Fundamentals Of Laparoscopic Surgery Research Articles

The Performance Gap for Residents in Transfer of Intracorporeal Suturing Skills From Box Trainer to Operating Room

Training on laparoscopic box trainer (BT) improves suturing skills in the operating room (OR). Optimal laboratory training should provide trainees with an adequate level of skills that can be transferred to the OR with no decline in performances. This study aimed to compare OR intracorporeal suturing performances of residents who trained with a fundamentals of laparoscopic surgery (FLS) BT vs. those of experienced laparoscopists. This was a prospective observational study. Residents received training with an FLS BT over a period of 4 months. Their performances with the BT and in the OR were then compared with those of experienced senior surgeons. OR assessment took place during a laparoscopic myomectomy. Performance evaluation was based on time taken and 2 validated qualitative assessment tools (GOALS and the Moorthy checklist). One academic tertiary care center, La Conception Hospital, Assistance Publique -Hopitaux de Marseille, Marseille, France, was involved. Twelve gynecology residents and 6 experienced laparoscopic surgeons. Following the FLS training period, performances of residents with the BT were equivalent to those of the experienced surgeons. When tested in the OR, the trained residents performed more slowly than experienced surgeons (279.75 vs. 159.75s; p = 0.001), and they obtained lower qualitative outcomes in terms of GOALS (13 vs. 16.75; p = 0.002) and checklist (18.25 vs. 21; p = 0.049). Transfer from the BT to the OR revealed an increase in time taken that was significantly higher for the trained residents' group than for the experienced group (137s vs. 49s; p < 0.001). A performance gap emerged between trained residents and experienced surgeons when transferring from the BT to the OR. Finding an intermediate training platform between the BT and independently suturing in the OR is hence warranted.

Factors associated with simulator-assessed laparoscopic surgical skills of veterinary students.

OBJECTIVE To determine whether simulator-assessed laparoscopic skills of veterinary students were associated with training level and prior experience performing nonlaparoscopic veterinary surgery and other activities requiring hand-eye coordination and manual dexterity. DESIGN Experiment. SAMPLE 145 students without any prior laparoscopic surgical or fundamentals of laparoscopic surgery (FLS) simulator experience in years 1 (n = 39), 2 (34), 3 (39), and 4 (33) at a veterinary college. PROCEDURES A questionnaire was used to collect data from participants regarding experience performing veterinary surgery, playing video games, and participating in other activities. Participants performed a peg transfer, pattern cutting, and ligature loop-placement task on an FLS simulator, and FLS scores were assigned by an observer. Scores were compared among academic years, and correlations between amounts of veterinary surgical experience and FLS scores were assessed. A general linear model was used to identify predictors of FLS scores. RESULTS Participants were predominantly female (75%), right-hand dominant (92%), and between 20 and 29 years of age (98%). No significant differences were identified among academic years in FLS scores for individual tasks or total FLS score. Scores were not significantly associated with prior surgical or video game experience. Participants reporting no handicraft experience had significantly lower total FLS scores and FLS scores for task 2 than did participants reporting a lot of handicraft experience. CONCLUSIONS AND CLINICAL RELEVANCE Prior veterinary surgical and video game experience had no influence on FLS scores in this group of veterinary students, suggesting that proficiency of veterinary students in FLS may require specific training.

Retention of laparoscopic and robotic skills among medical students: a randomized controlled trial.

