McGill Inanimate System For Training And Evaluation Of Laparoscopic Skills Research Articles

Evaluation and usability study of low-cost laparoscopic box trainer “Lap-Pack”: a 2-stage multicenter cohort study

Introduction: Laparoscopic training is restricted in low resource settings due to limited access to specialist training equipment and financial constraints. This study aimed to evaluate simulation skills and usability of an original low-cost laparoscopic trainer, the “Lap-Pack,” developed at the University of Leeds, UK. Methods: Stage I evaluation was conducted in Kolkata (India) between March, 12 and 14, 2019. Laparoscopic simulation training was based on the 5 domains of fundamentals of laparoscopic surgery (FLS), which assessed skill acquisition across 7 rural surgeons from North-East India. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) criteria was used to statistically analyze trainee performance between pretraining and posttraining sessions. Also, Lap-Pack was qualitatively compared with a commercial box trainer, Inovus Pyxus HD (IPHD). Stage II involved a multi-center usability study in 2 centers of India and the United Kingdom (2019). Seventy-eight participants performed 2 FLS tasks using Lap-Pack and provided scores on a 25-point questionnaire, including a preestablished Face-Validity Criteria and 4 evaluation categories—Usability, Camera, View, and, Material. Results: In stage I, the total posttraining MISTELS score for Lap-Pack was higher, that is 773.37 (SD: 183.67) than pretraining score, that is 351.2 (SD: 471.5). The posttraining scores showed laparoscopic skill acquisition with statistically significant (P<0.05) difference for precision cutting, intracorporeal and extracorporeal knot. In stage II, Lap-Pack scored highly in Face-Validity with a combined mean score of 4.81 [95% confidence interval (CI): 4.52–5.09, P<0.05] out of a possible 6. It scored highest (scale: 1=low to 7=high) in Usability 6.14 (95% CI: 6.05–6.22, P<0.05) and Camera 6.14 (95% CI: 6.01–6.27, P<0.05). The “Lightweight” (6.46, 95% CI: 6.32–6.60, P<0.05) and “Portability” (6.35, 95% CI: 6.18–6.51, P<0.05) features of Lap-Pack were appreciated. Conclusion: The Lap-Pack is a suitable low fidelity simulator for laparoscopic training in a low-resource setting.

Comparison of a single-access glove port with a SILS\u2122 port in a surgical simulator model using MISTELS

BackgroundRecent advances in laparoscopy both in human and veterinary medicine have looked at means of being less invasive by using single-port access surgery as opposed to multiport access surgery. The glove port has gained popularity as a cost-effective alternative to commercially available single-port access devices. The primary aim of this study was to compare the glove port to the SILS™ port in a simulator model using the first two MISTELS (McGill inanimate system for training and evaluation of laparoscopic skills) tasks (peg transfer and pattern cutting).MethodsTwenty-two novices were enrolled in this experimental study. Each participant had 60 min to practise both MISTELS tasks using two-port laparoscopy. Thereafter participants performed both tasks using the glove and SILS™ port with scores being calculated based on task completion time and errors. Higher scores were indicative of better performance. Participants were assigned into two groups with the starting order of the single ports being randomly selected. A self-evaluation questionnaire with three questions was completed by each participant after testing, rating each port.ResultsSignificantly (p < 0.05) higher scores were achieved using the glove port compared to the SILS™ port when performing both tasks. The glove port was subjectively evaluated as easier to use with more manoeuvrability of the instruments than the SILS™ port.Implications of the studyThe glove port’s improved manoeuvrability and ease of use make it a cost-effective alternative to the SILS™ port, for use in single-port laparoscopic veterinary surgery.

Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study

BackgroundBenefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. MethodsA 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. ResultsSeven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. ConclusionStructured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.

Face, construct, and concurrent validity of a simulation model for laparoscopic ovariectomy in standing horses.

