic training modalities and assess how AR compares to the education system, 31 papers were systematically reviewed, and the findings were compiled. Results Both the available products as well as the technology as an educational modality were evaluated. Results Studies reported relatively increased speed of learning, improved ability to multitask, procedural accuracy, hand-eye coordination and bimanual operation in a reduced practice time and increased success rate with AR in healthcare education. One of the limitations of AR is that it doesn’t reflect the non-technical skills required in the operation. Compared with other modalities AR provided faster skill acquisition and was widely preferred, except when compared against a human cadaver model for straight laparoscopic colorectal skills acquisition. AR tends to have a higher initial purchasing cost but does not require the costly specialist facilities or services that cadaver or animal models do, 150 trusts in the NHS preliminary data is showing an estimated annual saving of £117m. Conclusion AR simulation has the potential to become the new gold standard for laparoscopic surgical training, and beyond, pending further development of literature to increase knowledge of the technology and its capabilities, on top of technological evolution to increase clinical realism.

Be prepared! Impact of structured video-assisted coaching on performance in a simulated bleeding exercise during laparoscopic surgery.

Bleeding during laparoscopic surgery is stressful and requires immediate efficient management. Skills for complication management are rarely trained. This study aims to investigate the impact of video-assisted coaching on laparoscopic skills acquisition and performance in emergency bleeding situations. Participants faced simulated emergency scenarios during laparoscopy involving bleeding management in porcine aorta/kidney specimens. Four sequences were conducted over two days, with a structured video-assisted coaching provided between sequences. Performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. The study involved 27 participants attending the advanced colorectal surgery module at the 40th Annual Davos Course in 2023. 54 video sequences were analyzed. Structured video-assisted coaching improved the GOALS sum score by 0.36 (95%CI: 0.21-0.50, P < 0.001) in contrast to simple repetition (0.05 with 95%CI: -0.43 to 0.53, P = 0.826). This association was observed for depth of perception (P < 0.001), bimanual dexterity (P < 0.001), tissue handling (P < 0.001), overall performance (P < 0.001), and efficiency (P < 0.001). Autonomy did not significantly improve (P = 0.55). Findings were consistent regardless of age, gender, and overall laparoscopic experience of the participants. However, a weaker effect of structured video-assisted coaching was observed in participants with experience in laparoscopic surgery. Structured video-assisted coaching improved performance in laparoscopic skills in complex and stress-inducing bleeding scenarios. The findings of this study support the incorporation of video-assisted coaching and complication management exercises into surgical training curricula.

862 An Overview of Laparoscopic Surgical Training Modalities – How Does Augmented Reality Simulation Compare?

Abstract Aim Compare different types of laparoscopic training modalities and assess how AR compares to the education system using the apprenticeship model on patients and alternative training modalities, including human cadavers, box trainers, and virtual reality (VR) simulators. AR is a novel introduction to laparoscopic surgical training and can superimpose digital images and physical models with the unique advantage of combining visual realism with true-to-life haptic feedback. Method 31 papers were systematically reviewed, and the findings were compiled. Results for the available products and the technology as an educational modality were evaluated. Results Studies reported increased speed of learning, improved ability to multitask, procedural accuracy, hand-eye coordination and bimanual operation in a reduced practice time and increased success rate with AR in healthcare education. One of the limitations of AR it doesn’t reflect the non-technical skills required in the operation. Compared with other modalities AR provided faster skill acquisition and was widely preferred, except when compared to the cadaver model for straight laparoscopic colorectal skills acquisition. AR tends to have a higher initial purchasing cost but does not require the costly specialist facilities or services that cadaver or animal models do, 150 trusts in the NHS preliminary data show an estimated annual saving of £117m. Conclusions AR simulation has the potential to become the new gold standard for laparoscopic surgical training, and beyond, pending further development of literature to increase knowledge of the technology and its capabilities, on top of technological evolution to increase clinical realism.

