Basic Laparoscopic Skills Research Articles

Peers versus Pros: Feedback using standards in simulation training

Creating and updating expert performance-based standards for simulators is labor intensive and requires the regular availability of expert surgeons. We investigated how peer performance based standards compare to expert performance based standards. One hundred medical students took part in a four-session laparoscopic basic skills simulator training course. Performance for the FLS videotrainer tasks were compared between students who received feedback based on either peer standards, expert standards or no feedback at all (control group). No difference in performance between our feedback groups was found. Compared to the control group, they were 18-36% faster but made 52% more errors for tasks on the FLS video trainer (U range [93.5-957], average p < .01). We demonstrated that feedback based on peer standards is equally effective as feedback based on expert standards. The found trade-off between speed and error is not desirable and warrants further investigation.

Single-site robotic cholecystectomy: comparison of clinical outcome and the learning curves in relation to surgeon experience in a community teaching hospital

BackgroundThe aim of this study was to analyze the experience of two surgeons who have different laparoscopic skills and case volume, with single-site robotic cholecystectomy (SSRC) and evaluate their learning curves.MethodsAll SSRCs performed between March 2013 and April 2015 were retrospectively reviewed. The patients were divided among two surgeons based on the surgeon’s level of laparoscopic skills and case volume. Surgeon 1 had experience in advanced laparoscopy while surgeon 2 had basic laparoscopic skills. Patients’ demographic data, intraoperative and short-term postoperative results were assessed.ResultsThe analysis included 102 patients for surgeon 1 and 15 patients for surgeon 2. There were no major or minor complications in either cohort. Operative time was significantly longer for surgeon 2, conversion to laparoscopy rate was 4% for surgeon 1 compared to 20% for surgeon 2, P = 0.044, which is statistically significant.ConclusionsSSRC is an easy and safe procedure that can be quickly learned and performed in a reproducible manner by surgeons with experienced laparoscopic skills and greater case volume.

A Systematic Review and Meta-analyis on the Effect of Training with Nintendo Wii TM in the Improvement of Basic Laparoscopic Skills Among Laparoscopic Novices

Introduction: Videogames offer the usual skills needed for laparoscopy namely, eye-hand coordination, depth perception, and bimanual operation. The impact of playing videogames on basic laparoscopic skills is still ambiguous with some studies showing correlation and with other studies demonstrating little or no effect. Objective: To determine the impact of training with Nintendo® WiiTM in the improvement of basic laparoscopic skill among laparoscopic novices by measuring the time to completion of eyehand coordination task, two-hand manipulation task, grasping and cutting task or grasping and clipping tasks. Methods: An electronic systematic search was done in online databases and search engines. This review included randomized prospective studies, written in English language, and published within the last 5 years. Participants included adults 19-29 years old, medical students and surgical residents, with a low video game experience, without or minimal experience in laparoscopic surgery and laparoscopic simulator. The studies compared the performance of participants in a laparoscopic simulator (SimbionixTM LapMentorTM or ProMIS) after training with Nintendo® WiiTM and measured their completion time of several tasks. Results: Training with Nintendo® WiiTM showed improvement in time to completion of eye-hand coordination task, two-hand manipulation task, and grasping and clipping task. The study however showed equivocal results in the grasping and cutting tasks Conclusion: Training with Nintendo® WiiTM can be used as a training tool for the improvement of basic laparoscopic skills of laparoscopic novices. Key words: Nintendo® WiiTM, surgical skills, laparoscopic skills

PD58-08 MENTAL TRAINING AND ITS EFFECT ON PROCEDURAL AND COGNITIVE LEARNING - A BLUEPRINT FOR UROLOGIC RESIDENTS IN A CONDENSED WORK ENVIRONMENT?

