Evaluation Of Laparoscopic Skills Research Articles

Evaluation of laparoscopic skills in medical students.

To evaluate the laparoscopic skills of medical students and identify personal characteristics in terms of greater easiness in performing laparoscopic surgical procedures. This study included medical students in the 6th semester of a Medical School in Brazil who answered 10 questions concerning their habits and characteristics. A laparoscopic platform and an abdominal synthetic model were used to assess surgical skills comprising the three following surgical steps: to pass the needle through the trocar and to place it in the laparoscopic needle holder, to perform a laparoscopic simple stitch in synthetic liver parenchyma and, to perform a laparoscopic surgical knot. The duration of the activity was limited to four minutes and the procedure was monitored by a laparoscopic surgeon. The study included 50 students. Of these, 18% completed the three surgical stages. Steps 1 and 2 were completed by 94% and 88% of students, respectively. No statistically significant variables were found when characteristics of the groups with and without success in the three stages were compared. The group that finished the activity had a faster time completing step 2 than the group that failed (mean time of 115.3 seconds against 157.8 seconds, p=0.03). The minority of students could complete effectively all three surgical steps. No personal traits related to greater surgical skill were identified.

Common surgical training program: standardization of learning quality.

The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities. To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS. The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted. 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p<0.001). The cost of the program represented a saving of 67.89%. The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.

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

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

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.

Comparison of a single-access glove port with a SILS\u2122 port in a surgical simulator model using MISTELS

BackgroundRecent advances in laparoscopy both in human and veterinary medicine have looked at means of being less invasive by using single-port access surgery as opposed to multiport access surgery. The glove port has gained popularity as a cost-effective alternative to commercially available single-port access devices. The primary aim of this study was to compare the glove port to the SILS™ port in a simulator model using the first two MISTELS (McGill inanimate system for training and evaluation of laparoscopic skills) tasks (peg transfer and pattern cutting).MethodsTwenty-two novices were enrolled in this experimental study. Each participant had 60 min to practise both MISTELS tasks using two-port laparoscopy. Thereafter participants performed both tasks using the glove and SILS™ port with scores being calculated based on task completion time and errors. Higher scores were indicative of better performance. Participants were assigned into two groups with the starting order of the single ports being randomly selected. A self-evaluation questionnaire with three questions was completed by each participant after testing, rating each port.ResultsSignificantly (p < 0.05) higher scores were achieved using the glove port compared to the SILS™ port when performing both tasks. The glove port was subjectively evaluated as easier to use with more manoeuvrability of the instruments than the SILS™ port.Implications of the studyThe glove port’s improved manoeuvrability and ease of use make it a cost-effective alternative to the SILS™ port, for use in single-port laparoscopic veterinary surgery.

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study

BackgroundBenefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. MethodsA 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. ResultsSeven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. ConclusionStructured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

Reliability testing of a modified MISTELS score using a low-cost trainer box

BackgroundTraining programs such as the fundamentals of laparoscopic surgery (FLS) that are based on simulation are being currently used in several western countries. FLS allows skill acquisition and evaluation of competency in laparoscopic surgery. On the practical side, evaluation is determined by the MISTELS metrics (MISTELS is the acronym for the McGill inanimate system for training and evaluation of laparoscopic skills).This training program may be modified so that it can be implemented in countries with limited resources using a low-cost trainer box. Would the use of a low-cost trainer box alter the reliability of the MISTELS score?Objective of studyThe aim of the study was to evaluate the reliability of a modified MISTELS using a low-cost trainer box.MethodsIt was a prospective study carried out at Habib Thameur hospital in Tunis (Tunisia), between April 2016 and August 2016. The study involved residents from different surgical specialties in the departments of general surgery and paediatric surgery of the hospital during 2015 and 2016.This study assessed the reliability of a modified MISTELS system (Only three tasks were performed out of the five tasks used in the original MISTELS system). Evaluation was based on Cronbach’s alpha and intraclass correlation coefficients (ICC).A low-cost trainer box was designed and constructed. The residents included in the study performed three series of three tasks using this trainer box. The first series was scored by two trained raters to evaluate inter-rater reliability. The two-other series were successively performed to evaluate test-retest reliability.ResultsThe internal consistency, assessed by Cronbach’s alpha, was at 0.929 which is an acceptable score. As for inter-rater and test-retest reliabilities that were assessed by ICCs, they yielded excellent scores that were at 1 and 0.95 (95% CI, 0.891–0.978) respectively.ConclusionsThe reliability of a modified MISTELS is not altered by the use of a low-cost trainer box. The score of the modified MISTELS is a reliable score for evaluating technical skills of surgical residents using a low-cost trainer box.

