Laparoscopic Suturing Training Research Articles

What is going on in augmented reality simulation in laparoscopic surgery?

BackgroundTo prevent unnecessary errors and adverse results of laparoscopic surgery, proper training is of paramount importance. A safe way to train surgeons for laparoscopic skills is simulation. For this purpose traditional box trainers are often used, however they lack objective assessment of performance. Virtual reality laparoscopic simulators assess performance, but lack realistic haptic feedback. Augmented reality (AR) combines a virtual reality (VR) setting with real physical materials, instruments, and feedback. This article presents the current developments in augmented reality laparoscopic simulation.MethodsPubmed searches were performed to identify articles regarding surgical simulation and augmented reality. Identified companies manufacturing an AR laparoscopic simulator received the same questionnaire referring to the features of the simulator.ResultsSeven simulators that fitted the definition of augmented reality were identified during the literature search. Five of the approached manufacturers returned a completed questionnaire, of which one simulator appeared to be VR and was therefore not applicable for this review.ConclusionSeveral augmented reality simulators have been developed over the past few years and they are improving rapidly. We recommend the development of AR laparoscopic simulators for component tasks of procedural training. AR simulators should be implemented in current laparoscopic training curricula, in particular for laparoscopic suturing training.

Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training

BackgroundError recognition predicts technical skill. A curriculum including error recognition may improve laparoscopic suturing performance. MethodsThirty novices were randomized into 2 groups. Each viewed an instruction videotape and underwent timed objective structured assessments of technical skills. Group A practiced the task, group B viewed an error-instruction video, practiced, followed by re-assessment. Participants counted errors on a videotape. Data were analyzed with the Fisher exact text, the Wilcoxon test, and the Kendall tau test. ResultsThe improvement in task time was greater in group A than in group B (P < .001). The objective structured assessments of technical skills scores improved for both groups, but did not reveal differences between the groups. Group B recognized significantly more errors than group A (P < 0.001). ConclusionsThe additional error instruction showed a negative impact on performance speed, but improved cognitive error recognition. Whether visual memory overload influenced the outcome requires further examination

The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation

Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic suturing training. All participants of several European Association for Endoscopic Surgery (EAES)-approved laparoscopic skills courses (N = 45) filled out a questionnaire on their opinion on laparoscopic suturing training. Additionally, participants with little or no laparoscopic suturing experience were allotted to two groups: group A (N = 10), who started training on the box trainer and subsequently the VR simulator (SimSurgery), and group B (N = 10), who began on the VR simulator followed by the box. Finally, suturing and knot-tying skills were assessed by an expert observer, using a standard evaluation form (eight items on five-point-Likert scale). The same was done after the initial training on the box in group A, as a control. Significant differences were calculated with the independent-sample t-test and the paired t-test. The total score of group A was higher than both group B and control (means of 30.80, 27.60, 28.20, respectively), but not significantly. The only tendency to a significant difference between group A and B was found in 'taking proper bites' (mean 4.10 versus 3.60, p = 0.054). All the participants scored the features of the box trainer significantly higher than those of the VR simulator (p < 0.001), 46.7% was of the opinion that the box alone would be sufficient for laparoscopic suturing training. From this study we can conclude that VR simulation does not have a significant additional value in laparoscopic suturing training, over traditional box trainers. One should consider that the future development in VR simulation should focus on basic skills and component tasks of procedural training in laparoscopic surgery, rather than laparoscopic suturing.

196: Limited feedback and video tutorials optimize learning and resource utilization during laparoscopic simulator training

Introduction: Performance feedback is essential for learning motor skills but optimal methods have not been defined for simulator-based training. Video tutorials may facilitate skill acquisition. The purpose of this study was to determine the impact of instructor feedback and video tutorials on skill acquisition during proficiency-based laparoscopic suturing training. Methods: Performance data from a prospectively maintained database were reviewed for three groups of novices (n=34 medical students) who completed proficiency-based laparoscopic suturing training on a FLS-type videotrainer model as part of two separate IRB-approved randomized controlled trials. All trainees viewed a video tutorial, completed baseline testing and practiced during one-hour sessions to a previously validated proficiency level (score = 512) with standardized feedback provided by a single expert instructor. Group I (n=9) received intense feedback during the early stages of skill acquisition and had no further video exposure, Group II (n=13) received limited feedback (<10 min per session) and no further video exposure, and Group III (n=12) had limited feedback (<10 min. per session) and watched the video tutorial deliberately during each session. Feedback was quantified on a 0 (none) to 4 (extensive) Likert-scale per repetition by the instructor. Personnel and materials cost was calculated. Comparisons were by ANOVA; p<0.05 was considered significant. Results: Baseline performance was similar in all groups and all participants achieved the proficiency level on two consecutive attempts. As shown below, Group III required the shortest training time and resources to reach proficiency. Conclusions: Limited instructor feedback is superior to intense feedback during the early stages of proficiency-based laparoscopic simulator training. Coupled with video tutorials, this type of feedback may accelerate the learning curve and improve resource utilization by minimizing the need for instructor involvement. Tabled 1Group Comparison Group I (n=9) Group II (n=13) Group III (n=12) p-value (ANOVA) Instructor Feedback per Repetition † 0-4 Likert scale 1 ± 0.3 0.23 ± 0.1 0.27 ± 0.1 <0.001 ⁎ Pair-wise comparisons not significant between groups II and III Video Tutorial Viewings (#) 1 ± 0 1 ± 0 8 ± 1 <0.001 Training Time to Proficiency (min) 148 ± 52 112 ± 46 86 ± 30 <0.02 ⁎ Pair-wise comparisons not significant between groups II and III Repetitions to Proficiency (#) 50 ± 17 38 ± 13 31 ± 9 <0.02 ⁎ Pair-wise comparisons not significant between groups II and III Cost per trainee $156 ± 50 $51 ± 18 $43 ± 13 <0.001 ⁎ Pair-wise comparisons not significant between groups II and III † 0-4 Likert scale Pair-wise comparisons not significant between groups II and III Open table in a new tab