Laparoscopic Simulator Research Articles

Optimizing modern surgical simulation through instructor feedback - insights from a retrospective observational study in a tertiary hospital.

Laparoscopic surgery is associated with a prolonged learning curve for emerging surgeons, and simulation-based training (SBT) has become increasingly prominent in this context due to stringent working time regulations and heightened concerns regarding patient safety. While SBT offers a safe and ethical learning environment, the accuracy of simulators in the context of evaluating surgical skills remains uncertain. This study aims to assess the precision of a laparoscopic simulator with regard to evaluating surgical performance and to identify the instructor's role in SBT. This retrospective study focused on surgical residents in their 1st through 5th years at the Department of Surgery of Linkou Chang Gung Memorial Hospital. The residents participated in a specially designed SBT program using the LapSim laparoscopic simulator. Following the training session, each resident was required to perform a laparoscopic procedure and received individualized feedback from an instructor. Both simulator and instructor evaluated trainees' performance on the LapSim, focusing on identifying correlations between the simulator's metrics and traditional assessments. Senior residents (n = 15), who employed more complex laparoscopic procedures, exhibited more significant improvements after receiving instructor feedback than did junior residents (n = 17). Notably, a stronger correlation between the simulator and instructor assessments was observed in the junior group (junior Global Operative Assessment of Laparoscopic Skills (GOALS) adjusted R2 = 0.285, p = 0.016), while no such correlations were observed among the senior group. A well-designed, step-by-step SBT can be a valuable tool in laparoscopic surgical training. LapSim simulator has demonstrated its potential in assessing surgical performances during the early stages of surgical training. However, instructors must provide intuitive feedback to ensure appropriate learning in later stages.

Life-threatening event in laparoscopic hepatic surgery: Training curriculum on sudden hepatic artery haemorrhage

BackgroundExposure of the hepatic artery is a fundamental step in many surgeries, during which iatrogenic hepatic artery injury may occur. Although the incidence of hepatic artery haemorrhage is low, its occurrence can lead to life-threatening haemorrhage. It is difficult and dangerous to accumulate clinical experience in laparoscopic hepatic artery repair in actual patients, and simulation training models for laparoscopic hepatic artery repair are currently lacking. In this study, a 3D printed model was designed to simulate the training curriculum for sudden hepatic artery haemorrhage, but whether training with the 3D printed model could yield superior skill improvement for surgeons remained to be determined.MethodsA new 3D printed model was designed for this study. Surgeons from the General Surgery Department of Sir Run Run Shaw Hospital participated in this simulation training. The surgical performance of each model was compared, and the authenticity of the model was evaluated and mechanically tested.ResultsExperienced surgeons performed better on the 3D printed model. After repeated training, inexperienced surgeons showed significant improvement of their laparoscopic hepatic artery repair skills. The authenticity of the model was generally satisfactory, but shortcomings persisted in the mechanical testing of artery wall tearing, necessitating further improvement.ConclusionsFew studies have investigated laparoscopic simulation training for sudden hepatic artery haemorrhage. This simulation model distinguishes surgeons with different levels of experience and allows those with less experience to improve their laparoscopic hepatic artery repair skills through training on the model.

The Effect of External Distractions on Simulated Laparoscopic Performance.

Background: Surgeons are exposed to unavoidable distractions while operating. Distractions can cause stress, and stress can impair cognition and motor skills to the detriment of surgeon performance. This study assessed the impact of distractions on surgeon stress levels and surgeon performance during simulated laparoscopic tasks. Methods: Twelve surgical trainees completed a peg-thread transfer task three times on a laparoscopic simulator in a neutral environment. Six trainees then completed the task three more times in an environment overlain with distractions commonly found in the operating theatre. Six others completed three more tasks in a neutral environment. Stress was measured by recording heart rate and by assessing responses to the NASA Task Load Index. Performance was measured using instrument tracking metrics and time to complete the task. Results: The distracted participants reported significantly higher effort, frustration, and physical demand than the neutral group, as measured by the NASA Task Load Index, (P = .001, .031, and .044, respectively). The neutral group completed their final task significantly faster compared with baseline (P = .049), while the distracted group failed to show this improvement. The distracted group showed higher hand discordance, suggesting reduced ambidexterity. Conclusion: Distraction negatively impacted some aspects of performance and resulted in subjective increased stress. In future, simulation may have a role in "stress inoculation," enabling surgeons to maintain performance, despite distractions.

