Basic Laparoscopic Skills Training Research Articles

Stress responses in surgical trainees during simulation-based training courses in laparoscopy

BackgroundSimulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees’ stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees’ stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting.MethodsWe conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants’ stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored.ResultsTwenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05).ConclusionTrainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees’ stress response during simulation-based skills training courses.

A multi-screen collaboration-based low-cost portable dry-lab simulator for basic laparoscopic skills training: A technical note

Laparoscopic skills training has always been crucial for novice surgeons. Readily accessible equipment, as well as structured training curriculum should be provided to guarantee adequate practice hours and skill proficiency. Dry-lab training is typically adopted before animal model surgery, usually comprising of purpose-built bulky simulators that is neither accessible nor portable. In this technical note, we designed a home-made simulator, using two 4 L water jugs as operating space that are communicated inside, plus an observation hole taped in between to mimic the triangular working space of laparoscopic surgery. Imaging was achieved via smartphone camera, which was wirelessly connected to a laptop and a projector for real-time display on multiple screens, using built-in multi-screen collaboration software. A self-regulated and proficiency-based training curriculum was adopted. This dry-lab simulator is low-cost, highly portable and easily replicable for basic laparoscopic skills training for the beginners to intermediate surgeons, which may serve as a good way for the standardized residency and specialist training program.

Aptitude and attitude: predictors of performance during and after basic laparoscopic skills training

BackgroundManual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on.PurposeTo assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training.MethodThirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures.ResultsThe statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks.ConclusionBy focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.

Teaching surgery novices and trainees advanced laparoscopic suturing: a trial and tribulations.

The benefits of minimally invasive surgery are numerous; however, considerable variability exists in its application and there is a lack of standardized training for important advanced skills. Our goal was to determine whether participation in an advanced laparoscopic curriculum (ALC) results in improved laparoscopic suturing skills. Study design was a prospective, randomized controlled trial. Surgery novices and trainees underwent baseline FLS training and were pre-tested on bench models. Participants were stratified by pre-test score and randomized to undergo either further FLS training (control group) or ALC training (intervention group). All were post-tested on the same bench model. Tests for differences between post-test scores of cohorts were performed using least squared means. Multivariable regression identified predictors of post-test score, and Wilcoxon rank sum test assessed for differences in confidence improvement in laparoscopic suturing ability between groups. Between November 2018 and May 2019, 25 participants completed the study (16 females; 9 males). After adjustment for relevant variables, participants randomized to the ALC group had significantly higher post-test scores than those undergoing FLS training alone (mean score 90.50 versus 82.99, p = 0.001). The only demographic or other variables found to predict post-test score include level of training (p = 0.049) and reported years of video gaming (p = 0.034). There was no difference in confidence improvement between groups. Training using the ALC as opposed to basic laparoscopic skills training only is associated with superior advanced laparoscopic suturing performance without affecting improvement in reported confidence levels. Performance on advanced laparoscopic suturing tasks may be predicted by lifetime cumulative video gaming history and year of training but does not appear to be associated with other factors previously studied in relation to basic laparoscopic skills, such as surgical career aspiration or musical ability.

Basic Laparoscopic Skills Training Is Equally Effective Using 2D Compared to 3D Visualization: A Randomized Controlled Trial.

Reduced depth perception due to two-dimensional (2D) visualization of a three-dimensional (3D) space represents a main challenge in acquiring basic laparoscopic skills (BLS); 3D visualization might increase training efficiency. This study aimed to assess whether BLS training on a standard box trainer using 2D is at least equally effective compared to 3D. Medical students were randomized to training of Fundamentals of Laparoscopic Surgery (FLS) tasks using either 2D or 3D for four weeks. Baseline and post-training tests were performed using the assigned visualization modality. Data of 31 participants were analyzed (n = 16 2D, n = 15 3D). Baseline test scores did not differ significantly between groups; only at the peg transfer task and total scores, the 3D group performed better than the 2D group. All scores improved significantly in both groups, with post training scores not differing significantly between groups. Non-inferiority of 2D compared to 3D was demonstrated for total score improvement and improvement in all individual FLS tasks except for suturing with extracorporeal knot tying. Post training test performance did not change significantly when changing to the unfamiliar modality. In conclusion, BLS training using standard 2D is at least equally effective as with 3D, without significant disadvantages when changing to the other modality.

