Laparoscopic Simulation Training Research Articles

A Low-Cost Platform for Laparoscopic Simulation Training.

With the new requirement for Fundamentals of Laparoscopic Surgery certification among graduating obstetrics and gynecology residents, there has been an increased interest in simulation training. The Fundamentals of Laparoscopic Surgery curriculum uses a commercial laparoscopic box trainer to practice and assess laparoscopic skills. We created a low-cost, space-efficient, portable and versatile training platform that allows for the breakdown of complex tasks, and we studied its user acceptability. A rectangular piece of pine wood purchased at a hardware store was used as a base; metal eye hooks were used as ports, and a blueprint was created to simulate placement of Fundamentals of Laparoscopic Surgery inserts. In addition to the Fundamentals of Laparoscopic Surgery skills, this platform can be used for any laparoscopic task (such as hysterectomy or cuff closure). Additionally, this platform can be used with or without a camera to allow for task breakdown into simpler components for faster learning. A usability and acceptability survey was administered to a convenient sample of faculty and trainees. Trainees and faculty responded favorably to the model. Residents, fellows, and attendings felt that the laparoscopic platform closely simulated the feel of performing live laparoscopy surgery. This is a novel low-cost laparoscopic platform to add to the gynecologic surgical education simulation toolkit.

Integration of production-university-research based on artificial intelligence for technological innovation and transformation in gastrointestinal surgery

Medical artificial intelligence is a deeply integrated field of production-university-research. The collaborative innovation system of "industry, education and research" has broken down the barriers between various disciplines and has shown great impetus in scientific and technological innovation and achievement transformation. The Affiliated Hospital of Qingdao University where the authors work, relying on Shandong Key Laboratory of Digital Medicine and Computer-Assisted Surgery and Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, has jointly established a close "industry-university-research" cooperation mechanism with the State Key Laboratory of Virtual Reality Technology and Systems of Beijing University of Aeronautics and Astronautics and Qingdao Hisense Medical Equipment Co., Ltd., which lasted for 10 years and carried out a series of useful explorations in scientific and technological innovation and achievement transformation in the field of gastrointestinal surgery of artificial intelligence with fruitful results. It mainly comprises of the following: (1) The research and development (R&D) of Hisense computer-assisted surgery (CAS) system has important clinical significance for laparoscopic gastrointestinal surgery guided by surrounding blood vessels that grasps globally the movement and variation of blood vessels in order to accurately select surgical strategies. (2) R&D of an automatic identification system for gastrointestinal diseases (namely image-assisted diagnosis system of artificial intelligence) initially applies deep neural network of artificial intelligence to the identification of lymph node metastases in rectal cancer, which has achieved accurate clinical diagnosis. (3) The virtual endoscopy platform for the gastrointestinal tract developed can successfully provide a new virtual endoscopy view of the intestinal wall eversion and realize the one-way navigation of the intestinal wall. (4) A localized platform of laparoscopic surgery simulation training is established with completely independent intellectual property rights. We realize that clinical requirement is the source of research and development, clinical practice is the source of innovation, and clinicians are practitioners of transformation of achievements. The establishment of artificial intelligence models often requires the support of massive and high-quality clinical data. Therefore, the effectiveness of its promotion and application can only be ensured by adopting a multi-center research approach. In the whole process of scientific and technological innovation and achievement transformation, the issues of medical ethics and intellectual property rights cannot be ignored.

Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study.

BackgroundSurgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents’ motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training.ObjectiveThe aim of this study was to establish construct validity for the laparoscopic serious game Underground.MethodsAll study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience.ResultsControlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable.ConclusionsWe established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.

Modelling and application of laparoscopic simulation system for panhysterectomy

Laparoscopic surgery simulation training system uses human anatomy visual reproduction and force-feedback technology, and uses a variety of medical image data on your computer to establish a virtual environment with vision, hearing, speaking, dynamic, smell, feel, touch. Surgeons conduct surgical training in the virtual environment, which includes suture, knotting, hand-eye coordination, organisational separation, and directional adaptation. In this paper, the issue of simulation-based training with laparoscopic simulation system is dealt with for training of internship surgeons in panhysterectomy. The model is built and the practical training results are analysed and compared for the performance of two groups of internship surgeons under model-based training and conventional training, respectively. The results show that there was no significant difference in total abdominal hysterectomy (TAH) and crossover test for the two groups of internship surgeons, whereas practice test scores increased significantly (p < 0.05), with the group using the model of laparoscopic simulation system scoring higher than the other group. It proves that the laparoscopic simulation system application in gynaecological surgery will help to improve the clinical skills of internship surgeons. The advanced simulation system makes a great contribution to reducing medical accidents, and improves progress of surgery and training.

