Prior Laparoscopic Experience Research Articles

Stakeholder perspectives on scaling robotic surgery in India: qualitative research.

Robotic surgery (RS) is a milestone in minimally invasive surgery. More than 500 surgeons are trained in RS in India, and more than 100 robotic systems have been installed across various centers. RS offers various benefits to patients and surgeons. Although it is rapidly advancing and has several advantages, a robotic system is a complex system that is equipped with complex instruments. Qualitative research aims to take a broad view of the perceptions of stakeholders of RS and to synthesize their views to gain insight into scaling RS. This qualitative study aimed to explore the perspectives of relevant stakeholders on RS to learn how to develop the field and make it more affordable. This study is based on grounded theory methodology and uses the standards for reporting qualitative research (SRQR) guidelines for reporting. Three premier hospitals that are pioneers in RS in India served as the study locations. Purposive sampling was used to collect data from surgeons, nurses, and insurance staff. The surgeons interviewed have national and international exposure and are consulting and performing robotic surgeries across India and internationally. We conducted one-on-one interviews and wrote memos to gather further information before approaching each stakeholder. Samples were determined based on theoretical saturation. Fellowship training, which includes simulation, bedside assistance, and individual cases under supervision, was found to be the standard training method. The stakeholders mentioned a few prerequisites for performing RS, such as prior laparoscopic experience, passion for surgical knowledge and skill, and proper case selection. The surgeons discussed some technical considerations of RS, such as medico-legal issues and mechanical faults associated with it. Although there is increased scope for establishing robotic surgery, surgeons feel that the cost of RS is high. From the interactions with the stakeholders, it is understood that robotic surgeons are the most significant players in RS. Robotic surgery demands more skills and more trained professionals to scale up. Key findings highlight the importance of fellowship training, prior laparoscopic experience, and proper case selection. While RS has potential for growth, high costs, and technical issues remain concerns. Insurance companies include robotic surgery in their policies under the category of "modernized medicine." Depending on the insurance plan that the patient selects, the necessity of the robotic surgery, and the surgeon's justification, the insurance company will pay for the patient's robotic surgery. To make it affordable for patients, complete insurance coverage is mandatory along with creating more awareness among patients. The growth of RS is inevitable in the future with other robotic companies emerging which will ultimately reduce the capital cost and robotic surgeons are pivotal in advancing RS.

Laparoscopic vs robotic inguinal hernia repair: a comparison of learning curves and skill transference in general surgery residents.

There is no consensus on whether laparoscopic experience should be a prerequisite for robotic training. Further, there is limited information on skill transference between laparoscopic and robotic techniques. This study focused on the general surgery residents' learning curve and skill transference within the twominimally invasive platforms. General surgery residents were observed during the performance of laparoscopic and robotic inguinal hernia repairs. The recorded data included objective measures (operative time, resident participation indicated by percent active time on console or laparoscopy relative to total case time, number of handoffs between the resident and attending), and subjective evaluations (preceptor and trainee assessments of operative performance) while controlling for case complexity, patient comorbidities, and residents' prior operative experience. Wilcoxon two-sample tests and Pearson Correlation coefficients were used for analysis. Twenty laparoscopic and forty-four robotic cases were observed. Mean operative times were 90min for robotic and 95min for laparoscopic cases (P = 0.4590). Residents' active participation time was 66% on the robotic platform and 37% for laparoscopic (P = < 0.0001). On average, hand-offs occurred 9.7 times during robotic cases and 6.3 times during laparoscopic cases (P = 0.0131). The mean number of cases per resident was 5.86 robotic and 1.67 laparoscopic (P = 0.0312). For robotic cases, there was a strong correlation between percent active resident participation and their prior robotic experience (r = 0.78) while there was a weaker correlation with prior laparoscopic experience (r = 0.47). On the other hand, prior robotic experience had minimal correlation with the percent active resident participation in laparoscopic cases (r = 0.12) and a weak correlation with prior laparoscopic experience (r = 0.37). The robotic platform may be a more effective teaching tool with a higher degree of entrustability indicated by the higher mean resident participation. We observed a greater degree of skill transference from laparoscopy to the robot, indicated by a higher degree of correlation between the resident's prior laparoscopic experience and the percent console time in robotic cases. There was minimal correlation between residents' prior robotic experience and their participation in laparoscopic cases. Our findings suggest that the learning curve for the robot may be shorter as prior robotic experience had a much stronger association with future robotic performance compared to the association observed in laparoscopy.

