The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training.

PURPOSE: The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills. METHODS: The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data. RESULTS: The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training. CONCLUSION: The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed. TRIAL REGISTRATION: This trial was retrospectively registered on clinicaltrials.gov (NCT06301230).

Stress responses in surgical trainees during simulation-based training courses in laparoscopy.

BACKGROUND: Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. METHODS: We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. RESULTS: Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). CONCLUSION: Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses.

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis.

Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.

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.

Universal meta-competencies of operative performances: a literature review and qualitative synthesis.

BACKGROUND: Prioritizing patient health is essential, and given the risk of mortality, surgical techniques should be objectively evaluated. However, there is no comprehensive cross-disciplinary system that evaluates skills across all aspects among surgeons of varying levels. Therefore, this study aimed to uncover universal surgical competencies by decomposing and reconstructing specific descriptions in operative performance assessment tools, as the basis of building automated evaluation system using computer vision and machine learning-based analysis. METHODS: The study participants were primarily expert surgeons in the gastrointestinal surgery field and the methodology comprised data collection, thematic analysis, and validation. For the data collection, participants identified global operative performance assessment tools according to detailed inclusion and exclusion criteria. Thereafter, thematic analysis was used to conduct detailed analyses of the descriptions in the tools where specific rules were coded, integrated, and discussed to obtain high-level concepts, namely, "Skill meta-competencies." "Skill meta-competencies" was recategorized for data validation and reliability assurance. Nine assessment tools were selected based on participant criteria. RESULTS: In total, 189 types of skill performances were extracted from the nine tool descriptions and organized into the following five competencies: (1) Tissue handling, (2) Psychomotor skill, (3) Efficiency, (4) Dissection quality, and (5) Exposure quality. The evolutionary importance of these competences' different evaluation targets and purpose over time were assessed; the results showed relatively high reliability, indicating that the categorization was reproducible. The inclusion of basic (tissue handling, psychomotor skill, and efficiency) and advanced (dissection quality and exposure quality) skills in these competencies enhanced the tools' comprehensiveness. CONCLUSIONS: The competencies identified to help surgeons formalize and implement tacit knowledge of operative performance are highly reproducible. These results can be used to form the basis of an automated skill evaluation system and help surgeons improve the provision of care and training, consequently, improving patient prognosis.

Application of laparoscopic surgery skills training course in the standardized residency training of surgery / 中华医学教育探索杂志

Objective:To explore the application effect of laparoscopic surgery skills training course in the standardized residency training of surgery.Methods:A total of 40 standardized trainees of surgical residents rotating in general surgery were selected as the research objects, and randomly divided into the experimental group and the control group. The experimental group was offered laparoscopic surgery skills training course. The course content includes theoretical teaching module, simulated teaching module, virtual teaching module and clinical surgery practice teaching module. The control group was taught by traditional theory teaching and clinical surgery practice teaching. At the end of the courses, the two groups of students were assessed for their skills in laparoscopic grasping and pass, suture and knotting. At the same time, a questionnaire survey was conducted among the students and teachers. The t-test was performed using SPSS 22.0 statistical software. Results:The theoretical scores of the experimental and control groups were (67.90±13.24) and (69.70±13.46), respectively, with no statistically significant difference ( P > 0.05). After the courses, the performance of grasping and pass, suture and knotting of the experimental group (15.25±3.24 and 5.45±2.14) was higher than that of the control group (11.25±2.12 and 2.75±1.16), and the difference was statistically significant ( P < 0.01).The questionnaire survey showed that the proportion of "better" feedback from students and teachers on laparoscopic skills training courses was significantly higher than that of "general" and "poor". Conclusion:The laparoscopic surgery skills training course can improve the laparoscopic surgery skills of the trainees in the standardized residency training of surgery, shorten the learning curve, and make the training standardized and homogeneous. It is worthy of wide promotion and application in the standardized training base.

Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students.

BACKGROUND: Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. METHODS: A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. RESULTS: Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). CONCLUSION: Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.

Surgesture: a novel instrument based on surgical actions for objective skill assessment.

