Acquisition Of Laparoscopic Skills Research Articles

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.

The application of virtual reality simulators in laparoscopic surgery training (a review)

Introduction: The last decade saw a significant introduction of minimally invasive surgery into medical practice. Laparoscopy has even become the gold standard for some interventions. This has led to an increased demand for qualified specialists. The acquisition of laparoscopic surgery skills entrains a time investment both on part of the trainee and the instructor. The need for an accelerated development of specific psycho-motor perceptions which are a requirement for the execution of laparoscopic procedures, led to the establishment of virtual reality simulator training. For the first time in Bulgaria, in 2016, the Medical University of Varna introduced formal education via the way of virtual reality laparoscopic simulators. They permit the development of laparoscopic skills even at the level of a medical student. Aim: The aim of the article is to analyze the efficiency of existing virtual reality simulators and their application in laparoscopic surgery training. Materials and Methods : А systematic literature analysis was performed via the databases PubMed , Web of Science , Scopus and Google Scholar using various combinations of the following keywords: “simulation”, “virtual*”, “VR”, “laparoscopic*”, “surgery”, “education”, “LapMentor”, “LapSim”, for articles published in the past 10 years. The keywords were in combination with Boolean operators “and”, “or”. After a thorough review of all pertinent articles the most relevant publications were selected. Results: The electronic inquiry yielded 106 articles in total. After the application of suitable inclusion and exclusion criteria, 98 of them were deemed unfit, leaving 8 randomized control trials. To meet the inclusion criteria, the publications needed to be systemized random prospective studies regarding virtual reality simulators in laparoscopic surgery. Conclusion: Advancements in the field of surgery follow closely the introduction of new technologies. This leads to the need for a change of traditional surgery training practices. The need of laparoscopic surgery specialists becomes greater with every passing year. The new generation of virtual reality simulators provides a complete set of basic skill procedures and complete operative procedures. Due to their limitless repeatability, an expert level of proficiency is able to be reached in a relatively short period of time. The surgical community must take note of the practices that have already been adopted by aviation training and introduce mandatory laparoscopic surgery training programs, which all specialists must undergo before undertaking procedures in the operating theater.

Effect of Short-term-focused Training on a Phantom Model in Improving Operative Room Performance Among Surgical Residents: A Randomized Trial.

Meta-analysis has shown the effectiveness of various training methods for the acquisition of laparoscopic skills in surgical training. However, there is very limited literature focusing on the translation of skill acquisition on training models into improved operating room (OR) performance. This study was conducted to evaluate the effectiveness of the Tuebingen trainer with integrated Porcine tissue in improving OR the performance of surgical trainees using standard assessment tools. The study was a single-blinded double-armed randomized control study conducted between July 2016 and March 2018. Eighteen, fourth, and fifth semesters of surgery residents were included in the study. The baseline performance was assessed in OR by performing laparoscopic cholecystectomy using validated scores, that is, Global Operative Assessment of Laparoscopic Skills (GOALS), Additional Five Criteria, Task-specific Checklist, Error Checklist, Visual Analogue Scale. The residents were then randomized into trainee and nontrainee groups. The training group received 5 days of short-term-focused training on the Tuebingen trainer, and the improvement was reassessed in OR. The demographic profile of residents was similar. The baseline scores were comparable. The training group showed statistically significant improvement in GOALS (9.88±1.76 to 12±0.66, P=0.05 vs. 10.33±1.5 to 11.4±2.24, P=0.28), task-specific checklist (42.22±10.92 to 53.33±14.14, P=0.027 vs. 45.55±10.13 to 50±17.32, P=0.51), and error checklist. The operating time significantly reduced (36.0±4.03 vs. 50.44±11.39, P=0.0025) following training. Our study concludes that the training on the Tuebingen trainer with integrated porcine organs results in a statistically significant improvement in the OR performance of surgical residents as compared with the nontrained residents, thereby indicating a transfer of skills from training to OR.