P-044 FEASIBILITY AND SAFETY OF A NEW ‘ON-DEMAND ROBOTICS' PLATFORM FOR INGUINAL HERNIA REPAIR

Abstract Aim To assess the feasibility, safety, and efficiency of a novel ‘on-demand robotics' platform for inguinal hernia repair. Materials &amp; Methods A robotic system consisting in a sterile surgeon console, two robotic instrument arms, and one robotic endoscope arm, was evaluated. This ‘on-demand robotics' platform allows surgeons to remain sterile and combine work at the surgeon console and at the patient bed, e.g. in case of emergency management. This open platform also integrates with existing operating room (OR) equipment such as 3D laparoscopic camera, insufflator, energy devices and trocars. We present the first series of 16 transabdominal preperitoneal inguinal hernia repair procedures (9 unilateral, 7 bilateral) performed with the robotic system. Safety outcomes and skin-to-skin procedure times were documented. All procedures were performed by one surgeon with extensive laparoscopic surgery experience. Results All 16 patients were successfully treated with no device-related adverse events. Most patients were discharged on the same day. 14 patients had reached 30 day follow-up with no morbidity and maintained outcome. Skin-to-skin procedure time was 64 and 84 minutes for unilateral and bilateral procedures respectively. Unilateral mean robotic times transitioned from 73 to 54 minutes between the 5 first and the last 4 cases, indicative of a fast learning curve. Conclusions “On-demand” robotic repair of inguinal hernia is feasible and safe. The described platform provides direct patient access to the sterile surgeon, and uses existing OR equipment. Surgeon's prior laparoscopic experience may also shorten learning curve.

1174 The Reporting of Centre and Surgeon Experience in Studies of Robot Assisted Cholecystectomy: A Systematic Review

Abstract Introduction Over 90% of cholecystectomies are performed using minimally invasive techniques. Robotic cholecystectomy (RC) has been developed to overcome technical limitations of laparoscopy, including improved range of movement and visualisation. Despite becoming increasingly widespread, the safety and efficacy of RC remain unestablished. This review aims to analyse the quality assurance reporting through centre and surgeon expertise in RC. Method A systematic search was conducted to identify all published studies reporting RC. Data on quality assurance measures were collected, including: centres involved, surgeons’ experience and training. Results Of the 1425 abstracts screened, 90 full-text papers were included. Sixty-four studies (71%) were single institutions. Of the thirty studies (33%) reporting centre type, 28 were conducted in specialist/regional/tertiary centres. Only four stated their caseload of RC. No studies described pre-specified criteria or minimum experience required for a surgeon to participate. Fifty-two (58%) reported the number of surgeons operating and 13 (14%) stated surgeons’ training grade. Two quantified previous RC experience, 7 stated prior laparoscopic experience. Only 21 (23%) described training prior to the surgeons’ first in-human procedure; animal based (n = 12), simulation (n = 12), observation (n = 4), lab-based (n = 3). Specific mentorship was reported in 8 studies, and 13 described dual operating. Conclusions Little information was provided about the experience and training of operating surgeons, making it difficult to ascertain whether replicable techniques were utilised which would allow development of a learning curve. This highlights the need for better transparency when reporting surgical innovation, to ensure the safe, evidence-based adoption of new technologies into clinical practice.

Implementing a robotic liver resection program does not always require prior laparoscopic experience

BackgroundPreliminary experience in laparoscopic liver surgery is usually suggested prior to implementation of a robotic liver resection program.MethodsThis was a retrospective cohort analysis of patients undergoing robotic (RLR) versus laparoscopic liver resection (LLR) for hepatocellular carcinoma at a center with concomitant initiation of robotic and laparoscopic programsResultsA total of 92 consecutive patients operated on between May 2014 and February 2019 were included: 40 RLR versus 52 LLR. Median age (69 vs. 67; p = 0.74), male sex (62.5% vs. 59.6%; p = 0.96), incidence of chronic liver disease (97.5% vs.98.1%; p = 0.85), median model for end-stage liver disease (MELD) score (8 vs. 9; p = 0.92), and median largest nodule size (22 vs. 24 mm) were similar between RLR and LLR. In the LLR group, there was a numerically higher incidence of nodules located in segment 4 (20.0% vs. 16.6%; p = 0.79); a numerically higher use of Pringle’s maneuver (32.7% vs. 20%; p = 0.23), and a shorter duration of surgery (median of 165.5 vs. 217.5 min; p = 0.04). Incidence of complications (25% vs.32.7%; p = 0.49), blood transfusions (2.5% vs.9.6%; p = 0.21), and median length of stay (6 vs. 5; p = 0.54) were similar between RLR and LLR. The overall (OS) and recurrence-free (RFS) survival rates at 1 and 5 years were 100 and 79 and 95 and 26% for RLR versus 96.2 and 76.9 and 84.6 and 26.9% for LLR (log-rank p = 0.65 for OS and 0.72 for RFS).ConclusionsBased on our results, concurrent implementation of a robotic and laparoscopic liver resection program appears feasible and safe, and is associated with similar oncologic long-term outcomes.

