Objective Assessment Of Laparoscopic Skills Research Articles

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs.

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

Prediction of laparoscopic skills: objective learning curve analysis

IntroductionPrediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box.MethodsSurgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency.ResultsA total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses.ConclusionThe learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.

Barcodes as Optical Marks for an Objective Assessment of Laparoscopic Skills in a Box Trainer.

Background/Need. The sensor-equipped box trainers can objectively evaluate psychomotor skills similar to virtual simulators. However, such box models are least of all involved in curricula in minimally invasive surgery, probably because of their complexity or high cost. This discrepancy prompted us to find a simple solution that provides an objective assessment of laparoscopic skills on any box trainer. Methodology and Device Description. We used QR code, Code 128, and Circular Code 128 as optical marks in tasks on box trainers. These were marks of errors and positive actions. Polyvinylchloride and a nontransparent silicone sheet served as materials for the tasks. All barcode images were printed with black ink on office paper. In addition, we have developed an app that allows dealing with selected types of barcodes. Preliminary results. We designed 6 tasks based on our approach. Every task provides a precision registration of time, errors, and correct actions, comparable with virtual simulators. However, only 4 tasks showed satisfactory results during face validity's obtaining. We found that primitive barcode scanning technology can provide an objective assessment of trainees on box trainers. The proposed approach is well suited for both commercial and custom box trainers. Current status. The research is currently underway to establish construct validity for the developed tasks. Besides, we intend to study features of other types of barcodes, such as Aztec Code, EAN-8, DataMatrix, and annular barcodes.

Crowd-Sourced and Attending Assessment of General Surgery Resident Operative Performance Using Global Ratings Scales

We sought to assess the extent to which both crowd and intraoperative attending ratings using objective structured assessment of technical skill (OSATS) or global objective assessment of laparoscopic skills (GOALS) would correlate with the system for improving procedural learning (SIMPL) Zwisch and Performance scales. Comparison of directly observed versus crowd sourced review of operative video. Operative video captured at 2 institutions. Six (6) core general surgery procedures, 3 open and 3 laparoscopic, were selected from the American Board of Surgery's Resident Assessments list.Thirty-two cases performed by General Surgery residents across all training levels at 2 institutions were filmed. Videos were condensed using a standardized protocol to include the critical portion of the procedure. Condensed videos were then submitted to crowd-sourced assessment of technical skills (C-SATS), an online crowd source-driven assessment service, for assessment using the appropriate resident assessment form (GOALS or OSATS) as well as with the SIMPL Zwisch and Performance scales. Crowd workers watched an educational tutorial on how to use the Zwisch and SIMPL Performance rating scales prior to participating. Attendings scored residents using the same tools immediately after the shared operative experience. Statistical analysis was performed using Pearson's correlation coefficient. Crowd raters evaluated 32 procedures using GOALS/OSATS, Zwisch and Performance (35-50 ratings per video). Attendings also evaluated all 32 procedures using GOALS/OSATS and 26 of the procedures using SIMPL Zwisch and Performance. Pearson correlation coefficients with 95% confidence intervals for crowd ratings were: GOALS and Zwisch -0.40 [-0.73 to 0.10], OSATS and Zwisch 0.11 [-0.41 to 0.57], GOALS and Performance -0.06 [-0.44 to 0.35], and OSATS and Performance 0.22 [-0.46 to 0.20]. Pearson correlation coefficients for attendings were: GOALS and Zwisch (0.77), OSATS and Zwisch (0.65), GOALS and Performance (0.93), and OSATS and Performance (0.59). Overall, correlations between crowd-sourced ratings using GOALS/OSATS and SIMPL global operative performance ratings tools were weak, yet for attendings, they were strong. Direct attending assessment may be required for evaluation of global performance while crowd sourcing may be more suitable for technical assessment. Further studies are needed to see if more extensive crowd training would result in improved ability for global performance evaluation.