FP5.2 - Skills-fade pilot study, inclusion of Return to Training Trainees in the ST3 General Surgical Bootcamp

Abstract Aims The concept of skills fade after time out of training is well recognised but there is a paucity of objective assessment of this in returning trainees. We sought to assess the utility of inclusion of returning trainees in a bootcamp by measuring performance and confidence. Methods In this pragmatic pilot study 8 General Surgery trainees returning from time out were offered a place on the ST3 Bootcamp of whom 3 agreed to participate. These trainees had been out of programme for a medical education fellowship, non-clinical research and parental leave respectively. Trainees received a 3 day period of intensive reskilling, covering open and laparoscopic skills, proctology, endoscopy, ward round managing the OP list and stressful environment. Their confidence and competence were assessed pre and post Bootcamp completion. Results Returning trainee confidence improved across the board. Trainees fed back that they found the open and laparoscopic simulation sessions most useful. All trainees objectively improved in laparoscopic skills although not in open skills or endoscopy and proctoscopy. The pressure of being assessed may have affected these finding or this may reflect a need for consistency of faculty and a more robust method of objectively assessing competence. Conclusion Inclusion of RTT trainees in surgical bootcamp improves confidence and enhances their return. Simulation should be included in a return to training programme. If objective assessment is used to evaluate their progress then this should be with predefined criteria or computer software to ensure that the evaluation is unbiased.

Simulation Education in Pediatric Surgery

Simulation education in pediatric surgery using laparoscopic simulators and virtual reality glasses Kyalio VR surgical training increases the efficiency of surgeon training, reduces the time of adaptation to real operations and improves the quality of medical care for children.

Replicating Visuo-Motor Remapping in the Laparoscopic Environment

Laparoscopy, a minimally invasive surgical technique, requires precise visuo-motor coordination. Because the surgical field is viewed through a camera which may need to be placed to one side of the would-be direct line of sight, rotational distortion is a concern. This study investigates adaptation to rotational distortions by replicating previous computerized two-dimensional perceptual-motor experiments, and measurement methods, using a non-virtual low-fidelity laparoscopic training simulator. This replication was chosen for the opportunity to observe the best-established adaptation mechanisms (gradual and axis-inversion) and carryover effects. To our knowledge, this is the first time that circular statistics are used to analyze directional error data collected in the laparoscopic environment. Results strongly indicated that gradual adaptation occurs with distortions below 90°, and there is leading evidence that axis-inversion occurs in distortions above 90°. This confirms previous observations of task performance decrement in the laparoscopic environment and provides clarification for new research directions.

Long Round-Trip Time Delay Effects on Performance of a Simulated Appendectomy Task.

INTRODUCTION: No current astronauts have surgical training, and medical capabilities for future missions do not account for it. We sought to determine the effect of communication delays and text-based communication on emergency medicine physician (EMP) performance of a simulated surgical procedure and the ideal training paradigm for remote surgery.METHODS: In this study, 12 EMPs performed an appendectomy on a virtual reality laparoscopic simulator after tutorial. EMPs were randomized into two groups: one (bedside) group performing with bedside directing from a surgeon and the second (remote) group performing with text-based communications relayed to the surgeon after a 210-s time delay. Both groups performed a second simulated surgery 7 mo later with 240-s delay. Collected data included time to completion, number of movements, path length, economy of motion, percentage of time with appropriate camera positioning, texts sent, and major complications.RESULTS: The remote group took significantly longer to complete the task, used more total movements, had longer path length, and had significantly worse economy of motion during the initial trial. At the 7-mo simulation, there were no significant differences between the two groups. There was a nonsignificant increase in critical errors in the remote group at follow-up (50% vs. 20% of trials).DISCUSSION: EMPs are technically able to perform a surgical operation with delayed just-in-time telementoring guidance via text-based communication. However, the ideal paradigm for training non-surgeons to perform surgical operations is unclear but is likely real-time bedside training rather than remote training.Kamine TH, Siu M, Stegemann S, Formanek A, Levin D. Long round-trip time delay effects on performance of a simulated appendectomy task. Aerosp Med Hum Perform. 2024; 95(9):703-708.

