Minimally Invasive Surgery Training Research Articles

Structured feedback and operative video debriefing with critical view of safety annotation in training of laparoscopic cholecystectomy: a randomized controlled study

BackgroundThe learning curve in minimally invasive surgery (MIS) is lengthened compared to open surgery. It has been reported that structured feedback and training in teams of two trainees improves MIS training and MIS performance. Annotation of surgical images and videos may prove beneficial for surgical training. This study investigated whether structured feedback and video debriefing, including annotation of critical view of safety (CVS), have beneficial learning effects in a predefined, multi-modal MIS training curriculum in teams of two trainees.MethodsThis randomized-controlled single-center study included medical students without MIS experience (n = 80). The participants first completed a standardized and structured multi-modal MIS training curriculum. They were then randomly divided into two groups (n = 40 each), and four laparoscopic cholecystectomies (LCs) were performed on ex-vivo porcine livers each. Students in the intervention group received structured feedback after each LC, consisting of LC performance evaluations through tutor-trainee joint video debriefing and CVS video annotation. Performance was evaluated using global and LC-specific Objective Structured Assessments of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores.ResultsThe participants in the intervention group had higher global and LC-specific OSATS as well as global and LC-specific GOALS scores than the participants in the control group (25.5 ± 7.3 vs. 23.4 ± 5.1, p = 0.003; 47.6 ± 12.9 vs. 36 ± 12.8, p < 0.001; 17.5 ± 4.4 vs. 16 ± 3.8, p < 0.001; 6.6 ± 2.3 vs. 5.9 ± 2.1, p = 0.005). The intervention group achieved CVS more often than the control group (1. LC: 20 vs. 10 participants, p = 0.037, 2. LC: 24 vs. 8, p = 0.001, 3. LC: 31 vs. 8, p < 0.001, 4. LC: 31 vs. 10, p < 0.001).ConclusionsStructured feedback and video debriefing with CVS annotation improves CVS achievement and ex-vivo porcine LC training performance based on OSATS and GOALS scores.

In-Theatre Simulation as a Training Tool for Laparoscopic Salpingectomy in Eldoret, Kenya

Background/Objective: Minimally invasive surgery (MIS) offers many advantages over open procedures including decreased patient safety risks and reduced burden on healthcare infrastructure. As low- and middle-income countries (LMICs) are disproportionately affected by these aspects of surgery, there is motivation to increase MIS. A multimodal training program in laparoscopic salpingectomies was piloted with a small cohort of OB-GYN registrars and consultants at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. This project assesses the in-theatre simulation’s (1) effectiveness in improving laparoscopic knowledge and skill confidence, and (2) feasibility for long-term implementation at MTRH and in similar settings.&#x0D; Methods: Participants completed a half-day in-theatre simulation of a laparoscopic salpingectomy. The simulation required participants to demonstrate knowledge of laparoscopic setup, proper patient positioning, procedure completion, equipment troubleshooting, and peri-and intra-operative complication management. Participants completed a multiple-choice laparoscopic knowledge quiz and Likert scale skill confidence survey immediately prior to and following the simulation. Pre- and post-simulation responses were compared to assess knowledge and confidence acquisition overall and across content topics.&#x0D; Results: There was a significant increase in the average knowledge quiz score from pre- to posttest (p=0.028). A significant difference between pre- and posttest confidence was noted in four of the six skills assessed. By topic, equipment troubleshooting (p&lt;0.001), and complication management (p&lt;0.01) saw the most improvement. Barriers to long-term sustainability include unpredictable theatre and laparoscopic tower access and availability of supplies for uterine modeling. A modified model using nitrile gloves as fallopian tubes will be piloted in future simulations as a more accessible alternative for long-term implementation.&#x0D; Conclusion: Despite limitations, in-theatre simulation has the potential to be an effective and sustainable teaching tool within a long-term MIS training program at Moi Teaching and Referral Hospital. The low-cost model and methods outlined may also be replicable in similar low-resource settings.

