Laparoscopic Simulator Research Articles

Laparoscopic Myomectomy Simulation Model for Post-Graduate Learners: Mastering Enucleation

<h3>Study Objective</h3> The objectives of this video are to highlight the fundamentals of laparoscopic myomectomy for postgraduate learners, and to describe a low fidelity simulation model for fibroid enucleation during straight stick laparoscopic myomectomy. <h3>Design</h3> Surgical simulation pilot. <h3>Setting</h3> Surgical simulation lab with use of laparoscopic box trainer. <h3>Patients or Participants</h3> Feedback on the simulation model was obtained from 2 fellowship trained minimally invasive gynecologic attending surgeons (MIGS) and 17 OB/GYN residents evenly distributed across post-graduate year. <h3>Interventions</h3> Using the described model, we assessed user experience and face validity via pre- and post-tests. <h3>Measurements and Main Results</h3> On post-test, 94% of post-graduate learners felt the tactile feedback on the fibroid to be realistic or very realistic. 100% felt starting the plane of enucleation to be realistic or very realistic. 88% felt as though the density of fibroid and number of tenaculum tear-offs was realistic or very realistic. Lastly, 94% of participants felt peeling fibers from the fibroid to be realistic or very realistic. Difficulties with the injection of vasopressin and excess mobility of the uterus during enucleation were cited as points for improvement. After the simulation, 76% felt comfortable or very comfortable with creating the hysterotomy and identifying the correct plane for enucleation as compared to 29% prior. Similarly, 82% of learners felt comfortable or very comfortable with enucleation via traction-counter traction approach as compared to only 35% prior. <h3>Conclusion</h3> This proposed low-fidelity model for laparoscopic myomectomy realistically simulated the fundamental steps of fibroid enucleation and served as a promising method to teach the nuances of haptic feedback on pilot testing. As no historical data is available, in future studies we aim to measure construct validity with predictive validation techniques in a cohort of attending surgeons, MIGS fellows, and OB/GYN residents across several sites.

Low-Cost High-Fidelity Minimally Invasive Myomectomy Model for Laparoscopic and Robotic-Assisted Simulation

<h3>Study Objective</h3> The objective of this video is to demonstrate the creation and use of a low-cost, high-fidelity model for simulating a minimally invasive myomectomy. <h3>Design</h3> N/A. <h3>Setting</h3> A simulation center within an academic medical institution. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Residents trialed a high-fidelity model created from a porcine tongue and small potatoes to represent a fibroid uterus. A grounding pad was affixed to the model in order to allow for the use of energy sources. A laparoscopic tower as well as a simulation robot was used to carry out the procedure. <h3>Measurements and Main Results</h3> The model was used to demonstrate the four components of a minimally invasive myomectomy: 1) planning and placement of the hysterotomy, 2) incision, 3) extraction of the fibroid, and 4) suturing the fibroid bed. Residents who used the model "agree"-d to "strongly agree"-d on a 5-point Likert scale that the model simulated in vivo tissue, and all felt that using the model helped them feel more comfortable participating in a minimally invasive myomectomy in the future. <h3>Conclusion</h3> Use of this novel high-fidelity myomectomy model allowed medical trainees to feel more comfortable participating in a minimally invasive myomectomy. Future directions for this model include validating the model in a larger population of trainees and surgeons with various experience levels and using this model to simulate entry into the endometrial cavity.