Face and construct validation study of novel 3D peg transfer models for training and evaluation of laparoscopic skills in two-dimensional and three-dimensional laparoscopic surgery

Face and construct validation study of novel 3D peg transfer models for training and evaluation of laparoscopic skills in two-dimensional and three-dimensional laparoscopic surgery

Effect of Short- Versus Long-Term Video Game Playing on Basic Laparoscopic Skills Acquisition of Veterinary Medicine Students.

The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.

Face, construct, and concurrent validity of a simulation model for laparoscopic ovariectomy in standing horses.

OBJECTIVE To develop and validate a simulation model for laparoscopic ovariectomy in standing horses. DESIGN Prospective cohort study. SAMPLE 15 third-year veterinary students and 4 equine surgeons with experience in laparoscopy. PROCEDURES A simulation model that mimicked laparoscopic ovariectomy in standing horses was developed. Face validity of the model was determined with a questionnaire completed by the equine surgeons. Construct validity was determined by comparing performance scores (based on time to completion and accuracy completing various operative tasks) for simulated laparoscopic ovariectomy performed in the model for the students with scores for the equine surgeons. Concurrent validity was assessed by comparing performance scores with scores obtained with the validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). RESULTS Questionnaire responses indicated that the simulation model replicated the operative experience to a high degree (face validity). Performance scores for simulated laparoscopic ovariectomy performed in the model were significantly different between the students and the equine surgeons (construct validity). Performance scores for the simulation model were significantly correlated with scores for the MISTELS (concurrent validity). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the simulation model had face, construct, and concurrent validity, suggesting that it may be useful when training students to perform laparoscopic ovariectomy in standing horses.

How Hormonal Contraceptive Use Impacts Laparoscopic Skill Acquisition in Biologically Female Medical Students

INTRODUCTIONHormonal contraceptive use is commonplace among biological females of reproductive age. Biological females typically have lower testosterone levels than males, and hormonal contraceptive use lowers that testosterone level even further. Higher testosterone levels are shown to be positively correlated with spatial ability and, ultimately, with better performance in surgical skill acquisition. Biological females, particularly those using hormonal contraceptives, may then be at a disadvantage for learning new surgical skills. However, the relationship between hormonal contraceptive use and surgical skill acquisition is not yet understood, and will be examined in this study.METHODSParticipants (anticipated n=50) are students of Oakland University William Beaumont School of Medicine and are participating under approval of the university's Institutional Review Board. This study makes use of laparoscopic box trainers and the peg transfer task from the MISTELS (McGill Inanimate System for Training and Evaluation of Laparoscopic Skills) battery of tests. The control and treatment groups are divided based on biologically female participants who do not use hormonal contraceptives, and those who do, respectively. Both groups perform several screening tasks regarding demographics, handedness, video game usage, mental rotation ability, and ovulation status. Participants then train on the peg transfer task, recording their times for each attempt until proficiency is reached. An ANCOVA, 2 (cycle/static) × 1 (frequency of repetitions) with spatial ability as a covariate, with appropriate post‐hocs as necessary, will be used to statistically analyze differences in the learning curves between naturally cycling participants and those using hormonal contraceptives.ANTICIPATED RESULTSCompared to the naturally cycling group, the group using hormonal contraceptives is expected to require greater time and number of attempts to reach proficiency on the peg transfer task.SIGNIFICANCEThe results are expected to support the hypothesis that hormonal contraceptive use is negatively correlated with surgical skill acquisition. This may have implications for informing contraceptive choices of biological females pursuing careers in surgery. In addition, it may inform future curriculum design for graduate medical programs, to maximize learning opportunities for aspiring surgeons.Support or Funding InformationDepartment of Biomedical Sciences Research Seed Fund, Oakland University William Beaumont School of Medicine.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