Development and Validation of a Homemade, Low-Cost Laparoscopic Simulator for Resident Surgeons (LABOT).

Several studies have demonstrated that training with a laparoscopic simulator improves laparoscopic technical skills. We describe how to build a homemade, low-cost laparoscopic training simulator (LABOT) and its validation as a training instrument. First, sixty surgeons filled out a survey characterized by 12 closed-answer questions about realism, ergonomics, and usefulness for surgical training (global scores ranged from 1—very insufficient to 5—very good). The results of the questionnaires showed a mean (±SD) rating score of 4.18 ± 0.65 for all users. Then, 15 students (group S) and 15 residents (group R) completed 3 different tasks (T1, T2, T3), which were repeated twice to evaluate the execution time and the number of users’ procedural errors. For T1, the R group had a lower mean execution time and a lower rate of procedural errors than the S group; for T2, the R and S groups had a similar mean execution time, but the R group had a lower rate of errors; and for T3, the R and S groups had a similar mean execution time and rate of errors. On a second attempt, all the participants tended to improve their results in doing these surgical tasks; nevertheless, after subgroup analysis of the T1 results, the S group had a better improvement of both parameters. Our laparoscopic simulator is simple to build, low-cost, easy to use, and seems to be a suitable resource for improving laparoscopic skills. In the future, further studies should evaluate the potential of this laparoscopic box on long-term surgical training with more complex tasks and simulation attempts.

‘Perfect practice makes perfect’: the role of laparoscopic simulation training in modern gynaecological training

Key content Unique psychomotor and perceptual challenges of laparoscopy – such as marred depth perception, the requirement for advanced hand–eye coordination and the use of long instruments – mean that laparoscopic trainees face a steep learning curve. The difficulties that trainees encounter in meeting required laparoscopic competencies may, in part, be overcome through the use of laparoscopic simulation training (LST), with benefits for trainees, patients, consultant staff and hospital budgets. There is growing evidence that LST improves patient outcomes, such as shorter operative duration, fewer intraoperative errors and cancellations, and reduced litigation. In 2017, the British Society for Gynaecological Endoscopy formally adopted the European Academy of Gynaecological Surgery's Gynaecological Endoscopic Surgical Education and Assessment programme; this programme is likely to play an increasing role in trainees’ attainment and validation of laparoscopic skills. Learning objectives To understand the role of laparoscopic simulation training in modern gynaecological training. To know about the European Academy of Gynaecological Surgery's Gynaecological Endoscopic Surgical Education and Assessment programme. Ethical issues How does laparoscopic simulation training benefit patient safety? How can trainees’ access to laparoscopic simulation training be standardised?

1966 Structured Teaching to Enhance Laparoscopy Learning

Study Objective To measure the impact of a standardized laparoscopic curriculum on knowledge and simulation skills assessment in Ob/Gyn residents Design Non-Randomized Control Trial Setting Three residency programs in Chicago, IL Patients or Participants Twenty-four residents Interventions A standardized laparoscopic curriculum was developed in accordance with Fundamentals of Laparoscopic Surgery (FLS) training guidelines. The educational program consisted of a didactic lecture with a written pre and post test and laparoscopic simulation training. Residents were trained in peg transfer and precision pattern cutting skills. A skills assessment was administered pre and post simulation training. This skills assessment measured time to completion of peg transfer and time to completion of precision cutting. Data points were assessed using a repeated measures analysis of variance. Measurements and Main Results The residents were evaluated with a significant improvement in knowledge score from 66.7% to 84.4% (p Conclusion Implementing a standardized curriculum improved resident knowledge and simulation skills in laparoscopic techniques. The program demonstrated an improvement in residency learning and could be applied to improve resident training in laparoscopy and FLS training.