Basic Laparoscopic Skills Training is Equally Effective Using Either 2d or 3d Visualization: A Randomized Controlled Trial

Study Objective To assess whether basic laparoscopic skills (BLS) training on a standard laparoscopic box trainer using 2D visualization is at least equally effective compared to 3D. Design Randomized controlled trial. Setting Tertiary care center, Vienna, Austria. Patients or Participants A total of 32 medical students of the Medical University of Vienna were recruited. Interventions Participants were randomized to BLS training using either 2D or 3D visualization and trained four Fundamentals of Laparoscopic Surgery (FLS) tasks for one hour twice a week for four weeks. Baseline and post training tests were performed. Improvement in total test scores and the scores for the four individual FLS tasks within the assigned visualization modality was assessed. The non-inferiority margin was set as 10% of the mean improvement in the 3D group. Measurements and Main Results Data of 31 participants were analysed (n=16 in the 2D, n=15 in the 3D group, n=1 drop out). Baseline test scores did not differ significantly between groups except for the peg transfer task and total scores, where participants in the 3D group scored better than those in the 2D group. Total scores as well as the scores for all four tasks separately improved significantly in both groups. Post training test total and single task scores did not differ significantly between the groups. Non-inferiority of 2D compared to 3D training modality could be demonstrated for the improvement in total scores and in all individual FLS tasks, except for the suturing with extracorporeal knot tying task. Only the peg transfer task showed superiority in score improvement in the 2D compared to the 3D group. Conclusion Learning BLS using standard 2D visualization is at least equally effective as with 3D visualization. 3D visualization seems to offer a slight advantage at baseline testing, but does not translate to better test scores at post training testing.

Face, Content, and Construct Validity of the Take-Home EoSim Augmented Reality Laparoscopy Simulator for Basic Laparoscopic Tasks.

Background: The eoSim® laparoscopic augmented reality (AR) simulator has instrument tracking capabilities that may be suitable for implementation in laparoscopic training. The objective is to assess face, content, and construct validity of this simulator for basic laparoscopic skills training. Methods: Participants were divided into three groups: novices (no training), intermediates (<50 laparoscopic procedures), and experts (>50 laparoscopic procedures). Three basic tasks were completed on the simulator: thread transfer (1), cyst dissection (2), and tube ligation (3). A questionnaire was completed on realism, didactic value, and usability of the simulator. Measured outcome parameters were as follows: time, distance, time off screen, average speed, acceleration, and smoothness. Results: Mean ± standard deviation scores on realism were positive (Task 1 or T1; 3.9 ± 0.7, P = .13, T2; 3.7 ± 0.7, P = .07, T3; 3.7 ± 0.07), as well as didactic value (T1; 3.9 ± 0.8, P = .71, T2; 3.9 ± 0.8, P = .31, T3; 4.0 ± 0.8, P = .40). Usability was valued the highest, with mean scores between 3.9 and 4.3 (T1; P = .71, T2; P = .80, T3; P = .85). Scores did not differ significantly between groups. Experts were significantly faster (Task 1; P < .001, Task 2; P = .042, Task 3: P < .001) with higher handling speed for tasks 2 and 3 (Task 1; P = .20, task 2; P = .034, task 3; P = .049). Results for other outcome parameters also indicated experts had better instrument control and efficiency than novices, although these differences did not reach statistical significance. Conclusions: The eoSim laparoscopic AR simulator is regarded as a realistic, accessible, and useful tool for the training of basic laparoscopic skills, with good face validity. Construct validity of the eoSim AR simulator was demonstrated on several core variables, but not all.

Step-by-step training in basic laparoscopic skills using two-way web conferencing software for remote coaching: A multicenter randomized controlled study

BackgroundDespite its advantages, few trainees outside of North America have access to simulation training. We hypothesized that a stepwise training method using tele-mentoring system would be an efficient technique for training in basic laparoscopic skills. MethodsResidents were randomized into two groups and trained to proficiency in intracorporeal suturing. The stepwise group (SG) practiced the task step-by-step, while the other group practiced comprehensively (CG). Each participant received weekly coaching via two-way web conferencing software. The duration of the coaching sessions and self-practice time were compared between the two groups. ResultsTwenty residents from 15 institutions participated, and all achieved proficiency. Coaching sessions using tele-mentoring system were completed without difficulties. The SG required significantly shorter coaching time per session than the CG (p = .002). There was no significant difference in self-practice time. ConclusionsThe stepwise training method with the tele-mentoring system appears to make efficient use of surgical trainees' and trainers' time.