A novel 3D-printed educational model for the training of laparoscopic bile duct Exploration:a pilot study for beginning trainees

BackgroundLaparoscopic common bile duct exploration (LCBDE) is a minimally invasive procedure for the removal of bile duct stones that is often performed by experienced hepatobiliary surgeons; beginners do not easily master this approach. AimTo investigate the effectiveness and practicality of a three-dimensional printed (3DP) anatomical model based on radiographic images in the training of LCBDE techniques and formulate standardized educational workflows. MethodsColored LCBDE training models were produced using 3DP technology. Twenty standardized training trainees were randomly divided into two groups: a 3DP model training group and a traditional laparoscopic simulation training group. Both groups received the same number of teaching hours. After a 4-weeks training course, the trainees’ subjective and objective progress in basic knowledge and manipulations were evaluated and compared. ResultsCompared with traditional laparoscopic simulation, 3DP model simulation training is of great significance in improving trainers' understanding of surgical procedures and cooperation during the operation. Trainees with 3DP models training demonstrated a significant improvement in their understanding of the key points of surgery (χ2 = 6.139, p = 0.013) and skills scores, especially in core procedural steps operation. More importantly, the trainees showed higher levels of satisfaction and self-confidence while assisting in the surgery. ConclusionWith the development of 3DP models, improvements in the learning effect for theoretical understanding and practical skills were significant. The present study is the initial educational experience with 3DP models to facilitate the operational capabilities of the trainees for LCBDE.

Current status of resident simulation training curricula: pearls and pitfalls.

Residency programs are required to incorporate simulation into their training program. Ideally, simulation provides a safe environment for a trainee to be exposed to both common and challenging clinical scenarios. The purpose of this review is to detail the current state of the most commonly used laparoscopic, endoscopic, and robotic surgery simulation programs in general surgery residency education, including resources required for successful implementation and benchmarks for evaluation. Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Resident and Fellow Task Force (RAFT) Committee performed a literature review using PubMed and training websites. Information regarding the components of the most commonly used laparoscopic, endoscopic, and/or robotic simulation curriculum, including both formal and informal benchmarks for evaluating training competence, were collected. Laparoscopic simulation revolves around the Fundamentals of Laparoscopic Surgery (FLS). Proficiency-based as well as virtual simulation have been utilized for FLS training curricula. Challenges include less direct translation to the technical complexities that can arise in laparoscopic surgery. Endoscopic simulation focuses on the Fundamentals of Endoscopic Surgery. There are virtual reality simulation platforms that can be used for skills assessment and training. Challenges include simulator types and access, as well as structured mentoring and feedback. Robotic simulation training curricula have not been standardized. Simulation includes one primary technology, which can be prohibitive based on cost and requirements for onboarding. While surgical simulation seems to be a fundamental and integrated part of surgical training, it requires a significant number of resources, which can be daunting for residency training programs. Regardless of the barriers outlined, the need for surgical simulation in laparoscopy, endoscopy, and robotics at surgical education training programs is clear.

A regional approach to gynaecological laparoscopic simulation in Northern Ireland

A regional approach to gynaecological laparoscopic simulation in Northern Ireland

The Role of Interprofessional Education in Optimizing Laparoscopic Skills Training: A Randomized Controlled Trial.

