Evaluación del entrenamiento de residentes en cirugía laparoscópica en el laboratorio basado en un modelo de anastomosis digestivas / Assessment of resident training in laparoscopic surgery based on a digestive system anastomosis model in the laboratory

IntroducciónLa complejidad de la cirugía laparoscópica hace necesario un entrenamiento específico fuera del quirófano para acortar la curva de aprendizaje y reducir la morbilidad. El objetivo del estudio es analizar la progresión en habilidades laparoscópicas tras un programa de entrenamiento en laboratorio.Material y métodosEstudio prospectivo de un programa de entrenamiento de residentes de 4 semanas anuales (20 h semanales) basado en anastomosis en endotrainer, realizado entre 2004 y 2007. Los parámetros principales fueron tiempo y número de anastomosis necesarias hasta llegar a una correcta ejecución. Una vez completada, la anastomosis se revisó conjuntamente mediante un residente y un monitor. Se registraron tiempo de ejecución y fallos anastomóticos (sutura floja, eversión de bordes y fuga).ResultadosDoce residentes realizaron 189 anastomosis yeyunoyeyunales (AYY) (media: 15,8) y 197 anastomosis gastroyeyunales (AGY) (media: 16,4). El tiempo medio de las AYY fue de 72,7min y el de las AGY fue de 87,2min. Se observó una gran reducción en el tiempo de ejecución desde el comienzo al final del programa. El porcentaje de anastomosis incorrectas disminuyó en función del tiempo de entrenamiento: el 26,6; el 21,8; el 17,1; el 17; el 16,1 y el 10,5% después de 20; 40; 60; 80; 100 y 120h, respectivamente. Considerando la reducción, tanto en tiempo de ejecución como en el índice de anastomosis incorrectas, después de 70h de entrenamiento la curva de aprendizaje alcanzaba una meseta.ConclusionesEl entrenamiento en endotrainer basado en anastomosis intestinales (tanto AYY o AGY) constituye un método útil de entrenamiento laparoscópico. Después de un entrenamiento de 70h se aprecia poca progresión (AU)

BackgroundThe complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program.Material and methodsProspective study of surgical resident training based on anastomosis performance on an “endotrainer”. The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded.ResultsTwelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70h of training the learning curve reaches a plateau zone.ConclusionsIntestinal anastomosis (either JJA or GJA) performed in “endotrainer” is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit (AU)

[Assessment of resident training in laparoscopic surgery based on a digestive system anastomosis model in the laboratory]. / Evaluación del entrenamiento de residentes en cirugía laparoscópica en el laboratorio basado en un modelo de anastomosis digestivas.

BACKGROUND: The complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program. MATERIAL AND METHODS: Prospective study of surgical resident training based on anastomosis performance on an "endotrainer". The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded. RESULTS: Twelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7 min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120 h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70 h of training the learning curve reaches a plateau zone. CONCLUSIONS: Intestinal anastomosis (either JJA or GJA) performed in "endotrainer" is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit.

[Surgical resident training program in minimally invasive surgery experimental laboratory (CENDOS)]. / Programa de formación del residente de cirugía en un laboratorio experimental de cirugía minimamente invasiva (CENDOS).

INTRODUCTION: The rapid development of laparoscopic surgery makes resident training programmes necessary. OBJECTIVE: To analyse the results of a structured programme of laparoscopic training in an experimental laboratory. MATERIAL AND METHOD: From 2003 until 2007, we trained 11 general surgery residents for 20 h every 3 months, for three years. The practice consisted of suture and anastomosis in Endo-Trainer with animal organs, as well as laparoscopic techniques in live animals. In the Endo-Trainer practice we evaluated the time and quality of anastomosis performance. In laparoscopic techniques (cholecystectomy and anti-reflux surgery) a task table was evaluated, from 0 (no errors) to 100 (severe lesion). RESULTS: In total, 314 anastomosis were performed by the 11 residents, with a median of 28.5 per resident (24-42). The mean time for the first gastro-jejunal anastomosis was 135 min (100-140) and 65 min (57.5-105) for the first jejunal-jejunal anastomosis. Maximum learning was achieved after 45 training hours. There were no appreciable differences between both types of anastomosis. There was inadequate anastomosis quality due to leakage in 17.1% during the learning period and 13.7% during the consolidation period. In the animal, 172 procedures were performed. In cholecystectomy and anti-reflux surgery the mean scores were 2.4 and 5.6 points, respectively. In the remaining procedures, subjectively evaluated by the monitors, the quality was adequate in 65%, deficient in 22% and highly deficient in 13%. CONCLUSIONS: This structured programme of laparoscopic skills based on intestinal anastomosis allows for quicker resident training.

