Laparoscopic suturing learning curve in an open versus closed box trainer

Rodrigues, Sharon P.; Horeman, Tim; Blomjous, M. S. H.; Hiemstra, Ellen; Dobbelsteen, John J. van den; Jansen, Frank-Willem

doi:10.1007/s00464-015-4211-0

Cited by 22 publications

(17 citation statements)

References 23 publications

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“…2 Accordingly, efficient teaching of the laparoscopic technique is paramount to achieving safe and widespread use of this technology. The beneficial effects of practical skills training in laparoscopic simulators such as black boxes or high-fidelity simulators to improve surgical performance have been investigated and discussed in several studies [3][4][5][6][7][8][9] and reviews. 10,11 Pearson et al showed that structured training significantly improves laparoscopic suturing skills, 5 which is the most difficult, rate-limiting step that requires time to master.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

et al. 2020

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Background. Our aim was to determine if a newly designed Najar needle holder (NNH) shortens the time for novices to improve advanced laparoscopy (AL) techniques (suturing/knot tying), compared with a conventional macro needle holder (MNH) in a simulator. Furthermore, we aimed to validate a new video scoring system determining AL skills. Methods. Forty-six medical students performed identical surgical tasks in a prospective, crossover study evaluating AL skills (NNH vs MNH). All subjects performed a double-throw knot, 2 single-throw knots following 3 running sutures in the Simball Box (SB) simulator. After resting, subjects switched needle holders. All tasks were videotaped and analyzed using SB software and by 2 independent reviewers using the Objective Video Evaluation Scoring Table (OVEST). Trial performance expressed as SB Overall Score (SBOS) and OVEST. Results. In the group starting with NNH (followed by MNH) OVEST was consistently high during both trials (median = 12.5, range = 6.5-18.0, and median = 13.5, range = 6.5-21.0; P = .2360). However, in the group starting with MNH, OVEST improved significantly when the participants changed to NNH (median = 10.0, range = 2.5-19.5, vs median = 14.5, range = 4.5-18.0; P = .0003); an improvement was also found with SBOS (median = 37%, range = 27% to 92%, vs median = 48%, range = 34% to 70%; P = .0289). In both trials, both independent reviewers’ OVEST measures correlated well: Trial 1: β = 0.97, P < .0001; and Trial 2: β = 0.95, P < .0001. A correlation also existed between SBOS and OVEST in both trials (β = 2.1, P < .0001; and β = 1.9, P = .0002). Conclusions. This study indicates a significantly higher improvement in laparoscopic suturing skills in novices training AL skills using NNH compared with MNH. Starting early, AL training in novices using NNH is a feasible option. Furthermore, OVEST used in experimental settings as an evaluation tool is comparable with the validated SBOS.

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Section: Introductionmentioning

confidence: 99%

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

et al. 2020

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“…A previous report indicated that the mirror visual feedback improved the motor performance of the hand in a neurophysiological study 25. Rodrigues et al 19. reported that novices benefit from starting their training with difficult basic laparoscopic skills in a transparent box trainer.…”

Section: Discussionmentioning

confidence: 98%

“…Various methods were introduced to objectively evaluate basic laparoscopic surgical skills, such as the virtual reality simulator system and physical trial program 17, 18, 19, 20. However, the influence of real‐time visual feedback for laparoscopic surgical training has not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

“…An important reason for the necessity of laparoscopic training is to become familiar with the visual limitation. However, only a few studies have investigated whether visualizing the surgical field through the transparent top of the box trainer helps to familiarize the trainer with laparoscopic surgical procedures 19. The primary goal of the present study was to verify whether laparoscopic training with real‐time visual feedback through a transparent view is useful to master laparoscopic surgical organ handling for novices.…”

Section: Introductionmentioning

confidence: 98%

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Effect of visual feedback during laparoscopic basic training using a box trainer with a transparent top