Background: This investigation evaluates the utility and benefits of integrating interprofessional education (IPE) into laparoscopic training, aiming to enrich medical education and skill acquisition methodologies. Methods: The study randomly allocated 36 participants of a 2023 laparoscopic training course into experimental and control groups, each comprising 18 individuals. The control group underwent traditional theory and practical training, whereas the experimental group additionally engaged in interdisciplinary instruction with nursing educators and participated in simulated laparoscopic surgery exercises. The effectiveness of this interdisciplinary approach was assessed by comparing laparoscopic theory and simulation performance, Objective Structured Assessment of Technical Skills (OSATS) scores in animal-based training, and course satisfaction between the groups. Moreover, the impact on interdisciplinary collaborative competencies was measured through pre- and post-training self-evaluations using the Interprofessional Collaborative Competency Attainment Survey (ICCAS) in the experimental group. Results: The experimental group demonstrated superior performance in laparoscopic theory and simulation, as well as higher OSATS scores, compared with the control group. Satisfaction ratings regarding the skills practice mode, effects, and instructional quality were also significantly better in the experimental group (P < .05, P < .01). Furthermore, participants in the experimental group reported significant pre-to-post training enhancements in interprofessional communication, team collaboration, role perception, conflict management, and learning and feedback marked by statistically significant differences (P < .05, P < .01). Conclusion: The introduction of an IPE framework significantly boosts laparoscopic training efficiency and promotes team collaboration awareness. This model effectively bridges gaps between disciplines, illustrating substantial applicative value and expansion potential within medical education and skill training arenas.

Development and validation of a high-quality simulator with exchangeable peritoneum for transabdominal preperitoneal laparoscopic inguinal hernia repair.

Practical simulation training with proper haptic feedback and the fragility of the human body is required to overcome the long learning curve associated with laparoscopic inguinal hernia repair (LIHR). However, few hernia models accurately reflect the texture and fragility of the human body. Therefore, in this study, we developed a novel model for transabdominal preperitoneal (TAPP) LIHR training and evaluated its validity. We developed a high-quality mock peritoneum with a hydrated polyvinyl alcohol layer and a unique two-way crossing cellulose fiber layer. To complete the simulation, the peritoneum was adhered to a urethane foam inguinal base with surgical landmarks. Participants could perform all the procedures required for the TAPP LIHR. Twenty-four surgeons performed TAPP LIHR simulation using a novel simulator. Their opinions were rated on a 5-point Likert scale. Additionally, 6 surgical residents and 10 surgical experts performed the procedure. Their performance was evaluated using the TAPP checklist score and procedure time. Most participants strongly agreed that the TAPP LIHR simulator with an exchangeable peritoneum model was useful. The participants agreed on the model fidelity for tactile sensation, forceps handling, and humanlike anatomy. In comparisons between surgical residents and experts, the experts had significantly higher scores (10.6 vs. 17.2, p < 0.05) and shorter procedure times (92.3 vs. 55.9 min; p < .05) than did surgical residents. We developed a high-quality exchangeable peritoneal model that mimics the human peritoneum's texture and fragility. This model enhances laparoscopic simulation training, potentially shortening TAPP LIHR learning curves.

476 Enhancing Surgical Education: Assessing the Impact of Laparoscopic Simulators in Learning Surgical Anatomy and Improving Surgical Skills

Abstract Aim We assessed laparoscopic simulators' efficacy in teaching surgical anatomy and enhancing surgical skills, offering insights into their role in shaping surgical education. Method 83 medical students and foundation year doctors were surveyed before and after a hands-on laparoscopic simulator session. Using a 5-point Likert scale, perceptions of the simulator's effectiveness in teaching surgical anatomy and the importance of laparoscopic simulator training for improving surgical skills were gauged. Attendees also rated the simulators’ effectiveness in providing information and exposure to Laparoscopic surgery. Scores underwent normality assessment via the Shapiro–Wilk test; a one-tailed T-test gauged statistical significance. Qualitative data was collected for deeper insights. Results Attendees exhibited a significant increase in belief in laparoscopic simulators as an effective means to learn surgical anatomy (mean before = 4.26, after = 4.49, p = 2.41 x 10-3). Agreement increased for the necessity of laparoscopic simulator training in medical education for improving surgical skills (mean pre-event = 4.36, after = 4.55, p = 3.31 x 10-3). Conclusions A notable surge in support for integrating laparoscopic simulators in medical education emerged, indicating a promising avenue for enhancing anatomical understanding in minimally invasive contexts. The positive shift underscores the increasing recognition of laparoscopic simulators as valuable tools for teaching surgical anatomy and skills. Future research should explore the impact of laparoscopic simulation training on long-term outcomes.