Although simulation training beneficially contributes to traditional surgical training, there are less objective data on simulation skills retention. To investigate the retention of laparoscopic and robotic skills after simulation training. We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naïve medical students were randomly assigned to practice peg transfer tasks on either laparoscopic (N=20, Fundamentals of Laparoscopic Surgery, Venture Technologies Inc., Waltham, MA) or robotic (N=20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks before (Stage 1: Baseline) and immediately after training (Stage 1: Post-training) using a modified validated global rating scale of laparoscopic and robotic operative performance. In Stage 2, participants were evaluated on both tasks 11-20weeks after training. Of the 40 students who participated in Stage 1, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. During Stage 2, there were no significant differences between groups in objective or subjective measures for the laparoscopic task. Laparoscopic-trained participants' performances on the laparoscopic task were improved during Stage 2 compared to baseline measured by time to task completion, but not by the modified global rating scale. During the robotic task, the robotic-trained group demonstrated superior economy of motion (p=.017), Tissue Handling (p=.020), and fewer errors (p=.018) compared to the laparoscopic-trained group. Robotic skills acquisition from baseline with no significant deterioration as measured by modified global rating scale scores was observed among robotic-trained participants during Stage 2. Robotic skills acquired through simulation appear to be better maintained than laparoscopic simulation skills. This study is registered on ClinicalTrials.gov (NCT02370407).

The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review.

Background:Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program.Materials and Methods:Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study.Results:Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints.Conclusion:The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.

Muscle fatigue and performance analysis during fundamental laparoscopic surgery tasks

The goal of this study is to detect muscle fatigue and time-to-fatigue in vulnerable muscle groups, before determining whether the former has any effect on surgical performance. In the experiment, surface electromyography (sEMG) was deployed to record the muscle activations of 12 subjects while performing fundamentals of laparoscopic surgery (FLS) tasks for a total of three hours. In all, 16 muscle groups were tested. The resultant data were then reconstructed using recurrence quantification analysis (RQA). In addition, a subjective fatigue assessment was conducted to draw comparisons with the RQA results. The subjects' performance was also investigated via a FLS task performance analysis, the results demonstrating that RQA can detect muscle fatigue in 12 muscle groups as well as their time-to-fatigue. The results also indicated that RQA and subjective fatigue assessment are very closely correlated (p-value < 0.05). However, the performance analysis results showed that the subjects' performance improved over time.

Training in Laparoscopic Surgery in Latin America

Introduction: The training of Residents and Surgeons in Laparoscopic Surgery in Latin America is performed in the OR (Operating Room) on the patient, which predisposes to the risk of many complications, both during learning as during the daily performance of this intervention. Objective: To evaluate the efficiency of the basic training program in Laparoscopic surgery in the development of cognitive and motor dexterities and skills. Methodology: CEPCEA (Center for Studies on Prevention and Correction of Abdominal Diseases) has developed a 5-day teaching system, based on the PBL (Problem-Based Learning) development of tests in manual skills on inanimate objects, biological and human tissue and permanent creation of easy to repeat tips, we combine the best of each continent: the American FLS (Fundamentals of Laparoscopic Surgery) Training, the Europeanoriginated Endotrainer and the Japanese KAIZEN. We took a pre-test and a practical post-test to the total cohort of trained surgeons during the period January-December 2016, tests which were based on time and on 20 theoretical questions with a value of 1 point per each correct answer. We used the SPSS v.21 as statistical software. Results: The population tested consisted of 55 trainees from different Latin-American countries who attended in groups of 4 to 6 participants of general surgery (32), gynecology (11), urology (3), surgery oncology (3), pediatric surgery (1), and others (5) who, on admission, had a mean of peg transfer time of 189.6 seconds, which at the end of their practical training of 4 days was of 68.4 seconds; while the results of the pretest and theoretical posttest showed a media of 5.8 And 14.9 points respectively. Conclusions: The CEPCEA teaching system is an efficient and necessary method for the development of manual and theoretical skills and dexterities in laparoscopic surgery in the various surgical specialties.

Cost Comparison of Fundamentals of Laparoscopic Surgery Training Completed With Standard Fundamentals of Laparoscopic Surgery Equipment versus Low-Cost Equipment

