Training In Laparoscopic Surgery Research Articles

The 'complements' to virtual simulation.

With the advancement of minimally invasive procedures in urology, the goal is to train a urologist who is highly competent and confident in performing these techniques. Because of the specific risks, visuospatial relationships, and the steep learning curve that is unique to laparoscopy, hands-on training on a box or a visual simulator is the recommended way to start learning laparoscopic skills. However, as Preece et al. [1] stated in their interesting article, simulation should complement other essential components of urology training programs such as participation in mentorship schemes and clinical fellowships, which also aid progression along the learning curve. Residents who are willing to perform laparoscopic surgery should train their laparoscopic skills on a regular basis. Previous research by Stolzenburg et al. [2] suggested that those who are willing to learn laparoscopic prostatectomy should practice daily on a pelvic trainer, especially knot tying and suturing. Laguna et al. [3] stated that it is almost impossible to finalize the residency training as a qualified laparoscopic surgeon. Based on the low level of laparoscopic skills displayed by last year's residents, it is advisable that those who are willing to perform laparoscopy as a urologist should improve their training and exposure to laparoscopy during residency or should consider a fellowship in laparoscopic surgery. Cadaveric educational programs are unique programs that may simulate real clinical experience in the operating room. In Turkey, this dedicated educational program consists of 3 main theoretical and practical parts and many subtopics. The cadaveric educational program allows all urology residents to perform basic and complex surgical operations on fresh frozen cadavers. The surgeries that may be performed as an example include simple procedures such as prostatic biopsies to complex laparoscopic procedures such as partial nephrectomy. This program is still in continuous growth and we hope to be able to expand it over all of Europe. There are several circumstances that may reduce the number of procedures according to the training of the surgeons such as: 1) the development of their individual laparoscopic skills, 2) the access to simulator training, 3) animal or cadaveric training and 4) clinical experience with an experienced mentor [4]. Also, the importance of training with animals has been published in the past [5]. Following the La Paz University Hospital training program, every kind of training in laparoscopic surgery is desirable, but a scheduled program with a frequent presence in the operating room and a constant suture training on the simulators, ensures a consistent training in laparoscopic urological surgery.

Current status of residency training in laparoscopic surgery in Brazil: a critical review.

IntroductionThe surgeon's formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination.ObjectiveTo review the surgical teaching ways used in services that published their results.MethodsSurvey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency.ResultsThe training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient. Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. ConclusionThe establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity.

Porcine Model In The Laparoscopic Liver Surgery Training.

The aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery.

Need for simulation in laparoscopic colorectal surgery training.

The dissemination of laparoscopic colorectal surgery (LCS) has been slow despite increasing evidence for the clinical benefits, with a prolonged learning curve being one of the main restrictions for a prompt uptake. Performing advanced laparoscopic procedures requires dedicated surgical skills and new simulation methods designed precisely for LCS have been established: These include virtual reality simulators, box trainers, animal and human tissue and synthetic materials. Studies have even demonstrated an improvement in trainees' laparoscopic skills in the actual operating room and a staged approach to surgical simulation with a combination of various training methods should be mandatory in every colorectal training program. The learning curve for LCS could be reduced through practice and skills development in a riskfree setting.

The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort

BackgroundConsiderable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience.MethodsFourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale.ResultsOverall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy.ConclusionsNeither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes.

Laparoscopic Appendectomy: Is There a Learning Curve after Completion of Colorectal Fellowships Training?

Purpose: Recent studies have shown that the procedure of laparoscopic appendectomy requires a learning curve before mastering. The aim of this study was to investigate the question of whether a surgeon who has been working as a first assistant for training in laparoscopic colorectal surgery can perform laparoscopic appendectomy without previous experience as an operator in laparoscopic appendectomy. Methods: Ninety consecutive patients who underwent laparoscopic appendectomy by a single surgeon were retrospectively enrolled in this study. The operating surgeon completed fellowship training of the colorectal cancer division as a first assistant for two years. The patients were divided into two groups by consecutive order: Group (A) included the initial 45 patients and Group (B) included the next 45 patients. The clinical patient demographics, histological diagnosis, and outcome variables including operation time, conversion to open surgery, complications, and length of hospital stay were compared between the two groups. Results: No difference in operation time was observed between the groups (mean: 58.22 min vs 66.6 min, p=0.097). Open conversion rate and drain insertion rate were similar between the two groups. There was no difference in length of hospital stay. Overall complication rate did not differ between the two groups. Moving average curve showed no specific time shortening point within these 90 enrolled patients. Conclusion: This study demonstrates that laparoscopic appendectomies performed by a surgeon who had achieved a training course as an assistant in laparoscopic colorectal surgery were performed safely without any difficulties during the learning period. This finding needs further validation in additional large-scale studies.