756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study

Abstract Aim The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors &amp; medical students, as well as the correlation between confidence and practical skills. Method 83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance &amp; normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted. Results Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event &amp; post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event &amp; post-event 1.71, 4.16 respectively, p = p = 2.99 10-23). Conclusions The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.

895 Innovating Automated Progress Tracking System (APS) for Laparoscopic Simulation Training in Low-Middle-Income-Countries Using LaApSi Models: Low-Cost High-Fidelity Performance Assessment System with Microcontroller Connectivity

Abstract Aim To develop a Low-Cost Automated Progress tracking system (APS) embedded in the silicon based Laparoscopic Appendicectomy Simulation (LaApSi) Model which enables real-time assessment of Laparoscopic Appendicectomy (LA). To assess its application and validity in the low-resource setting via Laparoscopic Surgery courses. Method APS architecture includes thin insulated wires embedded in the LaApSi Models at the mesoappendix, appendicular artery, and the base of the appendix which acts as an indicator when cut during the appendicectomy. These wires are further connected to the Printed Circuit Board (PCB) located at the base of the model which connects with the microcontroller and establishes communication with the computer giving real-time data. Results The prototyped APS model was able to establish key features: 1. Total duration of the procedure 2. Identify potential surgical hazard: blood vessel injury 3. Length at which the appendicectomy is performed 4. Injury to surrounding structures. These performance data were recorded in the database for further review, analysis, and comparison for progression in the simulation training. The system is set up on a points basis hence when a user makes a surgical error e.g., blood vessel injury during the surgical simulation in the APS LaApSi Model, -20 points (Blood Vessels Cut) appear on the computer screen (images available). Further assessment and validity of the APS models are planned to be carried out in low-resource settings in the next 8 weeks. Conclusions The availability of a model blueprint of this cost-effective APS system (&amp;lt;20£) to LMICs will address the key barrier of surgical simulation in low-resource settings.

681 Application of Low-Cost Automated Progress Tracking System (APS) on Laparoscopic Appendicectomy Simulation Models (LaApSi) for the Laparoscopic Simulation Training in the Lower-Middle-Income-Countries (LMICs)

Abstract Aim To assess the effectiveness of the Low-Cost Automated Progress Tracking System on Laparoscopic Appendicectomy (LA) Simulation Models (LaApSi) for Laparoscopic Training in Lower-Middle-Income-Countries (LMICs). To assess and record the progression of trainees’ performance during simulation training. Method After the successful application and validation of the LaApSi model during laparoscopic courses at LMICs, the APS system has been prototyped to assess the trainee’s progression of LA. This system helps to assess surgical steps during simulated LA with the help of the LaApSi model integrated with wires at various anatomical positions giving real-time computer feedback and allowing users to assess the timing of operation, blood vessel excision and injury to the base of the appendix/caecum. Results The prototype version tested in LMIC showed excellent results in the detection of the above-mentioned parameters (shown in photos). This cost-effective model (LaApSi&amp;lt; £5 and docking system &amp;lt;£15) showed huge potential as a laparoscopic training model in LMICs. There will be additional validation of 16 APS models during the Laparoscopic Surgery Course in Nepal in Jan 2024 in collaboration with Nepalese Doctors Association-UK which we believe will further solidify its application in the LMICs Conclusions There is a need for the transition to high-fidelity low-cost laparoscopic simulation models from the traditional training methods in the LMICs which in the long-term address global surgery values. These systems have the potential for remote proctorship in the rural parts adapting the Hub &amp; Spoke model and integrating AI and Machine Learning which eliminates the use of wires and sensors in the models.