Current Standard of Basic Laparoscopic Skills Training Amongst Junior Doctors in the UK

Current Standard of Basic Laparoscopic Skills Training Amongst Junior Doctors in the UK

Training on an inexpensive tablet-based device is equally effective as on a standard laparoscopic box trainer: A randomized controlled trial.

The aim of the study was to assess whether an inexpensive tablet-based box trainer (TBT) is at least equally effective compared with a standard box trainer (SBT) to learn basic laparoscopic skills (BLS). BLS training outside the operating room has been shown to be beneficial for surgical residency. However, simulation trainers are expensive and are not consistently available in all training centers. Therefore, TBT and other homemade box trainers were developed. Medical students were randomized to either a TBT or an SBT and trained 4 fundamentals of laparoscopic surgery (FLS) tasks for 1 hour twice a week for 4 weeks. A baseline test before the training period and a posttraining test were performed. All students then completed a questionnaire to assess their assigned box trainer. The primary outcome measure was the improvement in total test scores. Improvement in the scores for the 4 individual FLS tasks was chosen as a secondary outcome measure. Thirty-two medical students were recruited. Baseline test scores did not differ significantly between the groups. BLS improved significantly in both groups for the total score and for all 4 tasks separately. Participants in the TBT group showed a greater improvement of total scores than those in the SBT group, although this did not reach statistical significance; noninferiority of the TBT compared with the SBT concerning the improvement of total scores could be demonstrated. Regarding the individual FLS tasks, noninferiority of the TBT could be shown for the pattern cutting and the suturing with intracorporeal knot-tying task. The acceptance of the TBT by the trainees was very good. Learning BLS on a homemade TBT is at least equally effective as on an SBT, with the advantage of being very cost saving. Therefore, this readily available box trainer may be used as an effective, flexible training device outside the operating room to improve accessibility to simulation training.

Impact of 3D in the training of basic laparoscopic skills and its transferability to 2D environment: a prospective randomized controlled trial.

Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in laparoscopic surgery. However, a few studies have shown the impact of proficiency-based training and transferability of the skills from 2D to 3D system and vice versa. The purpose of this study was to investigate the impact of 2D and 3D environments on the time taken by novice trainees to learn basic laparoscopic skills and the transferability of the skills learnt in one environment to another. Medical students with no prior experience in training of laparoscopic tasks were randomly assigned to 2D or 3D groups. Both groups were trained in peg transfer and intracorporeal suture of Fundamentals of Laparoscopic Surgery (FLS) program until they attained predefined benchmarks. The practice times taken to reach the goal were compared. After they had reached the goal, all the participants were asked to repeat these tasks under both 2D and 3D environments. Their scores in both of the environments were compared. Eighty-eight participants were randomly assigned to 2D (n=44) or 3D (n=44) training groups. There was no difference between the backgrounds of both groups. The 3D training group was faster in reaching its goal in both tasks (p<0.001 and p=0.007, respectively). After reaching the goal, both groups were faster in the 3D environment in peg transfer (p=0.04, p=0.012). In intracorporeal suture, the 2D training group had similar scores in both the environments (p=0.32), but the 3D group was slower in the 2D environment (p=<0.001). The 3D environment helped shorten the training time of basic laparoscopic skills to novices. However, the novices trained in the 3D environment failed to transfer their skills to the 2D environment.

Perceptual Speed and Psychomotor Ability Predict Laparoscopic Skill Acquisition on a Simulator

Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate. A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate. The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands. In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training. Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = -0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures. PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training.

Porcine Cadaver Organ or Virtual-Reality Simulation Training for Laparoscopic Cholecystectomy: A Randomized, Controlled Trial

As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial. After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training. All research was performed in the Center for Surgical Technologies, Leuven, Belgium. In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium). The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p < 0.01). There were no significant differences between groups at retention testing. The virtual trainer group did not outperform the control group at any time. For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven.

