ABSTRACT
The concept of scarless surgery aims at further minimization of diagnostic and therapeutic interventions. Based on the success of flexible gastroenterological endoscopy and laparoscopic surgery, it combines their advantageous approaches in a synergistic manner. Animal experiments have achieved encouraging results in respect to the feasibility of various types of interventions in the peritoneal and retroperitoneal cavity. Further studies and improvement of instruments will have to prove the practicality and superiority of this concept for medical outcome and efficiency compared to present standards of practice in the potential fields of application. The replacement of certain minimally invasive procedures with scarless intervention techniques seems reasonable, as do new fields of application. After further improvement of the methodology, adequate organization, infrastructure, and teaching structures will have to be developed. If they succeed, the concept of scarless surgery can expect a promising future.
Subject(s)
Endoscopy/methods , Minimally Invasive Surgical Procedures , Animals , Clinical Trials as Topic , Endoscopy, Gastrointestinal , Female , Forecasting , Humans , Laparoscopy , Length of Stay , Male , Swine , Teaching , Time FactorsABSTRACT
BACKGROUND: The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) simulator is validated for laparoscopy training, but benchmarks and target scores for assessing single tasks are needed. METHODS: Control data for the MIST-VR traversal task scenario were collected from 61 novices who performed the task 10 times over 3 days (1 h daily). Data were collected on the time taken, error score, economy of movement, and total score. Test differences were analyzed through percentage scores and t-tests for paired samples. RESULTS: Improvement was greatest over tests 1 to 5 (improvement: test(1.2), 38.07%; p = 0.000; test(4.5), 10.66%; p = 0.010): between tests 5 and 10, improvement slowed and scores stabilized. Variation in participants' performance fell steadily over the 10 tests. CONCLUSION: Trainees should perform at least 10 tests of the traversal task-five to get used to the equipment and task (automation phase; target total score, 95.16) and five to stabilize and consolidate performance (test 10 target total score, 74.11).
Subject(s)
Benchmarking/standards , Computer Simulation , Education, Medical, Continuing , General Surgery/education , Laparoscopy/standards , User-Computer Interface , Adult , Clinical Competence , Equipment Design , Female , Humans , Male , Practice, Psychological , Teaching Materials/standardsABSTRACT
The demands on the modern surgeon are extremely complex. Especially in endoscopic surgery he must be able to carry out most complicated finemotoric motions which are not part of the natural action repertoire, sometimes under extreme conditions of stress. Such demands can be compared to those of top athletes. Within a cooperative project between the second chair of surgery of the University of Cologne and the sport psychologic working unit of the Heidelberg University department of sport and sports science the empirically sound Mental Practice (MP) which has been successfully applied in worldclass sports for a long time was modified so that an application of this training method is now possible for the training and continuing education of young surgeons. The following four types of surgery were emphasized: laparoscopic cholecystectomy, laparoscopic appendectomy, thyroidectomy and inguinal hernia. The article will focus on the detailed description of MP in surgery. At first, however, we are going to delineate MP in sports and will then turn to how it is modified and applied in the field of surgery. Besides the arrangement and exact description of surgeries, MP in this field requires the formulation of instructions which are summarized in instructional handbooks. These handbooks serve as target values for instrumental and cognitive simulation techniques which are applied in MP. The surgeon is thus provided with a foundation for the construction of functional mental representations of the surgery types which enables him to optimize the quality of his actions during the above mentioned surgeries.