OBJECTIVE To develop and validate a simulation model for laparoscopic ovariectomy in standing horses. DESIGN Prospective cohort study. SAMPLE 15 third-year veterinary students and 4 equine surgeons with experience in laparoscopy. PROCEDURES A simulation model that mimicked laparoscopic ovariectomy in standing horses was developed. Face validity of the model was determined with a questionnaire completed by the equine surgeons. Construct validity was determined by comparing performance scores (based on time to completion and accuracy completing various operative tasks) for simulated laparoscopic ovariectomy performed in the model for the students with scores for the equine surgeons. Concurrent validity was assessed by comparing performance scores with scores obtained with the validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). RESULTS Questionnaire responses indicated that the simulation model replicated the operative experience to a high degree (face validity). Performance scores for simulated laparoscopic ovariectomy performed in the model were significantly different between the students and the equine surgeons (construct validity). Performance scores for the simulation model were significantly correlated with scores for the MISTELS (concurrent validity). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the simulation model had face, construct, and concurrent validity, suggesting that it may be useful when training students to perform laparoscopic ovariectomy in standing horses.

How Hormonal Contraceptive Use Impacts Laparoscopic Skill Acquisition in Biologically Female Medical Students

INTRODUCTIONHormonal contraceptive use is commonplace among biological females of reproductive age. Biological females typically have lower testosterone levels than males, and hormonal contraceptive use lowers that testosterone level even further. Higher testosterone levels are shown to be positively correlated with spatial ability and, ultimately, with better performance in surgical skill acquisition. Biological females, particularly those using hormonal contraceptives, may then be at a disadvantage for learning new surgical skills. However, the relationship between hormonal contraceptive use and surgical skill acquisition is not yet understood, and will be examined in this study.METHODSParticipants (anticipated n=50) are students of Oakland University William Beaumont School of Medicine and are participating under approval of the university's Institutional Review Board. This study makes use of laparoscopic box trainers and the peg transfer task from the MISTELS (McGill Inanimate System for Training and Evaluation of Laparoscopic Skills) battery of tests. The control and treatment groups are divided based on biologically female participants who do not use hormonal contraceptives, and those who do, respectively. Both groups perform several screening tasks regarding demographics, handedness, video game usage, mental rotation ability, and ovulation status. Participants then train on the peg transfer task, recording their times for each attempt until proficiency is reached. An ANCOVA, 2 (cycle/static) × 1 (frequency of repetitions) with spatial ability as a covariate, with appropriate post‐hocs as necessary, will be used to statistically analyze differences in the learning curves between naturally cycling participants and those using hormonal contraceptives.ANTICIPATED RESULTSCompared to the naturally cycling group, the group using hormonal contraceptives is expected to require greater time and number of attempts to reach proficiency on the peg transfer task.SIGNIFICANCEThe results are expected to support the hypothesis that hormonal contraceptive use is negatively correlated with surgical skill acquisition. This may have implications for informing contraceptive choices of biological females pursuing careers in surgery. In addition, it may inform future curriculum design for graduate medical programs, to maximize learning opportunities for aspiring surgeons.Support or Funding InformationDepartment of Biomedical Sciences Research Seed Fund, Oakland University William Beaumont School of Medicine.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

The Evaluation of Learning Curves in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program

Technological developments have led to resurgent interest in stereoscopic visualization for laparoscopy. Evidence suggests that trainees achieve proficiency on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) in less total training time when using stereo visualization. Data from trainees using the Fundamentals of Laparoscopic Surgery (FLS) curriculum to train the MISTELS tasks indicate that the peg transfer task requires the greatest training time to reach proficiency. This task challenges basic hand‐eye coordination that is critical to performing more complex tasks. As monoscopic visualization remains the standard of care, our goal remains to train proficiency under monoscopic visualization. However, we propose incorporating stereo‐direct visualization (SDV) using open FLS box trainers, into the curriculum to accelerate learning. Novice surgery residents will train with the peg transfer task. Half will train to proficiency (&lt; 54 sec) under standard monoscopic video visualization. The SDV group will train to proficiency, then switch to traditional monoscopic video visualization and continue to train until proficiency is reached. We hypothesize that SDV training will facilitate the perceptual switch to reach proficiency in less total time. Results from this study may be employed to further guide the development of laparoscopic training curricula.