Minimally invasive tele-mentoring opportunity—the mito project

Simulation training is a validated method for acquiring laparoscopic skills. Training sessions may be sporadic or lack continuity in oversight by instructors since traditional programs mandate in-person teaching and evaluation. This study presents the development, implementation, and results of a novel smartphone application that enables remote teacher-student interaction. This interface is used to complete a validated program that provides learner-specific feedback. Outcomes of training via Lapp were compared to outcomes of traditional in-person training. A web-based and mobile iOS and Android application (Lapp) was developed to enable a remote student-teacher interaction. Instructors use Lapp to assess video recorded training sessions of students at distant locations and guide them through the laparoscopic skill course with specific and personalized feedback. Surgical trainees at two remote training centers were taught using Lapp. A control group was assessed during traditional simulation training at the training facility, with in-person feedback. Pre- and post-training performances were video recorded for each trainee and blindly evaluated by two experts using a global rating scale (GRS) and a specific rating scale (SRS). A total of 30 trainees were trained via Lapp and compared with 25 locally taught. Performance in the Lapp group improved significantly after the course in both GRS and SRS scores, from 15 [6-17] to 23 [20-25], and from 12 [11-15] to 18 [15-20], respectively. The results between both groups were comparable. Laparoscopic simulation training using a mobile app is as effective as in-person instruction in teaching advanced laparoscopic surgical skills. Lapp provides an effective method of teaching through simulation remotely and may allow expansion of robust simulation training curriculums.

Research on primary and advanced levels of laparoscopic simulation training on improving laparoscopic skills of gynecologic residents with different seniority

Objective To explore the value of primary and Advanced levels of laparoscopic simulating training in different seniority of gynecologic residents. Methods 77 residents in their first to forth training-year were divided into two groups: 1-2 year resident and 3-4 year resident, trained with different levels of simulating training plans respectively and then assessed in the Department of Obstetrics and Gynecology in Peking University Third Hospital. Results The qualified rate of primary and advanced simulation training was 85.7% and 57.1% respectively. The qualified rate of primary training (80.4% vs. 100.0%, P=0.028) and advanced training (12.5% vs. 57.14%, P=0.000) were significantly different between 1-2 year residents and 3-4 year residents. The operative skills improved significantly in all the residents. In the 1-2 year residents, the scores of the primary training increased more obviously, while in the 3-4 year residents, the scores of the advanced training increased significantly. Conclusion It might be more effective for residents with different seniority to receive different levels of simulating training accordingly, so as to improve their laparoscopic operative skills more effectively. Key words: Laparoscopy; Simulation training; Resident; Department of gynecology

Urology resident training in laparoscopic surgery - results of the first national survey in Poland.

IntroductionFor many urological procedures the open approach is being replaced by the laparoscopic approach. Laparoscopy technique requires special training conditions. A well-designed, step-by step training program is significantly important for shortening the learning curve.AimThe purpose of the study was to evaluate urology residents’ (UR) experience in laparoscopic procedures, training patterns and facilities available in departments of urology in Poland.Material and methodsThe survey developed by the authors included 18 questions concerning laparoscopy training and was distributed among UR who participated in 2 courses in laparoscopic surgery for UR in Poland in 2017. The survey consisted of questions regarding the number of laparoscopic procedures, acquired laparoscopic experience, laparoscopic simulation training and motivation for further learning.ResultsOf the 2017 invited UR in Poland, 108 (34%) completed the survey. Seventy-two (78%) UR from the study group have access to laparoscopic surgery in their department. Only 20 (25%) of urology departments are equipped with a laparoscopy box and a small number of UR perform regular training. As a primary operator basic (varicocele repair) and advanced (e.g. radical nephrectomy, radical prostatectomy, nephron-sparing surgery) laparoscopic procedures are performed respectively by 55 (71%) UR and 8 (10%) UR. Most residents evaluated their laparoscopic skills as poor (15, 19%), very poor (31, 40%) or absent (10, 13%), while only 22 (28%) evaluated them as at least satisfactory.ConclusionsLaparoscopic technique is available in most Polish training centers. However, the majority of UR consider their skills unsatisfactory. Additionally, a large number of Polish UR do not have access to intensive training. UR considered that their availability of training courses and fellowships is low. Surgical exposure among Polish UR comprises mainly minor laparoscopic procedures.

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.

Improved laparoscopic skills in gynaecology trainees following a simulation-training program using take-home box trainers.

Lack of time and access to equipment are recognised barriers to simulation training. To investigate the effect of a take-home laparoscopic simulator training program on the laparoscopic skills of gynaecology trainees. Participants (n=17 in 2015, n=16 in 2016) were supplied with a box trainer, associated equipment and instructions on self-directed training. A program was designed and implemented in 2015 comprising of ten weekly laparoscopic skills tasks and modified in 2016 to eight monthly tasks. Half of the participants were randomly allocated a supervisor. Participants performed baseline and post-training assessments of laparoscopic skills in a box trainer task (thread transfer) and virtual reality simulator tasks (laparoscopic tubal ligation and bilateral oophorectomy). Trainees in 2015 demonstrated an improvement in the median time to complete the laparoscopic tubal ligation task (baseline 124s vs post-training 91s, P=0.041). There was no difference in the number of tubal ligation bleeding incidents, or in the time taken to complete the box trainer thread transfer task. In 2016 trainees demonstrated improvement in tubal ligation time (baseline 251 vs 71 post-training, P=0.021) and bilateral oophorectomy time (baseline 891s vs 504 post-training, P=0.025). There was no significant difference in other outcome measures. There was no difference found in performance when groups were compared by supervisor allocation. A take-home box trainer simulation-training program was associated with improvement in laparoscopic skills. This type of program may improve trainee access to simulation training.