Quantifying the “Assistant Effect” in Robotic-Assisted Radical Prostatectomy (RARP): Measures of Technical Performance

Surgeons are reliant on the bedside assistant during robotic surgeries. Using a modified global rating scale (GRS), we aim to assess the association between an assistant's technical skill on surgeon performance in Robotic-Assisted Radical Prostatectomy (RARP). Prospective, intraoperative video from RARP cases at three centers were collected. Baseline demographic and RARP-experience data were collected from participating surgeons and trainees. The dissection of the prostatic pedicle and neurovascular bundle step (NVB) was analyzed. Expert analysts scored the console surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS), and the bedside assistant performance using a modified Objective Structured Assessment of Technical Skills (aOSATS). The primary outcome is the association between console surgeon performance, as measured by GEARS, and assistant skill, as measured by aOSATS. Spearman's rho correlations were used to test the relationship between assistant and surgeon technical performance, and a multivariable linear regression model was created to test this association while controlling for patient factors. 92 RARP cases were available for the analysis, comprising 14 console surgeons and 22 different bedside assistants. In only 5 (5.4%) cases, the neurovascular bundle step was completed by a trainee, and in 13 (14.1%) of cases, a staff-level surgeon acted as the bedside assistant. aOSATS score was significantly associated with robotic console experience (P=0.011), and prior laparoscopic experience (P<0.001). Assistant aOSATS score showed a weak but significant correlation with surgeon GEARS score during the neurovascular bundle step (spearman's rho=0.248, P=0.028). On linear regression, aOSATS remained a significant predictor of console surgeon performance (P=0.016), after controlling for patient age and BMI, prostate volume, tumor stage, and presence of nerve-sparing. This is the first study to assess the association between assistant technical skill and surgeon performance in RARP. Additionally, we have provided validity evidence for a modified OSATS global rating scale for training and assessing bedside assistant performance.

418 SYSTEMATIC REVIEW OF LEARNING CURVES IN MINIMALLY INVASIVE PARAESOPHAGEAL HERNIA REPAIR: IS THERE ENOUGH EVIDENCE FOR MENTORSHIP IN SURGICAL RESIDENCY?

Abstract Laparoscopic repair remains the approach of choice for the surgical management of symptomatic paraesophageal hernia (PEH), although robotic techniques are becoming increasingly popular. The learning curve for minimally invasive PEH repair can be variable and little is known of its potential impact upon surgical residents’ training. The aim of this review is to appraise current literature on learning curves in PEH repair and its impact on training and mentorship of surgical residents. Methods Literature searches were performed in three databases: MEDLINE (1980-2020), EMBASE and the Cochrane Library. Search results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data quality was assessed in accordance with the Newcastle-Ottawa Scale for cohort studies. Results A total of 6 studies were identified; 4 laparoscopic and 2 robotic assisted with 2678 patients assessed in total. One study used a cumulative sum (CUSUM) analysis to define learning with the remainder of studies using between 3 and 11 parameters. 2 studies evaluated trainees’ performance in performing laparoscopic PEH repair when mentored by surgeons who had achieved competence on the learning curve. Both studies reported equivalent clinical outcomes for laparoscopic PEH repair performed by trainees versus consultants, although one study suggested 5-year outcomes were inferior in the trainee group despite mentorship. Conclusion Despite being commonly performed, little is known about the learning curves for minimally invasive PEH repair. Furthermore, whether prior laparoscopic experience confers any advantage to performing robotic PEH repair is not known at present. Further data to help evaluate the learning curve for those performing PEH is required in order to enhance training and permit quicker attainment of competency.

Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study.

BackgroundSurgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents’ motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training.ObjectiveThe aim of this study was to establish construct validity for the laparoscopic serious game Underground.MethodsAll study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience.ResultsControlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable.ConclusionsWe established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.

A crossover study on the advantage of an additional rotation function in a needle holder compared to a conventional needle holder in a pelvitrainer model

Background: Needle-loading is the most challenging step in laparoscopic suturing. The rotational needle holder (RNH) is a handheld laparoscopic instrument, which increases the degree of freedom relative to the needle by the rotation of the instrument’s tip. By moving the jaws of the needle holder with a clamped needle a rotational movement is achieved, which allows the needle to be adjusted. The aim of this study was to compare the RNH with the conventional needle holder (CNH) in a pelvitrainer model. Methods: Twenty medical students with no prior laparoscopic experience performed four standardized exercises. The participants were randomly divided into two groups. Group RC performed the suture exercises using the RNH first and the CNH thereafter. Group CR performed these tasks in the reverse sequence. The number of errors, precision, and time taken were measured. After each task, the students had to answer specific questions about the methods used. Results: The 270-degree angle task was performed with significantly fewer mistakes (P=0.003) and more rapidly using the RNH in the second period (P=0.008). The students performed the 180-degree angle task more rapidly during the second run, regardless of which technique was used (P=0.042). Neither of the other two tasks showed any significant difference. The precision was very good overall, and in all four tasks it was superior when the rotational method was used, although no significant difference was observed. The students made more mistakes when using the CNH. The questionnaire confirmed a clear advantage for the RNH, but the participants expressed concerns about its counterintuitive handling. Conclusions: The advantages of the RNH were only partially confirmed. For some angles, the rotational function was beneficial. However, this value was decreased for participants with greater experience and superior laparoscopic skills. More intuitive control of the rotation function may potentially offer an advantage in terms of speed and may be associated with a steeper learning curve.

Safety of Direct Trocar Entry in Laparoscopy in a Structured Fellowship Programme

Introduction:The best method of primary trocar insertion in laparoscopy remains controversial. There are advocates for both initial Veress needle insertion as well as direct trocar insertion.Aim of the study: This study was carried out to find out the complication rate of direct trocar insertion as a method of laparoscopic entry and find out the learning curve of trainees in a structured fellowship programme.Methodology: Retrospective analysis was done over period of 5 years with a sample size of 2053 subjects.Results: 2053 laparoscopic surgeries were examined. Overall complication rate was 0.38%; subjects with previous abdominal surgery were found to have higher complication rate as compared to ones with no history of prior surgery. [0.46% and 0.35% respectively]. All trainees gained reasonable degree of confidence within 6 months.Conclusion: Direct trocar insertion is a safe method of laparoscopic entry, which can be taught to trainees with no prior laparoscopic experience, without an increase in entry complications.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 51-54

The Effect of Interruptions on Novices Learning a Challenging Surgical Skill

The goal of this study was to examine how interruptions affect the acquisition of laparoscopic skills among novices. Undergraduate students with no prior laparoscopic experience completed a basic laparoscopic training task requiring them to pick up and transfer colored objects in a predetermined sequence. The number of colored objects in the sequence was varied to produce three levels of task demand. During execution of the primary task, participants were exposed to a visual interruption by having their video display go blank. The length of interruptions was also varied to examine its effect on memory for the sequence of object moves. Results show greater perceived workload and sequence errors as the demand of the ring transfer task increased. Interruptions from simulated equipment failure were not found to negatively impact recollection of the predetermined color sequences.

MP01-18 QUANTIFYING THE ‘ASSISTANT EFFECT’ IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: MEASURES OF TECHNICAL PERFORMANCE

