The Welsh Institute for Minimal Access Therapy colonoscopy suitcase has construct and concurrent validity for colonoscopic polypectomy skills training: a prospective, cross-sectional study.

BACKGROUND: The Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase is an ex vivo porcine simulator for polypectomy training. OBJECTIVE: To establish whether this model has construct and concurrent validity. DESIGN: Prospective, cross-sectional study. SETTING: Endoscopic training center. PARTICIPANTS: Twenty novice (N), 20 intermediate (I), 20 advanced (Ad), and 20 expert (E) colonoscopists. INTERVENTION: A simulated polypectomy task aimed at removing 2 polyps; A (simple), B (complex). MAIN OUTCOME MEASUREMENTS: Two accredited colonoscopists, blinded to group allocation, scored performances according to Direct Observation of Polypectomy Skills (DOPyS) assessment parameters. Group performances were compared. Real-life DOPyS scores were correlated to simulator DOPyS results. RESULTS: Median overall DOPyS scores for novices were 1.00 (1.00-1.87) for A and 0.50 (0.00-1.00) for B (A vs B; P < .01). Intermediates scored 2.50 (2.00-2.88) for A and 2.00 (1.13-2.50) for B (A vs B; P = .03). The advanced group scored 3.00 (2.50-3.50) for A and 2.50 (2.00-3.00) for B (A vs B; P = .01). Experts scored 3.00 (3.00-3.88) for A and 3.00 (2.50-3.50) for B (A vs B; P = .47). Intergroup comparisons for A were, N vs I; P < .01, N vs Ad; P < .01, N vs E; P < .01, I vs Ad; P < .01, I vs E; P < .01, and Ad vs E; P = .46. Intergroup comparisons for B were, N vs I; P < .01, N vs Ad; P < .01, N vs E; P < .01, I vs Ad; P = .03, I vs E; P <.01, and Ad vs E; P = .06. There was no difference between real-life DOPyS scores and simulator scores (0.07). LIMITATIONS: The model does not have inbuilt assessment parameters. CONCLUSION: This simulator demonstrates construct and concurrent validity for colon polypectomy training.

Electrostatic precipitation is a novel way of maintaining visual field clarity during laparoscopic surgery: a prospective double-blind randomized controlled pilot study.

BACKGROUND: Ultravision™ is a new device that utilizes electrostatic precipitation to clear surgical smoke. The aim was to evaluate its performance during laparoscopic cholecystectomy. METHODS: Patients undergoing laparoscopic cholecystectomy were randomized into "active (device on)" or "control (device off)." Three operating surgeons scored the percentage effective visibility and three reviewers scored the percentage of the procedure where smoke was present. All assessors also used a 5-point scale (1 = imperceptible/excellent and 5 = very annoying/bad) to rate visual impairment. Secondary outcomes were the number of smoke-related pauses, camera cleaning, and pneumoperitoneum reductions. Mean results are presented with 95% confidence intervals (CI). RESULTS: In 30 patients (active 13, control 17), the effective visibility was 89.2% (83.3-95.0) for active cases and 71.2% (65.7-76.7) for controls. The proportion of the procedure where smoke was present was 41.1% (33.8-48.3) for active cases and 61.5% (49.0-74.1) for controls. Operating surgeons rated the visual impairment as 2.2 (1.7-2.6) for active cases and 3.2 (2.8-3.5) for controls. Reviewers rated the visual impairment as 2.3 (2.0-2.5) for active cases and 3.2 (2.8-3.7) for controls. In the active group, 23% of procedures were paused to allow smoke clearance compared to 94% of control cases. Camera cleaning was not needed in 85% of active procedures and 35% of controls. The pneumoperitoneum was reduced in 0% of active cases and 88% of controls. CONCLUSIONS: Ultravision™ improves visibility during laparoscopic surgery and reduces delays in surgery for smoke clearance and camera cleaning.

The Role of National Specialist Societies in Influencing Transformational Change in Low-Middle Income Countries - Reflections on the Model of Implementation for a National Endoscopy Training Programme in Bangladesh.

The British Society of Gastroenterology (BSG) and the Bangladesh Gastroenterology Society (BGS) have collaborated on an endoscopy training programme, which has grown up over the past decade from a small scheme borne out of the ideas of consultant gastroenterologists in Swansea, South Wales (United Kingdom) to improve gastroenterology services in Bangladesh to become a formalised training programme with broad reach. In this article, we document the socioeconomic and historical problems that beset Bangladesh, the current training needs of doctors and how the BSG-BGS collaboration has made inroads into changing outcomes both for gastroenterologists in Bangladesh, but also for the populations they serve.

Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy.

Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training.

Can endoscopists accurately self-assess performance during simulated colonoscopic polypectomy? A prospective, cross-sectional study.

BACKGROUND: The aim of this study was to establish if endoscopists can reliably self-assess their ability to perform simulated colonic polypectomy. METHODS: Novices, intermediates, advanced, and experts performed a video-recorded polypectomy task using the Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase simulator. This involved removal of a simple polyp (A) and a complex polyp (B). Participants self-assessed themselves using a Direct Observation of Polypectomy Skills (DOPyS) assessment form. Two blinded, independent, Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accredited assessors graded each performance using the same DOPyS scoring. The Spearman coefficient was used to determine the correlation between self and assessors' scores. RESULTS: Eighty participants completed the task. There was a weak correlation between assessors' scores and self-assessment scores for all groups (novices: ρ = -.44, P = .85; intermediates: ρ = -.16, P = .51; advanced: ρ = .16, P = .50; and experts: ρ = .07, P = .76). There was a strong correlation between scores from assessor 1 and 2 for polyp A (ρ = .80, P ≤ .01) and polyp B (ρ = .80, P ≤ .01). CONCLUSIONS: The correlation between self-assessment and assessors' scores is weak. Novices and intermediates underestimate performance, whereas advanced and experts overestimate performance. Regular feedback may improve accuracy.