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2018PD58-08 MENTAL TRAINING AND ITS EFFECT ON PROCEDURAL AND COGNITIVE LEARNING - A BLUEPRINT FOR UROLOGIC RESIDENTS IN A CONDENSED WORK ENVIRONMENT? Phillip Marks, Julia Kaulfuβ, Luis Kluth, Philippe Grange, Felix Chun, Margit Fisch, and Christian Meyer Phillip MarksPhillip Marks More articles by this author , Julia KaulfuβJulia Kaulfuβ More articles by this author , Luis KluthLuis Kluth More articles by this author , Philippe GrangePhilippe Grange More articles by this author , Felix ChunFelix Chun More articles by this author , Margit FischMargit Fisch More articles by this author , and Christian MeyerChristian Meyer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The work environments of current residents are fundamentally changing, characterized by a demand for cost-containment and dense working hours without compromising highest quality of care (outcome quality/patient safety). As a field, urology requires core competencies in cognitive processing of a diverse range of diseases and the perfection of many different manual skills (endoscopy, sonography, open surgery etc.). This training is cost- and time-consuming. We hypothesized that a specific mental training can enhance and optimize cognitive and manual skill acquisition. METHODS We designed a prospective trial of 24 laparoscopic novices (medical students) who were randomized to 1) a control group, 2) a video training group, 3) a mental training group. Mental training consisted of the identification of procedural key steps, relaxation, mental vocalization and mental imaging techniques over a course of 2 weeks after one initial supervised training session. All groups completed a basic training in 2 exercises of the official E-BLUS (European training in basic laparoscopic urological skills) curriculum (PEG transfer, cutting a circle) before intervention (video training, video training+mental training). Both exercises were assessed 48 h and 2 weeks after intervention. Primary endpoints were scores in a global rating scale (handling, efficiency of movement etc.), procedural time and error rates. Additionally, participants completed several theoretical tests examining spatial differentiation, theoretical knowledge and a test of performance strategies. Statistical analyses included ANOVA and general linear models with repeated measures. RESULTS All group baseline characteristics were homogeneous after randomization (p>0.05). Mental training improved time efficiency in PEG transfer but not cutting a circle exercises after 48 h (p=0.017). Mental training significantly improved the global rating scale score (p=0.035) and performance strategies (p=0.041) after 2 weeks. Participants who received and exercised mental training significantly reduced procedural error rates and improved their performance strategies (p=0.02 and p=0.01, respectively). There was no significant differences between the groups with regards to cognitive functioning tests or theoretical knowledge testing. CONCLUSIONS In this randomized controlled trial of laparoscopic novices, mental training significantly improved procedural time efficiency and performance strategies, while theoretical knowledge did not significantly change. The regular and continuous integration of mental training strategies into urological residency might serve as a blueprint to improve and streamline manual skill acquisition and performance while retaining cost- and time-efficiency. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1136-e1137 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Phillip Marks More articles by this author Julia Kaulfuβ More articles by this author Luis Kluth More articles by this author Philippe Grange More articles by this author Felix Chun More articles by this author Margit Fisch More articles by this author Christian Meyer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transvaginal Natural Orifice Transluminal Endoscopic Surgery as a Rescue for Total Vaginal Hysterectomy