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2018MP01-18 QUANTIFYING THE ‘ASSISTANT EFFECT’ IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: MEASURES OF TECHNICAL PERFORMANCE Mitchell Goldenberg, Hossein Sadat, Jason Lee, Antonio Finelli, Rajiv Singal, and Teodor Grantcharov Mitchell GoldenbergMitchell Goldenberg More articles by this author , Hossein SadatHossein Sadat More articles by this author , Jason LeeJason Lee More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Rajiv SingalRajiv Singal More articles by this author , and Teodor GrantcharovTeodor Grantcharov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.124AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While robotic-assisted surgery provides several advantages to the surgeon, it also requires the surgeon to be reliant on the bedside assistant for various steps of the procedure. Despite the importance of their role, our ability to assess and understand the impact of the assistant on surgeon performance remains limited. We use modified global rating scales (GRS) to quantify the effect of assistant skill on surgeon technical performance during robotic-assisted radical prostatectomy (RARP). METHODS Prospective, intraoperative video from consecutive RARP cases at a quaternary cancer-referral center was collected. Baseline demographic and RARP-experience data was collected from participating surgeons and trainees. The dissection of the prostatic pedicle and neurovascular bundle step (PPNVB) was selected for analysis to quantify assistant performance. Expert analysts scored the surgeon performance using the Global Evaluative Assessment of Robotic Skills (GEARS), and assistants were rated using a modified Objective Structured Assessment of Technical Skills (aOSATS) GRS, comprised of four of the seven OSATS domains. Kruskal-Wallis tests and Spearmans Rho correlations tested the relationship between aOSATS, previous experience, and surgeon technical performance. RESULTS A total of 34 RARP cases had complete surgeon and assistant assessment data for analysis. Four faculty and 10 trainee bedside assistants were included in the study. Surgeons had all completed more than 50 cases at the console at the time of the study. Trainee experience as bedside assist ranged from 0 to over 30 cases. aOSATS score was significantly associated with bedside experience (p=.001), console experience (p=.0.005), but not prior laparoscopic experience (p=.217). aOSATS score showed moderate positive correlation with surgeon GEARS score during the PPNVB step (0.533, p=.001), as shown in Figure-1. CONCLUSIONS This is the first study to assess the impact of assistant technical skill on surgeon performance in RARP. Additionally, we have provided validity evidence for a modified OSATS GRS for training and assessing bedside assistant performance. Our hypothesis-generating data suggests that bedside assistants must be technically skilled to allow the surgeon to perform at their best. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e10 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mitchell Goldenberg More articles by this author Hossein Sadat More articles by this author Jason Lee More articles by this author Antonio Finelli More articles by this author Rajiv Singal More articles by this author Teodor Grantcharov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The influence of prior laparoscopic experience on learning laparoendoscopic single site surgery: a prospective comparative preliminary study using cystorraphy in a live porcine model

BackgroundThe purpose of this study is to assess the impact of prior laparoscopic experience on the ability to learn laparoendoscopic single site surgery (LESS) skills.MethodsA total of 33 urologists who completed a training program in LESS surgery were recruited for this study. After completing the educational course and training, the study participants demonstrated LESS suturing and knot-tying via a 2-cm cystotomy in a live porcine model for 15 min. An objective structured assessment of technical skills (OSATS) was used to evaluate videos of each participant’s procedure. The participants were divided according to laparoscopic experience; advanced experienced group (AS), intermediate experienced group (IS), novice group (NS).ResultsThree participants in the NS group completed the porcine cystorrhaphy in 15 min (30.0%), 3 (25.0%) completed the task in the IS group, and 3 (27.2%) completed it in the AS group. There were no statistically significant differences in the mean total OSATS quality score (NS; 16.7, IS; 18.5, AS; 16.8) among the 3 groups. Concerning all each assessment, there were also no statistically significant difference. Additionaly, the mean total OSATS quantity score (NS; 4.1, IS; 3.5, AS; 4.3) did not differ significantly among groups. The NS group succeeded a mean of 1.4 knots, the IS group succeeded 0.9, and the AS group 1.3 (p = 0.727).ConclusionsThere was no significant difference among the groups in LESS proficiency after training. Surgeons who were novices in conventional laparoscopic surgery reached comparable scores to those of experienced laparoscopic surgeons after training.

Does rating the operation videos with a checklist score improve the effect of E-learning for bariatric surgical training? Study protocol for a randomized controlled trial

