Learning curve on the TrEndo laparoscopic simulator compared to an expert level.

BACKGROUND: The aim of this study was to determine growth in trainee laparoscopic skill as recorded by the TrEndo laparoscopic simulator during a laparoscopic training course, compared to an expert level. METHODS: A prospective observational cohort study was conducted between February 1 and November 31, 2010. Trainees in laparoscopic surgery completed a basic laparoscopic suturing task on a laparoscopic box trainer at three successive assessment points during a laparoscopic training course. Experts were assessed only once to define an expert level. The TrEndo recorded four motion analysis parameters (MAPs) individually for each hand and the amount of time taken to complete the suturing task. RESULTS: Seventy-two residents and 56 experts were included in this study. Overall, the amount of time taken on the suturing task and seven out of eight MAPs significantly increased toward an expert level during the course, representing an improvement in task efficiency. During the first training day, the amount of time spent on the suturing task and five out of eight MAPs improved significantly. After the retention period, five out of eight MAPS demonstrated a significant improvement compared to the end of the first training day. CONCLUSIONS: Laparoscopic skill of trainees as recorded by the TrEndo laparoscopic simulator grows toward an expert level during a laparoscopic training course in a large and heterogeneous study group. Construct validity of the TrEndo is established.

Open knot-tying skills: resident skills assessed.

AIM: Open knot-tying and suturing skills are fundamental surgical skills, founding many alternative knot-tying techniques. It is therefore mandatory for residents to possess adequate basic open knot-tying skills. The aim of this study was to compare an objective assessment of open knot-tying skills by residents to a resident's own estimation of his or her knot-tying skills, before and after a knot-tying course. MATERIAL AND METHODS: A prospective observational cohort study was performed. At baseline level, after 1 training day in the Advanced Suturing Course (ASC) in the Netherlands and Belgium and after 6 weeks of autonomous practice (i.e. self-practice), 99 residents' open knot-tying skills were objectively evaluated using the Objective Structured Assessment of Technical Skills (OSATS). The resident's own confidence in these skills was also evaluated. RESULTS: The ASC substantially and significantly improved residents' knot-tying skills according to the OSATS between baseline and post-measurement. The observed improvement after 1 training day decreased after 6 weeks of autonomous practice. Self-confidence increased directly after the training program and was maintained 6 weeks later. Residents having completed the first 3 years of residency displayed an overall greater self-confidence than residents not having completed the first 3 years of residency, although the increase in self-confidence was significantly larger in the latter after 6 weeks' autonomous training. CONCLUSION: There is a divergence between residents' objectified open knot-tying skills and self-confidence in these skills. The ASC improved open knot-tying skills according to the OSATS, however this improvement decreased after a 6-week period of autonomous practice. Self-confidence, in contrast, was maintained or increased. Further research is needed to correlate validated training programs with clinical outcomes and to determine whether residents' open knot-tying skills and self-confidence are retained beyond 1 year.

Validation of a new box trainer-related tracking device: the TrEndo.

BACKGROUND: There is an increasing demand for structured objective ex vivo training and assessment of laparoscopic psychomotor skills prior to implementation of these skills in practice. The aim of this study was to establish the internal validity of the TrEndo, a motion-tracking device, for implementation on a laparoscopic box trainer. METHODS: Face validity and content validity were addressed through a structured questionnaire. To assess construct validity, participants were divided into an expert group and a novice group and performed two basic laparoscopic tasks. The TrEndo recorded five motion analysis parameters (MAPs) and time. RESULTS: Participants demonstrated a high regard for face and content validity. All recorded MAPs differed significantly between experts and novices after performing a square knot. Overall, the TrEndo correctly assigned group membership in 84.7 and 95.7% of cases based on two laparoscopic tasks. CONCLUSION: Face, content, and construct validities of the TrEndo were established. The TrEndo holds real potential as a (home) training device.

[Simulation-based training in minimally invasive surgery: the Advanced Suturing Course]. / Simulatieonderwijs in minimaal-invasieve chirurgie: de 'Advanced suturing course'.