7758 The New Generation Articulated Laparoscopy in Gynecologic Surgery

<h3>Study Objective</h3> To discuss the advantages and disadvantages of a novel articulated laparoscopic device compared to conventional laparoscopy and to demonstrate its benefits using a simulator model. <h3>Design</h3> Educational video. <h3>Setting</h3> Laparoscopic simulator box at a simulation center. <h3>Patients or Participants</h3> We present a novel articulated laparoscopic instrument and our experience with the implementation of this device using a simulator box. <h3>Interventions</h3> The standardized Fundamental laparoscopic skill (FLS) peg transfer, tip positioning and laparoscopic suturing. <h3>Measurements and Main Results</h3> Conventional laparoscopy requires high skills mainly due to challenging ergonomics and a two-dimensional vision. Robotic surgery flourished as it improves precision with wristed instruments making surgical movements more intuitive and easier to master. However, limitations of robotic surgery include the absence of haptic or tactile feedback and a higher cost. Additionally, availability may be a problem in certain settings. We present a novel hand-held articulated laparoscopic device that provides haptic feedback, short set up time, and lower cost while improving precision and dexterity with wristed instruments. <h3>Conclusion</h3> This novel articulated laparoscopic instrument may be an option to offer minimal invasive surgery with increased dexterity at a lower cost compared with robotic surgery. This option potentially combines the benefits of conventional laparoscopy and robotic surgery. Future research is needed to determine the learning curve and operative advantages of this device.

8549 Simplifying Laparoscopic Suturing for the Gynecologic Trainee: A Systematic Approach for Reproducible Needle Handling

<h3>Study Objective</h3> Laparoscopic suturing and needle handling are core components of gynecologic surgical management of many benign and malignant disease processes. Adoption of a reproducible technique for laparoscopic needle loading and handling is beneficial for the gynecologic trainee. <h3>Design</h3> Educational demonstration of a surgical technique. <h3>Setting</h3> The demonstration of this method is shown in a laparoscopic simulator trainer with a vaginal cuff model. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> This video demonstrates a 3-step approach for safe and efficient needling loading and handling in a simulation environment. 1. Grasp the suture one to two centimeters from the swaged end of the needle to serve as the fulcrum of movement. 2. Lightly grasp the body of the needle so it may act as a pendulum for the swing. 3. Maintain tension on the suture to allow for needle rotation. <h3>Measurements and Main Results</h3> N/A <h3>Conclusion</h3> Mastering laparoscopic needle handling and suturing are important fundamentals of gynecologic laparoscopic surgery. The swing technique may be used in a variety of port configurations making it adaptable and transferable across a wide setting of operations. Additionally, it uses minimal needle grasps for increased safety and efficiency. Learning this reproducible and methodical swing technique may help develop safe and efficient needle handling practices for the gynecologic trainee.

Development and Validation of a Laparoscopy Simulation Model of Pyeloplasty for Pediatric Patients.

Introduction: Given the extensive training required for laparoscopic pyeloplasty and the difficulties achieving this training, there is a need to recreate the activity in a controlled environment, but high-fidelity models are unavailable or expensive. Our objective was to develop a model of pyeloureteral junction stenosis, resembling the anatomical details and consistency of natural tissue, for a replicable, cheaper, and realistic simulation model of laparoscopic pyeloplasty in children. Materials and Methods: A three-dimensional, printed synthetic model was created from magnetic resonance urography. The model comprises a plastic kidney as the reusable structure and a silicone renal pelvis and ureter as the interchangeable structure. We evaluated realism and performance with surgeons and residents at different levels of training, comparing operative time and complications of the procedure. Results: Twenty-four participants were recruited; 41.7% had previous experience in laparoscopic pyeloplasty, with 5.5 years of experience in laparoscopic surgery (interquartile range [IQR] 2-7.75). There were no cases of stenosis, but leaks accounted for 41.7%. The procedure lasted 72 minutes (IQR 55-90), with significant differences according to the level of training (85 minutes for residents, 68 minutes for pediatric surgeons and urologists, and 40 minutes for laparoscopic surgeons; P: .011) and years of previous experience in laparoscopic surgery (P: .003). Conclusions: A high-fidelity, replicable, and low-cost pyeloureteral stenosis model was developed to simulate laparoscopic pyeloplasty in pediatric patients.

5G-Assisted Remote Guidance in Laparoscopic Simulation Training Based on 3D Printed Dry Lab Models.

