SIMULATION TRAINING

Evaluation of procedural simulation as a training and assessment tool in general surgery

Simulating a laparoscopic appendectomy

Simulating a laparoscopic appendectomy

Simulating a laparoscopic appendectomy

Published on

October 4, 2016

Journal of Surgical Education

Flemming Bjerrum, Jeanett Strandbygaard, Susanne Rosthøj, Teodor Grantcharov, Bent Ottesen, Jette Led Sorensen
Flemming Bjerrum, Jeanett Strandbygaard, Susanne Rosthøj, Teodor Grantcharov, Bent Ottesen, Jette Led Sorensen
Flemming Bjerrum, Jeanett Strandbygaard, Susanne Rosthøj, Teodor Grantcharov, Bent Ottesen, Jette Led Sorensen

Overview

A prospective cohort study evaluated a virtual reality module designed for practicing laparoscopic appendectomy, involving 45 surgeons categorized as novices, intermediates, and experienced based on their procedural experience. Participants underwent one familiarization attempt followed by 20 practice sessions. Results indicated that experienced surgeons performed the procedure with significantly fewer movements and less time than novices during the initial attempt. All groups showed significant improvement over practice sessions, although only a limited number of specific performance parameters differed between novices and intermediates. Notably, novices were at a higher risk for specific errors such as burn damage to the cecum and pressure damage to the appendix.

While the simulator demonstrated potential as a training tool, it requires further refinement for effective assessment. The findings suggest that procedural simulation can provide insights into movement parameters, but future research should aim to enhance the specificity and variability of these metrics to better evaluate surgical competence.

Results

The time and movement parameters were significantly different during the first attempt, and more experienced surgeons used fewer movements and less time than novices (p < 0.01), although only 2 parameters were significantly different between novices and intermediates. All 3 groups improved significantly over 20 attempts (p < 0.0001). The intraclass correlation coefficient varied between 0.55 and 0.68 and did not differ significantly between the 3 groups (p > 0.05). When comparing novices with experienced surgeons, novices had a higher risk of burn damage to cecum (odds ratio [OR] = 3.0 [95% CI: 1.3; 7.0] p = 0.03), pressure damage to appendix (OR = 3.1 [95% CI: 2.0; 4.9] p < 0.0001), and grasping of the appendix (OR = 2.9 [95% CI: 1.8; 4.7] p < 0.0001). The risk of causing a perforation was not significantly different among the different experience levels (OR = 1.9 [95% CI: 0.9; 3.8] p = 0.14). Only 3 out of 5 error parameters differed significantly when comparing novices and experienced surgeons. Similarly, when comparing intermediates and novices, it was only 2 of the parameters that differed.

Copyright. All Rights Reserved 2024
Copyright. All Rights Reserved 2024
Copyright. All Rights Reserved 2024