Training for the Fundamentals of Laparoscopic Surgery (FLS) skills test can be expensive. Previous work demonstrated that training on an ergonomically different, low-cost platform does not affect FLS skills test outcomes. This study compares the average training cost with standard FLS equipment and medical-grade consumables versus training on a lower cost platform with non-medical-grade consumables. Subjects were prospectively randomized to either the standard FLS training platform (n = 19) with medical-grade consumables (S-FLS), or the low-cost platform (n = 20) with training-grade products (LC-FLS). Both groups trained to proficiency using previously established mastery learning standards on the 5 FLS tasks. The fixed and consumable cost differences were compared. Training occurred in a surgical simulation center. Laparoscopic novice medical student and resident physician health care professionals who had not completed the national FLS proficiency curriculum and who had performed less than 10 laparoscopic cases. The fixed cost of the platform was considerably higher in the S-FLS group (S-FLS, $3360; LC-FLS, $879), and the average consumable training cost was significantly higher for the S-FLS group (S-FLS, $1384.52; LC-FLS, $153.79; p < 0.001). The LC-FLS group had a statistically discernable cost reduction for each consumable (Gauze $9.24 vs. $0.39, p = 0.002; EndoLoop $540.00 vs. $40.60, p < 0.001; extracorporeal suture $216.45 vs. $25.20, p < 0.001; intracorporeal suture $618.83 vs. $87.60, p < 0.001). The annual fixed and consumable cost to train 5 residents is $10,282.60 in the S-FLS group versus $1647.95 in the LC-FLS group. This study shows that the average cost to train a single trainee to proficiency using a lower fixed-cost platform and non-medical-grade equipment results in significant financial savings. A 5-resident program will save approximately $8500 annually. Residency programs should consider adopting this strategy to reduce the cost of FLS training.

Usefulness of virtual reality in assessment of medical student laparoscopic skill

BackgroundThis study evaluates if undergraduate medical trainees' laparoscopic skills acquisition could be assessed using a virtual reality (VR) simulator and how the resultant metrics correlate with performance of Fundamentals of Laparoscopic Surgery (FLS) tasks. Our hypothesis is that the VR simulator metrics will correlate with passing results in a competency-based curriculum (FLS). Materials and methodsTwenty-eight fourth-year medical students applying for surgical residency were recruited to participate in a VR training curriculum comprised of camera navigation, hand eye coordination, and FLS tasks: circle cutting (CC), ligating loop (LL), peg transfer (PT), and intracorporeal knot tying (IKT). Students were given 8 wk to achieve proficiency goals, after which they were observed performing FLS tasks. The ability of the VR simulator to detect penalties in each of the FLS tasks and correlations of time taken to complete tasks are reported. ResultsTwenty-five students trained in all components of the curriculum. All students were proficient in camera navigation and hand eye coordination tasks. Proficiency was achieved in CC, LL, PT, and IKT by 21, 19, 23, and one student, respectively. VR simulation showed high specificity for predicting zero penalties on the observed CC, LL, and PT tasks (80%, 75%, and 80%, respectively). ConclusionsVR can be used to assess medical student's acquisition of laparoscopic skills. The absence of penalties in the simulator reasonably predicts the absence of penalties in all FLS skills, except IKT. The skills acquired by trainees can be used in residency for further monitoring of progress toward proficiency.

Laparoscopic skill assessment of practicing surgeons prior to enrollment in a surgical trial of a new laparoscopic procedure.

Outcomes of surgical trials hinge on surgeon selection and their underlying expertise. Assessment of expertise is paramount. We investigated whether surgeons' performance measured by the fundamentals of laparoscopic surgery (FLS) assessment program could predict their performance in a surgical trial. As part of a prospective multi-institutional study of minimally invasive inguinal lymphadenectomy (MILND) for melanoma, surgical oncologists with no prior MILND experience underwent pre-trial FLS assessment. Surgeons completed MILND training, began enrolling patients, and submitted videos of each MILND case performed. Videos were scored with the global operative assessment of laparoscopic skills (GOALS) tool. Associations between baseline FLS scores and participant's trial performance metrics were assessed. Twelve surgeons enrolled patients; their median total baseline FLS score was 332 (range 275-380, max possible 500, passing >270). Participants enrolled 87 patients in the study (median 6 per surgeon, range 1-24), of which 72 (83%) videos were adequate for scoring. Baseline GOALS score was 17.1 (range 9.6-21.2, max possible score 30). Inter-rater reliability was excellent (ICC=0.85). FLS scores correlated with improved GOALS scores (r=0.57, p=0.05) and with decreased operative time (r=-0.6, p=0.02). No associations were found with the degree of patient recruitment (r=0.02, p=0.7), lymph node count (r=0.01, p=0.07), conversion rate (r=-0.06, p=0.38) or major complications(r=-0.14, p=0.6). FLS skill assessment of surgeons prior to their enrollment in a surgical trial is feasible. Although better FLS scores predicted improved operative performance and operative time, other trial outcome measures showed no difference. Our findings have implications for the documentation of laparoscopic expertise of surgeons in practice and may allow more appropriate selection of surgeons to participate in clinical trials.