This is a pilot study to assess the utility of applying 5G-assisted remote guidance in laparoscopic simulation training. A single trainee of a junior surgeon was recruited to complete three steps of tasks including basic task 1, basic task 2, and model task, and the performance was recorded and evaluated. The operator completed each task three times. Except for basic task 1, all tasks were remotely guided by a more experienced surgeon using 5G technology. Tasks completion time and a 30-point objective structured assessment of technical skills (OSATS) score were utilized to assess the results of simulation training. All remote guidance processes were successfully completed without significant network latency. Through basic task 1, the operator quickly became familiar with the trained laparoscopic instruments. For basic task 2, OSATS scores increased from 16 to 24 points, and completion time decreased from 1500 to 986 s after training under 5G-assisted remote guidance. For model tasks, OSATS scores increased from 15 to 26 points, and completion time decreased from 1734 to 1142 s. This is a novel mode of laparoscopic simulation training to increase the convenience of training. Perhaps in the near future, surgeons can simulate difficult operations at home or in the office, and accurately grasp the possible situations that may occur in actual operations in advance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12262-022-03590-2.

Simulation-based skills training: a qualitative interview study exploring surgical trainees’ experience of stress

IntroductionStress can affect the ability to acquire technical skills. Simulation-based training (SBT) courses allow surgical trainees to train their technical skills away from stressful clinical environments. Trainees’ subjective experiences of stress during SBT courses on laparoscopic surgery remains understudied. Here, we explored the subjective stress experiences of surgical trainees during mandatory laparoscopic SBT courses. We aimed to obtain a broader understanding of which factors of the simulation training the trainees perceived as eliciting stress.MethodsA qualitative study with semistructured individual interviews was undertaken to explore trainees’ subjective experiences of stress. Twenty surgical trainees participated while attending courses at a national training center for advanced laparoscopic surgery. Questions explored trainees’ stress experiences during the SBT courses with a focus on perceived stressors related to laparoscopic simulation training on two box-trainers and one virtual reality simulator. Interview data were analyzed using inductive, qualitative content analysis methods to identify codes, categories, and themes.ResultsFindings indicated that trainees have a variety of stress experiences during laparoscopic SBT. Three main themes were identified to be related to stress experiences: simulation task requirements, psychomotor skill levels and internal pressures, with subcategories such as task difficulty and time requirements, unrealistic haptic feedback and realism of graphics, inconsistent and poor technical performance, and self-imposed pressures and socio-evaluative threats.ConclusionsInsights into surgical trainees’ experience of stress during laparoscopic SBT courses showed that some stress experiences were directly related to simulation training, while others were of psychological nature. The technical and efficiency requirements of simulation tasks elicited stress experiences among trainees with less laparoscopic experience and lower levels of psychomotor skills. Self-imposed pressures played an integral part in how trainees mobilized and performed during the courses, suggesting that levels of stress might enhance laparoscopic simulation performance. For course facilitators aiming at optimizing future laparoscopic SBT courses, attending to the realism, providing clarity about learning objectives, and having awareness of individual differences among trainees’ technical level when designing the simulation tasks, would be beneficial. Equally important to the laparoscopic SBT is to create a psychological safe learning space in order to reduce the internal pressures of trainees.

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points). ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

Comparison of two cable configurations in 3D printed steerable instruments for minimally invasive surgery.

In laparoscopy, a small incision size improves the surgical outcome but increases at the same time the rigidity of the instrument, with consequent impairment of the surgeon's maneuverability. Such reduction introduces new challenges, such as the loss of wrist articulation or the impossibility of overcoming obstacles. A possible approach is using multi-steerable cable-driven instruments fully mechanical actuated, which allow great maneuverability while keeping the wound small. In this work, we compared the usability of the two most promising cable configurations in 3D printed multi-steerable instruments: a parallel configuration with all cables running straight from the steerable shaft to the handle; and a multi configuration with straight cables in combination with helical cables. Twelve participants were divided into two groups and asked to orient the instrument shaft and randomly hit six targets following the instructions in a laparoscopic simulator. Each participant carried out four trials (two trials for each instrument) with 12 runs per trial. The average task performance time showed a significant decrease over the first trial for both configurations. The decrease was 48% for the parallel and 41% for the multi configuration. Improvement of task performance times reached a plateau in the second trial with both instruments. The participants filled out a TLX questionnaire after each trial. The questionnaire showed a lower burden score for the parallel compared to multi configuration (23% VS 30%). Even though the task performance time for both configurations was comparable, a final questionnaire showed that 10 out of 12 participants preferred the parallel configuration due to a more intuitive hand movement and the possibility of individually orienting the distal end of the steerable shaft.