Satisfaction of surgeons with the current state of training in minimally invasive surgery: a survey among German surgeons

BackgroundMinimally invasive surgery (MIS) requires intense education and training with structured supervision and feedback. However, a standardized training structure is lacking in Germany. This nationwide survey aimed to assess the current state of minimally invasive surgery (MIS) training and factors impacting surgeons' satisfaction.MethodsBetween July and October 2021, an online survey was conducted among general, abdominal, and thoracic surgeons in Germany. The survey collected data on department size, individual operative experience, availability of MIS training equipment and curricula, and individual satisfaction with training. A linear regression analysis was conducted to investigate factors influencing the surgeons’ satisfaction with the MIS training.ResultsA total of 1008 surgeons participated in the survey, including residents (26.1%), fellows (14.6%), attendings (43.8%), and heads of departments (15.2%). Of the respondents, 57.4% reported having access to MIS training equipment, 29.8% and 26% had a curriculum for skills lab MIS training and intraoperative MIS training, respectively. In multivariate linear regression analysis, strongest predictors for surgeons’ satisfaction with skills lab MIS training and intraoperative training were the availability of respective training curricula (skills lab: β 12.572; p < 0.001 & intraoperative: β 16.541; p < 0.001), and equipment (β 5.246; p = 0.012 & β 4.295; p = 0.037), and experience as a first surgeon in laparoscopy (β 12.572; p < 0.001 & β 3.748; p = 0.007). Additionally, trainees and teachers differed in their satisfaction factors.ConclusionGermany lacks standardized training curricula and sufficient access to MIS training equipment. Trainees and teachers have distinct factors influencing their satisfaction with MIS training. Standardized curricula, equipment accessibility, and surgical experience are crucial for improving surgeons’ satisfaction with training.

Development of long-term courses in minimally invasive surgery training for the acquisition and retention of laparoscopic skills

IntroductionNumerous training methods have been developed to demonstrate the effectiveness of minimally invasive surgery (MIS) skills’ training. However, there remains a dearth of long-term supervised training, leaving surgeons without the opportunity for continuous practice. Thus, our objective is to report our outcomes for long-term training courses and establish a new approach for organizing a prolonged MIS training course that ensures continuity and encourages sustained practice. MethodsRetrospective study analysis of scores and performance of trainees during our training experience between 2019 and May 2023. Demographics, gender, MIS experience and performance of the participants in each type of modality, virtual and presential, was analyzed. ResultsThe study involved 110 participants. Due to lack of data only 97 were analyzed. In the virtual courses group, there were 63 participants. The average general score of the first encounter during the intensive stage was 2.49 ± 0.75, while the average general score of the last encounter was 3.62 ± 0.56. For the presential courses, the mean general score during the first encounter was 1.88 ± 0.60, and by the last meeting of the intensive stage, the mean general score increased to 3.51 ± 0.69. Notably, among virtual courses 55% of the participants attended to at least 1 follow-up meeting whereas only 2 participants (5.9%) among the in-person group attended the 4-month follow-up meeting. ConclusionThe study shows the effectiveness of virtual and presential long-term MIS courses for acquiring and retaining endoscopic skills and highlights the benefits of virtual courses in terms of accessibility and learning improvement. Type of studyLevel IV

Video-based training of situation awareness enhances minimally invasive surgical performance: a randomized controlled trial

BackgroundMany training curricula were introduced to deal with the challenges that minimally invasive surgery (MIS) presents to the surgeon. Situational awareness (SA) is the ability to process information effectively. It depends on general cognitive abilities and can be divided into three steps: perceiving cues, linking cues to knowledge and understanding their relevance, and predicting possible outcomes. Good SA is crucial to predict and avoid complications and respond efficiently. This study aimed to introduce the concept of SA into laparoscopic training.MethodsThis is a prospective, randomized, controlled study conducted at the MIS Training Center of Heidelberg University Hospital. Video sessions showing the steps of the laparoscopic cholecystectomy (LC) were used for cognitive training. The intervention group trained SA with interposed questions inserted into the video clips. The identical video clips, without questions, were presented to the control group. Performance was assessed with validated scores such as the Objective Structured Assessment of Technical Skills (OSATS) during LC.Results72 participants were enrolled of which 61 were included in the statistical analysis. The SA-group performed LC significantly better (OSATS-Score SA: 67.0 ± 11.5 versus control: 59.1 ± 14.0, p value = 0.034) and with less errors (error score SA: 3.5 ± 1.9 versus control: 4.7 ± 2.0, p value = 0.027). No difference in the time taken to complete the procedure was found. The benefit assessment analysis showed no difference between the groups in terms of perceived learning effect, concentration, or expediency. However, most of the control group indicated retrospectively that they believed they would have benefitted from the intervention.ConclusionThis study suggests that video-based SA training for laparoscopic novices has a positive impact on performance and error rate. SA training should thus be included as one aspect besides simulation and real cases in a multimodal curriculum to improve the efficiency of laparoscopic surgical skills training.

