Ability to Perform Laparoscopic Intra- and Extracorporeal Suture Ligations in a Live Canine Ovariectomy Model after Simulation Training

Abstract

Veterinary resident training in minimally invasive surgery is currently inconsistent and depends on innate psychomotor skills. Simulation training has been shown to effectively increase basic skills, but demonstration of simulation training effects on advanced skills in the operating room is sparse. We aimed to determine if simulation-trained novice surgeons were able to perform laparoscopic suture ligation in live dogs. Three novice laparoscopic surgeons underwent a 12-session simulation training program with subsequent laparoscopic skills testing to demonstrate competency. The median skills scores of trainees and of one experienced surgeon were 417 and 472, respectively. Eighteen healthy client-owned (shelter) dogs were operated on by four surgeons: one experienced American College of Veterinary Surgeons (ACVS) diplomate, two novice ACVS residents, and one novice ACVS diplomate. Laparoscopic ovariectomy was performed with suture ligation of the ovarian pedicles. Successful surgery was defined as no evidence of ovarian vessel bleeding after transection of the pedicles. Simulation-trained novices performed successful suture-ligated ovariectomies in 11/13 dogs (85%), and the experienced surgeon in 5/5 (100%) dogs. Median total ligation time was 30 minutes (range: 17–57), which was not different among surgeons ( p = .118). Median total surgery time was 105 minutes (range: 69–156) for novices and 89 minutes (range: 65–99) for the experienced surgeon ( p = .038). Extensive simulation training including suturing may contribute toward surgery residents being able to perform complex laparoscopic procedures. These results need to be confirmed in larger numbers of trainees.

Significant transfer of surgical skills acquired in an advanced laparoscopic training program for total laparoscopic gastropexy assessed in a live porcine model

“…This strategy was tested in previous studies on medical students who achieved advanced technical skills in laparoscopic suturing comparable to those of senior residents in a short time [3]. The effects of 10 practical sessions were evaluated in laparoscopic suturing simulation resulting in novices being able to safely complete oophorectomy in bitches with extra and intracorporeal ligation [33].…”

Training residents in minimally invasive surgery; confirming competence or hoping for the best?

“…We have also noticed that advanced performance on live patients in immediate conjunction with the training program seemed to add significant motivation. 45…”

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs

“…The disadvantages are the high cost of the equipment and a training curriculum using simulators that requires a prolonged learning scheme [12]. In addition, training veterinary surgeons in small and large animal MIS demands the development of suitable simulators to learn the surgical protocols before applying them to the real patient [13,14]. This fact has also been evidenced in conventional curricula in veterinary schools [15][16][17].…”

“…Moreover, its development is a continuous challenge for the achievement of competency-based learning [17]. Training to develop surgical competencies to perform laparoscopic ovariohysterectomy in bitches has been reported on simulators designed for veterinary [13,16,18] and human laparoscopy [19]. Canine spaying and neutering are among the most important surgical competencies for veterinary medicine students and residents of veterinary surgery [13].…”

“…Training to develop surgical competencies to perform laparoscopic ovariohysterectomy in bitches has been reported on simulators designed for veterinary [13,16,18] and human laparoscopy [19]. Canine spaying and neutering are among the most important surgical competencies for veterinary medicine students and residents of veterinary surgery [13]. Authors agree that one of the most critical factors for learning surgical skills for MIS is deliberate practice and the number of repetitions: a training program of 12 simulation sessions resulted in mean suture times that did not vary significantly between surgeons, in addition to achieving an 85% success rate in the completion of the ovariohysterectomy procedure by resident laparoscopic surgeons [13].…”