Artificial intelligence in laparoscopic simulation: a promising future for large-scale automated evaluations.

IntroductionA limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algorithm and expert evaluators in assessing basic laparoscopic-simulated training exercises.MethodsThe AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evaluators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise.ResultsAfter the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively.ConclusionThis first approach of AI use in basic laparoscopic skills simulated training assessment shows promising results, providing a preliminary framework to expand the use of AI to other basic laparoscopic skills exercises.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09576-1.

211. STUDENT (CROWD SOURCED) ASSESSMENT OF LAPAROSCOPIC ASSISTED PERCUTANEOUS NEEDLE JEJUNOSTOMY PLACEMENT IS EQUIVALENT TO EXPERT ASSESSMENT, EXCEPT FOR PROCEDURE-SPECIFIC STEPS

Abstract Objective and Structured Assessment of Technical Skills (OSATS) is an important and frequently used method to give feedback on surgical skills during surgical training. Feedback is usually given by qualified surgeons, but their availability is often limited. Aim of our study was to investigate whether OSATS performed by novice medical students and students trained in a laparoscopic jejunostomy simulation setup was equivalent to OSATS performed by experts in laparoscopic assisted percutaneous needle jejunostomy placement. Fifty-six volunteers (32 inexperienced students, 12 trained students and 12 expert surgeons) were invited to participate. An instruction video with the procedure’s essential steps was displayed on an online survey platform. Thereafter five edited videos with essential steps of the procedure, performed by operators with a different level of expertise, were shown. Each video was followed by a standardized OSATS form, assessing nine different procedural aspects: fluency of the entire procedure, use of instruments, tissue respect, placement of stitches, tissue bridge between bowel and wall, submucosal needle tunneling, advancing the catheter, camera use and end result. Nonparametric statistics were used. Thirty-seven (66%) volunteers—21 novice students (66%), 8 trained students (67%) and 8 surgeons (67%)—completed all five forms within 30 days. Median time to complete OSATS forms for novice students, trained students and experts was 22, 21 and 14.5 days respectively (p = 0.88). Median time needed per video was 825, 881 and 793 seconds respectively (p = 0.60). Average total scores per item showed no differences between novice students, trained and experts, except for items submucosal needle tunneling” (p = 0.0082) and advancing the catheter” (p = 0.0154) which both were rated higher by experts than by both groups of students. Using standardized OSATS to evaluate laparoscopic assisted percutaneous needle jejunostomy placement, steps with common laparoscopic skills were rated equally by novice students, trained students and experts. These skills can be correctly evaluated without advanced training of the evaluator. Two procedure-specific items were rated differently by experts, compared to students. These procedure-specific items probably need more advanced training, explaining the different appreciation of the assessed manipulations by expert surgeons.

270 The Innate Aptitude's Effect on the Surgical Task Performance

Abstract Aim Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Method A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3-null hypothesis, and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusions Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

EP-524 Implementing Simulation Based Learning (SBL) to Reduce the Gap in Surgical Training, A Theoretical Evaluation Approach

BackgroundThe current surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher surgical trainees, rendering the traditional apprenticeship model obsolete. It became evident that the future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome the obstacle of reduced exposure in surgical education and operative training.DiscussionIn our theoretical analysis, we will discuss the efficacy, safety and impact of relying on SBL to fill the gaps in surgical training.Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory.In a high fidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis.On balance, given the complexity of skills learnt, it remains difficult to measure the efficacy of transferring the learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth.ConclusionThe disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of the adjuncts that fill in the gaps on the short and medium term. Implementing SBL in surgical training curriculum, should be evaluated for efficacy and cost effectiveness.