Maemura

Mataki

Kurahara

et al. 2017

Annals of Gastroent Surgery

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Laparoscopic surgical training using a box trainer facilitates mastery of laparoscopic surgery. Few studies have investigated whether visualizing the surgical field in the box trainer improves performance of laparoscopic surgical procedures during laparoscopic training. An original box trainer equipped with a transparent top made of mesh covered with a latticed structure was developed and used for evaluation of novices during laparoscopic training. Three tasks (levels 1 to 3) involving organ handling while setting the surgical field were arranged to evaluate the efficacy of training. Forty‐five students were divided into three groups: group A, students without practical training; group B, students trained using the covered box trainer; and group C, students trained using the transparent box trainer. Completion time of each task before and after training was compared. Training significantly reduced the operating time, with a significant difference between the level 1 task and the levels 2 (P<.001) and 3 (P<.0001) tasks. There was no significant difference in operating time between the levels 2 and 3 tasks. Overall time reduction rate in group C was significantly shorter than that in group A, but not in group B. The time reduction rate for the level 3 task was lowest in group C, with a statistically significant difference existing in group A (P<.001). Visual feedback during surgery through the transparent top of the laparoscopic box trainer helped reduce the learning time required to carry out laparoscopic surgery.

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“…Classicamente, a grande dificuldade na capacitação em procedimentos laparoscópicos é a aquisição da competência para trabalhar em duas dimensões com a visão direcionada para o monitor e a manipulação do instrumental sem visão direta, percepção de profundidade alterada, campo de trabalho reduzido, posição fixa dos trocartes, além da percepção de inversão dos movimentos das pinças (efeito fulcral) e perda da percepção háptica 4 devido à resistência dentro dos trocartes e aos instrumentos cirúrgicos longos 5 . Essas particularidades fazem que a capacitação na técnica laparoscópica apresente singularidades e abordagens próprias 6 .…”

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Avaliação de progressão da competência de estudantes de medicina na realização de pontos cirúrgicos em simulador de laparoscopia

et al. 2019

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Objetivo: avaliar a progressão da competência e a curva de aprendizagem de estudantes de Medicina submetidos a treinamento para a realização de nós e pontos cirúrgicos. Métodos: estudo prospectivo, longitudinal, intervencionista, realizado de abril/2016 a janeiro/2017, com a participação de 29 estudantes de Medicina, do primeiro ao terceiro ano, com progressão de habilidades para realização de nós e pontos laparoscópicos em ambiente de simulação em quatro etapas, com duração de 16 horas. Foi estabelecida a tarefa de realizar pontos laparoscópicos, com cinco seminós, em molde de sutura, em 18 minutos. Foram realizados os testes de ANOVA, Mann-Whitney e o qui-quadrado. Foram realizadas regressões lineares simples e múltiplas, sendo consideradas significativas as comparações com valor de p ≤ 0,05. Resultados: foram analisadas as médias do número de seminós (1,0 a 14,0, (IC-95%) 4,49 (3,80/5,19), pontos laparoscópicos intracorpóreos (0,1 a 2,7, (IC-95%) 0,87 (0,72/1,02), os tamanhos dos cotos dos fios (0,1 a 2,9, (IC-95%) 0,95 (0,72/1,18) e ajustes dos seminós iniciais (0,2 a 2,9, (IC-95%) 0,92 (0,76/1,07) e sequenciais (0,3 a 10,0, (IC-95%) 3,32 (2,84/3,80), entre as etapas do treinamento. Houve significância estatística em todos os parâmetros avaliados. A progressão na execução de pontos laparoscópicos foi evidente com coeficiente de regressão linear igual a 0,511. A curva de aprendizagem demonstrou que 96,3% dos estudantes realizaram, pelo menos, um ponto laparoscópico ao final do treinamento. Conclusão: o estudo revelou que os alunos apresentaram progressão na competência e evolução na curva de aprendizagem na realização de pontos laparoscópicos em ambiente de simulação ao final do treinamento.

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Laparoscopic suturing learning curve in an open versus closed box trainer

Cited by 22 publications

References 23 publications

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

Effect of visual feedback during laparoscopic basic training using a box trainer with a transparent top

Avaliação de progressão da competência de estudantes de medicina na realização de pontos cirúrgicos em simulador de laparoscopia

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