PD19-03 LARGE-SCALE EVIDENCE OF CONSTRUCT VALIDITY: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-03 LARGE-SCALE EVIDENCE OF CONSTRUCT VALIDITY: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE Timothy Kowalewski, Robert Sweet, Ashleigh Menhadji, Timothy Averch, Geoffrey Box, Timothy Brand, Michael Fearrandino, Jihad Kaouk, Bodo Knudsen, Jamie Landman, Benjamin Lee, Bradley Schwartz, Bryan Comstock, Cory Schaffhausen, Elspeth McDougall, and Thomas Lendvay Timothy KowalewskiTimothy Kowalewski More articles by this author , Robert SweetRobert Sweet More articles by this author , Ashleigh MenhadjiAshleigh Menhadji More articles by this author , Timothy AverchTimothy Averch More articles by this author , Geoffrey BoxGeoffrey Box More articles by this author , Timothy BrandTimothy Brand More articles by this author , Michael FearrandinoMichael Fearrandino More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Jamie LandmanJamie Landman More articles by this author , Benjamin LeeBenjamin Lee More articles by this author , Bradley SchwartzBradley Schwartz More articles by this author , Bryan ComstockBryan Comstock More articles by this author , Cory SchaffhausenCory Schaffhausen More articles by this author , Elspeth McDougallElspeth McDougall More articles by this author , and Thomas LendvayThomas Lendvay More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.702AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urological Association created the Basic Laparoscopic Urologic Skills (BLUS) skills tasks to objectively measure technical skills proficiency of urology trainees. We sought to establish construct validity of the psychomotor skills portion of this curriculum using objective performance metrics and structured assessment by video review. METHODS After IRB approval, (n=454) videos of dry-lab laparoscopic tasks: Peg Transfer (n=110), Cutting (n=110), Intracorporeal Suturing (n=115), and Clip Applying (n=119) tasks were assessed by lay-people from the Amazon.com Mechanical Turk crowd sourcing platform. These performance scores were correlated with tool motion metrics captured from the Electronic Data Generation and Evaluation (EDGE) system (Simulab Corp, Seattle WA) for all tasks. We sought at least 30 Crowd-Sourced Assessment of Technical Skills (C-SATS) ratings via the validated Global Objective Assessment of Laparoscopic Skills (GOALS) survey tool with an added pass/fail domain. We compared the mean of GOALS domain ratings with objective metrics using Spearman's rho correlation statistics. We estimated performance-specific passing probabilities through mean GOALS score cut-offs previously established by blinded faculty reviews of a representative subset (n=24) of Peg Transfer and Suturing videos with receiver operating characteristic (ROC) curves based on Pass/Fail criteria. RESULTS Spearman's rho between composite GOALS scores and the composite EDGE scores ranged from moderately strong to very strong (Peg Transfer 0.84, Cutting 0.72, Suturing, 0.80 and Clip Apply 0.61). ROC curves for crowd-only pass/fail (AUC=.99) and crowd and EDGE score pass/fail (AUC=.94 Peg Transfer,.93 Cutting,.88 Suturing, and.79 Clip Apply) compare favorably with or exceed the ROC characteristics of the original validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(MISTELS)/Fundamentals of Laparoscopic Surgery(FLS) work. CONCLUSIONS We conclude that the agreement between crowd-generated composite GOALS scores and EDGE-derived objective metrics over a large corpus of 454 basic laparoscopic technical skills videos provides evidence of construct validity for the BLUS tasks. Table 1. Correlations of n=454 technical skills performances between mean crowd GOALS scores and objective tool motion metrics. Spearman’s rho (p-value) is shown for each task. – indicates not significant. Crowd Scores vs. Peg Transfer Cutting Suturing Clip Apply EDGE Score 0.84 (0.00) 0.72 (0.00) 0.80 (0.00) 0.61 (0.00) Time -0.79 (0.00) -0.55 (0.00) -0.76 (0.00) -0.59 (0.00) Path Length -0.77 (0.00) -0.70 (0.00) -0.78 (0.00) -0.47 (0.00) Jerk Cost -0.57 (0.00) -0.57 (0.00) -0.61 (0.00) -0.28 (0.00) Movement Count -0.55 (0.00) -0.57 (0.00) -0.65 (0.00) -0.39 (0.00) Economy of Motion 0.35 (0.00) -- -- 0.34 (0.00) Force Variance -- -- -- -- Max Force -- -- -- -- © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e392 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Kowalewski More articles by this author Robert Sweet More articles by this author Ashleigh Menhadji More articles by this author Timothy Averch More articles by this author Geoffrey Box More articles by this author Timothy Brand More articles by this author Michael Fearrandino More articles by this author Jihad Kaouk More articles by this author Bodo Knudsen More articles by this author Jamie Landman More articles by this author Benjamin Lee More articles by this author Bradley Schwartz More articles by this author Bryan Comstock More articles by this author Cory Schaffhausen More articles by this author Elspeth McDougall More articles by this author Thomas Lendvay More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can stereoscopic technologies build better surgeons? The effects of stereoscopy and spatial visualization ability on laparoscopic performance in surgical residents (536.12)

