Mentoring a surgical team towards procedural competence in the early learning curve for selective fetoscopic laser photocoagulation

Abstract

INTRODUCTION Selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS) is challenging for new surgeons at the start of their learning curve. We described an approach utilising telementoring and team-based training to facilitate rapid attainment of the skills required for safe and efficient practice with a limited caseload. METHODS We conducted a prospective observational study of SFLP performed by the novice primary surgical team in three stages: under direct on-site supervision from an expert mentor (Group 1), with remote tele-guidance from that mentor (Group 2) and independently (Group 3), at an academic tertiary hospital in Singapore. The primary team undertook regular training on high-fidelity tissue models to accelerate skills acquisition and complement the surgical performance. RESULTS 9 patients diagnosed with Stage 2 TTTS were assessed for procedural characteristics, surgical outcomes and perinatal survival following SFLP. There were no significant differences in operative duration, anastomoses ablated, gestational age or birth weight at delivery. The complications observed were: recurrent TTTS (22.2% of pregnancies), twin anaemia polycythaemia sequence (33.3%), preterm prelabour membrane rupture (22.2%) and delivery at < 32 weeks (44.4%). ≥ 1 twin was live-born in 88.9% of cases, while postnatal survival to six months of ≥ 1 twin occurred in 77.8% of cases. CONCLUSION Systematic mentoring and specialised skills training are useful in aiding new surgeons to negotiate the steep learning curve and achieve good outcomes at the start of a new practice, particularly in the setting of low patient numbers. This is best paired with dedicated model training to achieve and maintain surgical dexterity for this complex procedure.

Remote hands‐on training with a novel “video‐game” simulator for teaching fetoscopic laser techniques for ablation of placental anastomoses in twin‐to‐twin syndrome

“…The potential role of remote simulation-enhanced education in surgical, including fetal therapy, techniques has been addressed by others. 4,5 Although there is no built-in tool for measuring learning curves, this is something that can be developed within the software and represents an area for further research. We feel that this development enhances medical education opportunities and also addresses some of the realities of the multiple costs of conference travel reported by our group and others.…”

“…The potential role of remote simulation‐enhanced education in surgical, including fetal therapy, techniques has been addressed by others 4,5 . Although there is no built‐in tool for measuring learning curves, this is something that can be developed within the software and represents an area for further research.…”

The evolution of surgical virtual education and telementoring: One surgeon's journey

“…2020—Natarajan and colleagues 94 conducted fetoscopic laser photocoagulation (SFLP) for twin‐ to‐twin transfusion syndrome using telementored guidance by a novice primary surgical team under three different conditions: (1) direct on‐site supervision, (2) remote telementoring, and (3) independent execution.…”

Resilience amidst winds of change

“…We have continued to highlight subject matters that are of topical interest, especially for our local medical community, even as we remain an international medical journal that accepts quality academic submissions from across the world. Some of these recent publications addressed diverse topics such as mentoring and competency, (2) medical professionalism, (3) responding to the challenges of COVID-19, (4) COVID-19 vaccine-related concerns, (5) and colon cancer screening at a younger age. (6) A highlight of the SMJ has been our Continuing Medical Education (CME) articles with online CME quizzes that are pre-approved for the Singapore Medical Council Category 3B CME programme.…”