SP1.2.2 Core Surgical Training Bootcamp- a five year review

Abstract Aims Surgical bootcamps may improve abilities across cognitive, affective and psychomotor domains. This deanery bootcamp is an intensive program involving induction, focussed teaching of core content, technical and non-technical skills. We aim to describe the successes and areas for development for this course through five years of feedback. Method A free three-day programme is delivered with lectures, workshops, skills teaching and simulation. Trainees are loaned equipment for self-taught surgical skills practice and laparoscopic simulation. Trainees must meet simulator proficiency targets which may improve early laparoscopic skills. Five years of feedback was analysed and previous attendees were contacted for retrospective focussed feedback. Results Across five years, 96–100% of trainees reported that they enjoyed the experience and would recommend attendance to others. 88–100% felt more confident to assess a surgical patient and 100% of responding attendees felt more prepared to begin core training. In the retrospective survey, 75% felt that Bootcamp helped them to get the best out of training and 70% felt that Bootcamp had improved their chances of passing annual progression meetings. There is evidence that attendance at induction core surgical bootcamps correlates with appointment to a national training number. In our study 50% of attendees regarded Bootcamp as helpful towards gaining their specialty training post. Conclusion This annual deanery bootcamp has benefited from five years of feedback and improvement. The program has evolved to reflect changes in the surgical curriculum and to tackle new challenges in education. We believe that each deanery should offer this and our format is applicable nationally and internationally.

EP-19 The innate aptitude's effect on the surgical task performance

Abstract Aims Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Methods A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusion Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

BJS Prize 3 PPE-induced systemic hypercapnic-hypoxaemia: translational implications for impaired cognitive-clinical-functional performance

Abstract Background Personal Protective Equipment (PPE) has been reported to adversely influence pulmonary gas exchange, resulting in systemic hypercapnic-hypoxaemia and cerebral hyperperfusion-induced cephalalgia. This study aimed to determine to what extent these changes impact functional cognition and manual dexterity given their relevance to surgical performance. Method Thirty-one surgical trainees (20 male, 11 female, aged 29 yr. (29.2 ± 2) participated in a randomised single-blind repeated measures crossover trial, completing one-hour of standardised laparoscopic simulation tasks, on two separate occasions (same day), once in Standard Operating Attire (SOA), and once in full PPE (including FFP3 mask). Global Cerebral Blood Flow (gCBF) was determined using duplex arterial ultrasound. Cognition and manual dexterity were assessed by timed Grooved Pegboard and a novel measure of laparoscopic bead placement. Results Following one-hour of simulation, PPE (compared with SOA) increased heart rate (93 ± 13 b/min vs. 79 ± 13 b/min, p=0.001), decreased peripheral O2 saturation (96.9% ±1% vs. 97.9% ±1%, p=0.001), increased gCBF (Δ+7 ± 8 mL/min/100g vs. + 1 ± 11 mL/min/100g, p=0.016; reflecting hypercapnic-hypoxic cerebral vasodilatation) and skin temperature increased by 0.6°C (p=0.001). Cephalalgia was reported by 21 (67.7%) participants wearing PPE vs. 13 (41.9%) wearing SOA (p=0.001). Dominant hand pegboard and laparoscopic bead performance were both impaired by PPE: 71.1s (±12) vs. 61.4s (±12), p=0.001; 270.7s (±135) vs. 192.5s (±67), p=0.001 respectively. Conclusion Collectively, these findings are the first to demonstrate that PPE-induced systemic hypercapnic-hypoxaemia is associated with important impaired cognitive-clinical-functional performance that may have a cerebrovascular basis.