Simulation in surgical education: a review of a multi- tiered gynaecological laparoscopy workshop

Background: While minimally access approach has become the gold standard for many gynaecological procedures, laparoscopic surgery has a steep learning curve and many trainees face challenges acquiring the necessary skills. The aim of our study was to evaluate the effectiveness of a multi-tiered laparoscopy simulation workshop for gynaecology residents. Approach: An observational study was conducted at SingHealth Duke-National University of Singapore (NUS) Institute of Medical Simulation Centre (SIMS) between November 2016 and November 2017. Gynaecology residents were recruited to attend two separate one-day workshops held in November 2016 and November 2017 respectively, involving didactic lectures, dry-lab simulation and animal training. Participants rated various learning domains of the training workshops using a five-point scale Likert in pre- and post-workshop surveys. Findings: The study enrolled 16 residents in total. On a Likert scale from 1 to 5 (1 being poor and 5 being excellent), participants rated significant improvement in domains of general laparoscopy skills acquisition (1.7 + 0.6 to 4.9 + 0.4; p&lt;0.001), dry lab simulation (1.9 + 0.5 to 4.8 + 0.4; p&lt;0.001), confidence in laparoscopy suturing skills (1.1 + 0.3 to 4.8 + 0.4; p&lt;0.001) and laparoscopy knowledge (2.1 + 0.5 to 4.7 + 0.5; p&lt;0.001). Conclusion: A combination of didactic lectures, dry-lab simulation and animal training under expert supervision and guidance dramatically improved surgical skills and confidence in gynaecology residents. Such a multi-tiered format allows for effective learning and acquisition of laparoscopic skills.

Associations Between Binocular Depth Perception and Performance Gains in Laparoscopic Skill Acquisition.

The ability to perceive differences in depth is important in many daily life situations. It is also of relevance in laparoscopic surgical procedures that require the extrapolation of three-dimensional visual information from two-dimensional planar images. Besides visual-motor coordination, laparoscopic skills and binocular depth perception are demanding visual tasks for which learning is important. This study explored potential relations between binocular depth perception and individual variations in performance gains during laparoscopic skill acquisition in medical students naïve of such procedures. Individual differences in perceptual learning of binocular depth discrimination when performing a random dot stereogram (RDS) task were measured as variations in the slope changes of the logistic disparity psychometric curves from the first to the last blocks of the experiment. The results showed that not only did the individuals differ in their depth discrimination; the extent with which this performance changed across blocks also differed substantially between individuals. Of note, individual differences in perceptual learning of depth discrimination are associated with performance gains from laparoscopic skill training, both with respect to movement speed and an efficiency score that considered both speed and precision. These results indicate that learning-related benefits for enhancing demanding visual processes are, in part, shared between these two tasks. Future studies that include a broader selection of task-varying monocular and binocular cues as well as visual-motor coordination are needed to further investigate potential mechanistic relations between depth perceptual learning and laparoscopic skill acquisition. A deeper understanding of these mechanisms would be important for applied research that aims at designing behavioral interventions for enhancing technology-assisted laparoscopic skills.

The effects of unilateral transcranial direct current stimulation on unimanual laparoscopic peg-transfer task

IntroductionEfficient training methods are required for laparoscopic surgical skills training to reduce the time needed for proficiency. Transcranial direct current stimulation (tDCS) is widely used to enhance motor skill acquisition and can be used to supplement the training of laparoscopic surgical skill acquisition. The aim of this study was to investigate the effect of anodal tDCS over the primary motor cortex (M1) on the performance of a unimanual variant of the laparoscopic peg-transfer task. MethodsFifteen healthy subjects participated in this randomized, double-blinded crossover study involving an anodal tDCS and a sham tDCS intervention separated by 48 h. On each intervention day, subjects performed a unimanual variant of laparoscopic peg-transfer task in three sessions (baseline, tDCS, post-tDCS). The tDCS session consisted of 10 min of offline tDCS followed by 10 min of online tDCS. The scores based on the task completion time and the number of errors in each session were used as a primary outcome measure. A linear mixed-effects model was used for the analysis. ResultsWe found that the scores increased over sessions (p < 0.01). However, we found no effects of stimulation (anodal tDCS vs. sham tDCS) and no interaction of stimulation and sessions. ConclusionThis study suggests that irrespective of the type of current stimulation (anodal and sham) over M1, there was an improvement in the performance of the unimanual peg-transfer task, implying that there was motor learning over time. The results would be useful in designing efficient training paradigms and further investigating the effects of tDCS on laparoscopic peg-transfer tasks.