BackgroundLaparoscopic training has become an important part of surgical education. Laparoscopic Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure performed. Surgeons must be well trained prior to operating on a patient. Multimodality training is vital for bariatric surgery. E-learning with videos is a standard approach for training. The present study investigates whether scoring the operation videos with performance checklists improves learning effects and transfer to a simulated operation.Methods/designThis is a monocentric, two-arm, randomized controlled trial. The trainees are medical students from the University of Heidelberg in their clinical years with no prior laparoscopic experience. After a laparoscopic basic virtual reality (VR) training, 80 students are randomized into one of two arms in a 1:1 ratio to the checklist group (group A) and control group without a checklist (group B). After all students are given an introduction of the training center, VR trainer and laparoscopic instruments, they start with E-learning while watching explanations and videos of RYGB. Only group A will perform ratings with a modified Bariatric Objective Structured Assessment of Technical Skill (BOSATS) scale checklist for all videos watched. Group B watches the same videos without rating. Both groups will then perform an RYGB in the VR trainer as a primary endpoint and small bowel suturing as an additional test in the box trainer for evaluation.DiscussionThis study aims to assess if E-learning and rating bariatric surgical videos with a modified BOSATS checklist will improve the learning curve for medical students in an RYGB VR performance. This study may help in future laparoscopic and bariatric training courses.Trial registrationGerman Clinical Trials Register, DRKS00010493. Registered on 20 May 2016.

Simulation-based camera navigation training in laparoscopy\u2014a randomized trial

BackgroundInexperienced operating assistants are often tasked with the important role of handling camera navigation during laparoscopic surgery. Incorrect handling can lead to poor visualization, increased operating time, and frustration for the operating surgeon—all of which can compromise patient safety. The objectives of this trial were to examine how to train laparoscopic camera navigation and to explore the transfer of skills to the operating room.Materials and methodsA randomized, single-center superiority trial with three groups: The first group practiced simulation-based camera navigation tasks (camera group), the second group practiced performing a simulation-based cholecystectomy (procedure group), and the third group received no training (control group). Participants were surgical novices without prior laparoscopic experience. The primary outcome was assessment of camera navigation skills during a laparoscopic cholecystectomy. The secondary outcome was technical skills after training, using a previously developed model for testing camera navigational skills. The exploratory outcome measured participants’ motivation toward the task as an operating assistant.ResultsThirty-six participants were randomized. No significant difference was found in the primary outcome between the three groups (p = 0.279). The secondary outcome showed no significant difference between the interventions groups, total time 167 s (95% CI, 118–217) and 194 s (95% CI, 152–236) for the camera group and the procedure group, respectively (p = 0.369). Both interventions groups were significantly faster than the control group, 307 s (95% CI, 202–412), p = 0.018 and p = 0.045, respectively. On the exploratory outcome, the control group for two dimensions, interest/enjoyment (p = 0.030) and perceived choice (p = 0.033), had a higher score.ConclusionsSimulation-based training improves the technical skills required for camera navigation, regardless of practicing camera navigation or the procedure itself. Transfer to the clinical setting could, however, not be demonstrated. The control group demonstrated higher interest/enjoyment and perceived choice than the camera group.

Direct Vision Box Training for Surgical Trainees with Little or No Prior Laparoscopic Experience

Direct Vision Box Training for Surgical Trainees with Little or No Prior Laparoscopic Experience

Does Prior Laparoscopic and Open Surgery Experience Have Any Impact on Learning Curve in Transition to Robotic Surgery?

OZ It has been 15 years since the Food And Drug Administration approved the Da Vinci® robotic surgery system. Robotic applications are being used extensively in urology, particularly in radical prostatectomy. Like all hightech products, this system also has a high cost and a steep learning curve, therefore, preventing it from becoming widespread. There are various studies on the effect of open surgery or laparoscopy experience on the learning curve of robotic surgery. Analyzing these interactions well will provide valuable information on making the training period of robotic system more efficient.