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function

Concerns of Quality and Safety in Public Domain Surgical Education Videos: An Assessment of the Critical View of Safety in Frequently Used Laparoscopic Cholecystectomy Videos

Online videos are among the most common resources for case preparation. Using crowd sourcing, we evaluated the relationship between operative quality and viewing characteristics of online laparoscopic cholecystectomy videos. We edited 160 online videos of laparoscopic cholecystectomy to 60 seconds or less. Crowd workers (CW) rated videos using Global Objective Assessment of Laparoscopic Skills (GOALS), the critical view of safety (CVS) criteria, and assigned overall pass/fail ratings if CVS was achieved; linear mixed effects models derived average ratings. Views, likes, dislikes, subscribers, and country were recorded for subset analysis of YouTube videos. Spearman correlation coefficient (SCC) assessed correlation between performance measures. One video (0.06%) achieved a passing CVS score of ≥5; 23%, ≥4; 44%, ≥3; 79%, ≥2; and 100% ≥1. Pass/fail ratings correlated to CVS, SCC 0.95 (p < 0.001) and to GOALS, SCC 0.79 (p < 0.001). YouTube videos (n= 139) with higher views, likes, or subscribers did not correlate with better quality. The average CVS and GOALS scores were no different for videos with >20,000 views (22%) compared with those with <20,000 (78%). There is an incredibly low frequency of CVS and average GOALS technical performance in frequently used online surgical videos of LC. Favorable characteristics, such as number of views or likes, do not translate to higher quality.

Evaluation of crowd-sourced assessment of the critical view of safety in laparoscopic cholecystectomy.

Faculty experts (FE) and crowd workers (CW) can assess technical skill, but assessment of operative technique has not been explored. We sought to evaluate if CW could be taught to assess completion of the critical view of safety (CVS) in laparoscopic cholecystectomy. We prepared 160 blinded, surgical videos of laparoscopic cholecystectomy from public domain websites. Videos were edited to ≤60s, ending when a structure was cut/clipped. CW analyzed videos using Global Objective Assessment of Laparoscopic Skills (GOALS) and CVS criteria assessment tools after watching an instructional tutorial. Ten videos were randomly selected from each performance quartile based on GOALS. Five FE rated the 40 videos using GOALS and CVS. Linear mixed effects models derived average CW and FE ratings for GOALS and CVS for each video. Spearman correlation coefficients (SCC) were used to assess the degree of correlation between performance measures. Satisfactory completion of the CVS was defined as scoring an average CVS≥5. Videos with an average GOALS≥15 were considered top technical performers. A high degree of correlation was seen between all performance measures: CVS ratings between CW and FE, SCC 0.89 (p<0.001); GOALS and CVS ratings SCC 0.77 (p<0.001) for CW, and SCC 0.71 (p<0.001) for FE. Sixteen videos were assigned top technical performer ratings by both CW and FE but the average CVS was inadequate (3.8 and 3.6, respectively), and the percentage of satisfactory CVS≥5 was 12.5%. A high degree of correlation was found between CW and FE in assessment of the CVS. However, in this video analysis, high technical performers did not achieve a complete CVS in most cases. Educating CW to assess operative technique for the identification of low or average performers is feasible and may broaden the application of this assessment and feedback tool.

Construct validity of a video-tracking system based on orthogonal cameras approach for objective assessment of laparoscopic skills

This study was aimed to establish the construct validity of a video-tracking system based on orthogonal cameras approach for assessment of laparoscopic psychomotor skills in training environments. The camera-tracking system consists of two webcams placed in orthogonal configuration at a distance of 13.5 cm. The orthogonal cameras employ a color segmentation algorithm to register the 3D motions of the laparoscopic instruments using colored tapes placed on the distal end. For construct validity, 31 participants (4 experts and 27 residents) performed three training tasks in a laparoscopic box trainer with the built-in orthogonal cameras system. Eleven motion-related parameters were used to evaluate their performance. Statistical analysis was performed, and results between two groups were compared using a Mann-Whitney U-test. Construct validity results showed statistical differences in almost all motion-related parameters for assessment of laparoscopic technical skills. Results demonstrated that the orthogonal video-based tracking system was able to differentiate laparoscopic experience between experts and trainees surgeons. The orthogonal cameras system was successfully validated in a laparoscopic box trainer. This video-based tracking system was able to distinguish performance between experts and trainees surgeons, showing its potential as a reliable tool to assess laparoscopic psychomotor skills. The orthogonal cameras allow incorporating the advantages of this video motion-tracking technology with the benefits of the traditional laparoscopic box trainers, creating realistic haptic feedback and allowing the evaluation of psychomotor skills of the surgeons.

