Operator competence in fetoscopic laser surgery for twin–twin transfusion syndrome: validation of a procedure‐specific evaluation tool

Abstract

Objectives

Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double‐twin survival rate

“…This may be explained by his starting with the first procedures in technically easier cases with posterior placentae, the possibility of immediate intervention by the supervising experienced operator if technical difficulties occurred and a final check as to whether all anastomoses had been coagulated. It is possible that in the future a recently developed procedure‐specific evaluation tool to assess the performance of trainees may be helpful in ensuring that they have reached a sufficient level of competence to perform the procedure unsupervised.…”

Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience

“…The findings by Papanna et al are important because they could be useful in establishing guidelines for training future fetoscopic interventionists and developing methods for regular audits of the performance of individual operators or centres. A performance assessment tool for FLP, developed by Peeters et al, (41) included a validated checklist of the essential steps in FLP and also evaluated its use to ensure the competency of future fetal surgeons before they performed the procedure unsupervised, illustrating that operators may reach a level of competence after at least 25 FLP procedures. Previous studies have reported learning curves for FLP by grouping initial series and comparing it to later series.…”

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

“…While there are many commercially available simulators for some areas of medicine, such as laparoscopy (Larsen et al, 2012) and endoscopy (King et al, 2016), the SILICONE project (SImulator for Laser therapy and Identification of Critical steps of Operation: New Education program) aimed to develop a standardized training program for laser therapy for TTTS (Peeters et al, 2015c). This project used Delphi methodology to define 55 substeps essential to the procedure, and then developed an evaluation instrument that was validated using a silicone simulator (Peeters et al, 2015b; Peeters et al, 2015a). The authors concluded that proficiency-based simulator training improves performance for fetoscopic laser therapy, and recommended practice on a simulator prior to carrying out FLP for TTTS in pregnant women.…”

“…Many types of WBA have been developed, but there continues to be concern about validity and reliability, and the demand on resources when running WBAs (Shalhoub et al, 2014). In regard to fetal therapy, the SILICONE project group has reported good inter-observer reliability and the ability to discriminate experts from novices using the assessment tool they have developed for FLP (Peeters et al, 2015a).…”