BackgroundTransvaginal surgery is the most minimally invasive surgery for a gynecologic procedure but can be challenging for many to perform as evidenced by its declining rate. Vaginal removal of the adnexal structures can be difficult because of poor visualization. Factors such as abnormal pathology, incidental finding of early-stage endometriosis or adhesions from previous cesarean section or surgery, and obesity may further complicate the procedure. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) may be performed during vaginal surgery using basic laparoscopic single-site skills as a “rescue” procedure for the complete removal of the adnexae. This allows the surgeon to complete the procedure vaginally without requiring conversion or addition of abdominal incisions. The combination of total vaginal hysterectomy (TVH) with NOTES as a “rescue” procedure may be a useful tool for gynecologic surgeons for removal of the adnexae and performance of other pelvic procedures. Study ObjectiveTo demonstrate various common pelvic procedures that can be performed by transvaginal NOTES after completion of TVH. DesignVariety demonstrations of the transvaginal NOTES technique as a “rescure” for total vaginal hysterectomy with narrated video footage (Canadian Task Force classification III). SettingAcademic tertiary care hospital. PatientsPatients with various surgeries including prophylactic bilateral salpingectomy, salpingo-oophorectomy, adhesiolysis, and incidental finding of superficial endometriosis resection. This video is exempt from institutional review board review at our institution. InterventionsTransvaginal NOTES adnexal surgery and other procedures using basic laparoscopic single-site surgical skills. Measurements and Main ResultsSalpingectomy, oophorectomy, lysis of adhesions, and resection of endometriosis can be performed using NOTES at the time of vaginal hysterectomy. ConclusionNOTES allows the surgeon to survey the pelvis for pathology and to complete other pelvic procedures transvaginally during TVH with no additional abdominal incisions. Transvaginal NOTES can be considered a “rescue” approach and can be a helpful tool for the pelvic surgeon.

Saving robots improves laparoscopic performance: transfer of skills from a serious game to a virtual reality simulator.

Residents find it hard to commit to structural laparoscopic skills training. Serious gaming has been proposed as a solution on the premise that it is effective and more motivating than traditional simulation. We establish construct validity for the laparoscopic serious game Underground by comparing laparoscopic simulator performance for a control group and an Underground training group. A four-session laparoscopic basic skills course is part of the medical master students surgical internship at the Radboud University Medical Centre. Four cohorts, representing 107 participants, were assigned to either the Underground group or the control group. The control group trained on the FLS video trainer and the LapSim virtual reality simulator for four sessions. The Underground group played Underground for three sessions followed by a transfer session on the FLS video trainer and the LapSim. To assess the effect of engaging in serious gameplay on performance on two validated laparoscopic simulators, initial performance on the FLS video trainer and the LapSim was compared between the control group (first session) and the Underground group (fourth session). We chose task duration as a proxy for laparoscopic performance. The Underground group outperformed the control group on all three LapSim tasks: Camera navigation F(1) = 12.71, p < .01; Instrument navigation F(1) = 8.04, p < .01; and Coordination F(1) = 6.36, p = .01. There was no significant effect of playing Underground for performance on the FLS video trainer Peg Transfer task, F(1) = 0.28, p = .60. We demonstrated skills transfer between a serious game and validated laparoscopic simulator technology. Serious gaming may become a valuable, cost-effective addition to the skillslab, if transfer to the operating room can be established. Additionally, we discuss sources of transferable skills to help explain our and previous findings.

Evaluation of Basic Laparoscopic Surgical Skills course programme for surgery residents- at a simulation lab in south India.

Introduction : Patient safety is the important priority in surgical education. The new training models and curriculum are needed for maintaining safety and quality of surgical performance. An established laparoscopic surgical skill(LSS) grade 1 level 1 programme running for surgical residents is being already taken up in various european countries under the support of European Association of Endoscopic Surgeons. Aim : The aim of the paper is to evaluate the perception of surgery residents on LSS Grade 1 Level 1 course in South India. Material and methods : A total of 5 accredited LSS Grade I Level 1 courses were held in GSL SMART LAB between April 2013 and December 2016. The demographic data and pre-course surgical experience in laparoscopic surgery of the participants were recorded. After completion of 12 hrs practice on endotrainer and lap mentor combined, the participants attended two days of basic laparoscopic surgical skill programme with different modes of assessment/examination related to basic laparoscopic skills. The participants filled the course evaluation form to evaluate course progress, course materials, assessment, staff, course location and overall impression of the course on a 1-10 scale to evaluate feedback information. Results : 34 surgery residents were enrolled in an LSS Grade I Level 1 programme. The mean age of the participants was 28.294 years (SD = 3.51), the male/female ratio was 31/3 and previous experience with laparoscopic surgery was limited. Overall impression of the course was rated with 8.8 points (SD = 0.78). The applicability of the course content in practice and the balance between theory and hands-on training were also rated very well – mean 8.8 (SD = 1.01) and 8.1 points (SD = 0.80) respectively. Conclusions : The result of this study shows that the course is a well balanced training programme, meeting the expectations of individual surgery residents. Hence, the overall interest in the programme suggests that it might become the future Indian standard of surgical education in laparoscopic surgery. Success of the course may be drawn after the completion of clinical assessment of enrolled participants.

