Prediction of laparoscopic skills: objective learning curve analysis

Abstract

Introduction Prediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box. Methods Surgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency. Results A total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses. Conclusion The learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

“…In contrast, during a study on robotic inguinal hernia repair, objective robot generated performance metrics have been shown to be accurate and more reliable than self-awareness or even faculty surgeons assessment [47]. This was also concluded by our previous work regarding the use of objective force-based parameters to assess technical skills during laparoscopic skills training [29,30,48]. Following force-based assessment tools for LS, validity evidence for objective assessment tools for RAS in accumulating [15,16,[49][50][51][52].…”

A spaced retraining schedule with 2‐day interval improves the acquisition and retention of simulation‐based basic arthroscopic skills

“…Arthroscopic methods are rapidly developing, and residents are being required to master increasingly complex surgical skills in a shorter period [2]. Thus, it is important to consider the steep learning curve of this specialty [16][17][18][19][20][21]. In recent years, simulation training has been used in other surgical areas, and studies have shown that practising surgical skills using a proven simulator can effectively shorten the learning curve [20].…”

“…In recent years, simulation training has been used in other surgical areas, and studies have shown that practising surgical skills using a proven simulator can effectively shorten the learning curve [20]. Given the ethical limitations of practising new techniques on humans and the need for extensive and repetitive practise, simulatorbased training provides a feasible alternative [1,2,13,17].…”

Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy

“…The main surgeon and surgical team need skilled laparoscopic operating skills and tacit cooperation, which put forward high requirements for liver surgeons and therefore limit the development of laparoscopic right posterior lobe liver surgery, and reports indicate that it is still being explored. 13 Because of its special anatomic relationship, for right posterior lobe liver lesions, surgeons often choose to perform right hemihepatectomy in order to reduce the difficulty, remove more healthy liver tissues and increase the risk of liver failure, which is not in line with the concepts of rapid recovery and precision surgery. 14 Studies have shown that laparoscopic nonanatomical right posterior lobectomy in the left lateral decubitus position with a pararectus view port has the advantages of wide field of view, simple steps, short operation time, and less bleeding, which is more conducive to laparoscopic resection of right posterior lobe tumors of the liver.…”

“…Because the right posterior lobe of the liver is deeply located, covered by the costal arch, and difficult to expose, the section area during right posterior lobectomy is larger than that during right hemihepatectomy, and this section has a portal sheath system intersecting the right hepatic vein system, 12 and various intrahepatic ducts encountered during parenchymal transection are complex and have a high risk of intraoperative bleeding, resulting in the fact that it is often difficult to effectively control bleeding when laparoscopic operations encounter massive hemorrhage, and conversion to laparotomy is necessary. The main surgeon and surgical team need skilled laparoscopic operating skills and tacit cooperation, which put forward high requirements for liver surgeons and therefore limit the development of laparoscopic right posterior lobe liver surgery, and reports indicate that it is still being explored 13 . Because of its special anatomic relationship, for right posterior lobe liver lesions, surgeons often choose to perform right hemihepatectomy in order to reduce the difficulty, remove more healthy liver tissues and increase the risk of liver failure, which is not in line with the concepts of rapid recovery and precision surgery 14 …”