Crowd-Sourced Assessment of Technical Skills for Validation of Basic Laparoscopic Urologic Skills Tasks

The BLUS (Basic Laparoscopic Urologic Skills) consortium sought to address the construct validity of BLUStasks and the wider problem of accurate, scalable and affordable skillevaluation by investigating the concordance of 2 novel candidate methods with faculty panel scores, those of automated motion metrics and crowdsourcing. A faculty panel of surgeons (5) and anonymous crowdworkers blindly reviewed a randomized sequence of a representative sample of 24 videos (12 pegboard and 12 suturing) extracted from the BLUS validation study (454) using the GOALS (Global Objective Assessment of Laparoscopic Skills) survey tool with appended pass-fail anchors via the same web based user interface. Pre-recorded motion metrics (tool path length, jerk cost etc) were available for each video. Cronbach's alpha,Pearson's R and ROC with AUC statistics were used to evaluate concordance between continuous scores, and as pass-fail criteria among the 3 groups of faculty, crowds andmotion metrics. Crowdworkers provided 1,840 ratings in approximately 48 hours, 60 times faster than the faculty panel. The inter-rater reliability of mean expert and crowd ratings was good (α=0.826). Crowd score derived pass-fail resulted in 96.9% AUC (95% CI 90.3-100; positive predictive value 100%, negative predictive value 89%). Motion metrics and crowd scores provided similar or nearly identical concordance with faculty panel ratings and pass-fail decisions. The concordance of crowdsourcing with faculty panels and speed of reviews is sufficiently highto merit its further investigation alongside automated motion metrics. The overall agreement among faculty, motion metrics and crowdworkers provides evidence in support of the construct validity for 2 of the 4BLUS tasks.

Crowd-sourced assessment of technical skills: an opportunity for improvement in the assessment of laparoscopic surgical skills

BackgroundObjective, unbiased assessment of surgical skills remains a challenge in surgical education. We sought to evaluate the feasibility and reliability of Crowd-Sourced Assessment of Technical Skills. MethodsSeven volunteer general surgery interns were given time for training and then testing, on laparoscopic peg transfer, precision cutting, and intracorporeal knot-tying. Six faculty experts (FEs) and 203 Amazon.com Mechanical Turk crowd workers (CWs) evaluated 21 deidentified video clips using the Global Objective Assessment of Laparoscopic Skills validated rating instrument. ResultsWithin 19 hours and 15 minutes we received 662 eligible ratings from 203 CWs and 126 ratings from 6 FEs over 10 days. FE video ratings were of borderline internal consistency (Krippendorff’s alpha = .55). FE ratings were highly correlated with CW ratings (Pearson’s correlation coefficient = .78, P < .001). ConclusionWe propose the use of Crowd-Sourced Assessment of Technical Skills as a reliable, basic tool to standardize the evaluation of technical skills in general surgery.