Specialist's training for laparoscopic surgery in Wet-lab educational operating theatre

To develop system for students training in laparoscopic surgery by using of Wet-lab educational operating theatre. We have launched laparoscopic surgery teaching program for students of Ryazan State Medical University. This system includes several stages. At the first stage professional selection was carried out on 'dry' laparoscopic simulators among III-IV-year students of medical faculty. So, 10 people were selected. The second stage included theoretical and practical parts consisting of development of basic laparoscopic skills on 'dry' simulators. 5 students who scored the maximum points were admitted to the next stage. The third stage is working in Wet-lab operating theatre with a mentor. There were 10 sessions on 10 laboratory pigs. Final stage of our study compares two groups of participants: main group - 5 students who underwent above-described program and control group of 5 residents without experience for laparoscopic operations. The participants of the main group had significantly higher OSATS score compared with another group (20 vs. 10; p<0.05). Movements effectiveness estimated by measuring of movements trajectory total length was also higher in main group than in control group (6 vs. 20; p<0.05). Experts' subjective assessment according to 10-point scale was also higher for students than for interns (9 vs. 5, p<0.05). Participants in the main group required significantly less time to complete the task compared with the control group (40 vs. 90 minutes, p<0.05). Our experience has shown that training system with Wet-lab operating theatre is effective for quick and efficient training of medical students in main laparoscopic procedures. In our opinion, introduction of students into 'advanced' surgery from early age will make it possible to get finally highly professional specialists.

ОПЫТ ИСПОЛЬЗОВАНИЯ ОРИГИНАЛЬНОГО ВИДЕОТРЕНАЖЕРА ДЛЯ ОСВОЕНИЯ БАЗОВЫХ НАВЫКОВ В ЛАПАРОСКОПИЧЕСКОЙ ХИРУРГИИ

Introduction. For development of laparoscopic skills, box training simulators and virtual computer simulators of different complexity are used as training tools. All of them have advantages and disadvantages. Objective. To study the possibility and efficiency of department-created original video simulator for providing basic laparoscopic skills to students. Material and methods. The study was performed on the original laparoscopic video simulator with the participation of 42 students of the 6th year of studying. The digital data processed using the parametric methods of statistical analysis. Results. Exercises after two training gave a significant improvement on the criterion of speed (time). Subjectively, most of participants began to perform them more clearly and confidently, the number of unnecessary movements and mistakes decreased. Conclusions. The laparoscopic simulator is effective for training of basic endovideosurgical manipulations and can be used in educational process by the senior students at a preliminary stage before classes on simulator of virtual reality.

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.

A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying

BackgroundTraining of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1–G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T2) in the same manner than at T1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T3) in the same manner than at T1 and T2. At each repetition, scoring was based on the time taken for task completion system.ResultsThe scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001).ConclusionsOur data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.

Effect of simulator orientation during skills training on performance of basic laparoscopic tasks by veterinary students.