Outcomes of Fundamentals of Laparoscopic Surgery (FLS) mastery training standards applied to an ergonomically different, lower cost platform.

Using previously established mastery learning standards, this study compares outcomes of training on standard FLS (FLS) equipment with training on an ergonomically different (ED-FLS), but more portable, lower cost platform. Subjects completed a pre-training FLS skills test on the standard platform and were then randomized to train on the FLS training platform (n=20) or the ED-FLS platform (n=19). A post-training FLS skills test was administered to both groups on the standard FLS platform. Group performance on the pretest was similar. Fifty percent of FLS and 32% of ED-FLS subjects completed the entire curriculum. 100% of subjects completing the curriculum achieved passing scores on the post-training test. There was no statistically discernible difference in scores on the final FLS exam (FLS 93.4, ED-FLS 93.3, p=0.98) or training sessions required to complete the curriculum (FLS 7.4, ED-FLS 9.8, p=0.13). These results show that when applying mastery learning theory to an ergonomically different platform, skill transfer occurs at a high level and prepares subjects to pass the standard FLS skills test.

Retention of Laparoscopic and Robotic Skills 12 Weeks After Simulation Training

BACKGROUND: Although minimally invasive simulation modeling provides a supplement for traditional surgical training, there is less objective data on longer-term skills retention. METHODS: We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naive medical students were randomly assigned to practice pegboard transfer tasks on either laparoscopic (N=20, Fundamentals of Laparoscopic Surgery, VT Medical Inc., Waltham, MA) or robotic (N=20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks immediately after training using previously validated global rating scales of laparoscopic operative performance. In the second stage, participants were evaluated on both tasks 12 weeks after training. RESULTS: Of the 40 participants who participated in the initial training phase, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. Twelve weeks after training, there were no significant differences between groups in objective measures or global rating scale composite scores for the laparoscopic task. However, the robotic practice group demonstrated significantly higher global rating scale composite scores on the robotic simulation task (11.8 versus 9.4, P=.04). Robotic training was associated with improved economy of motion (P=.017) and fewer ring drops (P=.018) on the robotic platform. DISCUSSION: Robotic skills acquired through simulation appear to be easier to maintain than laparoscopic skills gained via simulation.

Laparoscopic and Robotic Skills Are Transferable in a Simulation Setting: A Randomized Controlled Trial

BACKGROUND: Residents are increasingly being trained on robotic techniques instead of traditional laparoscopy. Although simulation training does provide an effective supplement for traditional surgical training, less is known if skills are transferable between the laparoscopic and robotic platforms. METHODS: In a randomized single-blinded controlled trial of 40 simulation-skill-naive medical students, participants completed a baseline evaluation on a robotic pegboard-transfer task (Mimic dV-Trainer) and laparoscopic peg-transfer task (Fundamentals of Laparoscopic Surgery). Skills were evaluated using validated objective and subjective global rating scales (GRS) by two blinded expert surgeons. Participants were randomized to practice on either the robotic (N=20) or laparoscopic (N=20) task. After practice, participants were reevaluated performing both tasks. RESULTS: At baseline, there were no significant differences in objective measures (time to task completion, motion metrics) or composite GRS scores on both tasks between the groups. Participants performed their respective tasks faster (P&lt;.001, P&lt;.003), more efficiently (P&lt;.001) and with a higher percent improvement in composite GRS scores (P&lt;.001). The laparoscopic group improved their robotic performance with an increase in mean composite GRS scores of 15–20 but this change did not reach statistical significance (P=.091). Participants who practiced robotically significantly improved their laparoscopic performance with an increase in mean composite GRS scores of 15–19 (P&lt;.02). DISCUSSION: Skills learned on either the robotic or laparoscopic platform appear to be transferable; however, robotic skills appear to be more transferable to the laparoscopic platform, than vice versa.