Medical students and residents of both sexes have similar learning curves for laparoscopy simulator training

BackgroundSimulation-based laparoscopy training is a standard part of modern surgical education. Studies focused on optimizing training for surgical residents have often used medical students as study participants. This has been criticized as medical students might have different prerequisites for surgical skills training due to their limited knowledge and exposure to real-life laparoscopic procedures. Simulation-based training has also been criticized for favouring male trainees due to its resemblance with video games and focus on competition. This study aimed to investigate if there is any difference in skills acquisition between novice surgical residents and medical students for proficiency-based laparoscopic training. Furthermore, to examine if there was a difference between male and female participants. MethodWe did a post-hoc study combining data from 59 participants from four previously published randomized trials. We compared residents with medical students and females with male participants across studies with identical training programs. ResultsThe median time to reach proficiency in the first training program comparison was 295 (IQR: 269-357) and 318 (241-445) minutes, respectively, for the residents and medical students (p=0.87). Male trainees spent 323 (IQR: 281-371) minutes to reach proficiency compared to 318 (IQR: 241-445)minutes for females (p=0.73). In the second training program comparison, the residents and medical students spent 169 (IQR: 123-229) and 165 (IQR: 128-214) minutes (p=0.67), respectively, reaching proficiency. The times for males and females were 166 (IQR: 61-151)minutes and 169 (61-117) minutes, respectively (p=0.74). ConclusionSimilar learning curves were observed for laparoscopic skills acquisition for residents and medical students. No difference was observed between male and female participants for proficiency-based laparoscopy simulator training.

The impact of video gaming and playing a musical instrument on robotic surgical simulator performance - the Robotic Surgical Simulator Study (RS3)

BackgroundA personal history of video gaming has been associated with improved laparoscopic skills acquisition in some but not all studies. The impact of playing a musical instrument on laparoscopic or robotic proficiency is less investigated. MethodsThis study evaluates the impact of video gaming, playing a musical instrument, and other demographic parameters on robotic simulator proficiency in a cohort of 27 participants. Candidates performed 3 standardized exercises on a virtual reality robotic training platform, resulting in a proficiency score. After completing a detailed survey, participants repeated the standardized exercises to obtain a basic learning curve. Gaming history, playing a musical instrument, surgical experience, and demographic parameters were correlated with overall robotic proficiency and improvement during the experimental session. ResultsParticipants with previous gaming history had 33 % higher overall robotic performance scores (p = 0.02). There was no difference in performance between surgical trainees and attending physicians with high volume laparoscopic surgery experience (average of 77 laparoscopic procedures). In this small cohort, playing an instrument had no influence overall (p = 0.2), but we found a trend towards increased proficiency in those playing the piano, yielding 30 % higher scores (p = 0.14). Participants performed up to 22 % better in the second run of the "Suture Sponge" exercises (p = 0.08), indicating a steep learning curve of simulated robotic surgery. ConclusionsA history of video gaming and playing the piano is associated with improved performance on a virtual-reality robotic surgical simulator. The steep learning curve underlines the benefit of virtual robotic surgical training before performing robotic procedures on patients.

Exploring the Impact of Hand Dominance on Laparoscopic Surgical Skills Development Using Network Models.

Laparoscopic surgery demands high precision and skill, necessitating effective training protocols that account for factors such as hand dominance. This study investigates the impact of hand dominance on the acquisition and proficiency of laparoscopic surgical skills, utilizing a novel assessment method that combines Network Models and electromyography (EMG) data. Eighteen participants, comprising both medical and non-medical students, engaged in laparoscopic simulation tasks, including peg transfer and wire loop tasks. Performance was assessed using Network Models to analyze EMG data, capturing muscle activity and learning progression. The NASA Task Load Index (TLX) was employed to evaluate subjective task demands and workload perceptions. Our analysis revealed significant differences in learning progression and skill proficiency between dominant and non-dominant hands, suggesting the need for tailored training approaches. Network Models effectively identified patterns of skill acquisition, while NASA-TLX scores correlated with participants' performance and learning progression, highlighting the importance of considering both objective and subjective measures in surgical training. The study underscores the importance of hand dominance in laparoscopic surgical training and suggests that personalized training protocols could enhance surgical precision, efficiency, and patient outcomes. By leveraging advanced analytical techniques, including Network Models and EMG data analysis, this research contributes to optimizing clinical training methodologies, potentially revolutionizing surgical education and improving patient care.

Comparative study to determine the proper sequence of simulation training, pelvic trainer versus virtual reality simulator: a pilot study