OBJECTIVE To determine whether basic laparoscopic skills acquired during training in the horizontal plane would transfer to the vertical plane and vice versa. DESIGN Evaluation study. SAMPLE POPULATION 26 first- and second-year veterinary students with no prior laparoscopic skills training or surgical experience. PROCEDURES Participants were nonrandomly assigned to 2 groups. Group 1 (n = 15) underwent laparoscopic skills training in the horizontal plane, and group 2 (17) underwent laparoscopic skills training in the vertical plane. Following training, participants were tested on their ability to perform 5 laparoscopic tasks, first in the horizontal plane and then the vertical plane (group 1) or first in the vertical plane and then in the horizontal plane (group 2). All training and testing were performed with an augmented-reality laparoscopic simulator. RESULTS 3 participants in each group did not complete the study. For group 1, scores for 3 of the 5 tasks were significantly worse when tested in the vertical plane than when tested in the horizontal plane. For group 2, scores for 2 of the 5 tasks were significantly worse when tested in the horizontal plane than when tested in the vertical plane. For 3 tasks, the difference in scores for the training versus orthogonal plane was significantly lower for group 2 than for group 1. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that basic laparoscopic skills acquired in 1 plane frequently did not transfer to the orthogonal plane. Because veterinary surgeons may be required to treat patients in various positions, development of laparoscopic training models to simulate the vertical plane is recommended.

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

Validation of the VBLaST pattern cutting task: a learning curve study.

Mastery of laparoscopic skills is essential in surgical practice and requires considerable time and effort to achieve. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC©) is a virtual simulator that was developed as a computerized version of the pattern cutting (PC) task in the Fundamentals of Laparoscopic Surgery (FLS) system. To establish convergent validity for the VBLaST-PC©, we assessed trainees' learning curves using the cumulative summation (CUSUM) method and compared them with those on the FLS. Twenty-four medical students were randomly assigned to an FLS training group, a VBLaST training group, or a control group. Fifteen training sessions, 30min in duration per session per day, were conducted over 3weeks. All subjects completed pretest, posttest, and retention test (2weeks after posttest) on both the FLS and VBLaST© simulators. Performance data, including time, error, FLS score, learning rate, learning plateau, and CUSUM score, were analyzed. The learning curve for all trained subjects demonstrated increasing performance and a performance plateau. CUSUM analyses showed that five of the seven subjects reached the intermediate proficiency level but none reached the expert proficiency level after 150 practice trials. Performance was significantly improved after simulation training, but only in the assigned simulator. No significant decay of skills after 2weeks of disuse was observed. Control subjects did not show any learning on the FLS simulator, but improved continually in the VBLaST simulator. Although VBLaST©- and FLS-trained subjects demonstrated similar learning rates and plateaus, the majority of subjects required more than 150 trials to achieve proficiency. Trained subjects demonstrated improved performance in only the assigned simulator, indicating specificity of training. The virtual simulator may provide better opportunities for learning, especially with limited training exposure.

Virtual interactive suturing for the Fundamentals of Laparoscopic Surgery (FLS)

BackgroundSuturing with intracorporeal knot-tying is one of the five tasks of the Fundamentals of Laparoscopic Surgery (FLS), which is a pre-requisite for board certification in general surgery. This task involves placing a short suture through two marks in a penrose drain and then tying a double-throw knot followed by two single-throw knots using two needle graspers operated by both hands. A virtual basic laparoscopic skill trainer (VBLaST©) is being developed to represent the virtual versions of the FLS tasks, including automated, real time performance measurement and feedback. In this paper, we present the development of a VBLaST suturing simulator (VBLaST-SS©). Developing such a simulator involves solving multiple challenges associated with fast collision detection, response and force feedback. MethodsIn this paper, we present a novel projection-intersection based knot detection method, which can identify the validity of different types of knots at haptic update rates. A simple and robust edge-edge based collision detection algorithm is introduced to support interactive knot tying and needle insertion operations. A bimanual hardware interface integrates actual surgical instruments with haptic devices enabling not only interactive rendering of force feedback but also realistic sensation of needle grasping, which realizes an immersive surgical suturing environment. ResultsExperiments on performing the FLS intracorporeal suturing task show that the simulator is able to run on a standard personal computer at interactive rates. ConclusionsVBLaST-SS© is a computer-based interactive virtual simulation system for FLS intracorporeal knot-tying suturing task that can provide real-time objective assessment for the user’s performance.