BACKGROUND: Due to varied surgical skills and the lack of an efficient rating system, we developed Surgesture based on elementary functional surgical gestures performed by surgeons, which could serve as objective metrics to evaluate surgical performance in laparoscopic cholecystectomy (LC). METHODS: We defined 14 LC basic Surgestures. Four surgeons annotated Surgestures among LC videos performed by experts and novices. The counts, durations, average action time, and dissection/exposure ratio (D/E ratio) of LC Surgestures were compared. The phase of mobilizing hepatocystic triangle (MHT) was extracted for skill assessment by three professors using a modified Global Operative Assessment of Laparoscopic Skills (mGOALS). RESULTS: The novice operation time was significantly longer than the expert operation time (58.12 ± 19.23 min vs. 26.66 ± 8.00 min, P < 0.001), particularly during MHT phase. Novices had significantly more Surgestures than experts in both hands (P < 0.05). The left hand and inefficient Surgesture of novices were dramatically more than those of experts (P < 0.05). The experts demonstrated a significantly higher D/E ratio of duration than novices (0.79 ± 0.37 vs. 2.84 ± 1.98, P < 0.001). The counts and time pattern map of LC Surgestures during MHT demonstrated that novices tended to complete LC with more types of Surgestures and spent more time exposing the surgical scene. The performance metrics of LC Surgesture had significant but weak associations with each aspect of mGOALS. CONCLUSION: The newly constructed Surgestures could serve as accessible and quantifiable metrics for demonstrating the operative pattern and distinguishing surgeons with various skills. The association between Surgestures and Global Rating Scale laid the foundation for establishing a bridge to automated objective surgical skill evaluation.

The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study.

OBJECTIVES: To investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes. BACKGROUND: Laparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency. METHOD: A longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training. RESULTS: Laparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months. CONCLUSION: In this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.

Tangible effects of the COVID-19 pandemic: A fall in dexterity amongst surgical trainees?

BACKGROUND: The coronavirus pandemic has had an indisputable impact on surgical training. The qualitative effect on the perceived confidence and capability of trainees has been widely reported. In order to fully delineate the scope of the problem, quantitative data is also required. METHODS: This cross-sectional study collected compared data on the laparoscopic skills (pre- and post-pandemic) of first-year urology residents in the United Kingdom, who attended the annual Urology Simulation Boot Camp (USBC) in 2018 and 2019 (pre-pandemic), and 2021 (post-pandemic). RESULTS: Pre-pandemic group performance was significantly better in 2 out of 4 tasks (Task 3 p < 0.001) (Task 4 p = 0.003) during the practice session. During the assessment, pre-pandemic group performance was better (p = 0.017) for Task 2 and significantly faster (p = 003) for Task 4. CONCLUSIONS: Our results provide evidence to support the notion that the coronavirus pandemic has had a tangible and detrimental effect on the technical skills of surgical trainees.

Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries. DATA SOURCES: PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials, prospective comparative studies, and prospective single-group studies with pre- and posttraining assessments that reported surgical simulation-based training before gynecologic surgery were included. METHODS: Reviewers independently identified the studies, obtained data, and assessed the study quality. The results were analyzed according to the type of gynecologic surgery, simulation, comparator, and outcome data, including clinical and patient-related outcomes. The maximum likelihood random effects model meta-analyses of the odds ratios and standardized mean differences were calculated with estimated 95% confidence intervals. RESULTS: Twenty studies, including 13 randomized controlled trials, 1 randomized crossover trial, 5 nonrandomized comparative studies, and 1 prepost study were identified. Most of the included studies (14/21, 67%) were on laparoscopic simulators and had a moderate quality of evidence. Meta-analysis showed that compared with traditional surgical teaching, high- and low-fidelity simulators improved surgical technical skills in the operating room as measured by global rating scales, and high-fidelity simulators decreased the operative time. Moderate quality evidence was found favoring warm-up exercises before laparoscopic surgery. There was insufficient evidence to conduct a meta-analysis for other gynecologic procedures. CONCLUSION: Current evidence supports incorporating simulation-based training for a variety of gynecologic surgeries to increase technical skills in the operating room, but data on patient-related outcomes are lacking.

Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study.

AIM: This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. METHODS: In this prospective randomised trial, novices (n = 40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. RESULTS: The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 s versus 267 s taken for the first three attempts and 283 s versus 187 s taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.3 versus 6.2 errors per individual). CONCLUSION: When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors. KEY STATEMENT: Traditional rigid needle holder leads to faster task completion times and lower error rates when compared with an articulating laparoscopic needle holder in 2D vision.

