Objective To assess the effect of virtual reality training on an actual
laparoscopic operation.Design Prospective randomised controlled and blinded trial.Setting Seven gynaecological departments in the Zeeland region of
Denmark.Participants 24 first and second year registrars specialising in gynaecology
and obstetrics.Interventions Proficiency based virtual reality simulator training in
laparoscopic salpingectomy and standard clinical education (controls).Main outcome measure The main outcome measure was technical performance
assessed by two independent observers blinded to trainee and training status using a
previously validated general and task specific rating scale. The secondary outcome measure
was operation time in minutes.Results The simulator trained group (n=11) reached a median total score of
33 points (interquartile range 32-36 points), equivalent to the experience gained after
20-50 laparoscopic procedures, whereas the control group (n=10) reached a median total
score of 23 (22-27) points, equivalent to the experience gained from fewer than five
procedures (P<0.001). The median total operation time in the simulator trained group
was 12 minutes (interquartile range 10-14 minutes) and in the control group was 24 (20-29)
minutes (P<0.001). The observers’ inter-rater agreement was 0.79.Conclusion Skills in laparoscopic surgery can be increased in a clinically
relevant manner using proficiency based virtual reality simulator training. The
performance level of novices was increased to that of intermediately experienced
laparoscopists and operation time was halved. Simulator training should be considered
before trainees carry out laparoscopic procedures.Trial registration ClinicalTrials.gov NCT00311792.
Objective The purpose of this study was to develop a global-and a procedure-specific rating scale based on a well-validated generic model (objective structured assessment of technical skills) for assessment of technical skills in laparoscopic gynaecology. Furthermore, we aimed to investigate the construct validity and the interrater agreement (IRA) of the rating scale. We investigated both the gamma coefficient (Kendall's rank correlation), which is a measure of the strength of dependence between observations, and the kappa value for each of the ten individual items included in the rating scale.Design Prospective cohort, observer-blinded study.Setting Departments of Obstetrics and Gynaecology in Zealand, Denmark.Population Twenty one gynaecologists or gynaecological trainees.Material and methods Twenty-one video recordings of right side laparoscopic salpingectomies were collected prospectively, eight from novices (defined as <10 procedures), seven from intermediate experienced (20-50 procedures) and six from experts (>200 procedures). All operations were performed by the same operative principles and using a standardised technique. The recordings were analysed by two independent, blinded observers.Main outcome measures Construct validity of the rating scale based on operative performance (median of total score) and interrater reliability.Results There were significant differences between the three groups: median score of novices 24.00 versus intermediate 29.50 versus expert 39.50, P < 0.003) The IRA was 0.83 overall. The gamma correlation coefficient was 0.91. The kappa values varied from 0.510-0.933 for each of the individual items of the rating scale.Conclusions The procedure-specific rating scale for laparoscopic salpingectomy is a valid and reliable tool for assessment of technical skills in gynaecological laparoscopy.
The results support the hypothesis that prophylactic treatment with tranexamic acid reduces the overall total blood loss, the incidence of substantial blood loss, and the need for reoperations owing to postoperative hemorrhage in relation to benign hysterectomy. No incidences of serious adverse events occurred. Thus, tranexamic acid should be considered as a prophylactic treatment prior to elective benign hysterectomy.
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