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.

Objective Evaluation of the Effects of Deployment on Laparoscopic Skills: The Simulation and Deployment Laparoscopic Skills Study.

To assess the effects of deployment on basic laparoscopic skills of general surgeons and obstetrics/gynecology (OB/GYN) physicians. This was a prospective 10-site study. Active duty Army OB/GYN and general surgery physicians scheduled to deploy were invited to participate. Before deployment, they performed fundamentals of laparoscopic surgery (FLS) tasks and specialty-specific procedures on a virtual reality laparoscopic simulator. Upon returning, physicians repeated the same evaluations. Questions about perceived comfort with laparoscopic procedures were asked before and after deployment. Statistical analysis included paired t tests for continuous variables and nonparametric for ordinal data with a p value of <0.05 considered significant. 121 deploying providers were invited to participate; 35 agreed and 29 completed the predeployment skills assessment. After deployment, 15 providers had postassessment evaluation data collected, and their results were used for analysis. Though physicians reported a decrease in their perception of preparedness for advanced laparoscopic procedures and complications, there was no decrement in their performance of FLS tasks or the basic laparoscopic procedures. Time away from regular clinical practice during deployments did not significantly affect surgeons' performance as measured by a virtual reality laparoscopic simulator. Additional study on effects on advanced procedures should be considered.

Goal setting results in improvement in surgical skills: A randomized controlled trial

The objective of this randomized controlled trial was to determine whether a goal-setting program integrated into a surgical training curriculum would improve performance on simulation testing times and confidence with laparoscopic operative skills. Beginning in 2013, 36 students and 26 general surgery residents were randomized separately into 3 groups. Trainees were either given no time goals for each of 5 Fundamentals of Laparoscopic Surgery (FLS) tasks or were given time goals that were the mean time scores or the best time scores reported in the literature for passing each FLS task. All trainees were evaluated for each task with time scores and a confidence survey both prior to and after the training program. For the students, all confidence scores and task times improved significantly from pre- to post-training. The average percent improvement in task times was greater for all 5 tasks in the 2 groups assigned to the goals compared to the no-goals group with the combined 5-task, mean percent improvement (P=.02). Overall, the students assigned to the mean-goal group improved more than the best or no-goal groups (P=.048). In the residents assigned to goals, all task times improved significantly pre/post, although the overall average percent improvement between groups was not different. Residents in both the no-goals and the goals groups improved their confidence with skills pre- to post-training. The addition of achievable goals, defined as the average task time for residents who passed the FLS, was beneficial to students, because by achieving these goals, the students were able to achieve faster task times with improved confidence. Setting appropriate goals may improve laparoscopic operative skills in students. Suitable goals were also shown to strengthen accuracy and confidence in residents' laparoscopic operative skills.

Retention of laparoscopic skills in naive medical students who underwent short training.

Simulators are useful tools in the development of laparoscopic skills. However, little is known about the effectiveness of short laparoscopic training sessions and how retention of skills occurs in surgical trainees who are naïve to laparoscopy. This study analyses the retention of laparoscopic surgical skills in medical students without prior surgical training. A group of first- and second-year medical students (n=68), without prior experience in surgery or laparoscopy, answered a demographic questionnaire and had their laparoscopic skills assessed by the Fundamentals of Laparoscopic Surgery (FLS) training protocol. Subsequently, they underwent a 150-minute training course after which they were re-tested. One year after the training, the medical students' performance in the simulator was re-evaluated in order to analyse retention. Of the initial 68 students, a total of 36 participated throughout the entire study, giving a final participation rate of 52%. Thirty-six medical students with no gender predominance and an average age of 20years were evaluated. One year after the short training programme, retention was 69.3% in the peg transfer (p<0.05) and 64.2% in ligature (p<0.05) compared with immediate post-training evaluation. There was no significant difference in suturing. The average sample score in the baseline test was 8.3, in the post-training test it was 89.7, and in the retention test it was 84.2, which corresponded to a skill retention equivalence of 93%. There was a significant retention of the laparoscopic surgical skills developed. Even 1year after a short training session, medical students without previous surgical experience showed that they have retained a great part of the skills acquired through 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.