BackgroundIncreased surgical efficacy has led to a remarkable increase in the usage of minimally invasive surgical procedures since their inception. The use of simulation in surgical teaching has grown significantly during the past 10 years. Several laparoscopic simulators have been built. Virtual reality (VR) simulators and box trainers (BTs), often known as pelvic trainers, are the two primary training modalities used in hospitals and clinical training institutes for the development and acquisition of laparoscopic skills. Our study aimed to evaluate the proper sequence of pelvic trainers and VR simulator training to improve laparoscopic gynecological skills.MethodologyWe carried out this pilot study at the Virtual Endoscopic Simulation and Skills Acquisition Laboratory at the Obstetrics and Gynecology Department in the Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Egypt, from February to August 2022. All residents with minimal or without laparoscopic experience (twenty residents) were divided into two groups and classified as (group A versus group B). Group A’s training began with a pelvic trainer, which was tested using a checklist. Later, the group trained on a virtual reality simulator, which tested them using an electronic autoassessment. After training on a virtual reality simulator and passing an electronic autoassessment test, group B moved on to pelvic trainers and had a checklist-based assessment.ResultsWe compared pelvic trainer tasks between the training groups, and detected no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.646, 0.341, 0.179, and 0.939 respectively); when we compared VR simulator tasks between the training groups, there were no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.79, 0.3, 0.33, and 0.06, respectively).ConclusionThere was no difference in training, between residents who started on a pelvic trainer or the VR simulator; therefore, both could be used in laparoscopic training with no preferred order.Trial registrationThe trial was registered at clinicaltrials.gov with the name “Pelvic trainer vs VRS” and the identifier “NCT05255614.” The registration date was January 19, 2022, and the trial was prospectively registered. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=22&sid=S000BR5D&cx=t6mc14

Dyadic practice for the acquisition of laparoscopic skills (DALS)-A randomized controlled trial.

Laparoscopic simulation is integral to surgical education but requires significant resources. We aimed to compare the effectiveness of dyadic practice (DP), involving two individuals working together, to individual practice (IP) for novices acquiring laparoscopic skills and assess their learning experience. We conducted a Randomized Controlled Trial comparing DP and IP for novice medical students who completed a laparoscopic simulation workshop. Participants were assessed individually pre-course (test 1), post-course (test 2), and 8-week retention (test 3) using a validated quantitative method. A post-course questionnaire and interview, analyzed with thematic analysis, assessed the learning experience. In total, 31 DP and 35 IP participants completed the study. There was no difference in mean scores between DP and IP groups in all three tests: test 1 (p=0.55), test 2 (p=0.26), test 3 (p=0.35). In trend analysis, the DP group improved post-course (test 1 vs. 2: p=0.02) and maintained this level at the retention test (2 vs. 3: p=0.80, 1 vs. 3: p=0.02). Whilst the IP group also improved post-course (test 1 vs. 2: p<0.001), this improvement was not retained (2 vs. 3: p=0.003, 1 vs. 3: p=0.32). Thematic analysis revealed that DP participants valued peer support, peer feedback and observation time, but also acknowledged the limitations of reduced practical time and issues with teamwork. DP is non-inferior to IP for novices learning laparoscopic skills, is well received and may lead to superior long-term skill retention.

Development of long-term courses in minimally invasive surgery training for the acquisition and retention of laparoscopic skills

IntroductionNumerous training methods have been developed to demonstrate the effectiveness of minimally invasive surgery (MIS) skills’ training. However, there remains a dearth of long-term supervised training, leaving surgeons without the opportunity for continuous practice. Thus, our objective is to report our outcomes for long-term training courses and establish a new approach for organizing a prolonged MIS training course that ensures continuity and encourages sustained practice. MethodsRetrospective study analysis of scores and performance of trainees during our training experience between 2019 and May 2023. Demographics, gender, MIS experience and performance of the participants in each type of modality, virtual and presential, was analyzed. ResultsThe study involved 110 participants. Due to lack of data only 97 were analyzed. In the virtual courses group, there were 63 participants. The average general score of the first encounter during the intensive stage was 2.49 ± 0.75, while the average general score of the last encounter was 3.62 ± 0.56. For the presential courses, the mean general score during the first encounter was 1.88 ± 0.60, and by the last meeting of the intensive stage, the mean general score increased to 3.51 ± 0.69. Notably, among virtual courses 55% of the participants attended to at least 1 follow-up meeting whereas only 2 participants (5.9%) among the in-person group attended the 4-month follow-up meeting. ConclusionThe study shows the effectiveness of virtual and presential long-term MIS courses for acquiring and retaining endoscopic skills and highlights the benefits of virtual courses in terms of accessibility and learning improvement. Type of studyLevel IV

745 The Effect of 3D Versus 2D Training Models in Laparoscopic Skills Acquisition: A Randomised Controlled Trial of Novice Medical Students