Evaluation and usability study of low-cost laparoscopic box trainer “Lap-Pack”: a 2-stage multicenter cohort study

Introduction: Laparoscopic training is restricted in low resource settings due to limited access to specialist training equipment and financial constraints. This study aimed to evaluate simulation skills and usability of an original low-cost laparoscopic trainer, the “Lap-Pack,” developed at the University of Leeds, UK. Methods: Stage I evaluation was conducted in Kolkata (India) between March, 12 and 14, 2019. Laparoscopic simulation training was based on the 5 domains of fundamentals of laparoscopic surgery (FLS), which assessed skill acquisition across 7 rural surgeons from North-East India. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) criteria was used to statistically analyze trainee performance between pretraining and posttraining sessions. Also, Lap-Pack was qualitatively compared with a commercial box trainer, Inovus Pyxus HD (IPHD). Stage II involved a multi-center usability study in 2 centers of India and the United Kingdom (2019). Seventy-eight participants performed 2 FLS tasks using Lap-Pack and provided scores on a 25-point questionnaire, including a preestablished Face-Validity Criteria and 4 evaluation categories—Usability, Camera, View, and, Material. Results: In stage I, the total posttraining MISTELS score for Lap-Pack was higher, that is 773.37 (SD: 183.67) than pretraining score, that is 351.2 (SD: 471.5). The posttraining scores showed laparoscopic skill acquisition with statistically significant (P&lt;0.05) difference for precision cutting, intracorporeal and extracorporeal knot. In stage II, Lap-Pack scored highly in Face-Validity with a combined mean score of 4.81 [95% confidence interval (CI): 4.52–5.09, P&lt;0.05] out of a possible 6. It scored highest (scale: 1=low to 7=high) in Usability 6.14 (95% CI: 6.05–6.22, P&lt;0.05) and Camera 6.14 (95% CI: 6.01–6.27, P&lt;0.05). The “Lightweight” (6.46, 95% CI: 6.32–6.60, P&lt;0.05) and “Portability” (6.35, 95% CI: 6.18–6.51, P&lt;0.05) features of Lap-Pack were appreciated. Conclusion: The Lap-Pack is a suitable low fidelity simulator for laparoscopic training in a low-resource setting.

O52: THE IMPACT OF STUDENT BACKGROUND ON PERFORMANCE AND STRESS DURING SURGICAL SIMULATION

Abstract Introduction Early exposure of medical students to surgical skills has been associated with an increased interest in pursuing a career in surgery. This study aimed to investigate the impact of student background on basic laparoscopic skills acquisition and perceived stress to workload during simulation. Method Students were recruited to a course modelled on the European Basic Laparoscopic Urological Skills (E-BLUS) programme. Students filled out a pre-course demographic survey, and a post-course survey that evaluated perceived stress to workload (SURG-TLX). Pre- and post-course confidence in laparoscopic skills, performance in the course, as well as SURG-TLX parameters were statistically compared for all demographic factors. Result Twenty-three participants completed the course, fifteen (65%) of which were female. Ten students were junior (first and second year), and thirteen were senior (third year and above). Hobbies were grouped into either requiring hand-eye coordination (n=9), manual dexterity (n=9), or no relevance to surgery (n=5). No significant differences were found in demographic factors for course performance or pre- and post-course confidence. No significant differences were found between male and female students, and between different hobby groups, in all SURG-TLX parameters. Senior students reported a significantly higher Physical Demand of the SURG-TLX compared to juniors (p=0.042). No differences were found in other parameters. Conclusion Our study showed no correlation between student background (notably sex and stage of medical school) and basic laparoscopic skills acquisition or stress during simulation. We therefore suggest that medical students are provided with more exposure to acquire basic laparoscopic skills regardless of their background. Take-home message Medical student background is not a discriminator in surgical simulation performance and stress. All medical students, regardless of their sex or stage of medical school, should be given the opportunity to practice laparoscopic skills.

Impact of formal tuition, supervised practice and feedback on the acquisition of basic laparoscopic skills by novices using a box trainer

Impact of formal tuition, supervised practice and feedback on the acquisition of basic laparoscopic skills by novices using a box trainer

Changes in attentional resources during the acquisition of laparoscopic surgical skills.