Acquisition of surgical skill is a multifaceted process, in which practice, and innate human factors such as spatial visualization ability (Vz) play key roles. Elevated Vz (HVz) is thought to facilitate surgical skill acquisition. The benefit of viewing laparoscopic skills in stereo (3D) is undetermined in experienced populations, and may show differing effects between those of variable Vz. The Vz of surgical residents will be evaluated using a Mental Rotations Test, and then surgical skill will be measured via the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Participants will complete the MISTELS tasks in both 3D and monoscopic format (2D) while being randomly assigned to complete the task in either 2D first or 3D first. Scoring of the MISTELS is based on time, completion and efficiency. It is hypothesized that HVz individuals will score higher than LVz counterparts. Prior research in novice subjects suggests that the effects of 3D and 2D viewing yields variable results based on an individual’s Vz, such that LVz trainees may benefit more than HVz from 3D viewing after a period of experience. If 3D viewing enhances surgical skill in our subjects, it may suggest future use in laparoscopic training curricula. Comparison of current results with those of novice subjects may suggest the intervening effects of experience on the effect of Vz and/or viewing modality.

Manual Laparoscopic Skills Development Using a Low-Cost Trainer Box in Tanzania

To explore the feasibility and effectiveness of guided practice using a low-cost laparoscopic trainer on the development of laparoscopic skills by surgeons in a resource-poor setting. This was a prospective trial involving a pretest/posttest single-sample design. Study participants completed a background survey and pretest on the 5 McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks using a simulator developed and validated by researchers from the University of California, San Francisco. On completion of a 3-month guided practice course, participants were again tested on the MISTELS tasks and completed an exit survey. The Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. Fourteen Tanzanian surgery residents and specialists completed the study. Most of the subjects were surgical residents (64.3%). Only 2 participants (14.2%) had previous laparoscopic training, and baseline laparoscopic surgical experience was limited to intraoperative observation only. Study subjects practiced the MISTELS tasks for an average of 8.67 hours (range: 4.75-15.25) over the 3-month course. On the posttest, participants improved significantly in performance of each of the MISTELS tasks (p < 0.001). Total scores on the tasks increased from 24 ± 44 on the pretest to 384 ± 49 on the posttest (p < 0.001). All study participants were satisfied with the course, found the training personally valuable, and felt that their laparoscopic skills had improved on completion of the training. We have demonstrated the feasibility and effectiveness of training with a low-cost laparoscopic trainer box in Tanzania. Study participants achieved impressive posttest scores on the 5 MISTELS tasks with minimal baseline laparoscopic exposure. We feel that guided training by an expert was key in ensuring correct technique during practice sessions.

Effect of Two Instrument Designs on Laparoscopic Skills Performance

To determine whether laparoscopic skills performance is affected by instrument design. Randomized crossover study. Veterinarians (n = 14) with variable laparoscopic experience. Laparoscopic skills performance was assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Participants performed 3 MISTELS tasks twice during 2 sessions (4 tests total). Each set of instruments (set A, B) was used once during each session, and instrument order was switched between the first and second sessions. Surgeons were randomly allocated to either the AB-BA or the BA-AB sequence in a balanced fashion. Scores were compared between instrument sets A and B. Overall, participants performed better when using set A compared with set B. This difference was most striking in the pattern-cutting task (which used scissors and graspers), less convincing in the peg transfer task (which used 2 graspers), and nonexistent in the ligature loop task (which used 1 grasper and 1 pretied ligature loop). Laparoscopic skills performance, as assessed by MISTELS testing, is affected by instrument design.