47: The role of virtual reality simulation in the evaluation of laparoscopic skills in gynecology

47: The role of virtual reality simulation in the evaluation of laparoscopic skills in gynecology

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

The Evaluation of Learning Curves in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program

Technological developments have led to resurgent interest in stereoscopic visualization for laparoscopy. Evidence suggests that trainees achieve proficiency on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) in less total training time when using stereo visualization. Data from trainees using the Fundamentals of Laparoscopic Surgery (FLS) curriculum to train the MISTELS tasks indicate that the peg transfer task requires the greatest training time to reach proficiency. This task challenges basic hand‐eye coordination that is critical to performing more complex tasks. As monoscopic visualization remains the standard of care, our goal remains to train proficiency under monoscopic visualization. However, we propose incorporating stereo‐direct visualization (SDV) using open FLS box trainers, into the curriculum to accelerate learning. Novice surgery residents will train with the peg transfer task. Half will train to proficiency (&lt; 54 sec) under standard monoscopic video visualization. The SDV group will train to proficiency, then switch to traditional monoscopic video visualization and continue to train until proficiency is reached. We hypothesize that SDV training will facilitate the perceptual switch to reach proficiency in less total time. Results from this study may be employed to further guide the development of laparoscopic training curricula.

PD19-03 LARGE-SCALE EVIDENCE OF CONSTRUCT VALIDITY: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-03 LARGE-SCALE EVIDENCE OF CONSTRUCT VALIDITY: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE Timothy Kowalewski, Robert Sweet, Ashleigh Menhadji, Timothy Averch, Geoffrey Box, Timothy Brand, Michael Fearrandino, Jihad Kaouk, Bodo Knudsen, Jamie Landman, Benjamin Lee, Bradley Schwartz, Bryan Comstock, Cory Schaffhausen, Elspeth McDougall, and Thomas Lendvay Timothy KowalewskiTimothy Kowalewski More articles by this author , Robert SweetRobert Sweet More articles by this author , Ashleigh MenhadjiAshleigh Menhadji More articles by this author , Timothy AverchTimothy Averch More articles by this author , Geoffrey BoxGeoffrey Box More articles by this author , Timothy BrandTimothy Brand More articles by this author , Michael FearrandinoMichael Fearrandino More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Jamie LandmanJamie Landman More articles by this author , Benjamin LeeBenjamin Lee More articles by this author , Bradley SchwartzBradley Schwartz More articles by this author , Bryan ComstockBryan Comstock More articles by this author , Cory SchaffhausenCory Schaffhausen More articles by this author , Elspeth McDougallElspeth McDougall More articles by this author , and Thomas LendvayThomas Lendvay More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.702AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urological Association created the Basic Laparoscopic Urologic Skills (BLUS) skills tasks to objectively measure technical skills proficiency of urology trainees. We sought to establish construct validity of the psychomotor skills portion of this curriculum using objective performance metrics and structured assessment by video review. METHODS After IRB approval, (n=454) videos of dry-lab laparoscopic tasks: Peg Transfer (n=110), Cutting (n=110), Intracorporeal Suturing (n=115), and Clip Applying (n=119) tasks were assessed by lay-people from the Amazon.com Mechanical Turk crowd sourcing platform. These performance scores were correlated with tool motion metrics captured from the Electronic Data Generation and Evaluation (EDGE) system (Simulab Corp, Seattle WA) for all tasks. We sought at least 30 Crowd-Sourced Assessment of Technical Skills (C-SATS) ratings via the validated Global Objective Assessment of Laparoscopic Skills (GOALS) survey tool with an added pass/fail domain. We compared the mean of GOALS domain ratings with