BackgroundIncreasing familiarity and practice might free up mental resources during laparoscopic surgical skills training. The aim of the study was to track changes in mental resource allocation during acquisition of laparoscopic surgical skills.MethodsMedical students with no previous experience in laparoscopic surgery took part in a 5-week laparoscopic training curriculum. At the beginning and end of the training period, one of the training tasks was combined with a secondary auditory detection task that required pressing a foot switch for defined target tones, creating a dual-task situation. During execution of the two concurrent tasks, continuous electroencephalographic measurements were made, with special attention to the P300 component, an index of mental resources. Accuracy and reaction times of the secondary task were determined.ResultsAll 14 participants successfully completed the training curriculum. Target times for successful completion of individual tasks decreased significantly during training sessions (P <0.001 for all tasks). Comparing results before and after training showed a significant decrease in event-related brain potential amplitude at the parietal electrode cluster (P300 component, W = 67, P = 0.026), but there were no differences in accuracy (percentage correct responses: W = 48, P = 0.518) or reaction times (W = 42, P = 0.850) in the auditory detection task.ConclusionThe P300 decrease in the secondary task over training demonstrated a shift of mental resources to the primary task: the surgical exercise. This indicates that, with more practice, mental resources are freed up for additional tasks.

The Spaced Learning Concept Significantly Improves Acquisition of Laparoscopic Suturing Skills in Students and Residents: A Randomized Control Trial.

Spaced learning consists of blocks with highly condensed content that interrupted by breaks during which distractor activities, such as physical activity, are performed. The concept has been shown to be superior in complex motor skill acquisition like laparoscopic suturing and knot tying. Preliminary studies have solely been conducted with medical students. Therefore, it remained unanswered if the spaced learning concept would also work for pediatric surgery residents. The study aimed to evaluate the effectiveness of spaced learning, students, and residents were asked to perform four surgeons' square knots on a bowel model within 30 minutes prior and post 3 hours of hands-on training. To examine the long-term skills, the same subjects were asked to perform a comparable, but more complex task 12 months later without receiving training in the meantime. Total time, knot stability, suture accuracy, knot quality, and laparoscopic performance were assessed. Additionally, motivation was accessed by using the questionnaire on current motivation. Differences were calculated using mixed analysis of variance, Mann-Whitney U test, and multivariate analysis of covariance. A total of 20 medical students and 14 residents participated in the study. After randomization, 18 were trained using the spaced learning concept and 16 via conventional methods. Both groups had comparable baseline characteristics and improved significantly after training in all assessed measures. The spaced learning concept improved procedure performance as well as knot quality and stability in both students and residents. However, residents that trained via spaced learning showed significantly better long-term results regarding knot quality and speed in comparison to students. Although anxiety was significantly reduced in both training groups over time, residents were significantly more interested regarding knot tying than students. This study dispels any remaining doubt that the spaced learning concept might only work for medical students. It appears that the spaced learning concept is very suitable for residents in acquiring complex motor skills. It is superior to conventional training, resulting in improved procedural performance as well as knot quality and speed. Hence, tailored training programs should not only be integrated early on in students' curricula but also in surgical training programs.

Laparoscopic skills training: the effects of viewing mode (2D vs. 3D) on skill acquisition and transfer

BackgroundThree-dimensional (3D) visual displays have been suggested to aid laparoscopic skills training by providing the depth cues not present in traditional two-dimensional (2D) displays. However, few studies have robustly investigated the impact of viewing mode (2D vs. 3D) on learning outcomes.PurposeTo examine how viewing mode (2D vs. 3D) impacts the acquisition and transferability of basic laparoscopic skills by comparing performance between transfer and control groups on a complete proficiency-based training program.MethodA counterbalanced between-subjects design was employed. Each participant was randomly allocated to one of four groups, comprising two transfer groups (trained in one viewing mode and tested in the alternate mode: the 2D → 3D and 3D → 2D groups) and two control groups (trained and tested in one viewing mode: the 2D → 2D and 3D → 3D groups). Participants completed proficiency-based training in six laparoscopic training tasks. Testing included two further repetitions of all tasks under test conditions. Objective performance measures included the total number of repetitions to reach proficiency, and total performance scores (i.e. time + error penalties across all repetitions) in training and testing.ResultsThe groups trained in 3D demonstrated superior training performance (i.e. less time + errors) and took fewer repetitions to reach proficiency than the groups trained in 2D. The groups tested in 3D also demonstrated superior test performance compared to those tested in 2D. However, training mode did not yield significant test differences between the groups tested in 2D (i.e. 2D → 2D vs. 3D → 2D), or between the groups tested in 3D (i.e. 3D → 3D vs. 2D → 3D).ConclusionNovices demonstrate superior performance in laparoscopic skills training using a 3D viewing mode compared to 2D. However, this does not necessarily translate to superior performance in subsequent testing or enhanced learning overall. Rather, test performance appears to be dictated by the viewing mode used during testing, not that of prior training.

