Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study

Ellis, Scott Michael; Varley, M.R.; Howell, Stuart; Trochsler, Markus; Maddern, Guy J.; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

doi:10.1007/s00464-015-4619-6

Cited by 14 publications

(11 citation statements)

References 19 publications

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“…The Fundamentals of Laparoscopic Surgery (FLS) programme uses SBTT to teach laparoscopic skills14, and performance speed and accuracy may be associated with intraoperative performance15 16. Complex motor skills such as precision cutting and single‐incision laparoscopy are difficult to acquire and also prone to decay17, 18, 19, 20. Improved strategies to optimize the efficiency and effectiveness of complex surgical skill training models are required.…”

Section: Introductionmentioning

confidence: 99%

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

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BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct‐current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation‐based laparoscopic surgical skill acquisition.MethodsIn this double‐blind, sham‐controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation‐based training. Primary outcomes of laparoscopic pattern‐cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent‐to‐treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern‐cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non‐simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

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Section: Introductionmentioning

confidence: 99%

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

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“…When evaluating the success of an educational intervention, the recognized confounder of skill decay must be considered. Skill and knowledge can quickly decay after simulation‐based education, with one study reporting decay as early as 2 weeks . Educational theory suggests the benefit of simulation stems from repetitive practice .…”

Section: Discussionmentioning

confidence: 99%

A Mixed‐methods Comparison of Participant and Observer Learner Roles in Simulation Education

Bullard

Weekes

Cordle

et al. 2018

AEM Education and Training

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Background: Traditional simulation-based education prioritizes participation in simulated scenarios. The educational impact of observation in simulation-based education compared with participation remains uncertain. Our objective was to compare the performances of observers and participants in a standardized simulation scenario. Methods:We assessed learning differences between simulation-based scenario participation and observation using a convergent, parallel, quasi-experimental, mixed-methods study of 15 participants and 15 observers (N = 30). Fifteen first-year residents from six medical specialties were evaluated during a simulated scenario (cardiac arrest due to critical hyperkalemia). Evaluation included predefined critical actions and performance assessments. In the first exposure to the simulation scenario, participants and observers underwent a shared postevent debriefing with predetermined learning objectives. Three months later, a follow-up assessment using the same case scenario evaluated all 30 learners as participants. Wilcoxon signed rank and Wilcoxon rank sum tests were used to compare participants and observers at 3-month follow-up. In addition, we used case study methodology to explore the nature of learning for participants and observers. Data were triangulated using direct observations, reflective field notes, and a focus group.Results: Quantitative data analysis comparing the learners' first and second exposure to the investigation scenario demonstrated participants' time to calcium administration as the only statistically significant difference between participant and observer roles (316 seconds vs. 200 seconds, p = 0.0004). Qualitative analysis revealed that both participation and observation improved learning, debriefing was an important component to learning, and debriefing closed the learning gap between observers and participants.Conclusions: Participants and observers had similar performances in simulation-based learning in an isolated scenario of cardiac arrest due to hyperkalemia. Findings support current limited literature that observation should not be underestimated as an important opportunity to enhance simulation-based education. When paired with

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“…LDN) is critical for the acquisition and mastery of core cases in transplantation, especially in laparoscopic cases. The literature is replete with data on the benefit of short‐interval repetition plays in the long‐term acquisition and retention of laparoscopic skills . It also appears that skill repetition within the initial 12 weeks after introduction is critical to retain the core knowledge and skills that are necessary long term .…”

Section: Discussionmentioning

confidence: 99%

“…The literature is replete with data on the benefit of short‐interval repetition plays in the long‐term acquisition and retention of laparoscopic skills . It also appears that skill repetition within the initial 12 weeks after introduction is critical to retain the core knowledge and skills that are necessary long term . Furthermore, because our sTSFs return as teachers after they have graduated from the OPR, this enables them to keep their skills sharp in a refresher setting—a crucial component of the long‐term acquisition and maintenance of laparoscopic skills .…”

Section: Discussionmentioning

confidence: 99%

Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis

Serrano

Bangdiwala

Vock

et al. 2017

American Journal of Transplantation

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The United Network for Organ Sharing recommends that fellowship‐trained surgeons participate in 15 laparoscopic donor nephrectomy (LDN) procedures to be considered proficient. The American Society of Transplant Surgeons (ASTS) mandates 12 LDNs during an abdominal transplant surgery fellowship. We performed a retrospective intraoperative case analysis to create a risk‐adjusted cumulative summation (RACUSUM) model to assess the learning curve of novice transplant surgery fellows (TSFs). Between January 2000 and December 2014, 30 novice TSFs participated in the organ procurement rotation of our ASTS‐approved abdominal transplant surgery fellowship. Measures of surgical performance included intraoperative time, estimated blood loss, and incidence of intraoperative complications. The performance of senior TSFs was used to benchmark novice TSF performance. Scores were tabulated in a learning curve model, adjusting for case complexity and prior TSF case volume. Rates of adverse surgical events were significantly higher for novice TSFs than for senior TSFs. In univariable analysis, multiple renal arteries, high BMI, prior abdominal surgery, male donor, and nephrolithiasis were correlated with higher incidence of adverse surgical events. Based on the RACUSUM model, high intraoperative time is mitigated after 28 procedures, incidence of intraoperative complications tends to diminish after 24 procedures, and improvement in estimated blood loss did not remain consistent. TSFs exhibit a tipping point in LDN performance by 24–28 cases and proficiency by 35–38 cases.

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Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study

Cited by 14 publications

References 19 publications

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

A Mixed‐methods Comparison of Participant and Observer Learner Roles in Simulation Education

Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis

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