Next in Surgical Data Science: Autonomous Non-Technical Skill Assessment in Minimally Invasive Surgery Training.

It is well understood that surgical skills largely define patient outcomes both in Minimally Invasive Surgery (MIS) and Robot-Assisted MIS (RAMIS). Non-technical surgical skills, including stress and distraction resilience, decision-making and situation awareness also contribute significantly. Autonomous, technologically supported objective skill assessment can be efficient tools to improve patient outcomes without the need to involve expert surgeon reviewers. However, autonomous non-technical skill assessments are unstandardized and open for more research. Recently, Surgical Data Science (SDS) has become able to improve the quality of interventional healthcare with big data and data processing techniques (capture, organization, analysis and modeling of data). SDS techniques can also help to achieve autonomous non-technical surgical skill assessments. An MIS training experiment is introduced to autonomously assess non-technical skills and to analyse the workload based on sensory data (video image and force) and a self-rating questionnaire (SURG-TLX). A sensorized surgical skill training phantom and adjacent training workflow were designed to simulate a complicated Laparoscopic Cholecystectomy task; the dissection of the cholecyst's peritonial layer and the safe clip application on the cystic artery in an uncomfortable environment. A total of 20 training sessions were recorded from 7 subjects (3 non-medicals, 2 residents, 1 expert surgeon and 1 expert MIS surgeon). Workload and learning curves were studied via SURG-TLX. For autonomous non-technical skill assessment, video image data with tracked instruments based on Channel and Spatial Reliability Tracker (CSRT) and force data were utilized. An autonomous time series classification was achieved by a Fully Convolutional Neural Network (FCN), where the class labels were provided by SURG-TLX. With unpaired t-tests, significant differences were found between the two groups (medical professionals and control) in certain workload components (mental demands, physical demands, and situational stress, p&lt;0.0001, 95% confidence interval, p&lt;0.05 for task complexity). With paired t-tests, the learning curves of the trials were also studied; the task complexity resulted in a significant difference between the first and the second trials. Autonomous non-technical skill classification was based on the FCN by applying the tool trajectories and force data as input. This resulted in a high accuracy (85%) on temporal demands classification based on the z component of the used forces and 75% accuracy for classifying mental demands/situational stress with the x component of the used forces validated with Leave One Out Cross-Validation. Non-technical skills and workload components can be classified autonomously based on measured training data. SDS can be effective via automated non-technical skill assessment.

Training residents in minimally invasive surgery; confirming competence or hoping for the best?

BackgroundVeterinary minimally invasive surgery (MIS) is rapidly developing, and most surgeons are performing MIS in their clinical practice. The technical skills of presented surgical techniques are increasingly complex. Required training of American College of Veterinary Surgeons (ACVS) surgical residents in soft tissue MIS (laparoscopy/thoracoscopy) are limited to traditional apprentice training. Unfortunately, such training has been found insufficient to create competent MIS surgeons.Aim of the reviewThis review discusses development of MIS training for Doctor of Medicine (M.D.) residents in context of veterinary applicability and investigates comparative evidence for how to best train veterinary residents in soft tissue MIS.ConclusionsA structured curriculum, with validated tasks and clear training goals have been found imperative for training success. Such a curriculum includes both didactic sessions and manual skills training, with video tutorials and reading material to inform and motivate the residents.Implications of key findingsACVS residents and diplomates may benefit if a MIS curriculum was developed and made available to all training programs.