objective metrics using Spearman's rho correlation statistics. We estimated performance-specific passing probabilities through mean GOALS score cut-offs previously established by blinded faculty reviews of a representative subset (n=24) of Peg Transfer and Suturing videos with receiver operating characteristic (ROC) curves based on Pass/Fail criteria. RESULTS Spearman's rho between composite GOALS scores and the composite EDGE scores ranged from moderately strong to very strong (Peg Transfer 0.84, Cutting 0.72, Suturing, 0.80 and Clip Apply 0.61). ROC curves for crowd-only pass/fail (AUC=.99) and crowd and EDGE score pass/fail (AUC=.94 Peg Transfer,.93 Cutting,.88 Suturing, and.79 Clip Apply) compare favorably with or exceed the ROC characteristics of the original validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(MISTELS)/Fundamentals of Laparoscopic Surgery(FLS) work. CONCLUSIONS We conclude that the agreement between crowd-generated composite GOALS scores and EDGE-derived objective metrics over a large corpus of 454 basic laparoscopic technical skills videos provides evidence of construct validity for the BLUS tasks. Table 1. Correlations of n=454 technical skills performances between mean crowd GOALS scores and objective tool motion metrics. Spearman’s rho (p-value) is shown for each task. – indicates not significant. Crowd Scores vs. Peg Transfer Cutting Suturing Clip Apply EDGE Score 0.84 (0.00) 0.72 (0.00) 0.80 (0.00) 0.61 (0.00) Time -0.79 (0.00) -0.55 (0.00) -0.76 (0.00) -0.59 (0.00) Path Length -0.77 (0.00) -0.70 (0.00) -0.78 (0.00) -0.47 (0.00) Jerk Cost -0.57 (0.00) -0.57 (0.00) -0.61 (0.00) -0.28 (0.00) Movement Count -0.55 (0.00) -0.57 (0.00) -0.65 (0.00) -0.39 (0.00) Economy of Motion 0.35 (0.00) -- -- 0.34 (0.00) Force Variance -- -- -- -- Max Force -- -- -- -- © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e392 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Kowalewski More articles by this author Robert Sweet More articles by this author Ashleigh Menhadji More articles by this author Timothy Averch More articles by this author Geoffrey Box More articles by this author Timothy Brand More articles by this author Michael Fearrandino More articles by this author Jihad Kaouk More articles by this author Bodo Knudsen More articles by this author Jamie Landman More articles by this author Benjamin Lee More articles by this author Bradley Schwartz More articles by this author Bryan Comstock More articles by this author Cory Schaffhausen More articles by this author Elspeth McDougall More articles by this author Thomas Lendvay More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can stereoscopic technologies build better surgeons? The effects of stereoscopy and spatial visualization ability on laparoscopic performance in surgical residents (536.12)

Acquisition of surgical skill is a multifaceted process, in which practice, and innate human factors such as spatial visualization ability (Vz) play key roles. Elevated Vz (HVz) is thought to facilitate surgical skill acquisition. The benefit of viewing laparoscopic skills in stereo (3D) is undetermined in experienced populations, and may show differing effects between those of variable Vz. The Vz of surgical residents will be evaluated using a Mental Rotations Test, and then surgical skill will be measured via the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Participants will complete the MISTELS tasks in both 3D and monoscopic format (2D) while being randomly assigned to complete the task in either 2D first or 3D first. Scoring of the MISTELS is based on time, completion and efficiency. It is hypothesized that HVz individuals will score higher than LVz counterparts. Prior research in novice subjects suggests that the effects of 3D and 2D viewing yields variable results based on an individual’s Vz, such that LVz trainees may benefit more than HVz from 3D viewing after a period of experience. If 3D viewing enhances surgical skill in our subjects, it may suggest future use in laparoscopic training curricula. Comparison of current results with those of novice subjects may suggest the intervening effects of experience on the effect of Vz and/or viewing modality.