OBJECTIVE: To investigate the additional value of the Advanced Suturing Course (ASC) in the basic laparoscopic skills training curriculum for residents. DESIGN: Prospective cohort study. METHOD: Laparoscopic skills of 162 participants attending one of 17 ASCs held during the period April 2008-December 2010, were assessed before and after the training. Subjective and objective evaluation was performed using the Objective Structured Assessment of Technical Skills (OSATS) list and Motion Analysis Parameters (MAPs), recorded with the Training in Endoscopy tracking system, respectively. Confidence of participants in various laparoscopic tasks was rated using a visual analogue scale. RESULTS: At the end of the first course day, mean OSATS-scores were significantly higher for open and laparoscopic knot-tying tasks than before the first course day. After 6 weeks of autonomous training, these scores were unaltered. Right hand MAPs were also unaltered after this training period. Confidence of participants in completing an open or a laparoscopic knot increased significantly during the entire course, as well as confidence in completing an open or laparoscopic intestinal anastomosis. CONCLUSION: Medical simulation-based skills training appears to be an efficient method to improve certain basic laparoscopic skills in a relatively short period. Regular practice, sufficient opportunities for evaluation and feedback, and skills assessment are hereby critical.

Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection.

BACKGROUND: Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-week autonomous training period at home on a traditional laparoscopic box trainer. Previous research did not demonstrate a significant progress in laparoscopic skills after this training period. This study aims to identify factors determining autonomous training on a laparoscopic box trainer at home. METHODS: Residents (n = 97) attending 1 of 7 ASC courses between January 2009 and June 2011 were consecutively included. After 6 weeks of autonomous, training a questionnaire was completed. A random subgroup of 30 residents was requested to keep a time log. All residents received an online survey after attending the ASC. We performed outcome comparison to examine the accuracy of individual responses. RESULTS: Out of 97 residents, the main motives for noncompliant autonomous training included a lack of (training) time after working hours (n = 80, 83.3%), preferred practice time during working hours (n = 76, 31.6%), or another surgical interest than MIS (n = 79, 15.2%). Previously set training goals would encourage autonomous training according to 27.8% (n = 18) of residents. Thirty participants submitted a time log and reported an average 76.5-minute weekly training time. All residents confirmed that autonomous home practice on a laparoscopic box trainer is valuable. CONCLUSIONS: Autonomous practice should be structured and inclusive of adequate and sufficient feedback points. A minimally required practice time should be set. An obligatory assessment, including corresponding consequence should be conducted. Compliance herewith may result in increased voluntary (autonomous) simulator based (laparoscopic) training by residents.

Mapping the maze of minimally invasive surgery simulators.

BACKGROUND: Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS: A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS: Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS: No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.

Evaluation of a technical skills training program in surgical residents.

BACKGROUND: In recent years, the interest for training programs to teach technical skills has enormously grown. The aim of this study was to evaluate the influence of surgical training on the technical skills of surgical residents. METHODS: Forty residents participated in a training program consisting of 1 training day followed by 6 weeks of autonomous training. Participants were asked to rate their confidence with the open and laparoscopic knot-tying technique by a visual analog scale before and after the training day (post), and after the period of autonomous training (follow-up). Objective assessment was performed according to the Objective Structured Assessment of Technical Skills. RESULTS: Mean (+ or - standard deviation) baseline confidence of participants with the open technique was 68.2 + or - 14.5, increased post to 76.4 + or - 13.2 (P < 0.001), and was 77.8 + or - 9.6 at follow-up (not significant). Mean objective score was post increased from 19.2 + or - 3.5 to 21.4 + or - 3.4 (P = 0.001) but decreased to 20.2 + or - 4.1 at follow-up. For the laparoscopic technique, mean confidence increased from 20.6 + or - 14.4 to 47.2 + or - 19.0 post, and 62.7 + or - 14.0 at follow-up (P < 0.001 for both). Mean objective score was post increased from 22.1 + or - 8.2 to 34.9 + or - 6.4 (P = 0.001), which did not change at follow-up (33.3 + or - 7.5). CONCLUSIONS: In this study, confidence in the open knot-tying technique first increased after the initial training day and then stabilized, whereas the objective level initially improved, but returned to baseline level at follow-up. Regarding the laparoscopic technique, a significant increase of confidence after both the training and after 6 weeks of follow-up was observed. Improvement of the objective level after the training day was maintained at follow-up.