Evaluation of a remote-controlled laparoscopic camera holder for basic laparoscopic skills acquisition: a randomized controlled trial

BackgroundUnsteady camera movement and poor visualization contribute to a difficult learning curve for laparoscopic surgery. Remote-controlled camera holders (RCHs) aim to mitigate these factors and may be used to overcome barriers to learning. Our aim was to evaluate performance benefits to laparoscopic skill acquisition in novices using a RCH.MethodsNovices were randomized into groups using a human camera assistant (HCA) or the FreeHand v1.0 RCH and trained in the (E-BLUS) curriculum. After completing training, a surgical workload questionnaire (SURG-TLX) was issued to participants.ResultsForty volunteers naïve in laparoscopic skill were randomized into control and intervention groups (n = 20) with intention-to-treat analysis. Each participant received up to 10 training sessions using the E-BLUS curriculum. Competency was reached in the peg transfer task in 5.5 and 7.6 sessions for the ACH and HCA groups, respectively (P = 0.015), and 3.6 and 6.8 sessions for the laparoscopic suturing task (P = 0.0004). No significance differences were achieved in the circle cutting (P = 0.18) or needle guidance tasks (P = 0.32). The RCH group experienced significantly lower workload (P = 0.014) due to lower levels of distraction (P = 0.047).ConclusionsRemote-controlled camera holders have demonstrated the potential to significantly benefit intra-operative performance and surgical experience where camera movement is minimal. Future high-quality studies are needed to evaluate RCHs in clinical practice.Trial registrationISRCTN 83733979

The effect of verbal feedback, video feedback, and self-assessment on laparoscopic intracorporeal suturing skills in novices: a randomized trial.

Laparoscopic skill acquisition involves a steep learning curve and laparoscopic suturing is an exceptionally challenging task. By improving the way feedback is given, trainees can learn these skills more effectively. This study aims to establish the most effective form of structured feedback on laparoscopic suturing skill acquisition in novices, by comparing the effects of expert verbal feedback, video review with expert feedback (video feedback), and video review with self-assessment. A prospective randomized blinded trial comparing verbal feedback, video feedback, and self-assessment. Novices in laparoscopic surgery were tasked with performing laparoscopic suturing with intracorporeal knot tying. Time was given for practice, and pre- and post-feedback assessments were undertaken. Suturing performance was measured using a task-specific checklist and global ratings. A post-study questionnaire was used to measure participant-perceived confidence, knowledge, and experience levels. Fifty-one participants were randomized and allocated equally into the three groups. Performance in all three groups improved significantly from baseline. Video feedback had the largest improvement margin with checklist and global score improvements of 17.1% (± 9.9%) and 14.7% (± 9.3%), respectively. Performance improvements between groups were statistically significant in the global components (p = 0.004) but not the checklist components (p = 0.186). Global score improvement was significantly better in the video feedback group but was statistically insignificant between the self-assessment and verbal feedback groups. Questionnaire responses demonstrated positive results in confidence, knowledge, and experience levels, across all three study groups, with no differences between the groups (p > 0.05). Structured video feedback facilitates reflection and self-directed learning, which improves the ability to develop proficiency in surgical skills. Combining both self-assessment and video feedback may be beneficial over verbal feedback alone due to the advantages of video review. These techniques should therefore be considered for implementation into surgical education curricula.

Analysis of Instrument Motion and the Impact of Residency Level and Concurrent Distraction on Laparoscopic Skills

Using a laparoscopic box trainer fitted with motion analysis trackers and software, we aim to identify differences between junior and senior residents performing the peg transfer task, and the impact of a distracting secondary task on performance. General surgery residents were asked to perform the laparoscopic peg transfer task on a trainer equipped with a motion tracker. They were also asked to perform the laparoscopic task while completing a secondary task. Extreme velocity and acceleration events of instrument movement in the 3 rotational degrees of freedom were measured during task completion. The number of extreme events, defined as velocity or acceleration exceeding 1 SD above or below their own mean, were tabulated. The performance of junior residents was compared to senior residents. Simulation learning institute, Beaumont Hospital, Royal Oak, Michigan. Thirty-seven general surgery residents from Beaumont Hospital, Royal Oak. When completing the primary task alone, senior residents executed significantly fewer extreme motion events specific to acceleration in pitch (16.63 vs. 20.69, p = 0.04), and executed more extreme motion events specific to velocity in roll (16.14 vs. 15.11, p = 0.038), when compared to junior residents. With addition of a secondary task, senior residents had fewer extreme acceleration events specific to pitch, (14.69 vs. 22.22, p < 0.001). While junior and senior residents completed the peg transfer task with similar times, motion analysis identified differences in extreme motion events between the groups, even when a secondary task was added. Motion analysis may prove useful for real-time feedback during laparoscopic skill acquisition.