Manual Laparoscopic Skills Development Using a Low-Cost Trainer Box in Tanzania

To explore the feasibility and effectiveness of guided practice using a low-cost laparoscopic trainer on the development of laparoscopic skills by surgeons in a resource-poor setting. This was a prospective trial involving a pretest/posttest single-sample design. Study participants completed a background survey and pretest on the 5 McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks using a simulator developed and validated by researchers from the University of California, San Francisco. On completion of a 3-month guided practice course, participants were again tested on the MISTELS tasks and completed an exit survey. The Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. Fourteen Tanzanian surgery residents and specialists completed the study. Most of the subjects were surgical residents (64.3%). Only 2 participants (14.2%) had previous laparoscopic training, and baseline laparoscopic surgical experience was limited to intraoperative observation only. Study subjects practiced the MISTELS tasks for an average of 8.67 hours (range: 4.75-15.25) over the 3-month course. On the posttest, participants improved significantly in performance of each of the MISTELS tasks (p < 0.001). Total scores on the tasks increased from 24 ± 44 on the pretest to 384 ± 49 on the posttest (p < 0.001). All study participants were satisfied with the course, found the training personally valuable, and felt that their laparoscopic skills had improved on completion of the training. We have demonstrated the feasibility and effectiveness of training with a low-cost laparoscopic trainer box in Tanzania. Study participants achieved impressive posttest scores on the 5 MISTELS tasks with minimal baseline laparoscopic exposure. We feel that guided training by an expert was key in ensuring correct technique during practice sessions.

Construction and Validation of a Low-Cost Laparoscopic Simulator for Surgical Education

IntroductionTo construct a trainer that would achieve the equivalent goals of the Fundamentals of Laparoscopic Surgery (FLS) trainer at an economical cost. A validation study comparing our homemade (HM) trainer vs the FLS trainer was performed. A literature search as well as a price comparison with other commercially available laparoscopic trainers is presented. MethodsThe HM laparoscopic trainer was constructed using a prefabricated hard plastic frame with a vinyl plastic sheet affixed as the roof. A row of light-emitting diode lights and a charge-coupled device camera were mounted on the inside roof of the frame. Electrical wires were spliced to supply power to both the light-emitting diode lights and the camera. The charge-coupled device camera was connected to a liquid crystal display screen which was affixed directly across from the user. Subjects were prospectively randomized to perform the 5 tasks put forth by the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills on both the HM trainer and the FLS trainer (pegboard transfer, pattern cut, placement of ligating loop, extracorporeal knot suture, and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. SettingThe construction of the trainer and the validation study were performed at the Central Michigan University College of Medicine Department of Simulation. ParticipantsSubjects consisted of third- and fourth-year medical students (n = 30). ResultsA laparoscopic trainer box was constructed and assembled in 2 hours. The HM trainer cost $309 representing a cost savings of $1371. Results of the validation study demonstrated no statistical difference in times to complete 3 out of the 5 tasks as well as no difference in total time to complete all 5 tasks (p value< 0.05). ConclusionValid laparoscopic simulators can be constructed at an economical cost.

Effect of Two Instrument Designs on Laparoscopic Skills Performance

To determine whether laparoscopic skills performance is affected by instrument design. Randomized crossover study. Veterinarians (n = 14) with variable laparoscopic experience. Laparoscopic skills performance was assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Participants performed 3 MISTELS tasks twice during 2 sessions (4 tests total). Each set of instruments (set A, B) was used once during each session, and instrument order was switched between the first and second sessions. Surgeons were randomly allocated to either the AB-BA or the BA-AB sequence in a balanced fashion. Scores were compared between instrument sets A and B. Overall, participants performed better when using set A compared with set B. This difference was most striking in the pattern-cutting task (which used scissors and graspers), less convincing in the peg transfer task (which used 2 graspers), and nonexistent in the ligature loop task (which used 1 grasper and 1 pretied ligature loop). Laparoscopic skills performance, as assessed by MISTELS testing, is affected by instrument design.

Effects of two training curricula on basic laparoscopic skills and surgical performance among veterinarians

To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training. Evaluation study. 17 veterinarians at 1 institution. Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B). Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores. MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.