Validation of the AUA BLUS Tasks

Standardized assessment of laparoscopic skill in urology is lacking. Weinvestigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address thisneed. This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites. Using the EDGE (Electronic Data Generation and Evaluation) device (Simulab, Seattle, Washington) 454 recordings were collected on peg transfer, pattern cutting, suturing and clip applying tasks, which together comprise the expert determined BLUS tasks. We collected synchronized video and tool motion data for each trial. For each task errors, time, path length, economy of motion, peak grasp force and EDGE score were collected. An expert panel of 5 faculty members performed GOALS (Global Objective Assessment of Laparoscopic Skills) evaluations on a representative subset of peg transfer and suturing skill tasks performed by 24 participants (IRR = 0.95). Demographically derived skill levels proved unsuitable to evaluate construct validity. Separation of mean scores by grouped skill levels was strongest for the suturing task. Objective motion metrics and errors supported construct validity vis-à-vis correlation with blinded expert video ratings (motion metrics R(2) = 0.95, p <0.01). Expert scores appeared to reward errors in suturing but not in block transfer. BLUS skill task performance scoring can discriminate among basic laparoscopic technical skill levels. Self-reported demographics are an unreliable source of determining laparoscopic technical skill.

PD19-04 VALIDATION OF LAPAROSCOPIC TRAINING CURRICULUM: THE BASIC LAPAROSCOPIC UROLOGIC SKILLS (BLUS) INITIATIVE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-04 VALIDATION OF LAPAROSCOPIC TRAINING CURRICULUM: 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, 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 , 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.2015.02.703AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard basic laparoscopic training is required for urologic trainees to ensure proficiency prior to graduation from residency. The American Urological Association created the Basic Laparoscopic Urologic Skills (BLUS) skills tasks as an objective assessment tool to determine laparoscopic skills proficiency. 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, eight US medical teaching institutions contributed 117 subjects of varying skill from medical student to full-time faculty urologist. All subjects performed four dry-lab laparoscopic tasks: Peg Transfer, Cutting, Intracorporeal Suturing, and Clip Applying. The Electronic Data Generation and Evaluation (EDGE) laparoscopic platform (Simulab Corp, Seattle WA) recorded synchronized video and tool motion metrics for all tasks along with proctor-entered task errors. Skill levels were assigned by both demographically-derived status (training level) and blinded video review by five faculty urologists employing the Global Objective Assessment of Laparoscopic Skills (GOALS) instrument for a representative subset of the database (12 Suturing, 12 Peg Transfer; maximum, median, and minimum task times). We employed Pearson's correlation to evaluate agreement between metrics and ground truth. RESULTS Using the structured assessment tool – GOALS – provided skill discrimination. Demographically-derived assignments were less correlated with skill. Task time, path length, and motion smoothness (jerk cost) correlated with ground truth structured video assessment (-0.69, -0.69 -0.79 respectively) for Peg Transfer and (-0.86, -0.91 -0.84 respectively) for Suturing (p<0.01). Inter-rater reliability of the five experienced faculty GOALS reviewers was >0.9. CONCLUSIONS The BLUS Peg Transfer and Intracorporeal Suturing skill tasks showed good construct validity based on a consensus of established objective performance metrics and blinded video review by experienced faculty. Training level or case experience alone may be inadequate to assign proficiency levels, thus more objective quantification of skill is required for advancement strategies in training centers. Table 1. Correlation of GOALS scores provided by five expert laparoscopists and EDGE objective performance metrics. Expert GOALS Assessments vs. Tool Metrics Peg Transfer Task Suturing Task N=24, Pearsons R n=12 n=12 R (p-value) R (p-value) EDGE Overall Score 0.95 (0.00) 0.95 (0.00) Task Time -0.91 (0.00) -0.95 (0.00) Tool Path Length -0.95 (0.00) -0.81 (0.00) Jerk Cost -0.63 (0.03) -0.82 (0.00) Movement Count -0.94 (0.00) -0.72 (0.01) Grasp Force NS NS Max Grasp Force NS NS Economy of Motion 0.62 (0.03) NS Errors -0.68 (0.02) 0.62 (0.03) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e392-e393 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 Elspeth McDougall More articles by this author Thomas Lendvay More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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 ...