Análisis de los estilos de aprendizaje en un curso de habilidades técnicas laparoscópicas. Implicaciones para el entrenamiento quirúrgico / Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training

Introducción: El aprendizaje de las técnicas quirúrgicas es un proceso dinámico. David Kolb describió en los años ochenta un modelo de aprendizaje que permite adaptar el tipo de enseñanza y mejorar los resultados de esta. El objetivo del estudio es identificar los estilos de aprendizaje según Kolb de los participantes en un curso de habilidades técnicas laparoscópicas y comprobar si existe relación con el rendimiento final de la tarea realizada. Métodos: Estudio observacional descriptivo que incluye 64 participantes que completaron un curso intensivo donde realizaron anastomosis intestinales manuales laparoscópicas. Todos ellos completaron el inventario de estilos de aprendizaje de Kolb. En cada anastomosis se recogió el tiempo de ejecución y se valoró su calidad. Posteriormente, los datos fueron analizados estadísticamente. Resultados: El estilo de aprendizaje más frecuente fue el asimilador (39,1%). No se observan diferencias significativas entre los estilos y el sexo de los participantes, su categoría profesional, el tiempo en realizar la anastomosis o su calidad. Conclusiones: El estilo de aprendizaje predominante es el asimilador, sin diferencias entre categorías, edad o sexo. No existe relación entre el estilo de aprendizaje de los participantes y los resultados obtenidos en el curso. (AU)

Introduction: Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. Methods: An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. Results: The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. Conclusions: Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course. (AU)

Recovery of Surgical Training Through Extended Laparoscopic Simulation Training.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has adversely affected surgical training internationally. Laparoscopic surgery has a steep learning curve necessitating repetitive procedural practice. We evaluate the efficacy of short- and long-duration simulation training on participant skill acquisition to support the recovery of surgical training.  Methods A prospective, observational study involving 18 novice medical students enrolled in a five-week course. Nodal timed assessments involved three tasks: hoop placement, stacking of sugar cubes and surgical cutting. One month post-completion, we compared the ability of six novice course participants to that of six surgical trainees who completed a smaller portion of the course curriculum. Results Course participants (n=18) completed tasks 111% faster on their third and last course attempt. The surgical trainee group (n=6) took 46% longer to complete tasks compared to the six re-invited course participants, whose ability continued to advance on their fourth effort with a combined 154% earlier completion time compared to try one. Conclusions This study supports the adoption of a structured, extended, regular and spaced-out simulation course or curriculum to cultivate greater skill acquisition and retention amongst surgical trainees, and improve patient care.

Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training.

INTRODUCTION: Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. METHODS: An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. RESULTS: The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. CONCLUSIONS: Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.

Transference of skills in robotic vs. laparoscopic simulation: a randomized controlled trial.

BACKGROUND: Elucidating how robotic skills are best obtained will enable surgeons to best develop future robotic training programs. We perform a randomized controlled trial to assess the performance of robotic compared to laparoscopic surgery, transference of pre-existing skills between the two modalities, and to assess the learning curve between the two using novice medical students. METHODS: Forty students were randomized into either Group A or B. Students practiced and were tested on a peg transfer task in either a laparoscopic simulator (LS) and robotic simulator (RS) in a pre-defined order. Performance, transference of skills and learning curve were assessed for each modality. Additionally, a fatigue questionnaire was issued. RESULTS: There was no significant difference between overall laparoscopic scores (219 ± 19) and robotic scores (227 ± 23) (p = 0.065). Prior laparoscopic skills performed significantly better on robotic testing (236 ± 12) than without laparoscopic skills (216 ± 28) (p = 0.008). There was no significant difference in scores between students with prior robotic skills (223 ± 16) than without robotic skills (215 ± 22) (p = 0.162). Students reported no difference in fatigue between RS and LS. The learning curve plateaus at similar times between both modalities. CONCLUSION: Novice medical students with laparoscopic skills performed better on a RS test than students without laparoscopic training, suggesting a transference of skills from laparoscopic to robotic surgery. These results suggest laparoscopic training may be sufficient in general surgery residencies as the skills transfer to robotic if used post-residency.

Construction of a 3D Surgical Model for Minimally Invasive Partial Nephrectomy: the Urotrainer VK-1.

PURPOSE OF REVIEW: Minimally invasive partial nephrectomy (MIPN) is a very challenging technique and complications may occur during its learning curve. It is important to acquire surgical skills to minimize operative risks. Surgical skills may be acquired through simulation devices or mentoring by a mentor. RECENT FINDINGS: We designed a 3D operable model with multiple and variant surgical scenarios in order to facilitate surgical training in MIPN. The model delivered a real-life feel and handle. To our knowledge, this is the first minimally invasive partial nephrectomy simulator to encompass a series of scenarios with multiple levels of difficulty while delivering a real-life experience.

Training minimally invasive surgery's basic skills: is expensive always better?

INTRODUCTION: Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed. MATERIAL AND METHODS: The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). RESULTS: HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available. CONCLUSION: Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.

Effect of video games playing on surgical simulation training: a systematic review.

INTRODUCTION: Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. AIM: This study aims to systematically review the existing evidence. MATERIALS AND METHODS: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. RESULTS: Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). CONCLUSIONS: Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.