Initial Experience of the Training Centre of Minimally Invasive Surgery at Ahli Arab Hospital in Gaza

Background: Minimally Invasive Surgery (MIS) training outside operation room is still done by simulation in different training centers worldwide. Strong validity of such a training was evidenced using either the physical simulator (trainer box) or a biological model or a virtual reality (VR) or an animal model. Currently MIS is rapidly spreading worldwide in different surgical centers depending on the fact that MIS training is an essential prerequisite for any surgeon even with a vast experience in open surgery. A well-structured proficiency-based curriculum is essential to provide training for individuals who need to acquire MIS skills. Aim: To prove the efficiency and accuracy of training laparoscopic skills on combination of physical simulator as the dry module to be scored by a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) scoring system and on laparoscopic simulator as the wet module (Full Turkey model) using the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring items. Methods: One hundred and thirty-nine surgeons of different surgical specialties, age and experience levels (during the period from July 2018 to July 2019) were subjected to this curriculum-based training. All trainees received the basic cognitive knowledge in groups of fifteen to eighteen. In the hands on training each group is divided into three subgroups to fit the available six fundamental laparoscopic surgery (FLS) training boxes. Trainees are monitored by at two mentored per trainer in the different FLS skills and tasks. A modified (MISTELS) was used to score the five Fundamental Laparoscopic Surgery (FLS) skills and tasks that are the standard of the Society of American Gastroenterology Endoscopic Surgery (SAGES). Modifications entail the scoring time to be in minutes rather than in seconds. Some extra-activities were added to the first three skills/tasks. A score sheet was designed for each task considering both the scoring time and penalties. In Wet lab, not only the five tasks were repeated but also a complementary skill such as Veress needle insertion, port insertion and camera manipulation together with dissection e.g. intracorporeally in cholecystectomy were provided through a full Turkey model on a laparoscopic simulator. Trainees’ performance was measured with integration of cognitive knowledge post-testing, score in the modified MISTEL in dry lab and by the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring in wet laboratory. The mean of total score of the trainee before training was 35.28 while after training was 82.59 but Cronbach’s Alpha value in the pre and post testing scored 0.778 and 0.799 respectively Results: Majority of trainees showed improvement in all measured domains in different stations. In cognitive knowledge the mean score difference between the pre and post testing was 50.1and 72.14 respectively. This is statistically significant as shown in the student T-test value of 19.13. This indicates that the trainees are having some knowledge but definitely refined and improved on post testing. In Dry Lab there is a dramatic improvement in the post testing compared to pretests where there was a clear statistical significance of a P value of 0.01 in all the five skills and tasks between the pre and post test of each. In wet Lab the Global Operative Assessment of Laparoscopic Surgery (GOALS) scoring system Which is used to assess skill of surgeons in clinical settings in OR is used to simulate clinical sessions on a Full Turkey Model on laparoscopic simulator set. GOALS scoring in Full Turkey model proves its feasibility and efficiency in most trainees where Mean score was 84.1, The Median 84.0, and the Std = 5.38. Construct validity of this triad methodology of cognitive knowledge, dry lab and wet lab of full Turkey model is evident among different trainees of different groups with no florid significance of different surgeons in relation scores achieved and age group proving validity of this type of training. There is no statistical differences between age group and the final score of overall training the mean average of the trainees ages less than 35 years old was 81.2% followed by the trainees above 45 years old 79.7% with very simple difference in mean with trainees aged between 35 years old to 45 years old 79.6%. Conclusion: MIS training integrating a triad of training modules of MIS cognitive knowledge, traditional physical box trainer and a biological wet lab on a full Turkey model is fairly feasible and effective in the acquisition of fundamental laparoscopic skills and tasks. Global Operative Assessment of Laparoscopic Skills (GOALS) can be a valid tool to assess trainees outside operation room.

Common surgical training program: standardization of learning quality.

The various surgical specialties in our center have used the simulation and experimental surgery resources available for their training tasks in minimally invasive surgery (MIS) in an individualized manner. With this learning model, a great dispersion of effort and expense was observed, so it was decided to create a unified program based on the following: shared learning, synergy among specialties, moderation of the economic cost, and rational use of the facilities. To describe and assess our consensually designed training program in order to consolidate a shared learning strategy that will enable our residents to acquire and perfect surgical skills in MIS. The program consists of various increasingly complex phases implemented on a continuous basis throughout the period of specialized training in the virtual laboratory and experimental operating room. The assessment methods were based on quantifiable criteria: percentage of efficiency and completion time of the "McGill Inanimate System for Training and Evaluation of Laparoscopic Skills" (MISTELS) exercises at the beginning and end of the program. An economic study was also conducted. 20 residents have completed the program. Mean times show a significant reduction in each of the exercises. The efficiency percentages at the end of the program were higher than at the beginning (p<0.001). The cost of the program represented a saving of 67.89%. The new MIS training program improved the quality of learning in a safe environment, establishing common criteria among the different specialties and an improved use of resources.