Module Based Training Improves Performance in Laparoscopic Surgery: A Nationwide Randomized Controlled Trial

Objectives: New working time directives reduce the available training hours for futuresurgeons. Laparoscopic training must be more efficient, and deliberate clinical operative training within a short time-frame (module based training) might help achieve this goal. This study set out to measure the effect of such a module based training programme for surgical trainees applied to laparoscopic cholecystectomy. Method: Randomized controlled trial in Danish surgical training hospitals. Thirty-five Danish surgical specialty trainees (registrars) were randomized to either module based training including performance of 20 procedures within 4-8 weeks or standard clinical training. The laparoscopic cholecystectomies were videotaped and blindly rated by three professors/consultants using the validated tool: Global Objective Assessment of Laparoscopic Skills (GOALS). Results: Data show a significant effect of the module based training program on technical skills compared to standard training at one year follow-up despite equal number of performed procedures in the two groups (p=0.010). Due to a large number of drop-outs only ten participants completed the study with the required number of videotaped operations. Inter-rater reliability showed Cronbach’s alpha=0.37. Conclusions: Only few trainees completed the study and inter-rater reliability was low, which highlight some of the challenges in educational randomized studies. Despite this, module based training showed promising effect as an efficient method in clinical skills training of surgical registrars.

New dog, new tricks: trends in performance on the Fundamentals of Laparoscopic Surgery simulator for incoming surgery residents

Exposure to laparoscopic surgery during medical school has increased over recent years. The Fundamentals of Laparoscopic Surgery (FLS) simulator allows for objective assessment of laparoscopic skills. This study aimed to determine whether the fundamental laparoscopic skills of incoming surgery residents have improved. The initial FLS performance of first-year residents between 2003 and 2008 was identified from a prospective database. Linear regression was used to determine the effect of incoming year on performance of the five FLS simulator tasks (peg transfer, pattern cut, endoloop placement, suture with an extracorporeal knot [EC], suture with an intracorporeal knot [IC]) and the total score. Statistical significance was defined as a p value less than 0.05. A total of 63 first-year residents were identified from the database. The total FLS scores improved over time (r=0.39; p=0.001). The scores for peg transfer did not change significantly, but the scores for pattern cutting (r=0.37; p=0.002), endoloop placement (r=0.36; p=0.004), suture with EC (r=0.32; p=0.02), and suture with IC (r=0.26; p=0.03) all improved significantly over the 5years. The baseline fundamental laparoscopic skills of incoming surgery residents appear to have improved over time. This may be due to increased clinical laparoscopic exposure and availability of laparoscopic simulation in medical school.

Virtual reality laparoscopic simulator for assessment in gynaecology

A validated virtual reality laparoscopic simulator minimally invasive surgical trainer (MIST) 2 was used to assess the psychomotor skills of 21 gynaecologists (2 consultants, 8 registrars and 11 senior house officers). Nine gynaecologists failed to complete the VR tasks at the first attempt and were excluded for sequential evaluation. Each of the remaining 12 gynaecologists were tested on MIST 2 on four occasions within four weeks. The MIST 2 simulator provided quantitative data on time to complete tasks, errors, economy of movement and economy of diathermy use--for both right and left hand performance. The results show a significant early learning curve for the majority of tasks which plateaued by the third session. This suggests a high quality surgeon-computer interface. MIST 2 provides objective assessment of laparoscopic skills in gynaecologists.

Virtual reality laparoscopic simulator for assessment in gynaecology

A validated virtual reality laparoscopic simulator minimally invasive surgical trainer (MIST) 2 was used to assess the psychomotor skills of 21 gynaecologists (2 consultants, 8 registrars and 11 senior house officers). Nine gynaecologists failed to complete the VR tasks at the first attempt and were excluded for sequential evaluation. Each of the remaining 12 gynaecologists were tested on MIST 2 on four occasions within four weeks. The MIST 2 simulator provided quantitative data on time to complete tasks, errors, economy of movement and economy of diathermy use—for both right and left hand performance. The results show a significant early learning curve for the majority of tasks which plateaued by the third session. This suggests a high quality surgeon–computer interface. MIST 2 provides objective assessment of laparoscopic skills in gynaecologists.