Laparoscopic skills acquisition: a study of simulation and traditional training

Training in basic laparoscopic skills can be undertaken using traditional methods, where trainees are educated by experienced surgeons through a process of graduated responsibility or by simulation-based training. This study aimed to assess whether simulation trained individuals reach the same level of proficiency in basic laparoscopic skills as traditional trained participants when assessed in a simulated environment. A prospective study was undertaken. Participants were allocated to one of two cohorts according to surgical experience. Participants from the inexperienced cohort were randomized to receive training in basic laparoscopic skills on either a box trainer or a virtual reality simulator. They were then assessed on the simulator on which they did not receive training. Participants from the experienced cohort, considered to have received traditional training in basic laparoscopic skills, did not receive simulation training and were randomized to either the box trainer or virtual reality simulator for skills assessment. The assessment scores from different cohorts on either simulator were then compared. A total of 138 participants completed the assessment session, 101 in the inexperienced simulation-trained cohort and 37 on the experienced traditionally trained cohort. There was no statistically significant difference between the training outcomes of simulation and traditionally trained participants, irrespective of the simulator type used. The results demonstrated that participants trained on either a box trainer or virtual reality simulator achieved a level of basic laparoscopic skills assessed in a simulated environment that was not significantly different from participants who had been traditionally trained in basic laparoscopic skills.

Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial

BackgroundThe purpose of this study was to determine whether training on fresh cadavers improves the laparoscopic skills performance of novices. MethodsJunior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, were randomized into control (group A) and practice groups (group B). Group B performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers (FFCs) improvised from fundamentals of laparoscopic skills technical curriculum. Performance on cadavers was scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. The baseline technical ability of the 2 groups and any transfer of skills from FFCs was measured using a full procedural laparoscopic cholecystectomy task on a virtual reality simulator before and after practice on FFCs, respectively. Nonparametric tests were used for analysis of the results. ResultsTwenty candidates were randomized; 1 withdrew before the study commenced, and 19 were analyzed (group A, n = 9; group B; n = 10). Four of 5 tasks (nondominant to dominant hand transfer, simulated appendectomy, intracorporeal, and extracorporeal knot tying) on FFCs showed significant improvement on learning curve analysis. After training, significant improvement was shown for safety of cautery (P = .040) and the left arm path length (P = .047) on the virtual reality simulator by the practice group. ConclusionsTraining on FFCs significantly improves basic laparoscopic skills and can improve full procedural performance.

Task-specific bench model training versus basic laparoscopic skills training for laparoscopic radical prostatectomy: a randomized controlled study

Performing a laparoscopic urethrovesical anastomosis (LUA) after a radical prostatectomy is technically challenging for the novice laparoscopic surgeon. We developed a low-fidelity urethrovesical model (UVM) to allow a urologist to practise this critical step. The aim of our study was to compare the effect of task-specific bench model training (anastomotic suturing on the UVM) with that of basic laparoscopic suturing on intracorporeal urethrovesical anastomosis performance. We recruited 28 senior surgical residents, fellows or staff surgeons for this prospective, single-blinded, randomized controlled study. We randomly assigned participants to an intervention group practising LUA on the UVM or to a control group practising basic laparoscopic suturing and knot-tying on a foam pad. After practising, we videotaped participants performing 5 intra-corporeal interrupted sutures on a foam pad and a LUA on the UVM. A blinded expert scored the videotaped performance using a laparoscopic suturing checklist (CL) and a global rating scale (GRS), and timed the performance. On the foam pad suturing task, the group that trained on the UVM had significantly higher CL scores (10.9 v. 8.1, p = 0.017). On the LUA task, the group that trained on the UVM had significantly higher CL scores (10.9 v. 8.1, p = 0.017), GRS (29.6 v. 22.8, p = 0.005) and shorter times (27.6 v. 38.3 min, p = 0.004) than the control group. Our task-specific bench model was shown to be superior to basic laparoscopic suturing drills on a foam pad.