National disparities in use of minimally invasive surgery for rectal cancer in older adults.

Minimally invasive surgery (MIS) is safe and improves outcomes in older persons with rectal cancer but may be underutilized. As older persons are the largest surgical population, investigation of the current use and factors impacting MIS use is warranted. Our goal is to investigate the trends and disparities that affect utilization of MIS in older persons with rectal cancer. The National Cancer Database was reviewed for persons 65 years and older who underwent curative resection for rectal adenocarcinoma from 2010 to 2017. Cases were stratified by surgical approach (open or MIS [laparoscopic or robotic]). Univariate analysis compared patient and provider demographics across approaches. Multivariate analysis investigated variables associated with MIS use. Main outcome measures were trends and factors associated with MIS use in older persons. Of 31,910 patients analyzed, 51.9% (n=16,555) were open and 48.1% (n=15,355) MIS. The MIS cohort was 66.7% (n=10,236) laparoscopic and 33.3% (n=5119) robotic. MIS increased from 29% in 2010 (n=1197; 25% laparoscopic, 4% robotic) to 65% in 2017 (n=2382; 35% laparoscopic, 30% robotic), likely from annual increases in robotics (OR 1.24/year, p < 0.0001). In the unadjusted analysis, there were significant differences in MIS use by age, race, comorbidity, socioeconomic status, and facility type. In multivariate analysis, patients with advancing age (OR 0.93, p < 0.001), major comorbidity (OR 0.75, p < 0.001), total proctectomy (OR0.78, p < 0.001), and advanced pathologic stage (OR 0.51, p < 0.001) were less likely to undergo MIS. Nationwide, less than half of rectal cancer cases in older persons were performed with MIS, despite steady robotic growth. Patient and facility factors impacted MIS use. Further work on regionalizing rectal cancer care and ensuring equitable MIS access and training could improve utilization.

Lapnurse—A Blended Learning Course for Nursing Education in Minimally Invasive Surgery: Design and Experts’ Preliminary Validation of Its Online Theoretical Module

Background: The implantation of Minimally Invasive Surgery (MIS) leads to the specialization of nurses in this surgical field. However, there is no standard curriculum of MIS Nursing in Europe. Spanish and Portuguese nurses are inexperienced and have poor training in MIS. For that, a blended learning course for nursing education in MIS (Lapnurse) has been developed. This work aims to detail the course design and to preliminary validate by experts its online theoretical module. Methods: Lapnurse consists of an online module with nine theoretical lessons and a face-to-face module with three practical lessons. The e-learning environment created to provide the online module, with didactic contents based on surgical videos and innovative 3D designs, has been validated by two technicians (functionality) and four nurses with teaching experience in MIS (usability and content). Results: The E-learning platform meets all technical requirements, provides whole and updated multimedia contents correctly applied for educational purposes, incorporates interactivity with 3D designs, and has an attractive, easy-to-use and intuitive design. Conclusions: The lack of knowledge in MIS of Spanish and Portuguese nurses could be addressed by the blended learning course created, Lapnurse, where the e-learning environment that provides theoretical training has obtained a positive validation.

Training for Minimally Invasive Surgery for IBD: A Current Need.

Surgery for inflammatory bowel diseases (IBD) management has passed through an important evolution over the last decades, with innovative strategies and new technologies, especially in minimally invasive surgery (MIS) approaches. MIS procedures for IBD include multiport laparoscopy, single-port surgery, robotics, and the use of transanal platforms. These approaches can be used in the surgical management of both Crohn's disease (CD) and ulcerative colitis (UC). There are significant peculiarities in the surgical field in CD and UC, and their perfect understanding are directly related to better outcomes in IBD patients, as a consequence of improvement in knowledge by IBD surgeons. Different strategies to train colorectal surgeons were developed worldwide, for better application of MIS, usually for malignant or non-IBD benign diseases. There is a significant lack of evidence in specific training strategies for MIS in the IBD field. In this review, the authors outline the importance of adequate surgical training in IBD MIS, by discussing the current evidence on different approaches and emphasizing the need for better training protocols included in multidisciplinary teams in IBD centers throughout the globe.

Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study.

BackgroundSimulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access.ObjectiveThis study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence.MethodsFor the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed.ResultsA good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67).ConclusionsThe development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

Implementation of laparoscopy and thoracoscopy in small animal practice following an intensive training course

This study aimed to assess trainee perceptions regarding the usefulness of an intensive hands-on minimally invasive surgery (MIS) training, as well as the subsequent implementation experience. An online questionnaire was emailed to 110 small animal veterinarians who attended the course between 2007 and 2017. The questionnaire comprised three sections: general attendee information, questions pertaining to the received laparoscopic and thoracoscopic training, and finally enquiries on cumulative post-training and current MIS practice. Forty-five veterinarians answered the questionnaire. Most respondents had prior laparoscopy and/or thoracoscopy experience (95.2 %), but close to half (46.7 %), modified their clinical practice as a result of the training. Seventy-five percent of the totally inexperienced participants started practicing MIS within two years of attending the course. A large proportion of respondents indicated their need for additional training for more advanced laparoscopy (71.1%) and thoracoscopy (77.8%) procedures. Accordingly, the main difficulty found by respondents regarding MIS implementation was insufficient training (37.8%). The most frequently encountered difficulty during procedures was bleeding (46.7%), while the most feared complication was related to anesthesia (31.1%). Ovariectomy and ovariohysterectomy were the most frequently performed minimally invasive procedures in trainee working centers. MIS training promotes the introduction of laparoscopy and thoracoscopy into clinical practice and expands the type of surgeries performed with these approaches. Nonetheless, a single intensive program does not comply with the diverse training needs of small animal practitioners.

Can effective pedagogy be ensured in minimally invasive surgery e-learning?

Introduction Effectiveness of e-learning diminishes without the support of a pedagogical model to guide its use. In minimally invasive surgery (MIS), this has been reported as a limitation when technology is used to deliver contents without a sound pedagogical background. Material and methods We describe how a generic pedagogical model, the 3D pedagogy framework, can be used for setting learning outcomes and activities in e-learning platforms focused on MIS cognitive skills. A demonstrator course on Nissen fundoplication was developed following the model step-by-step in the MISTELA learning platform. Course design was informed by Kolb’s Experiential learning model. Content validation was performed by 13 MIS experts. Results Ten experts agreed on the suitability of content structuring done according to the pedagogical model. All experts agreed that the course provides means to assess the intended learning outcomes. Conclusions This work showcases how a general-purpose e-learning framework can be accommodated to the needs of MIS training without limiting the course designers’ pedagogical approach. Key advances for its success include: (1) proving the validity of the model in the wider scope of MIS skills and (2) raising awareness amongst stakeholders on the need of developing training plans with explicit, rather than assumed, pedagogical foundations. Abbreviations: MIS: minimally invasive surgery; TEL: technology enhanced learning

EAES online educational resources: a survey of the membership of the European Association for Endoscopic Surgery (EAES).

The European Association for Endoscopic Surgery (EAES) strives to be a leader in promoting the development and expansion of minimally invasive surgery (MIS). Part of the association's mission statement is "to become an information hub for all practitioners of MIS". It is therefore important that the education segment of the association continues to be actively monitored and updated to ensure this mission statement is met. This project aimed to understand the trainees requirement in fulfilling this role, and to develop an practical action plan to ensure such requirements are adequately met. Two sequential questionnaires were sent to all members of the EAES. The questionnaires sought to understand the demographics of the EAES membership, and their training requirements. This followed a Delphi methodology. The data collected included training status, level of competence in laparoscopic surgery and tools needed for improving laparoscopic skills. Four hundred and sixty-five responded to the first survey, and 209 responded to the second survey. There were 112 trainees (24.1%) in the first round. More than 50% of trainees were less than 8years from graduation from medical school. Only 162 (34.8%) of respondents performed MIS in more than half their practice. Videos of common procedures were ranked the highest in terms of what trainees required to help improve their laparoscopic skills, followed by e-learning modules. There is a significant training gap identified amongst the trainee population of the EAES with regards to MIS training. Trainees were not performing MIS enough for them to feel confident with their skills. The EAES could fulfill this training requirement via expertly curated videos, and e-learning modules written by senior specialists.

