Development and evaluation of a high-fidelity canine laparoscopic ovariectomy model for surgical simulation training and testing

Abstract

OBJECTIVE To develop and evaluate a high-fidelity simulated laparoscopic ovariectomy (SLO) model for surgical training and testing. DESIGN Evaluation study. SAMPLE 15 veterinary students (novice group), 5 veterinary surgical interns or residents (intermediate group), and 6 veterinary surgeons (experienced group). PROCEDURES Laparoscopic surgery experience was assessed by questionnaire and visual analog scales. Basic laparoscopic skills were assessed with a commercial training model. A commercial canine abdomen model was customized with a high-fidelity simulated canine female genital tract. Each subject's SLO performance (laparoscopic entry, dissection along marked planes, and left ovariectomy) was evaluated by measurement of surgical time and errors (splenic puncture and deviation from dissection marks) and with global and operative component rating scales. Construct and concurrent validity were assessed by correlation of SLO results with self-estimated measures of experience level and with basic laparoscopic skills test results, respectively. Face validity was assessed with a questionnaire completed by intermediate and experienced group participants. RESULTS 13 participants (3/15, 5/5, and 5/6 in the novice, intermediate, and experienced groups, respectively) completed SLO within the preset time. No difference in errors was found among groups. Completion time was significantly correlated with self-estimated experience level (r = −0.626), confirming construct validity, and with basic laparoscopic skills scores (r = −0.552) and global (r = −0.624) and operative component (r = −0.624) rating scale scores, confirming concurrent validity. Overall mean face validity score was low (64.2/100); usefulness of the model for surgical training received the highest score (8/10). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested the SLO model may be a useful surgical training tool. Further studies are needed to confirm usefulness of the model in veterinary laparoscopy training.

Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review

“…Validity is conceived as a hypothesis, where the collected validity evidence supports hypothesis' acceptance or rejection (56). This type of validation has been performed in human (57) and veterinary surgery (15,58,59). Unfortunately, a universally accepted model, including validation as a whole, with no fragmentation of validation levels, does not exist.…”

Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs

“…3,4,6,9,[22][23][24][25][26][27][28][29][30] Recent reports have described the development and validation of high-fidelity canine abdominal model laparoscopic simulators. 4,25,26 However, evidence regarding the transfer of skills from simulation to the veterinary operative setting remains limited. The authors have found no published reports on the level of proficiency in simulation-based training required to safely advance to a live-animal-based setting.…”

“…Indeed, general surgical skills do not broadly translate to laparoscopic surgical skills because of loss of depth perception on a two-dimensional video image, impaired hand-eye coordination, limitations on haptic feedback, angle of approach, instrument movement, and the fulcrum effect. [3][4][5][6][7] Overcoming these obstacles involves a steep learning curve even for experienced surgeons, and the risk of morbidity is increased when novice laparoscopic surgeons perform surgical procedures in live animals. 5,[8][9][10][11] Concerns for patient welfare, use of purpose-bred animals for teaching purposes, handling of cadavers, and costs associated with prolonged surgery in live patients have prompted a shift toward integration of simulation for instruction and assessment of laparoscopic skills in human and veterinary medicine.…”

“…8,16,[19][20][21] Research efforts have focused on laparoscopic simulation-based training and competency assessment, ranging from benchtop basic skills models to high-fidelity simulators, for their efficacy in training veterinary students, residents, and practitioners. 3,4,6,9,[22][23][24][25][26][27][28][29][30] Recent reports have described the development and validation of high-fidelity canine abdominal model laparoscopic simulators. 4,25,26 However, evidence regarding the transfer of skills from simulation to the veterinary operative setting remains limited.…”

“…This evolution justifies development of specific training protocols to facilitate integration of MIS into veterinarian surgical training. Indeed, general surgical skills do not broadly translate to laparoscopic surgical skills because of loss of depth perception on a two‐dimensional video image, impaired hand‐eye coordination, limitations on haptic feedback, angle of approach, instrument movement, and the fulcrum effect 3‐7 . Overcoming these obstacles involves a steep learning curve even for experienced surgeons, and the risk of morbidity is increased when novice laparoscopic surgeons perform surgical procedures in live animals 5,8‐11 .…”