Training of basic laparoscopic skills in surgical education

Background / objectiveThe study was carried out to evaluate the potential use of laparoscopic simulators to enhance basic laparoscopic skills until proficiency is reached.Materials and methodsThe study participants were divided into two groups according to their experience in laparoscopic procedures: no prior experience (group A; n = 16) and laparoscope navigation experience (group B; n = 16). All the participants performed nineattempts of three basic laparoscopic skill tasks (“Instrument navigation”, “Cutting”, “Clip applying”) on the LapSim® simulator during three sessions within one month. The distribution of practice sessions was standardized by performing three attemptsfor each task per session and no more than one session per week. The assessment of laparoscopic skills was based on the cumulative score for each task measured by the computer system.ResultsTrainees in the group A were younger (22.2 ± 1.3 vs. 26.1 ± 1.3 years, P &lt; 0.001). There were statistically significant differences in cumulative scores for all three tasks after the first five attempts between the two groups (P &lt; 0.001). Comparison of thecumulative scores for the task “Instrument navigation” after the sixth attempt (P = 0.073), for the task “Clip applying” after the seventh attempt (P = 0.287), and for the task “Cutting” after the eighth attempt (P = 0.080) showed no significant differences among the study groups.ConclusionsThe results indicated that a group of trainees with no prior laparoscopic experience acquired the basic laparoscopic skills significantly faster. Proficiency in the laparoscopic basic tasks was achieved within 6–8 repetitions in both groups. These findings suggest that training of practical skills in using laparoscopic simulators should be integrated into medical education much earlier.Key words: surgical education, simulation, laparoscopy, virtual reality simulator, LapSimBazinių laparoskopinių įgūdžių įgijimas studijuojant mediciną TikslasAtlikti tyrimą, siekiant įvertinti kompiuterinių laparoskopinių simuliatorių naudojimą medicinos studijoms mokant pagrindinių laparoskopinių operacijų įgūdžių, kol bus įgyta reikiama patirtis.MetodikaTyrimo dalyviai pagal patirtį buvo suskirstyti į dvi grupes: vienos grupės tiriamieji neturėjo jokios išankstinės laparoskopinių operacijų patirties (A grupė, n=16), o kitos grupės turėjo tik navigacijos laparoskopu patirties (B grupė, n=16). Visi dalyviai pertrejas pratybas su laparoskopiniu virtualiu simuliatoriumi LapSim® atliko trijų pagrindinių laparoskopinių užduočių („Instrumentų navigacija“, „Pjovimas“, „Kabučių uždėjimas“) devynis bandymus. Kiekvieną užsiėmimą atskira užduotis buvo kartojamatris kartus, o užsiėmimas vyko ne dažniau nei kartą per savaitę. Vertintas galutinis užduoties rezultatas. Laparoskopinių operacijų įgūdžiai vertinti kompiuterine sistema pagal išvestinį kaupiamąjį kiekvienos užduoties balą.RezultataiA grupės dalyviai buvo jaunesni (22,2±1,3 vs. 26,1±1,3 metų, p&lt;0,001). Išanalizavus visų trijų užduočių kaupiamuosius balus po pirmųjų penkių bandymų, abi grupės skyrėsi statistiškai reikšmingai (p&lt;0,001). Tyrimą tęsiant ir lyginant išvestinį kaupiamąjįbalą atliekant užduotį „Instrumentų navigacija“ po šešto bandymo (p=0,073), užduotį „Kabučių uždėjimas“ po septinto bandymo (p=0,287), užduotį „Pjovimas“ po aštunto bandymo (p = 0,080), jokių reikšmingų skirtumų tarp tiriamų grupių nerasta.IšvadosTyrimo rezultatai parodė, kad net be laparoskopinių operacijų patirties tokių operacijų pagrindinius įgūdžius laparoskopiniu simuliatoriumi įgyjama greičiau. Chirurginės simuliacijos užduočių kartojimas iki 6–8 bandymų leidžia įgyti gerus pagrindiniųlaparoskopinių operacijų įgūdžius. Šie rezultatai rodo, kad praktinių įgūdžių mokymas naudojant laparoskopinį simuliatorių turėtų būti įtrauktas į medicinos studijų programą.Reikšminiai žodžiai: chirurgijos studijos, simuliacija, laparoskopija, virtualios realybės simuliatorius, LapSim.

