Hysteroscopy training and learning curve of 30° camera navigation on a new box trainer: the HYSTT

Abstract

Despite the upcoming use of hysteroscopy and increased applicability during the last decades, little work has been done regarding the development of hysteroscopic training models in comparison to laparoscopy. Camera navigation is often perceived to be an easy task, but it is far from an innate ability, especially when an angled optic is used. This study investigated the learning curve of hysteroscopic 30°c amera navigation on a new box trainer: Hysteroscopic Skills Training and Testing (HYSTT). This prospective study (Canadian Task Force II-2) enrolled 30 novices (medical students) and ten experts (gynecologists who had performed >100 diagnostic 30°hysteroscopies). All participants performed nine repetitions of a 30°camera exercise on the HYSTT. Novices returned after 2 weeks and performed a second series of five repetitions to assess retention of skills. The parameter procedure time and structured observations on performance using the Global Rating Scale provided measurements for analysis. The learning curve is represented by improvement per procedure. Two-way repeated-measures analysis of variance was used to analyze learning curves. Effect size (ES) was calculated to express the practical significance of the results (ES ≥0.50 indicates a large learning effect). For both parameters, significant improvements were found in novice performance within nine repetitions. Moderate to large learning effects were established (p <0.05; ES 0.44-0.71). Retention of skills and prolonged learning curves were observed. The learning curve, established in this study, of hysteroscopic 30°camera navigation skills on the HYSTT box trainer, indicates a good training capacity and provides the first step towards recommended implementation into a training curriculum.

The Development and Psychometric Validation of A Low-Cost Anthropomorphic 3D-Printout Simulator for Training Basic Skills Applicable to Office-Based Hysteroscopy

“…However, equipping the model with resources for training vaginoscopy, the insertion of the hysteroscope through the uterine cervix and managing irrigation and complications would have substantially increased the cost of the simulator. These limitations have also been found in other studies [19,21,30].…”

“…For this reason, the face validity of anthropomorphic simulators must rely on expert perception about the realism of the internal appearance of the simulator [17,18]. To meet the requirement, the simulator developed for this present study was lined with colored texturized silicone to give it a realistic aspect, mimicking the endometrial cavity, and the tubal ostia were marked [19]. The silicone lining also aimed to protect the hysteroscope lens during the training sessions.…”

EndoTrainer: a novel hybrid training platform for endoscopic surgery

“…The used material can be resected with energy. Other examples are LYRA Hysteroscopy Trainer “EVA II” by Karl Storz, HYSTT training package from IDTrust Medica, [ 9 ], etc. None of them measure any parameter, neither evaluate the execution of the exercises.…”

Correlation of laparoscopic and hysteroscopic 30° scope camera navigation skills on box trainers

“…However, camera navigation skills can be trained easily and effectively outside the operating room [5,[9][10][11]. During the past years, several models have been developed and validated for camera navigation training in laparoscopy [3,12,13] and to a lesser extent in hysteroscopy [14]. The same principles can be observed in urology as well, for laparoscopy and cystoscopy [15].…”

“…Both were designed under auspices of the European Academy for Gynaecological Surgery (Leuven, Belgium). These models train various psychomotor skills including specific exercises for 30°camera navigation training [12,14].…”