Development of a Sustainable Simulator and Simulation Program for Laparoscopic Skills Training in Haiti.

Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training.

Surgical Simulation Update for Resident Education in Plastic Surgery

Simulation is defined as replication of a real-world process or system over time. Surgical Simulations have gained popularity in the recent years. There have been many studies evaluating the role of computer and real-life simulations in surgical training. In several surgical specialties, the use of standardized simulators has become a mandatory portion of the resident’s training, such as the fundamentals of laparoscopic surgery, which is a required part of the residency in general surgery.1 Simulators employ various types of models to represent real-world objects and systems. Some of the most common types of models in simulations include the following: Physical models: these types of models are physical objects representing a process or system in a controlled and simplified fashion. The systems used for training in fundamentals of laparoscopic surgery represent physical models of the abdomen. Mathematical models: these models provide a description of an object or a system using mathematical algorithms and concepts commonly within a computer simulation. Graphical models: these types of models are based on graphical depiction of an object or a system. Graphical models can be 2-dimensional or 3-dimensional. Finite element models: in this method of modeling, large and complex objects or systems are divided into much smaller and simpler parts with more predictable and defined behavior. The simulators can sum up the behavior of the smaller parts to replicate the larger and more complex objects. With advances in computer technology, the development of models has become easier and more affordable. A readily accessible source of data for creation of anatomical models is the Visible Human Project (https://www.nlm.nih.gov/research/visible/visible_human.html). The members of the American Council of Academic Plastic Surgeons Committee on Simulation in collaboration with a commercial animation company developed a computer-based simulator to teach the latissimus dorsi breast reconstruction technique to the residents and medical students.2 There are numerous other examples of simulators, both physical and computer based, which have been developed in the recent years by interested faculty and residents. An example is a project from the Case Medical Center in Cleveland, Ohio, which was spearheaded by one of the residents. With the help of a small institutional grant, a mobile application was developed to help improve the informed consent process by enabling the patient to visually navigate through a procedure.3 Touch Surgery is a London- and NYC-based company that has developed many simulations of surgical procedures based on real surgical videos. These simulations are accessible on smart phones and tablets (https://www.touchsurgery.com). With the advent of immersion technology, such as Oculus Rift (https://www.oculus.com/en-us/rift/) and Microsoft Hololens (https://www.microsoft.com/microsoft-hololens/en-us), the simulation world is experiencing a rapid shift toward virtual and augmented reality. Augmented reality represents a combination of computer-generated simulation and information superimposed on the real-world objects. The potential applications of these new technologies for medical and surgical training are immense. Surgical simulations have improved significantly in the recent years. Required technology has become more readily available. More surgeon educators should become involved in the development of simulators for training of the next generation of plastic surgeons.

Investigating the Influence of Hand Dominance on Postural Sway During Traditional and Simulated Laparoscopic Surgical Skills Practice.

This study examined how hand dominance could influence postural sway during laparoscopic skills practice. Ten inexperienced medical trainees performed a peg transfer task using the Fundamentals of Laparoscopic Surgery (FLS) training box and the virtual reality (VR) trainer. Surface electromyographic recordings of upper and lower limb muscles were taken, while the postural sway was measured by a pressure mapping system. Skills performance using the non-dominant hand required more muscle effort and increased more postural sway. Compared with the FLS training box, training with VR decreased the use of muscle effort and could reduce the influence of hand dominance on the overall postural sway during laparoscopic surgical skills practice.