Randomized controlled trials: a systematic review of laparoscopic surgery and simulation-based training.

Introduction:This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs.Methods:This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR).Results:This systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies).Conclusion:Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum.

Safe introduction of laparoscopic colorectal surgery even in remote areas of the world: the value of a comprehensive telementoring training program.

Advanced laparoscopic surgery training courses equipped with state-of-the-art lab facilities allow the acquisition of surgical skills in a harmless environment for the patients. In addition, active participation in intensive clinical mini-fellowship programs helps in acquiring clinical competence for the novice surgeons to properly manage patients affected by colorectal diseases. Despite this, inexperienced surgeons still need supervision during their first cases, especially to perform more complex laparoscopic procedures; however, availability of experts is particularly critical in remote areas of the globe. The aim of this study was to demonstrate the feasibility and effectiveness of a comprehensive theoretical and hands-on training program that included long-distance telementoring to assist inexperienced surgeons in performing laparoscopic colonic resections. One surgeon with no previous experience in laparoscopic colonic resection participated in an intensive training program that incorporated a theoretical master class and practical modules in the lab, including telementored sessions in experimental settings. A 4-week intensive clinical mini-fellowship was also part of the training program. After completion of the extended training program, two laparoscopic colorectal resections for colon cancer were successfully performed in a remote area of Russia with telementoring assistance from Italy. A highly integrated operative room and standard secured network system were used to connect the expert and the novice surgeon. After this preliminary experience, the remote learner successfully operated on 25 more patients without any further need for remote expert assistance. A comprehensive theoretical and practical mini-fellowship training program associated with initial telementoring assistance can help to safely start to perform advanced laparoscopic procedures, even in remote areas of the globe.

Laparoscopic bariatric surgery training program model: gastric bypass.

BackgroundLaparoscopy for bariatric surgery became the surgery of choice for surgeons worldwide. However, it is also more difficult to learn and has a great potential for complications. The specific training is fundamental to maintain the benefits without increasing the complications. This study presents a laparoscopic surgery training method for the treatment of obesity and to analyze its efficiency.MethodA training program for 36 surgeons with experience in open bariatric surgery was proposed, and the surgical results of their first laparoscopic surgeries were accompanied as for greater complications, such as death, intestinal obstruction, bleeding and fistula within the first 30 days.ResultsOf the 36 surgeons who completed the program, thirteen who performed 403 surgeries were accompanied for 18 months to evaluate morbidity and mortality. There were 4 cases of greater complications (1%).ConclusionsThe proposed program was efficient for this specific group of surgeons, as it permitted the participants to learn the procedure without increasing the initial complications in the learning curve.

Objective assessment of technique in laparoscopic colorectal surgery: what are the existing tools?

Assessment can improve the effectiveness of surgical training and enable valid judgments of competence. Laparoscopic colon resection surgery is now taught within surgical residency programs, and assessment tools are increasingly used to stimulate formative feedback and enhance learning. Formal assessment of technical performance in laparoscopic colon resection has been successfully applied at the specialist level in the English "LAPCO" National Training Program. Objective assessment tools need to be developed for training and assessment in laparoscopic rectal cancer resection surgery. Simulation may have a future role in assessment and accreditation in laparoscopic colorectal surgery; however, existing virtual reality models are not ready to be used for assessment of this advanced surgery.

An automated system for video documentation of all instances of fundamentals of laparoscopic surgery training: feasibility and potential advantages of extended assessment

IntroductionDocumentation of the acquisition of surgical skills is mandated during and after training. Assessment-driven feedback interspersed during Fundamentals of Laparoscopic Surgery (FLS) training is expected to improve the quality of practice and increase skill acquisition. But the direct observation of FLS task performance by experts required to form this feedback is not feasible because of staffing and cost limits. Video recordings can reproduce a display of FLS task performance identical to the original camera view and can provide the critical observations needed for FLS assessment. MethodsWe report the design and operation of an automated system for the capture of digital video clips of all FLS practice trials and for the support of remote, distributed assessments. ResultsAdvantages included permanent documentation of performance, quality controlled assessment by non-Medical Doctor personnel, accurate quantification of practice frequency, and emergence of new observations on patterns of intermediate skill development. The completeness and accuracy of the dataset support analyses of group learning rates and lay the foundation for scientific training curriculum development. ConclusionsWe conclude that video documentation of FLS training is feasible and worthwhile.