Programa de formación del residente de cirugía en un laboratorio experimental de cirugía minimamente invasiva (CENDOS) / Surgical resident training program in minimally invasive surgery experimental laboratory (CENDOS)

Introducción: el rápido avance de la cirugía laparoscópica obliga a cambiar los métodos de enseñanza de residentes. Objetivo: analizar los resultados de un programa estructurado de formación laparoscópica en laboratorio experimental. Material y método: entre 2003 y 2007, entrenamos a 11 residentes de cirugía general 20h por trimestre durante 3 años. Incluimos habilidades en suturas y anastomosis en endotrainer con órganos animales y técnicas laparoscópicas en animales vivos. En la práctica en cajas, se registraron tiempo y calidad anastomótica. En la laparoscopia realizada al animal (colecistectomía y antirreflujo), se puntuó una tabla de tareas de 0 (ningún error) a 100 (lesión grave).Resultados: los 11 residentes realizaron 314 anastomosis, con una media de 28,5 (24-42) anastomosis/residente. La mediana de tiempo para la primera anastomosis gastroyeyunal fue 135 (100-140) min y para la yeyunoyeyunal, 65 (57,5-105) min. El máximo aprendizaje se produjo transcurridas 45h de entrenamiento. No se apreciaron diferencias en la ejecución de ambas anastomosis. Se registró deficiente calidad anastomótica, determinada por existencia de fuga, en el 17,1% durante el período de aprendizaje y el 13,7% durante el de consolidación. En el animal realizaron 172 procedimientos. En colecistectomía y antirreflujo hubo una media de 2,4 y 5,6 puntos. En el resto de procedimientos, valorados subjetivamente por el monitor, la calidad de la técnica fue correcta en el 65%, mejorable en el 22% y muy mejorable en el 13%.Conclusiones: este programa estructurado de habilidades laparoscópicas basado en la ejecución de anastomosis intestinales permite acelerar la formación de los residentes (AU)

Introduction: The rapid development of laparoscopic surgery makes resident training programmes necessary. Objective: To analyse the results of a structured programme of laparoscopic training in an experimental laboratory. Material and method: From 2003 until 2007, we trained 11 general surgery residents for 20h every 3 months, for three years. The practice consisted of suture and anastomosis in Endo-Trainer with animal organs, as well as laparoscopic techniques in live animals. In the Endo-Trainer practice we evaluated the time and quality of anastomosis performance. In laparoscopic techniques (cholecystectomy and anti-reflux surgery) a task table was evaluated, from 0 (no errors) to 100 (severe lesion).Results: In total, 314 anastomosis were performed by the 11 residents, with a median of 28.5 per resident (24–42). The mean time for the first gastro-jejunal anastomosis was 135min (100–140) and 65min (57.5–105) for the first jejunal-jejunal anastomosis. Maximum learning was achieved after 45 training hours. There were no appreciable differences between both types of anastomosis. There was inadequate anastomosis quality due to leakage in 17.1% during the learning period and 13.7% during the consolidation period. In the animal, 172 procedures were performed. In cholecystectomy and anti-reflux surgery the mean scores were 2.4 and 5.6 points, respectively. In the remaining procedures, subjectively evaluated by the monitors, the quality was adequate in 65%, deficient in 22% and highly deficient in 13%.Conclusions: This structured programme of laparoscopic skills based on intestinal anastomosis allows for quicker resident training (AU)