Investigating the impact of innate dexterity skills and visuospatial aptitude on the performance of baseline laparoscopic skills in veterinary students.

To determine if manual dexterity and visuospatial skills can be used to predict baseline laparoscopic surgery skills in veterinary students. Pilot study. Veterinary students (n = 45) from years 1-4 volunteered for this study. An hour-long electronic questionnaire was completed by participants. The first section was used to collect demographics and information about prior nonsurgical experiences. The second section included 3 tests of visuospatial skills, including the Purdue Visualization of Rotations Test, Mental Rotations Test, and Raven's Advanced Progressive Matrices Test. Multiple tests were administered to assess innate dexterity, including the grooved pegboard test, indirect and direct zigzag tracking tests, and the 3Dconnexion proficiency test. Each dexterity test was performed once with the left hand and once with the right hand. The order of task performance was randomized. Basic laparoscopic skills were assessed using the validated fundamentals of laparoscopic surgery (FLS) peg transfer task. There was an association between left-handed grooved pegboard scores (95% CI -10046.36 to -1636.53, P-value = .008) and left-handed indirect zigzag tracking task (95% CI -35.78 to -8.20, P-value = .003) with FLS peg transfer scores. Individuals who reported playing videogames achieved higher scores on the FLS peg transfer task than those without videogame experience (95% CI 583.59 to 3509.97, P-value = .007). The results of this study suggest that dexterity was a better predictor of baseline laparoscopic skills than visuospatial skills in veterinary students.

Development Methodology of the Novel Endoscopic Stone Treatment Step 1 Training/Assessment Curriculum: An International Collaborative Work by European Association of Urology Sections.

Background: Simulation-based technical skill assessment is a core topic of debate, especially in high-risk environments. After the introduction of the E-BLUS (European Basic Laparoscopic Urological Skills) exam for basic laparoscopy, no more technical training/assessment urological protocols have been developed in Europe. Objective: We describe the methodology used in the development of the novel Endoscopic Stone Treatment step 1 (EST s1) assessment curriculum. Materials and Methods: The "full life cycle curriculum development" template was followed for curriculum development. A cognitive task analysis was run to define the most important steps and details of retrograde intrarenal surgery, in accordance with European Association of Urology (EAU) Urolithiasis guidelines. Training tasks were created between April 2015 and September 2015. Tasks and metrics were further analyzed by a consensus meeting with the European Section of Urolithiasis (EULIS) board in February 2016. A review, aimed to study available simulators and their accordance with task requirements, was subsequently run in London in March 2016. After initial feedback and further tests, content validity of this protocol was achieved during European Urology Residents Education Programme (EUREP) 2016. Results: The EST s1 curriculum development, took 23 months. Seventy-two participants tested the five preliminary tasks during EUREP 2015, with sessions of 45 minutes each. Likert-scale questionnaires were filled out to score the quality of training. The protocol was modified accordingly and 25 participants tested the four tasks during the hands-on training sessions of the European Section of Uro-Technology (ESUT) 2016 congress. One hundred thirty-four participants finally participated in the validation study in EUREP 2016. During the same event, 10 experts confirmed content validity by filling out a Likert-scale questionnaire. Conclusion: We described a reliable and replicable methodology that can be followed to develop training/assessment protocols for surgical procedures. The expert consensus meetings, strict adherence to guidelines, and updated literature search toward an Endourology curriculum allowed correct training and assessment protocol development. It is the first step toward standardized simulation training in Endourology with a potential for worldwide adoption.

Effect of Continuous Motion Parameter Feedback on Laparoscopic Simulation Training: A Prospective Randomized Controlled Trial on Skill Acquisition and Retention

To investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum. A Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy. Muenster University Hospital Training Center, Muenster, Germany. Medical students without previous surgical experience. Laparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention. Simulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.

