Evaluation of structured and quantitative training methods for teaching intracorporeal knot tying

Pearson, Adam M.; Gallagher, Anthony G.; Rosser, James C.; Satava, Richard M.

doi:10.1007/s00464-001-8113-y

Cited by 126 publications

(80 citation statements)

References 32 publications

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“…We used distributed practice in our study as the data fairly consistently support its superiority for motor skill acquisition [30], however there is still debate on the ideal timing of the training sessions. Performance feedback is another essential concept for simulator skill acquisition [40, [84][85][86]. Relevant to our study is the debate on whether concurrent feedback, provided during task performance, or summative feedback, provided at the end of task performance, is best.…”

Section: Resultsmentioning

confidence: 99%

Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation

Kolozsvari

Feldman

Vassiliou

et al. 2011

Journal of Surgical Education

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Section: Resultsmentioning

confidence: 99%

Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation

Kolozsvari

Feldman

Vassiliou

et al. 2011

Journal of Surgical Education

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“…In the literature, several studies have analyzed how laparoscopic suturing performance was affected by video instruction [1], dedicated courses [6,9], mechanical box trainers [2,7,11], suture material [12] and assisting devices [8]. These studies showed different outcomes, were performed in a nonrandomized setting, or lacked statistical significance.…”

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confidence: 99%

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

et al. 2007

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Background Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery, requiring extensive training. The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality (VR) simulator to a realistic laparoscopic environment. Methods Twenty surgical trainees underwent basic eyehand coordination training on a VR simulator (SIMENDO, DelltaTech, Delft, the Netherlands) until predefined performance criteria were met. Then, they were randomized into two groups. Group A (the experimental group) received additional training with the knot-tying module on the simulator, during which they had to tie a double laparoscopic knot ten times. Group B (controls) did not receive additional manual training. Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model. Their performance was captured on digital video and coded. Objective analysis parameters were: time taken to tie the knot and number of predefined errors made. Subjective assessments were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale. Results Trainees in group A (n = 9) were significantly faster than the controls (n = 10), with a median of 262 versus 374 seconds (p = 0.034). Group A made a significantly lower number of errors than the controls (median of 24 versus 36 errors, p = 0.030). Subjective assessments by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups. Conclusion Surgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls. The VR module is a useful tool to train laparoscopic knot-tying. Opportunities arose to improve simulator-based instruction that might enhance future training.

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“…36,[58][59][60][61][62][63][64][65] Individual variations exist in the rate of acquisition of technical skills, and therefore training to expert proficiency (as opposed to training for a certain duration) may be the most efficient means by which to enhance learning of technical skills on virtual-reality simulators. 66,67 Two randomized unblinded trials showed that, compared with participants with no training, those trained using virtualreality tools showed significantly improved learning, as measured by both previously validated global assessment measures and automatic simulator-generated parameters.…”

Section: Virtual Realitymentioning

confidence: 99%

“…In several randomized controlled trials, as well as a recent systematic review looking only at novice surgical trainees, virtual-reality training was shown to be at least as effective as benchtop training in the acquisition of technical skills. 65,[77][78][79][80] Notably, many of the identified studies had methodological limitations, including small sample sizes, inadequate blinding, disparate interventions and use of surrogate outcomes. 19,81,82 A small number of studies, however, suggest that virtual reality training may be superior to benchtop-model training.…”

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confidence: 99%

Simulation in surgical education

Palter

Grantcharov²

2010

Canadian Medical Association Journal

121

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Key points• Both technical and non-technical skills are essential for surgeons in training.• Technical skills learned on low-fidelity benchtop models, video-based trainers and virtual-reality models are transferable to the operating room.• Current evidence does not show a clear advantage of either virtual reality or synthetic models in teaching technical skills.• Evidence is lacking on how best to integrate each type of simulator into a holistic, proficiency-based curriculum. Simulation in surgical educationVanessa N. Palter MD, Teodor P. Grantcharov MD PhDPreviously published at www.cmaj.caReview those used for teaching minimally invasive procedures (referred to as tower trainers or video-box trainers). Numerous benchtop models are available for the simulation of a variety of procedures, including knot-tying, fascial closure, and suturing 14 (Figure 1). The most obvious limitation of such models is that they teach only one surgical technique rather than an entire operation. 5 Their use requires the presence of an expert to demonstrate the procedure and provide feedback on performance. 1,5 Tower trainers include a box with slits on the superior surface for trocar insertion. Real laparoscopic instruments are inserted through the trocars into the box, where the procedure is simulated. A camera inside the box provides video output to a monitor on which trainees can watch their own movements. These models can simulate a variety of techniques, including laparoscopic suturing, knot-tying, clip-applying and coordination drills.14 One of the most well-described tower trainers is the physical laparoscopy trainer known as the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills. This system consists of five tasks performed on an endotrainer box. 16 The tasks include peg transfer, cutting, placing a ligating loop and intracorporeal suturing. Virtual-reality simulationTraining by virtual-reality simulation encompasses systems designed to teach laparoscopic, endoscopic and percutaneous interventions. 13 The fidelity of virtual-reality simulators ranges widely, from the Minimally Invasive Surgical Trainer -Virtual Reality (MIST-VR) system, which is a low-fidelity system designed to teach general laparoscopic proficiency, to systems that teach component procedural skills and other systems that replicate entire operations 17 ( Figure 2 and Videos 1 and 2, available at www .cmaj .ca /cgi /content /full /cmaj .091743 /DC1). Unlike bench-model learning, the presence of an expert is not necessary when virtual-reality simulation is used. Such models allow for practice at varying levels of difficulty, can simulate complications and automatically provide objective measures of assessment, allowing for both formative and summative trainee assessment.18 Virtual-reality models have been criticized, however, for high initial cost of system acquisition, limited force-feedback with use of surgical instruments and lack of realism of graphics. 14,19The virtual operating room Benchtop models, virtual-reality models, and an...

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Evaluation of structured and quantitative training methods for teaching intracorporeal knot tying

Abstract: Structured training can be useful for the development of laparoscopic skills. MIST-VR is a valuable part of this training, particularly in the objective evaluation of performance.

Cited by 126 publications

References 32 publications

Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation

Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial

Simulation in surgical education

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