TU6.4 Inspiring future surgeons: comparing open vs laparoscopic simulated surgical skills

Abstract Background Applications to surgical training are declining. Whilst early introduction to surgical specialities may develop interest, medical schools do not place enough emphasis on the growing trend towards performing laparoscopic procedures. We hypothesised that exposing medical students to laparoscopy would stimulate an interest in pursuing a surgical career. Methods Clinical medical students were randomised into two groups: Laparoscopic skills with box trainer and open surgical skills. Each session lasted one hour and was organised and conducted by the same tutors. Prior to participation in the teaching session, each student completed a pre and post event questionnaires regarding their speciality interest. Results A total of 45 students participated. 18 (33%) expressed an interest in a surgical career prior to the event. After the session, 15/23 (65%) of students who participated in the laparoscopic skills session expressed an interest in a career in surgery. The open surgical skills group had a positive response from 9/22 (41%) with respect to a career in surgery. Conclusions Participation in our surgical skills course increased interest in pursuing a surgical career amongst clinical medical students. Of note, our laparoscopic skills session increased interest more in comparison to an open surgical skills session. Our study highlights the importance of introducing laparoscopy simulation to the medical school curriculum in order to maintain interest towards the surgical specialities.

Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial.

Laparoscopy requires specific psychomotor skills and can be challenging to learn. Most proficiency-based laparoscopic training programs have used non-haptic virtual reality simulators; however, haptic simulators can provide the tactile sensations that the surgeon would experience in the operating room. The objective was to investigate the effect of adding haptic simulators to a proficiency-based laparoscopy training program. A randomized controlled trial was designed where residents (n = 36) were randomized to proficiency-based laparoscopic simulator training using haptic or non-haptic simulators. Subsequently, participants from the haptic group completed a follow-up test, where they had to reach proficiency again using the non-haptic simulator. Participants from the non-haptic group returned to train until reaching proficiency again using the non-haptic simulator. Mean completion times during the intervention were 120min (SD 38.7min) and 183min (SD 66.3min) for the haptic group and the non-haptic group, respectively (p = 0.001). The mean times to proficiency during the follow-up test were 107min (SD 41.0min) and 58min (SD 23.7min) for the haptic and the non-haptic group, respectively (p < 0.001). The haptic group was not faster to reach proficiency in the follow-up test than during the intervention (p = 0.22). In contrast, the non-haptic group reached the required proficiency level significantly faster in the follow-up test (p < 0.001). Haptic virtual reality simulators reduce the time to reach proficiency compared to non-haptic simulators. However, the acquired skills are not transferable to the conventional non-haptic setting.

Development and validation of a low-cost laparoscopic simulation box

IntroductionThe acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. MethodsA laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. ResultsThe group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points). ConclusionThe laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

Application of an Optical Tracking System for Motor Skill Assessment in Laparoscopic Surgery.

Objective Motion analysis of surgical instruments can be used to evaluate laparoscopic surgical skills, and this study assessed the validity of an optical tracking system for the assessment of laparoscopic surgical motor skills. Methods Ten experienced surgeons and ten novices were recruited to complete the transferring tasks on a laparoscopic simulator. An optical tracking system, Micron Tracker, was used to capture the marker points on each instrument and to obtain the coordinates of the marker points and the corresponding instrument tip coordinates. The data are processed to create a coordinate system based on the laparoscopic simulator and to calculate the movement parameters of the instruments, such as operating time, path length, speed, acceleration, and smoothness. At the same time, the range of motion of the instrument (insertion depth and pivoting angle) is also calculated. Results The position that the tip of the instrument can reach is a small, irregularly shaped spatial area. Significant differences (p < 0.05) were found between the surgeon and novice groups in parameters such as operating time, path length, mean speed, mean acceleration, and mean smoothness. The range of insertion depth of the instruments was approximately 150 mm to 240 mm, and the pivoting angles of the left and right instruments were 30.9° and 46.6° up and down and 28.0° and 35.0° left and right, respectively. Conclusions The optical tracking system was effective in subjectively evaluating laparoscopic surgical skills, with significant differences between the surgeon and novice groups in terms of movement parameters, but not in terms of range of motion.