Effects of two training curricula on basic laparoscopic skills and surgical performance among veterinarians

To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training. Evaluation study. 17 veterinarians at 1 institution. Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B). Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores. MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.

Correlation of Laparoscopic Experience With Differential Functional Brain Activation

Regions of functional brain activation differ between novice and expert laparoscopists. We compared novice and expert laparoscopists using positron emission tomography (PET) during the peg transfer task of the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) protocol. The first scan (rest) was performed with the subject's eyes closed. The second scan (video 1) was performed while watching a peg transfer video. The third scan (peg 1) was acquired during the peg transfer task. The forth scan (peg 2) was performed after practicing 15 minutes. The fifth scan (video 2) was performed after peg 2 as the subject watched a video clip of a laparoscopic partial nephrectomy. The sixth scan (peg 3) was conducted during the final peg transfer task after 15 more minutes of practice. Feinstein Institute for Medical Research. Five novice and 5 expert laparoscopists. Differences in brain activation as determined by changes in regional cerebral blood flow on PET scans with oxygen 15-labeled water. The first analysis examined group differences between the 3 peg scans and the rest scan. The novice group had a significantly (P < .001) higher activation (with deactivation in the expert group) in the left precentral gyrus and insula and the right precuneus and inferior occipital gyrus. The second analysis compared the 2 video scans and the rest scan. In contrast to the expert group, the novices had significantly (P < .001) higher activation in the right precuneus and cuneus but deactivation in the bilateral posterior cerebellum. This study demonstrates differential regional brain activation patterns between novice and expert laparoscopists during surgery-related motor and visual association tasks.

Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study

Background The efficacy of laparoscopy simulators remains controversial. Methods This was a comparative prospective study that evaluated the impact of simulator training on technical competence during a real surgical procedure. Residents were divided into 3 groups: the Mcgill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) group, training on a simple simulator; LAP Mentor group, training on a virtual simulator; and control group. An initial evaluation was made by a validated score during a laparoscopic cholecystectomy. Each resident was then trained for 1 month. A second evaluation was then performed. Results Before/after scores were significantly improved in the MISTELS ( P = .042) and LAP Mentor ( P = .026) groups. It was not the case in the control group. There was a better progression in the MISTELS ( P = .026) and LAP Mentor ( P = .007) groups than in the control group. There was no significant difference between the MISTELS and LAP Mentor groups. Conclusions Simulator training provides a more rapid acquisition of competence in surgical technique.

Bringing the Skills Laboratory Home: An Affordable Webcam-Based Personal Trainer for Developing Laparoscopic Skills

The purpose of this work was to develop a more flexible system of laparoscopic surgery training with demonstrated effectiveness and construct validity. A personal, portable, durable laparoscopic trainer can be designed at low cost. The evaluation of expert surgeons on this device will reveal technical superiority over novices. With practice, novice surgeons can improve their performance significantly as measured by scores derived from performing skills with this training device. Prospective trial with observation and intervention components. The first aspect was observational comparison of novice and expert performance. The second was a prospective static-group comparison with pretest/posttest single-sample design. Tertiary-care academic medical center with affiliated general surgery residency. A total of 21 junior surgical residents and 5 experienced operators. Performance was assessed by the 5 tasks in the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS): pegboard transfer, pattern cutting, placement of ligating loop, extracorporeal knotting, and intracorporeal knotting. Each task was assessed for accuracy and speed. Expert surgeons scored significantly higher than novices on total score and 4 of the 5 MISTELS tasks (peg transfer, pattern cut, extracorporeal knot, and intracorporeal knot). After 4 months of home-based training, the novices improved in total score and 3 of the 5 tasks (peg transfer, pattern cut, and extracorporeal knot). A low-cost personal laparoscopic training device can be built by individual residents. With their use, residents can significantly improve performance in important surgical skills. Evaluation of the system supports its validity.