Convergent validation and transfer of learning studies of a virtual reality-based pattern cutting simulator.

Research has clearly shown the benefits of surgical simulators to train laparoscopic motor skills required for positive patient outcomes. We have developed the Virtual Basic Laparoscopic Skill Trainer (VBLaST) that simulates tasks from the Fundamentals of Laparoscopic Surgery (FLS) curriculum. This study aims to show convergent validity of the VBLaST pattern cutting module via the CUSUM method to quantify learning curves along with motor skill transfer from simulation environments to ex vivo tissue samples. 18 medical students at the University at Buffalo, with no prior laparoscopic surgical skills, were placed into the control, FLS training, or VBLaST training groups. Each training group performed pattern cutting trials for 12 consecutive days on their respective simulation trainers. Following a 2-week break period, the trained students performed three pattern cutting trials on each simulation platform to measure skill retention. All subjects then performed one pattern cutting task on ex vivo cadaveric peritoneal tissue. FLS and VBLaST pattern cutting scores, CUSUM scores, and transfer task completion times were reported. Results indicate that the FLS and VBLaST trained groups have significantly higher task performance scores than the control group in both the VBLaST and FLS environments (p<0.05). Learning curve results indicate that three out of seven FLS training subjects and four out of six VBLaST training subjects achieved the "senior" performance level. Furthermore, both the FLS and VBLaST trained groups had significantly lower transfer task completion times on ex vivo peritoneal tissue models (p<0.05). We characterized task performance scores for trained VBLaST and FLS subjects via CUSUM analysis of the learning curves and showed evidence that both groups have significant improvements in surgical motor skill. Furthermore, we showed that learned surgical skills in the FLS and VBLaST environments transfer not only to the different simulation environments, but also to ex vivo tissue models.

Fundamentals of Laparoscopic Surgery: Not Only for Senior Residents

Fundamentals of laparoscopic surgery (FLS) was developed by the Society of American Gastrointestinal and Endoscopic Surgeons to teach the physiology, fundamental knowledge, and technical skills required for basic laparoscopic surgery. We hypothesize that residents are doing more laparoscopic surgery earlier in residency, and therefore would benefit from an earlier assessment of basic laparoscopic skills. Here, we examine FLS test results and ACGME case logs to determine whether it is practical to administer FLS earlier in residency. FLS test results were reviewed for the 42 residents completing FLS between July 2011 and July 2016. ACGME case logs for current and former residents were reviewed for laparoscopic cases logged by each postgraduate year. Basic and complex laparoscopic cases were determined by ACGME General Surgery Defined Category and Minimums Report. Descriptive statistics were used for analysis. Academic general surgery residency, Washington University in St. Louis School of Medicine. Current and former general surgery residents. A total of 42 residents took and passed FLS between July 2011 and July 2016. All residents successfully passed the FLS knowledge and skills examinations on the first attempt regardless of their postgraduate year (PGY 3n = 13, PGY 4n = 15, and PGY 5n = 14). Total laparoscopic case volume has increased over time. Residents who graduated in 2012 or 2013 completed 229 laparoscopic cases compared to 267 laparoscopic cases for those who graduated from 2014 to 2016 (p = 0.02). Additionally, current residents completed more laparoscopic cases in the first 2 years of residency than residents who graduated from 2012 to 2016 (median current = 38; former = 22; p < 0.001). Examining laparoscopic case numbers for current residents by PGY demonstrated that the number of total and complex laparoscopic cases increased in each of the first 3 years of residency with the largest increase occurring between the PGY 2 and PGY 3 years. In the PGY 4 and PGY 5 years, most laparoscopic cases were complex. Increased use of laparoscopic surgery has led to a corresponding increase in laparoscopic case volume among general surgery residents. We would advocate for FLS testing to serve as an early assessment of laparoscopic knowledge and skill and should be performed before a significant increase in complex laparoscopic surgery during training.