ABSTRACT
BACKGROUND: Application of a LapSim-training model in the Students' Skills Lab as well as the objective evaluation of stress in a virtual operating room scenario offer new perspectives in laparoscopic simulation. METHODS: In a Students' Skills Lab , assessment of learning curves of laparoscopic basic skills and complex tasks was carried out with 28 individuals at a LapSim Virtual Reality (VR)-simulator in a training curriculum consisting of 9 units. In addition, in a virtual operating room scenario, stress evaluation was performed with 18 surgeons by means of a sympathicograph and, in that way, the laparoscopic error and complication rate were recorded. Three different stress reactions (SR 1-3) could be identified. RESULTS: In the Students' Skills Lab, at the beginning of the curriculum (unit 1), the best learning effects together with the improvement of the laparoscopic performance could be presented for the two parameters: Extent of movement of the laparoscopic instruments (length of path as well as degree of deviation from the "optimal course") and duration of the procedure. In the virtual stress scenario, the intraoperative error rate of surgeons with a stress reaction without recovery (SR-1) was lower than of those with recovery (SR-2) or without stress reaction (SR-3). CONCLUSION: Application of the LapSim Virtual Reality (VR)-simulator in the Students' Skills Lab and for stress and crisis simulation represents a new perspective in laparoscopic simulation, which will have to be further evaluated in the future. The transfer to the "real" operating room will have to be continued as a training and scientific validation paradigm.
Subject(s)
Computer Simulation , General Surgery/education , Laparoscopy , Models, Anatomic , User-Computer Interface , Adult , Arousal , Cholecystectomy, Laparoscopic/education , Clinical Competence , Curriculum , Heart Rate , Humans , Intraoperative Complications/psychology , Intraoperative Complications/surgery , Male , Medical Errors , Middle Aged , SoftwareABSTRACT
BACKGROUND: Minimally invasive surgery causes higher mental strain for surgeons than conventional surgery and is significantly more stressful in consecutive cases. This study aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skills and technical errors of the laparoscopic surgeon. METHODS: The LapSim virtual reality simulator was used. Stress measurement was carried out for 18 surgeons performing a virtual cholecystectomy using the LapSim simulator in the context of the patient simulator provided by the METI Corporation. In the course of the study, the surgeons were exposed to different external stressors (S1-S4) in defined intervals. The activity of the sympathetic nervous system was evaluated by skin resistance with the help of a sympathicograph. RESULTS: Three different surgeon-specific stress reactions (SSR) could be identified. The first, SSR-1, with significant stress reactions during the study without recovery, showed larger laparoscopic extensions of movement but fewer intraoperative complications than SSR-2 (recovery after the stress reactions) or SSR-3 (without significant stress reactions). CONCLUSIONS: The mental load of the laparoscopic surgeon might be highly optimized by continuous activity of the sympathetic nervous system. The question of what extent or quality of stress produces adverse effects remains unclear.