708 Innovating Low-Cost Automated Progress Tracking System (APS) for Laparoscopic Cholecystectomy Simulation (LaChSi) Models in the Lower Middle-Income Countries (LMICs) and Its Application for the Global HPB Surgery in Resource-Limited Settings

708 Innovating Low-Cost Automated Progress Tracking System (APS) for Laparoscopic Cholecystectomy Simulation (LaChSi) Models in the Lower Middle-Income Countries (LMICs) and Its Application for the Global HPB Surgery in Resource-Limited Settings

Medical students and residents of both sexes have similar learning curves for laparoscopy simulator training

BackgroundSimulation-based laparoscopy training is a standard part of modern surgical education. Studies focused on optimizing training for surgical residents have often used medical students as study participants. This has been criticized as medical students might have different prerequisites for surgical skills training due to their limited knowledge and exposure to real-life laparoscopic procedures. Simulation-based training has also been criticized for favouring male trainees due to its resemblance with video games and focus on competition. This study aimed to investigate if there is any difference in skills acquisition between novice surgical residents and medical students for proficiency-based laparoscopic training. Furthermore, to examine if there was a difference between male and female participants. MethodWe did a post-hoc study combining data from 59 participants from four previously published randomized trials. We compared residents with medical students and females with male participants across studies with identical training programs. ResultsThe median time to reach proficiency in the first training program comparison was 295 (IQR: 269-357) and 318 (241-445) minutes, respectively, for the residents and medical students (p=0.87). Male trainees spent 323 (IQR: 281-371) minutes to reach proficiency compared to 318 (IQR: 241-445)minutes for females (p=0.73). In the second training program comparison, the residents and medical students spent 169 (IQR: 123-229) and 165 (IQR: 128-214) minutes (p=0.67), respectively, reaching proficiency. The times for males and females were 166 (IQR: 61-151)minutes and 169 (61-117) minutes, respectively (p=0.74). ConclusionSimilar learning curves were observed for laparoscopic skills acquisition for residents and medical students. No difference was observed between male and female participants for proficiency-based laparoscopy simulator training.

Effect of three training programs on surgical performance in single-port laparoscopic surgery.

The aim of this study was to evaluate the effect of three training methodologies on the acquisition of psychomotor skills for laparoendoscopic single-site surgery (LESS), using straight and articulating instruments. A prospective study was conducted with subjects randomly divided into three groups, who performed a specific training for 12 days using three laparoscopic tasks in a laparoscopic simulator. Group-A trained in conventional laparoscopy setting using straight instruments and in LESS setting using both straight and articulating instruments. Group-B trained in LESS setting using straight and articulating instruments, whereas Group-C trained in LESS setting using articulating instruments. Participants' performance was recorded with a video-tracking system and evaluated with 12 motion analysis parameters (MAPs). All groups obtained significant differences in their performance in most of the MAPs. Group-C showed an improvement in nine MAPs, with a high level of technical competence. Group-A presented a marked improvement in bimanual dexterity skills. Training in LESS surgery using articulating laparoscopic instruments improves the quality of skills and allows smoother learning curves.

Development of a laparoscopic sigmoidectomy simulator: Sigmaster.

The sigmoid colon simulator was designed to accurately reproduce the anatomical layer structure and the arrangement of characteristic organs in each layer, and to have conductivity so that energy devices can be used. Dry polyester fibers were used to reproduce the layered structures, which included characteristic blood vessels, nerve sheaths, and intestinal tracts. The adhesive strength of the layers was controlled to allow realistic peeling techniques. The features of the Sigmaster are illustrated through a comparison of simulated sigmoidectomy using Sigmaster and actual surgery. We developed a laparoscopic sigmoidectomy simulator called Sigmaster. Sigmaster is a training device that closely reproduces the membrane structures of the human body and allows surgeons to experience the entire laparoscopic sigmoidectomy process.