Abstract Aim Determining whether the effect of laparoscopic technical skills acquisition will be superior with the use of low-fidelity 3D training models with contours compared to flat, 2D LapPass training models in novice medical students. Method This was a prospective, single-centre, two-arm, randomised controlled trial. Participants were randomised equally into either 3D or 2D group and performed two standardised laparoscopic tasks: (1) grasping and manipulation and (2) intracorporeal suturing on separate days. Performance was based on the GOALS tool, completion time and number of errors via 3 assessments (baseline, interim and post-training) each session. A post-study survey was used to measure participant-perceived confidence and performance. Results Sixty-two participants completed the study from April to June 2022. The two groups were homogenous regarding demographic data (p&amp;gt;0.05). Both groups had significantly superior performance post-training compared to baseline in the two tasks via the intra-group comparison (p&amp;lt;0.017). In the inter-group comparison, the 3D group had statistically significantly greater improvements in GOALS score parameter and depth perception domain in all comparisons in the two tasks (p&amp;lt;0.05). The time improvement and error reduction also favoured the 3D group. In the post-study survey, the 3D group reported significantly greater perceived post-training confidence and performance in the suturing task only (p&amp;lt;0.05). Conclusions The 3D training models resulted in a superior laparoscopic skills acquisition for novices in two tasks compared to 2D LapPass training models and should be incorporated into laparoscopic training curricula. Further work should focus on their long-term efficacy on a competency-based endpoint.

M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition

The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points). ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

Video game experience affects performance, cognitive load, and brain activity in laparoscopic surgery training.

Video games can be a valuable tool for surgery training. Individuals who interact or play video games tend to have a better visuospatial ability when compared to non-gamers. Numerous studies suggest that video game experience is associated with faster acquisition, greater sharpening, and longer retention of laparoscopic skills. Given the neurocognitive complexity of surgery skill, multimodal approaches are required to understand how video game playing enhances laparoscopy skill. Twenty-seven students with no laparoscopy experience and varying levels of video game experience performed standard laparoscopic training tasks. Their performance, subjective cognitive loading, and prefrontal cortical activity were recorded and analyzed. As a reference point to use in comparing the two novice groups, we also included data from 13 surgeons with varying levels of laparoscopy experience and no video game experience. Results indicated that video game experience was correlated with higher performance (R2 = 0.22, p <0.01) and lower cognitive load (R2 = 0.21, p <0.001), and the prefrontal cortical activation of students with gaming experience was relatively lower than those without gaming experience. In terms of these variables, gaming experience in novices tended to produce effects similar to those of laparoscopy experience in surgeons. Our results suggest that along the dimensions of performance, cognitive load, and brain activity, the effects of video gaming experience on novice laparoscopy trainees are similar to those of real-world laparoscopy experience on surgeons. We believe that the neural underpinnings of surgery skill and its links with gaming experience need to be investigated further using wearable functional brain imaging.

Impact of the Recorded Audio and Video Feedback on Simulated Surgical Performance: A Randomized Controlled Trial.

Simulation and coaching have become increasingly important in laparoscopic skills acquisition.This study was designed to evaluate if access to the recorded audio and video feedback after a single proctored session improves the acquisition of laparoscopic suturing skills in obstetrics and gynecology (OB/GYN) residents. Twenty OB/GYN residents received a single face-to-face coaching session on a laparoscopic vaginal cuff closure model. The session was recorded and residents were randomized to access either the video-only or the audio and video recording of the proctored session. The primary outcome measure was comparison of Global Operative Assessment of Laparoscopic Skills plus Vaginal Cuff Metrics (GOALS+) scores of the vaginal cuff closure prior to and following the proctored session. Only 30% of residents accessed the recorded sessions with junior residents most likely to access the recording.Baseline GOALS+ scores were significantly higher in senior residents (mean 21.7, SD 3.9) as compared to junior residents (mean 14.7, SD 3.2) (p<.001). While all learners' GOALS+ scores significantly improved after proctoring the intervention (p<.001), the senior residents continued to have significantly higher GOALS+ scores at the final assessment (mean 28.3, SD 4.2, p=.01) when compared to their junior residents (mean 24.0, SD 3.1). Due to the low uptake of the review of recorded proctored sessions among OB/GYN residents across skill and year levels, we were unable to assess the effect of recorded audio and video feedback on resident performance. However, the intervention of a single proctored session of simulated laparoscopic vaginal cuff closure significantly improved resident performance as assessed with GOALS+ scores.

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points). ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology

Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain–behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points). ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study

ObjectivesTo investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes.BackgroundLaparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency.MethodA longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training.ResultsLaparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months.ConclusionIn this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.