Application of failure mode and effect analysis in laparoscopic colon surgery training.

Aim To evaluate if application of failure mode and effect analysis (FMEA) to laparoscopy training can help surgeons acquire laparoscopy skills.MethodsAfter preparing a FMEA matrix of laparoscopic sigmoidectomy, we have introduced it during three laparoscopy courses. Forty-eight surgeons, divided into 24 teams of two surgeons, have participated in three courses. During each course, every team has performed three laparoscopic sigmoidectomies in three experimental animals (1 OR session every day). Risk priority number (RPN) has been calculated for every surgery, and the results have been discussed at the end of each training day with all participants.ResultsWe have observed a decline in the median RPN from 1339 during the first OR session through 62 during second OR session to reach 0 in the third OR session. Only two teams out of 24 were not able to reach a RPN of less than 300 during third OR session. When the type of failures were analysed, we have observed a shift from procedure-type failures to technical failures that depended on each participant technical abilities.ConclusionApplication of FMEA principles to laparoscopy training can help acquire non-technical skills necessary for safe laparoscopic surgery.

Training of Surgical Residents in Laparoscopic Procedures: A Case of Meckel's Diverticulum Treatment

Abstract Introduction: With advances in technology, laparoscopic surgery has replaced open surgery in many surgical procedures.1,2 Many patients nowadays expect a minimally invasive approach to their surgical operations, given the public notoriety the technique has gained. To keep practices financially viable and to keep abreast with a rapidly changing surgical atmosphere, an abundance of practicing surgeons have made training for advanced laparoscopic procedures a priority.3,4 For these reasons, the training of surgical residents in laparoscopic surgery is an important item. To support the importance of early training in laparoscopic surgery, we report a case of laparoscopic treatment of Meckel's diverticulum performed, under supervision, by a young resident during his first year of residency in general surgery. Case Report: A 25-year-old man presented for a lower tract digestive bleeding. Colonoscopy and upper GI endoscopy did not show any source of bleeding. A Tc99scintigraphy showed a radionuclide upt...

Panel discussion on the fundamentals of laparoscopic surgery program

Laparoscopic surgery develops fast in China in recent years,and it is widely applied in different fields in the digestive surgery and satisfactory results are achieved.However,uniformed training,technique standard and quality control standard are missing in the education of laparoscopic surgery in China.Fundamentals of laparoscopic surgery (FLS) program is developed by the Society of American Gastrointestinal and Endoscopic Surgeons in 2004.It is composed of congenital assessment and manual skills assessment.Twelve surgeons from China have taken FLS examination in April of 2014,and they introduced the content,features of FLS examination,some thoughts and inspirations on the training of laparoscopic surgery in China in this article. Key words: Fundamentals of laparoscopic surgery; Society of American Gastrointestinal and Endoscopic surgeons ; Standard

Gynecology resident laparoscopy training: present and future

Simulator education is essential to surgical training and it should be a requirement at all training programs across North America. Yet, in a survey of North American obstetrics and gynecology program directors (response rate 52%), we found that while 73% (n = 98) of programs teach laparoscopic skills, only 59% (n = 81) were satisfied with their curriculum. Most programs lacked standard setting in the form of theoretical examinations (94%, n = 127) or skills assessments (91%, n = 123) prior to residents performing surgery on patients in the operating room. Most programs (97%, n = 131) were interested in standardizing laparoscopy education by implementing a common curriculum. We present 3 core recommendations to ensure that gynecologists across North America are receiving adequate training in gynecologic laparoscopic surgery as residents: (1) uniform simulator education should be implemented at all training programs across North American residency programs; (2) a standardized curriculum should be developed using evidence-based techniques; and (3) standardized assessments should take place prior to operating room performance and specialty certification. Future collaborative research initiatives should focus on establishing the content of a standardized laparoscopy curriculum for gynecology residents utilizing a consensus method approach.