Utilizing transcranial direct current stimulation to enhance laparoscopic technical skills training: A randomized controlled trial

BackgroundTranscranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability. Prior work suggests it may enhance motor learning giving it the potential to augment surgical technical skill acquisition. ObjectivesThe aim of this study was to test the efficacy of tDCS, coupled with motor skill training, to accelerate laparoscopic skill acquisition in a pre-registered (NCT03083483), double-blind and placebo-controlled study. We hypothesized that relative to sham tDCS, active tDCS would accelerate the development of laparoscopic technical skills, as measured by the Fundamentals of Laparoscopic Surgery (FLS) Peg Transfer task quantitative metrics. MethodsIn this study, sixty subjects (mean age 22.7 years with 42 females) were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the FLS Peg Transfer Task during six 20-min training blocks, which were preceded and followed by a single trial pre-test and post-test. The primary outcome was changes in laparoscopic skill performance over time, quantified by group differences in completion time from pre-test to post-test and learning curves developed from a calculated score accounting for errors. ResultsLearning curves calculated over the six 20-min training blocks showed significantly greater improvement in performance for the bM1 group than the sham group (t = 2.07, p = 0.039), with the bM1 group achieving approximately the same amount of improvement in 4 blocks compared to the 6 blocks required of the sham group. The SMA group also showed greater mean improvement than sham, but exhibited more variable learning performance and differences relative to sham were not significant (t = 0.85, p = 0.400). A significant main effect was present for pre-test versus post-test times (F = 133.2, p < 0.001), with lower completion times at post-test, however these did not significantly differ for the training groups. ConclusionLaparoscopic skill training with active bilateral tDCS exhibited significantly greater learning relative to sham. The potential for tDCS to enhance the training of surgical skills, therefore, merits further investigation to determine if these preliminary results may be replicated and extended.

Evidence to support the early introduction of laparoscopic suturing skills into the surgical training curriculum

BackgroundThe objectives of this study were to investigate the relationship between the acquisition of laparoscopic suturing skills and other operative laparoscopic skills and to provide evidence to determine ideal time and duration to introduce laparoscopic suturing training.MethodsThe first part of the study explored the relationship between the acquisition of laparoscopic suturing skills and proficiency of other operative laparoscopic skills. The second part of the study consisted of an opinion survey from senior and junior trainees on aspects of training in laparoscopic suturing.ResultsOne hundred twenty-eight surgical trainees participated in this study. The total scores of task performance of 57 senior surgical trainees in laparoscopic suturing skills consisting of needle manipulation and intracoporeal knot tying were improved significantly after the training course (46.9 ± 5.3 vs 29.5 ± 9.4, P < .001), the improvement rate was 59%. No statistically significant correlations were observed between intracorporeal laparoscopic suturing skills and proficiency in the basic laparoscopic manipulative skills assessed before (r = 0.193; P = 0.149) and after (r = 0.024; P = 0.857) the training course. 91% of senior trainees and 94% junior trainees expressed that intracorporeal suturing should be introduced at an early stage of the training curriculum.ConclusionsThere was no statistically significant correlation between the performance on basic operative laparoscopic skills (non-suturing skills) and laparoscopic suturing skills observed in this study. The acquisition of basic laparoscopic skills is not a prerequisite for training in intracorporeal suturing and it may be beneficial for the surgical trainees to learn this skill early in the surgical training curriculum. Surgical trainees want to learn and practice laparoscopic suturing earlier than later in their training.

