Fundamentals of Laparoscopic Surgery simulator training to proficiency improves laparoscopic performance in the operating room—a randomized controlled trial

Sroka, Gideon; Feldman, Liane S.; Vassiliou, Melina C.; Kaneva, Pepa; Fayez, R; Fried, Gerald M.

doi:10.1016/j.amjsurg.2009.07.035

Cited by 476 publications

(250 citation statements)

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“…Supplementing operating room practice with SBTT provides trainees with risk‐free opportunities to accelerate their skill learning15 16, but at the cost of additional time and risks of decay or poor translation to the operating room10. Such challenges are important for more complex skills such as laparoscopy18 20, 36.…”

Section: Discussionmentioning

confidence: 99%

“…It relates only to simulation‐based training, although the same methodology has demonstrated transferability to real surgical skill15 16. Skill acquisition greatly benefits from instructor feedback, and combining tDCS with more formal feedback methods requires further study.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic skills are difficult to acquire, with loss of depth perception, lack of tactile sensation and altered hand–eye coordination being contributory factors13. The Fundamentals of Laparoscopic Surgery (FLS) programme uses SBTT to teach laparoscopic skills14, and performance speed and accuracy may be associated with intraoperative performance15 16. Complex motor skills such as precision cutting and single‐incision laparoscopy are difficult to acquire and also prone to decay17, 18, 19, 20.…”

Section: Introductionmentioning

confidence: 99%

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Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

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BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct‐current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation‐based laparoscopic surgical skill acquisition.MethodsIn this double‐blind, sham‐controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation‐based training. Primary outcomes of laparoscopic pattern‐cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent‐to‐treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern‐cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non‐simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

et al. 2018

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“…Thanks to training, some behaviors, skills and surgical gestures can be made automatically so the limited attentional resources that should be dedicated to them can be focused on other activities like decision making [9]. Simulators are becoming an important method for surgical training because they offer a low-stakes, learner-centered education as well as a reliable and reproducible environment [10][11][12][13] and there is a wide literature proving its utility [14][15][16][17][18]. Simulators are usually classified in three categories: box trainers, augmented reality simulators and virtual reality simulators.…”

Section: Introductionmentioning

confidence: 99%

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

et al. 2012

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Purpose Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to Ave tasks included in SINERGIA laparoscopic virtual reality simulator. Methods Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1-R8) of the Ave mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of Rl, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005. Results In total, 84.38 % of the metrics provided by SINER-GIA and included in this study show significant differences when comparing Rl and R8. Metrics are mostly improved in the Arst session of training (75.00 % when Rl and R4 are compared vs. 37.50 % when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics psychomotor skills are improved. On the other hand, Navigation just improves 60 % of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks. Conclusions Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the Arst part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.

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“…It is reasonable to assume FES will follow the course of FLS, and the skills developed on the endoscopic simulator used in FES education will translate to improved performance. Data published in January 2010 show that skills developed on the FLS simulator improves laparoscopic performance in the operating room [13]. FLS, and presumably FES, can be taught at all levels: medical school students, residents, and attending surgeons.…”

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confidence: 99%

Why fundamentals of endoscopic surgery (FES)?

et al. 2013

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As flexible endoscopy has moved into the mainstream, gastroenterologists have embraced many of the skills and techniques particular to this modality of diagnosis and intervention. Their adoption of flexible endoscopic technology and training, and the lack of enthusiasm for endoscopic therapy potentials by surgeons, has left many surgical residents and practicing surgeons deficient in endoscopic skills. As a result, education of surgical residents in flexible endoscopy has lagged and training of surgical residents in flexible endoscopy is increasingly coming under scrutiny and has become an area of debate. The medical literature and practice guidelines are replete with articles from surgeons and gastroenterologists debating the appropriate education and training in flexible endoscopy. Both surgical and gastroenterology professional societies have published guidelines for training in flexible endoscopy. These guidelines are often at odds with each other, citing opposing literature supporting their position on appropriate criteria for training in basic upper and lower endoscopy [1][2][3][4]. Flexible endoscopy is a critical element of any general surgeon's and colorectal surgeon's practice. In 2007, 74 % of rural surgeons performed more than 50 flexible endoscopic procedures each year, with 42 % of rural surgeons performing more than 200 flexible endoscopic procedures annually [5]. In a 2010 report on rural, under-served areas that lack gastroenterology services, 39.8 % of an American general surgeons' practice comprises flexible endoscopic procedures [6]. In Canada, surgeons were found to be the primary providers of flexible endoscopic services in smaller urban and rural areas [7].The American Board of Surgery (ABS) has begun to address the training inequity that exists between general surgery residents and gastroenterology fellows [8]. In an effort to ensure surgical residents are fully trained and competent in flexible endoscopy, the ABS has not only increased the minimum requirements for training general surgery residents in flexible endoscopy but has also undertaken the task of formalizing a flexible endoscopy curriculum for its residents. Currently, the ABS and Residency Review Committee (RRC) recommend 35 upper endoscopic procedures and 50 colonoscopies as the minimum number of procedures to be performed by surgical residents. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the ABS have long espoused that numbers do not ensure competency in surgical or endoscopic procedures. This position is fully supported by data. In 2004, the SAGES esophagogastroduodenoscopy (EGD) Outcomes Study Group prospectively reviewed 3,525 EGDs performed by surgeons, showing a high degree of success with low morbidity. There was no correlation between experience (i.e. number of cases performed) and completion rates or major complications [9]. A similar trial by the SAGES Colonoscopy Study Outcomes Group prospectively reviewed 13,580 colonoscopies performed by surgeons and found no correlation between ex...

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Fundamentals of Laparoscopic Surgery simulator training to proficiency improves laparoscopic performance in the operating room—a randomized controlled trial

Cited by 476 publications

References 23 publications

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition

Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Why fundamentals of endoscopic surgery (FES)?

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