Using mindfulness therapy in laparoscopic simulation training: a pilot study

Using mindfulness therapy in laparoscopic simulation training: a pilot study

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.

Supporting Third Year Medical Students' Skill Acquisition and Self-Efficacy with Coping Models and Process Feedback during Laparoscopic Knot Tying Simulation.

Background: During the third year general surgery clerkship, medical students are required to develop laparoscopic knot-tying skills. Knot-tying skills studies often rely on objective variables (e.g., time, materials used, number of iterations) that lend themselves to correlational analysis of pre- and post-intervention skill level. This study differs by examining how instructional interventions—role modeling and feedback—affect medical students' skill acquisition and self-efficacy during a laparoscopic surgical simulation training session.Methods: Seventy-eight surgical clerkship students were assigned randomly to one cell of a 2X2 factorial design. Participants observed one of two types of role modeling (expert vs. coping) and received either process-oriented or outcome-oriented feedback during a 30-min laparoscopic training session. Participants also completed several surveys that assessed their interest in surgery and their self-efficacy for laparoscopic knot tying.Results: Coping model groups tended to perform better on the knot tying task, though this was less the case in the presence of outcome feedback. Expert model groups slightly outperformed the coping model group on the peg transfer task, but in the presence of outcome feedback they reported the lowest satisfaction with their performance and the lowest self-efficacy for the knot tying task. The coping model combined with process feedback had a positive influence on students' efficiency in learning the task, on their satisfaction with their performance, and on their self-efficacy for laparoscopic knot typing.Conclusions: Results are discussed relative to self-regulated learning theory.

The development of a retroperitoneal dissection model

Knowledge of ureteric anatomy is essential for ureteric injury prevention in laparoscopic gynecologic surgery. Rates of injury increase with limited surgical experience and reduced surgical volume. Currently, there are no low-fidelity or high-fidelity simulation models for teaching and practicing ureteric dissection. Our goal was to design a laparoscopic simulation model for retroperitoneal anatomy with high face validity that is low-cost and easily reproducible. A low-fidelity 3-dimensional simulation model was developed that represents key anatomic structures encountered during retroperitoneal dissection and ureteric identification. Materials, construction steps, and costs were determined. The models were trialed by expert laparoscopic surgeons. Demographic information that included age, gender, surgical experience, and complex laparoscopic case volumes was collected. Face validity was assessed with a 5-item Likert-scale. The total cost of 1 model ranged from $65 to $75. The majority of the materials that were used were reusable, except for 2 components that cost <$1 per use. Seven expert surgeons participated in the study, all of whom were fellowship-trained minimally invasive gynecologic surgeons or currently enrolled in this type of fellowship program. Participants agreed or strongly agreed that the model resembled the texture of the ureter, vessels, and peritoneal layer (n=6; 86%), approximated the correct anatomic course of the ureter (n=7; 100%), and closely approximated live surgery (n=5; 71%). They also agreed or strongly agreed that the model would be useful for teaching laparoscopic retroperitoneal dissection (n=7; 100%), for assessing a learner's ability before performing in the operating room (n=6; 86%), was low-cost (n=7; 100%), and was easily reproducible (n=6; 86%). This unique model fills a gap in laparoscopic simulation training. No other low- or high-fidelity models for laparoscopic retroperitoneal ureteric dissection have been identified in the literature. This simulation model is low-cost, easily reproducible, closely resembles retroperitoneal dissection during laparoscopic gynecologic surgery, and can be used for education and assessment.

Characteristics predicting laparoscopic skill in medical students: nine years' experience in a single center.