A secondary learning curve in 3D versus 2D imaging in laparoscopic training of surgical novices

Stereoscopic (3D) imaging can be used to facilitate the learning of basic laparoscopic tasks. Its advantages over traditional endoscopic (2D) imaging include better depth perception and spatial orientation. However, the transition between 3D and 2D imaging systems has not been previously studied. This study compares the acquisition of basic laparoscopic skills in a laparoscopic-naïve population using both imaging systems, and explores the possibility of a secondary learning curve in the transition between systems. 26 novice learners were randomly allocated into two arms and taught to perform two basic laparoscopic tasks adopted from the fundamentals of laparoscopic surgery (FLS) curriculum, peg transfer (T1) and pattern cutting (T2) using either 2D or 3D imaging systems. These tasks were repeated until proficiency was achieved. Participants in each arm then repeated the tasks in the other viewing system (2D/3D vs 3D/2D). The parameters measured were: (a) time taken to complete the task and (b) number of attempts to achieve proficiency. There was a significant shortening of time required to achieve proficiency in T2 using a 3D system (mean difference-in-differences = - 65.4, 95% CI - 103.6 to - 27.2, t(24) = - 3.5, p value = 0.002) but no difference between 2D and 3D imaging systems for T1, a simpler task. Sub-group analysis of T1 and T2 between the 2D/3D and 3D/2D arms showed the presence of a secondary learning curve in the 2D/3D arm for both tasks, (T1: β-estimate - 2.68, 95% CI - 3.68 to - 1.68, p value = 0.0003; T2: β-estimate - 2.45, 95% CI - 3.75 to - 1.14, p value 0.004), but in the 3D/2D arm there was a secondary learning curve only for T2. (β-estimate 2.60, 95% CI 1.45-3.76, p value 0.001) CONCLUSION: 3D imaging can be an effective tool to speed the acquisition of proficiency in basic laparoscopic tasks for novice learners, especially in more complex tasks such as pattern cutting. The skills learned in 3D imaging can translate into 2D, albeit with a secondary learning curve.

Classical but Not Rap Music Significantly Improves Transferability and Long-Term Acquisition of Laparoscopic Suturing Skills: A Randomized Controlled Trial.

Acoustic distractions have been shown to increase the level of stress and workload in the operating room (OR). Noise significantly reduces surgical performance, but experienced surgeons are able to reduce the acoustic perception of their surroundings to maintain a high level of performance in complex surgical tasks. However, music has been shown to improve learning and performance of complex motor skills. The aim of this study was to evaluate the influence of music on transferability and long-term acquisition of laparoscopic suturing skills. To evaluate the effects of music on training, subjects were asked to perform four surgeon's square knots on a bowel model within 30 minutes-prior and post 3 hours of hands-on training. To examine long-term skills, the same students were asked to perform a comparable, but more complex, task (four slip knots in a model of esophageal atresia) 6 months post initial training, as a follow-up measurement. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan scale), and laparoscopic performance (Munz checklist) were assessed. Twenty-four students were included in the study; after simple randomization, 16 were trained while exposed to music (eight to Bach and eight to Bushido) and eight with traditional methods. Seven were lost due to follow-up. Both groups had comparable baseline characteristics and significantly improved after training, in all parameters assessed in this study. Subjects that trained with classical music were superior in terms of speed (p = 0.006), knot quality (p = 0.014), and procedural performance (p = 0.034) compared with controls. Music during acquisition of complex motor skills, like laparoscopic suturing and knot tying, is superior to traditional training. Especially music considered nondisturbing significantly improved speed, knot quality, and performance. Thus, incorporation of pleasant music into surgical skills training and the OR should be considered.

Using simulation to teach laparoscopic surgical skills – tips, pearls and pitfalls

Surgical training is radically changing in many countries worldwide. The traditional Halstedian model of time-bound apprenticeship is being replaced with competency-based learning surgical programmes. There has also been an increase in the use of simulation-based medical education (SBME) including the educational principles influencing the way that we acquire and maintain new surgical skills. These principles are not just unique to the surgical domain and can be applied to other procedural-based disciplines. Surgical SBME involves the acquisition of both technical and non-technical skills including; laparoscopic skills acquisition, basic surgical, emergency resuscitation, communication, leadership and team working skills. In technical skills acquisition laparoscopic surgery is ideally applicable to SBME. The skills utilised to safely perform this operative modality are unique and include altered depth perception, fulcrum effect, loss of haptic feedback, 2D to 3D realisation, fine motor skills and altered tissue handling. The educational techniques used to teach these skills in a simulation environment will be discussed, as well as, their adaptability to other procedural skills acquisition. The creation, validation and application of low-cost simulators will also be discussed and their application worldwide into different settings.