A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training

Previous randomized studies have compared high- versus low-fidelity laparoscopic simulators; however, no proficiency criteria were defined and results have been mixed. The purpose of this research was to determine whether there were any differences in the learning outcomes of participants who had trained to proficiency on low- or high-fidelity laparoscopic surgical simulators. We conducted a randomized, prospective crossover trial with participants recruited from New South Wales, Western Australia, and South Australia. Participants were randomized to high-fidelity (LapSim, Surgical Science) or low-fidelity (FLS, SAGES) laparoscopic simulators and trained to proficiency in a defined number of tasks. They then crossed over to the other fidelity simulator and were tested. The outcomes of interest were the crossover mean scores, the proportion of tasks passed, and percentage passes for the crossover simulator tasks. Of the 228 participants recruited, 100 were randomized to LapSim and 128 to FLS. Mean crossover score increased from baseline for both simulators, but there was no significant difference between them (11.0 % vs. 11.9 %). FLS-trained participants passed a significantly higher proportion of crossover tasks compared with LapSim-trained participants (0.26 vs. 0.20, p = 0.016). A significantly higher percentage of FLS-trained participants passed intracorporeal knot tying than LapSim-trained participants (35 % vs. 8 %, p < 0.001). Similar increases in participant score from baseline illustrate that training on either simulator type is beneficial. However, FLS-trained participants demonstrated a greater ability to translate their skills to successfully complete LapSim tasks. The ability of FLS-trained participants to transfer their skills to new settings suggests the benefit of this simulator type compared with the LapSim.

Single versus multimodality training basic laparoscopic skills

IntroductionEven though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality training of basic laparoscopic skills.MethodsThirty-six medical students without laparoscopic experience performed six training sessions of 45 min each, one per day, in which four different basic tasks were trained. Participants in the single-modality group (S) (n = 18) practiced solely on a virtual reality (VR) simulator. Participants in the multimodality group (M) (n = 18) practiced on the same VR simulator (2x), a box trainer (2x), and an augmented reality simulator (2x). All participants performed a pre-test and post-test on the VR simulator (the four basic tasks + one additional basic task). Halfway through the training protocol, both groups performed a salpingectomy on the VR simulator as interim test.ResultsBoth groups improved their performance significantly (Wilcoxon signed-rank, P < 0.05). The performances of group S and group M in the additional basic task and the salpingectomy did not differ significantly (Mann–Whitney U test, P > 0.05). Group S performed the four basic tasks in the post-test on the VR faster than group M (P ≤ 0.05), which can be explained by the fact that they were much more familiar with these tasks.ConclusionsTraining of basic laparoscopic tasks on single or multiple modalities does not result in different training outcome. Both training methods seem appropriate for the attainment of basic laparoscopic skills in future curricula.

Criterion-based laparoscopic training reduces total training time

IntroductionThe benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency.MethodsDuring four training sessions within 1 week (one session per day) 34 medical interns (no laparoscopic experience) practiced on two basic tasks on the Simbionix LAP Mentor virtual-reality (VR) simulator: ‘clipping and grasping’ and ‘cutting’. Group C (criterion-based) (N = 17) trained to reach predefined criteria and stopped training in each session when these criteria were met, with a maximum training time of 1 h. Group T (time-based) (N = 17) trained for a fixed time of 1 h each session. Retention of skills was assessed 1 week after training. In addition, transferability of skills was established using the Haptica ProMIS augmented-reality simulator.ResultsBoth groups improved their performance significantly over the course of the training sessions (Wilcoxon signed ranks, P < 0.05). Both groups showed skill transferability and skill retention. When comparing the performance parameters of group C and group T, their performances in the first, the last and the retention training sessions did not differ significantly (Mann–Whitney U test, P > 0.05). The average number of repetitions needed to meet the criteria also did not differ between the groups. Overall, group C spent less time training on the simulator than did group T (74:48 and 120:10 min, respectively; P < 0.001). Group C performed significantly fewer repetitions of each task, overall and in session 2, 3 and 4.ConclusionsCriterion-based training of basic laparoscopic skills can reduce the overall training time with no impact on training outcome, transferability or retention of skills. Criterion-based should be the training of choice in laparoscopic skills curricula.