Validation of the online theoretical module of a minimally invasive surgery blended learning course for nurses: A quantitative research study

BackgroundThe progressive development of Minimally Invasive Surgery (MIS) implies the need to train health professionals in such field, for which e-learning and blended learning methods are increasingly been used. Most nurses lack experience and training in MIS, so a laparoscopic blended learning course for nursing has been created. ObjectivesTo perform the validation of the online theoretical module of such course to evaluate student perception and satisfaction, sociability and usability metrics, and also the interest of nurses in blended learning. DesignA quantitative design has been used. Participants24 nurses participated in the validation tests performing the online module of the course. MethodsSubjective (questionnaires) and objective (performance statistics) metrics were analysed. ResultsThe e-learning environment has ease of access, good layout, consistency and intuitive navigation. Chat and forums have not been used and nurses miss a moderator. Participants consider that videos provide added value to the course, and contents are easily understandable and of high quality. However, questionnaires are not well balanced in difficulty and few interactive 3D designs have been viewed. Participants consider blended learning as the most effective training method for its flexibility in time and place. ConclusionsThis study suggests that a simple, easy-to-use and attractive e-learning environment has been developed to train nurses in MIS. However, installation of additional software should be avoided. A moderator/tutor should manage forums to encourage user participation, using conversational agents. But nevertheless, chats have no interest. Questionnaires for content evaluation should be designed with efficiency and equity. Videos designed according to micro-learning, with audio and interactivity, should be included. These courses should be designed to meet factors to promote the engagement of students. Blended learning is considered by nurses as ideal method for training, but further research to assess whether it improves learning outcomes is needed.

Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review.

BackgroundThe increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture–based human-computer interaction is currently being explored as a solution in surgical environments.ObjectiveThe aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS).MethodsFor this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected.ResultsA total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms.ConclusionsCOTS devices applied to hand and instrument gesture–based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up.

Video Tutorials Increase Precision in Minimally Invasive Surgery Training - a Prospective Randomised Trial and Follow-up Study.

Simulation-based practice has become increasingly important in minimally invasive surgery (MIS) training. Nevertheless, personnel resources for demonstration and mentoring simulation-based practice are limited. Video tutorials could be a useful tool to overcome this dilemma. However, the effect of video tutorials on MIS training and improvement of MIS skills is unclear. A prospective randomised trial (n = 24 MIS novices) was conducted. A video-trainer with three different tasks (#1 - 3) was used for standardised goal-directed MIS training. The subjects were randomised to two groups with standard instructional videos (group A, n = 12) versus comprehensive video tutorials for each training task watched at specific times of repetition (group B, n = 12). Performance was analysed using the MISTELS score. At the beginning and following the curriculum, an MIS cholecystectomy (CHE) was performed on a porcine organ model and analysed using the GOALS score. After 18 weeks, participants performed 10 repetitions of tasks #1 - 3 for follow-up analysis. More participants completed tasks #1 and #2 in group B (83.3 and 75%) than in group A (66.7 and 50%, ns). For task #2, there was a significant improvement in precision in group B (p < 0.001). For the entire cohort, the GOALS-Scores were 12.9 before and 18.9 after the curriculum (p < 0.001), with no significant difference between groups. Upon follow-up, 84.2% (task#1), 26.3% (task#2) and 100% (task#3) of MIS novices were able to reach the defined goals (A vs. B ns). There was a trend for a better MISTELS score in group B upon follow-up. Standardised comprehensive video tutorials watched frequently throughout practice can significantly improve precision in MIC training. This aspect should be incorporated in MIS training.

The resident's point of view in the learning curve of thymic MIS: why should I learn it?

Minimally invasive surgery (MIS) in thoracic surgery became quite popular during the last years. The aim of introducing and performing more MIS is to reduce surgical trauma, pain and complications in patients. Training in MIS increases operative time and thus cost in theatre but thus improves with experience. For a resident, the cases should be well selected with experienced supervision in a suitable setting with supporting staff and optimal instruments. Understanding the anatomy of the lung, using simulators, and attending workshops makes the learning curve shorter.