We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

Implementation of a Laparoscopic Simulation Training in Undergraduate Medical Education - The Lübeck Toolbox-Curriculum

Simulation-based training has become increasingly relevant in minimally invasive surgery (MIS). It is unclear whether or not the established Lübeck Toolbox (LTB) Curriculum for the acquisition of basic MIS skills can be implemented to supplement standard undergraduate education in surgery and how it would be accepted. Since 04/2015, students at the medical school of the University of Lübeck have had the option to complete the highly standardized and validated LTB Curriculum. It consists of six subsequent tasks with pre-defined learning goals. Video tutorials allow for a self-educating approach. The individual training progress is documented continuously as scheduled by the curriculum. The program was evaluated in a standardized manner using an established online platform for the evaluation of university courses at the University of Lübeck. Between 04/2015 and 07/2016, 63 students completed the LTB Curriculum. The general interest in a surgical specialty rose from an average of 1.61 (SD 0.78) before to 1.12 after the curriculum. The numbers of required repetitions for the training tasks 1 - 6 were median 24 (6 - 79), 23 (5 - 61), 7 (5 - 33), 15 (5 - 59), 16 (5 - 50), and 18 (7 - 48), respectively. None of the 63 students terminated the curriculum prematurely. On average, 4.35 (SD 1.58) hours per week were spent training with an overall duration of 4.1 (SD 1.2) weeks required to go through the LTB Curriculum. Evaluation results showed an overall rating of 1.0 (SD 0.17). The average learning progress, didactics and structure of the curriculum were rated as 1.0 (SD 0.24), 1.14 (SD 0.36), and 1.0 (SD 0.24), respectively. The relevance for the following study years and the future professional activity was reported to be 1.2 (SD 0.45) on average. As an addition to the regular undergraduate program, the Lübeck Toolbox Curriculum was well accepted by many students. Evaluation showed exceedingly positive results. Furthermore, the data suggest that the LTB Curriculum may increase the interest in a surgical specialty among medical students. This aspect seems to be relevant in times where surgeons should make every effort to recruit young doctors for surgical residency.

3D vision accelerates laparoscopic proficiency and skills are transferable to 2D conditions: A randomized trial

BackgroundLaparoscopy is difficult to master, in part because surgeons operate in a three-dimensional (3D) space guided by two-dimensional (2D) images. This trial explores the effect of 3D vision during a laparoscopic training program, and examine whether it is possible to transfer skills acquired with 3D conditions to 2D conditions. MethodsWe designed a randomized controlled trial where residents (n = 34) were randomized to proficiency-based laparoscopic simulator training under either 3D or 2D conditions. Subsequently, participants completed a retention test under 2D conditions. ResultsMean training time were reduced in the intervention group; 231 min versus 323 min; P = 0.012. There was no significant difference in the mean times to completion of the retention test; 92 min versus 95 min; P = 0.85. Conclusion3D vision reduced time to proficiency on a virtual-reality laparoscopy simulator. Furthermore, skills learned with 3D vision can be transferred to 2D vision conditions. Clinicaltrials.gov (NCT02361463).

Impact of Video Coaching on Gynecologic Resident Laparoscopic Suturing: A Randomized Controlled Trial

Study ObjectiveTo determine if the addition of video coaching to an obstetrics and gynecology resident laparoscopic simulation curriculum improves acquisition of suturing skills. DesignRandomized controlled trial (Canadian Task Force classification I). SettingAcademic teaching hospital with a residency program in obstetrics and gynecology. PatientsTwenty obstetrics and gynecology residents undergoing a 4-week laparoscopic simulation curriculum were video recorded weekly performing a suturing task on a validated vaginal cuff model. InterventionsResidents were randomized to standard simulation curriculum or standard curriculum plus weekly video coaching by an expert laparoscopic surgeon. Primary outcome measure was comparison of weekly Global Operative Assessment of Laparoscopic Skills plus Vaginal Cuff Metrics (GOALS+) scores of the suturing task. Measurements and Main ResultsBaseline GOALS+ scores did not differ across training groups (p = .406), although “senior” (postgraduate years 3 and 4) residents initially had significantly higher GOALS+ scores than “junior” (postgraduate years 1 and 2) residents (p < .001). GOALS+ scores significantly improved from week 1 to week 2 in the intervention group compared with the control group (p < .05). Junior coached residents had significantly higher GOALS+ scores at week 2 (mean, 28.06; standard deviation, 3.10) compared with the junior control residents (mean, 20.75; standard deviation, 6.38; p < .04). Over the 4-week period all residents showed significant improvement (p = .005), with novice residents improving more than experienced residents (p = .001). The junior coached residents exhibited a significant difference between weeks 1 and 2 when compared with the junior residents undergoing the standard curriculum. ConclusionVideo coaching during laparoscopic simulation training has the greatest impact early in junior learners' skill acquisition, thus providing another tool for simulation training curricula.