PWE-417 Incentivising laparoscopic deliberate practice in core surgical training

<h3>Introduction</h3> Frequent practice using a laparoscopic simulator is known to improve subsequent live operating skills. Achieving automation of motor movements prior to live training frees the trainee’s attention for higher skills. Despite this, trainees don’t avail themselves of opportunity for practice. We incentivised frequent laparoscopic practise within two Core Surgical Training (CST) programmes. <h3>Method</h3> 27 CST’s in their first general/urology/paediatric post were given a take-home laparoscopic simulator with instrument tracking software and assigned 6 online modules. Support was provided via social media and a helpdesk. Achievement of metric targets and uploading specified data merited an eCertificate. On production of this certificate, supervisors progressed trainees from camera-holding to operating (the incentive). Trainee views of the intervention and laparoscopic practice were assessed by questionnaires. <h3>Results</h3> Metric results show improvement across all domains for those who completed 1 or more modules (presented graphically). Trainee self-rated anxiety of laparoscopic operating was reduced post-study. 94% of participants thought simulator practise was worthwhile, 76% would recommend the programme. 88% reported improved confidence and motor skills. 41% of participants completed &gt;1 modules. 19% completed all. Comments indicated reasons for this, including the need to integrate simulation into curricular structures. Metric results showed improvement in 5 domains Motion smoothness, acceleration, speed, distance between instruments,% time off screen + time to completion. <h3>Conclusion</h3> The message from this feasibility study, the first to “incentivise” laparoscopic practice, indicates that simply incentivising practice with 24/7 access to simulators and targets, doesn9t result in frequent deliberate practice by trainees, though performance improves in those who do engage. Trainee feedback provides clear indicators of what to address to maximise uptake. It would suggest that to fully engage trainees, laparoscopic practice must be fully integrated into training and progress assessed within training. <h3>Disclosure of interest</h3> L. Nicol: None Declared, R. Partridge Conflict with: Founder of E-O surgical, J. Cleland: None Declared, S. Moug: None Declared, A. Paisley: None Declared, I. Ahmed: None Declared, K. Walker: None Declared. <h3>References</h3> Nagendran M, <i>et al</i>. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Cochrane Database Syst Rev. 2014;1 Dawe SR, <i>et al</i>. A Systematic Review of Surgical Skills Transfer After Simulation-Based Training Laparoscopic Cholecystectomy and Endoscopy. Ann Surg. 2014;259(2) Zapf MA, Ujiki MB. Surgical resident evaluations of portable laparoscopic box trainers incorporated into a simulation-based minimally invasive surgery curriculum. Surg Innov. 2015;22(1):83–7

Procedural specificity in laparoscopic simulator training: protocol for a randomised educational superiority trial

BackgroundThe use of structured curricula for minimally invasive surgery training is becoming increasingly popular. However, many laparoscopic training programs still use basic skills and isolated task training, despite increasing evidence to support the use of training models with higher functional resemblance, such as whole procedural modules. In contrast to basic skills training, procedural training involves several cognitive skills such as elements of planning, movement integration, and how to avoid adverse events. The objective of this trial is to investigate the specificity of procedural practice in laparoscopic simulator training.Methods/DesignA randomised single-centre educational superiority trial. Participants are 96 surgical novices (medical students) without prior laparoscopic experience. Participants start by practicing a series of basic skills tasks to a predefined proficiency level on a virtual reality laparoscopy simulator. Upon reaching proficiency, the participants are randomised to either the intervention group, which practices two procedures (an appendectomy followed by a salpingectomy) or to the control group, practicing only one procedure (a salpingectomy) on the simulator. 1:1 central randomisation is used and participants are stratified by sex and time to complete the basic skills. Data collection is done at a surgical skills centre.The primary outcome is the number of repetitions required to reach a predefined proficiency level on the salpingectomy module. The secondary outcome is the total training time to proficiency. The improvement in motor skills and effect on cognitive load are also explored.DiscussionThe results of this trial might provide new knowledge on how the technical part of surgical training curricula should be comprised in the future. To examine the specificity of practice in procedural simulator training is of great importance in order to develop more comprehensive surgical curricula.Trial registrationClinicalTrials.gov: NCT02069951

Is prior laparoscopy experience required for adaptation to robotic rectal surgery?: Feasibility of one-step transition from open to robotic surgery.

The objective of this study is to ascertain the impact of laparoscopic colorectal surgery (LCS) experience on the learning curve of robotic rectal cancer surgery (RRS). Whether LCS experience is mandatory on overcoming the learning curve of RRS or not remains undetermined. Before starting the robotic procedure, surgeon A had a limited experience of less than 30 LCS cases, whereas surgeon B had performed more than 300 cases of LCS. From the beginning, 100 consecutive, unselected RRS cases performed by each of the two surgeons were retrospectively analyzed (groups A and B). Perioperative surgical and oncologic outcomes were compared between the two groups. Clinicopathological characteristics between the two groups were similar. One case in group A was converted to open surgery. Mean operation time was shorter in group A than that of group B (272 vs. 344 min, p < 0.001). Overall perioperative morbidity rates were not different between the two groups (17.0 vs. 10.0 %, p = 0.214). There was no difference of circumferential resection margin positivity rate and retrieved lymph node numbers. In group A, the operation time decreased with a steep slope until 17 cases on the moving average curve. The slope in group B maintained a steady state and showed no remarkable changes throughout the study period. A one-step transition from open to robotic rectal cancer surgery can be achieved without having extensive prior laparoscopic experience.