Choosing the right physical laparoscopic simulator? comparison of LTS2000-ISM60 with MISTELS: validation, correlation, and user satisfaction

Background The LTS 2000-ISM60 (LTS; Realsim Systems, Alburquerque, NM, USA) is a computer enhanced video-laparoscopic training system. Our purpose was to validate the LTS and to correlate its scoring performance with that of the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), a widely used and well-validated physical simulator. Methods Participants (n = 124) included medical students, residents, fellows, and attending surgeons from general surgery, gynecology, and urology in 3 Canadian universities. They were classified in groups based on laparoscopic experience: novice, intermediate, competent, and expert. Participants (n = 124) were tested on the LTS, and 74 were tested on both the LTS and the MISTELS. A user satisfaction questionnaire was completed after each performance. Results LTS metrics showed a progressive improvement in total scores according to academic level as well as level of laparoscopic experience ( P < .001). Good correlation was found between the LTS and the MISTELS ( r = .79). Level of user satisfaction was highest with LTS. Conclusions Based on laparoscopic experience and academic level, the LTS has a comparable discriminating capability for level of performance with that of the MISTELS. The higher degree of user satisfaction attributed to the LTS could justify its use as a training and assessment tool for surgical specialties.

Hybrid Augmented Reality Simulator: Preliminary Construct Validation of Laparoscopic Smoothness in a Urology Residency Program

We examined the usefulness, reliability and applicability of the smoothness metric of the ProMIS hybrid simulator (Haptica, Dublin, Ireland) for a urology residency program. A total of 15 urology residents divided into junior and senior cohorts were followed prospectively for 6 training sessions. Validated McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) laparoscopic tasks were used. The ProMIS hybrid simulator smoothness parameter, a unit-free metric of movement efficiency, was recorded using 3-dimensional visual tracking technology. Results were compared between cohorts at the midpoint and end of the defined training sessions. End of study junior means were also retrospectively compared to senior mid training means. Statistical significance was determined using the Mann-Whitney U test (alpha = 0.05). Statistically significant differences between 8 junior and 7 senior cohorts were measured in all MISTELS tasks. A statistically significant performance variation was also detected at the mid and end testing times. When juniors and seniors were compared between sessions 1 and 3, and 4 and 6, statistically significant performance improvements were noted. Lastly, statistical differences were also maintained when mid session senior means were compared to end of session junior means. A 38% improvement in task completion in the senior cohort as well as a 10-fold decrease in variance was observed compared to a 12% improvement in juniors, indicating greater efficiency of movement in seniors. The laparoscopic smoothness metric in the hybrid simulator demonstrated construct validity by effectively differentiating between experienced and novice urology residents using validated MISTELS tasks. The outcome suggests that the hybrid simulator smoothness metric is a valuable asset in residency programs for preparatory training for live operative experience, allowing improved trainee assessment.

Predictors of Technical Skill Acquisition Among Resident Trainees in a Laparoscopic Skills Education Program

Administrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four-week laparoscopic skills development program. Laparoscopic skills in 35 first-year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four-week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson's correlation and paired t-test studies. Intake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04). A laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.

Laparoscopic Learning Evaluation over the Internet

Learning and refining laparoscopic surgical technique requires a continuous training process. For this learning process to have value, it must include objective evaluations and the interaction of expert surgeons. These surgeons, however, are normally located at third-level hospitals, so it is difficult for them to be available for this important process. In order to bring together learning and evaluation, we developed an Internet-based evaluation system for laparoscopic surgical technique. The system applies the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) evaluation methodology, and is remotely supervised by surgeons who specialize in laparoscopy.

Postural control during laparoscopic surgical tasks

Background Balance control during standing is essential while performing surgery. The postural sway must be controlled to enhance movement accuracy. Postural control was compared between novices and experts during standardized laparoscopic tasks. Methods Seven novices with limited exposition to laparoscopy were compared with 7 expert surgeons. The subjects were requested to perform 4 laproscopic tasks on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) and a quiet standing task while standing on 2 force platforms. An analysis of variance (ANOVA) with repeated measures was performed to compare groups and the different conditions. Significant level was set at P < .05. Results The technical requirements of the laparoscopic tasks impacted on postural sway in both anteroposterior and mediolateral directions. Furthermore, results indicate that the experts have a significantly better postural balance for all tasks compared to novices. Conclusion Postural sway increases with the technical requirements of minimally invasive surgery. This study showed that postural control performance while standing improves with laparoscopic expertise.