Advanced training in laparoscopic abdominal surgery: A systematic review

Simulation has spread widely this last decade, especially in laparoscopic surgery, and training out of the operating room has proven its positive impact on basic skills during real laparoscopic procedures. Few articles dealing with advanced training in laparoscopic abdominal surgery, however, have been published. Such training may decrease learning curves in the operating room for junior surgeons with limited access to complex laparoscopic procedures as a primary operator. Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles. Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series and one fifth were purely descriptive, but there were eight randomized trials. Pig models and video trainers as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainee satisfaction with improvement after training, but the improvements were mainly on the training tool itself. Some tools have been proven to be construct-valid. Higher-quality studies are required to appraise educational value in this field.

Short- and mid-term outcomes after early surgical training in laparoscopic colorectal cancer surgery: trainees' performance has no negative impact.

This study aimed to evaluate the safety and quality of laparoscopic colorectal cancer surgery undertaken by trainees. From a prospectively maintained database, we identified 456 consecutive patients who underwent laparoscopic resection for colorectal cancer between 2006 and 2010. Short-term operative outcomes, relapse-free survival (RFS), and overall survival (OS) were compared between operations undertaken by the experts (E group) and trainees (T group). Multivariate analyses were performed for RFS and OS in stage II/III disease. Trainees performed 313 surgeries (68.6%) and completed the procedure by themselves in 297 cases (94.9%). Short-term outcomes, including operative time, blood loss, conversion, complication, mortality, and retrieval of less than 12 lymph nodes, were comparable between the E group and the T group. After a median follow-up period of 35 months, RFS and OS were similar between the two groups, with the exception of OS for stage II (3-year OS for E group versus T group, 96.9% versus 87.0%; P=.029); however, this difference disappeared after multivariate analyses. Multivariate analyses showed that positive resection margin and higher log carcinoembryonic antigen (CEA) levels were associated with lower RFS. Furthermore, increasing age, positive resection margin, higher log CEA levels, intraoperative surgeon exchange, rectal cancer, postoperative complications, absence of postoperative chemotherapy, and shorter operative time were associated with poor OS. Laparoscopic operations undertaken by trainees did not negatively affect short-term outcomes and were not associated with impaired mid-term oncologic outcomes. Our findings support early initiation of training in laparoscopic surgery for colorectal cancer treatment.

A United Kingdom national survey of trends in ectopic pregnancy management

Our national survey demonstrates increased use of medical and laparoscopic management of ectopic pregnancy in the UK. In the UK in 2000, 35% of cases were managed by laparoscopy, 63% by laparotomy and 1% with medication. A recent review in the USA revealed increasing rates of medical management and decreasing rates of laparotomy; a trend driven by both cost-effectiveness and patient choice. A total of 119 early pregnancy units were surveyed regarding the nature and management of the three most recent cases of ectopic pregnancy; in addition, feasibility of training residents was also requested. Participants reported on 124 cases with a median of five cases per month per department. A total of 57% of cases were managed laparoscopically, 31% medically, 5% by laparotomy and 6% conservatively. Out of 44 centres, 29 have the facilities for training in both intermediate laparoscopic surgery and early pregnancy ultrasound.

Virtual reality training and assessment in laparoscopic rectum surgery

Virtual-reality (VR) based simulation techniques offer an efficient and low cost alternative to conventional surgery training. This article describes a VR training and assessment system in laparoscopic rectum surgery. To give a realistic visual performance of interaction between membrane tissue and surgery tools, a generalized cylinder based collision detection and a multi-layer mass-spring model are presented. A dynamic assessment model is also designed for hierarchy training evaluation. With this simulator, trainees can operate on the virtual rectum with both visual and haptic sensation feedback simultaneously. The system also offers surgeons instructions in real time when improper manipulation happens. The simulator has been tested and evaluated by ten subjects. This prototype system has been verified by colorectal surgeons through a pilot study. They believe the visual performance and the tactile feedback are realistic. It exhibits the potential to effectively improve the surgical skills of trainee surgeons and significantly shorten their learning curve.

A new ex vivo animal simulation model for skills training in laparoscopic colorectal surgery

The opportunity for using simulation in medical training has expanded in recent years. 1–3 Laparoscopic surgery is an area that is ideally suited to the use of simulators for the acquisition of clinical skills. 4 Simulation allows educators to have control over pre-selected scenarios, without distressing patients or encountering complications. 5