Improved laparoscopic skills in gynaecology trainees following a simulation‐training program using take‐home box trainers

Wilson, Erin; Janssens, Sarah; McLindon, Lucas A.; Hewett, David G.; Jolly, Brian; Beckmann, Michael

doi:10.1111/ajo.12802

Cited by 19 publications

(25 citation statements)

References 32 publications

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“…The beneficial impact that simulator-acquired skills have on real surgeries is today undeniable. The possibility of mentoring and learning in a non-stressful environment speeds up the learning curves and self-confidence of trainees, translating into better performance in clinical practice ( Wilson et al, 2019 ; Gala et al, 2013 ; Larsen et al 2009 ; Ahlborg et al, 2013 ; Lobão et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

Restaino¹,

Vargiu²,

Rosati³

et al. 2021

Facts Views Vis ObGyn

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Background: The introduction of ultra-high-definition laparoscopic cameras (4K), by providing stronger monocular depth perception, could challenge the existing 3D technology. There are few available studies on this topic, especially in gynaecological setting. Objectives: Prospective, single institution, randomised clinical trial (NCT04209036). Materials and Methods: The two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD by Olympus. The surgeons were all trainees and in their last year of residency and who had obtained the certificate of first or second level of the Gynaecological Endoscopic Surgical Education and Assessment program - GESEA program. Twenty-nine patients with benign uterine pathology were enrolled. Main outcome measures: To compare if the use three-dimensional (3D) versus ultra-high-definition laparoscopic vision system (4K) for total laparoscopic hysterectomy performed by trainees was associated with a shorter operative time. Results: The 3D vision system did not prove to be superior to the 4K vision system. Operators reported significantly more vision-related side effects when using 3D than 4K. Completing the GESEA training program was the only factor with a positive and statistically significant impact on the overall time of the procedure, especially when greater dexterity and tissue handling were required. Conclusions: Neither technology used proved superior to the other, although operators showed a preference for 4K over 3D due to the lower number of visual side effects. Attendance at courses on laparoscopic simulators and training programs allowed trainees to demonstrate excellent surgical skills.

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Section: Discussionmentioning

confidence: 99%

4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

Restaino¹,

Vargiu²,

Rosati³

et al. 2021

Facts Views Vis ObGyn

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“…This finding is similar to Villani et al study, where all laparoscopic liver resections were pooled and the effect of time on outcomes was studied. 25 Second generation laparoscopic surgeons 26,27 benefit from fellowship training as well as mentoring schemes, 26 where the learning acquired by the pioneers is distilled down to the next generation of surgeons. In addition to surgical techniques, there has been a parallel improvement in laparoscopic equipment, such as advanced energy devices and visual display screen including 4K and 3D technology.…”

Section: Hpbmentioning

confidence: 99%

“…In addition to surgical techniques, there has been a parallel improvement in laparoscopic equipment, such as advanced energy devices and visual display screen including 4K and 3D technology. Courses in advanced laparoscopic training and the availability of simulators [27][28][29] to practise skills outside the operating theatre can all contribute towards a shorter learning curve for the next wave of laparoscopic HPB surgeons. In our study, risk adjustment using the Iwate index reduced the observed learning curves for both surgeons for the end point of operating time, but did not affect the CUSUM plot for conversion rate.…”

Section: Hpbmentioning

confidence: 99%

Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM

Sultana

Marudanayagam

Sutcliffe

2019

HPB

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Background: Laparoscopic liver resection (LLR) requires training in both hepatobiliary surgery and advanced laparoscopy. Available data on LLR learning curves are derived from pioneer surgeons. The aims of this study were to evaluate the LLR learning curve for second generation surgeons, and to compare different CUSUM methodology with and without risk adjustment. Methods: Retrospective analysis of a prospective database of 111 consecutive patients who underwent LLR by two surgeons at a single centre between 2011 and 2016. The LLR learning curve for minor hepatectomy (MH) was evaluated for each surgeon using standard CUSUM before and after riskadjusting for operative difficulty using the Iwate index, and compared with Learning Curve (LC) CUSUM. The end points were operative time and conversion rate. Results: Standard CUSUM analysis identified a learning curve of 50-60 MH procedures. The corresponding learning curve reduced to 25-30 after risk-adjusting for operative difficulty, whilst LC-CUSUM identified a learning curve of 17-25 procedures. Conclusions: The learning curve for laparoscopic minor liver resection by second generation surgeons is shorter than that for pioneer surgeons. Laparoscopic HPB fellowship programmes may further shorten the learning curve, facilitating safe expansion of LLR. The LC-CUSUM method is an alternative technique that warrants further study.

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“…Support for at-home laparoscopic training has been growing in recent literature. Support first came with evidence of skill acquisition and construct validity for various developed tasks 6 , 7 , 8 , 9 , 10 , 11 . Randomized trials also demonstrated that skill acquisition with at-home trainers was equivalent to that of onsite trainers, proving this as a reasonable training alternative 12 .…”

Section: Introductionmentioning

confidence: 99%

Creating a Proficiency-based Remote Laparoscopic Skills Curriculum for the COVID-19 Era

Nagaraj

AbdelFattah

Scott

et al. 2022

Journal of Surgical Education

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Objective Social distancing restrictions due to COVID-19 challenged our ability to educate incoming surgery interns who depend on early simulation training for basic skill acquisition. This study aimed to create a proficiency-based laparoscopic skills curriculum using remote learning. Design Content experts designed five surgical tasks to address hand-eye coordination, depth perception, and precision cutting. A scoring formula was used to measure performance: cutoff time - completion time - (K × errors) = score; the constant K was determined for each task. As a benchmark for proficiency, a fellowship-trained laparoscopic surgeon performed three consecutive repetitions of each task; proficiency was defined as the surgeon's mean score minus two standard deviations. To train remotely, PGY1 surgery residents (n = 29) were each issued a donated portable laparoscopic training box, task explanations, and score sheets. Remote training included submitting a pre-test video, self-training to proficiency, and submitting a post-test video. Construct validity (expert vs. trainee pre-tests) and skill acquisition (trainee pre-tests vs. post-tests) were compared using a Wilcoxon test (median [IQR] reported). Setting The University of Texas Southwestern Medical Center in Dallas, Texas Participants Surgery interns Results Expert and trainee pre-test performance was significantly different for all tasks, supporting construct validity. One trainee was proficient at pre-test. After 1 month of self-training, 7 additional residents achieved proficiency on all five tasks after 2-18 repetitions; trainee post-test scores were significantly improved vs. pre-test on all tasks ( p =.01). Conclusions This proficiency-based curriculum demonstrated construct validity, was feasible as a remote teaching option, and resulted in significant skill acquisition. The remote format, including video-based performance assessment, facilitates effective at-home learning and may allow additional innovations such as video-based coaching for more advanced curricula.

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Improved laparoscopic skills in gynaecology trainees following a simulation‐training program using take‐home box trainers

Abstract: A take-home box trainer simulation-training program was associated with improvement in laparoscopic skills. This type of program may improve trainee access to simulation training.

Cited by 19 publications

References 32 publications

4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial

Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM

Creating a Proficiency-based Remote Laparoscopic Skills Curriculum for the COVID-19 Era

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