Initial Experience of the Training Centre of Minimally Invasive Surgery at Ahli Arab Hospital in Gaza

Background: Minimally Invasive Surgery (MIS) training outside operation room is still done by simulation in different training centers worldwide. Strong validity of such a training was evidenced using either the physical simulator (trainer box) or a biological model or a virtual reality (VR) or an animal model. Currently MIS is rapidly spreading worldwide in different surgical centers depending on the fact that MIS training is an essential prerequisite for any surgeon even with a vast experience in open surgery. A well-structured proficiency-based curriculum is essential to provide training for individuals who need to acquire MIS skills. Aim: To prove the efficiency and accuracy of training laparoscopic skills on combination of physical simulator as the dry module to be scored by a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) scoring system and on laparoscopic simulator as the wet module (Full Turkey model) using the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring items. Methods: One hundred and thirty-nine surgeons of different surgical specialties, age and experience levels (during the period from July 2018 to July 2019) were subjected to this curriculum-based training. All trainees received the basic cognitive knowledge in groups of fifteen to eighteen. In the hands on training each group is divided into three subgroups to fit the available six fundamental laparoscopic surgery (FLS) training boxes. Trainees are monitored by at two mentored per trainer in the different FLS skills and tasks. A modified (MISTELS) was used to score the five Fundamental Laparoscopic Surgery (FLS) skills and tasks that are the standard of the Society of American Gastroenterology Endoscopic Surgery (SAGES). Modifications entail the scoring time to be in minutes rather than in seconds. Some extra-activities were added to the first three skills/tasks. A score sheet was designed for each task considering both the scoring time and penalties. In Wet lab, not only the five tasks were repeated but also a complementary skill such as Veress needle insertion, port insertion and camera manipulation together with dissection e.g. intracorporeally in cholecystectomy were provided through a full Turkey model on a laparoscopic simulator. Trainees’ performance was measured with integration of cognitive knowledge post-testing, score in the modified MISTEL in dry lab and by the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring in wet laboratory. The mean of total score of the trainee before training was 35.28 while after training was 82.59 but Cronbach’s Alpha value in the pre and post testing scored 0.778 and 0.799 respectively Results: Majority of trainees showed improvement in all measured domains in different stations. In cognitive knowledge the mean score difference between the pre and post testing was 50.1and 72.14 respectively. This is statistically significant as shown in the student T-test value of 19.13. This indicates that the trainees are having some knowledge but definitely refined and improved on post testing. In Dry Lab there is a dramatic improvement in the post testing compared to pretests where there was a clear statistical significance of a P value of 0.01 in all the five skills and tasks between the pre and post test of each. In wet Lab the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring system Which is used to assess skill of surgeons in clinical settings in OR is used to simulate clinical sessions on a Full Turkey Model on laparoscopic simulator set. GOALS scoring in Full Turkey model proves its feasibility and efficiency in most trainees where Mean score was 84.1, The Median 84.0, and the Std = 5.38. Construct validity of this triad methodology of cognitive knowledge, dry lab and wet lab of full Turkey model is evident among different trainees of different groups with no florid significance of different surgeons in relation scores achieved and age group proving validity of this type of training. There is no statistical differences between age group and the final score of overall training the mean average of the trainees ages less than 35 years old was 81.2% followed by the trainees above 45 years old 79.7% with very simple difference in mean with trainees aged between 35 years old to 45 years old 79.6%. Conclusion: MIS training integrating a triad of training modules of MIS cognitive knowledge, traditional physical box trainer and a biological wet lab on a full Turkey model is fairly feasible and effective in the acquisition of fundamental laparoscopic skills and tasks. Global Operative Assessment of Laparoscopic Skills (GOALS) can be a valid tool to assess trainees outside operation room.

Prospective comparison of single encounter versus distributed laparoscopic training in novice learners: A controlled trial.

BACKGROUND:The traditional model of teaching surgical skills on “real” patients using graded responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. The purpose of our study was to determine if the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest that distributed training programs might have better outcomes, but the results are inconclusive. We designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained using the distributed method may have enhanced learning outcomes.MATERIALS AND METHODS:100 medical students were assigned in a 1:1 ratio to one of two groups. Group A underwent a single orientation and supervised practice session of 3 h duration. Group B underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive weeks. Participant scores were analyzed before and after the intervention and at 3- and 6-month intervals using repeat measures of ANOVA.RESULTS:Pretest and immediate posttest scores were comparable between the two groups. The 3-month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). The 6-month interval test showed no differences in scores between the two groups (P = 0.178).CONCLUSIONS:Distributed teaching resulted in significantly enhanced scores at 3-month assessment. However, similar scores at 6 months suggest the need for repeated intervention.