Comparison of different simulator training methods in laparoscopic colorectal surgery: A systematic review

Khoshe A Faraj, Anna Donen, Bijendra Patel. Barts and the London school of Medicine and Dentistry

Background: The spread of surgical simulation in the last decade and its role for training outside operating theatres has had many positive impacts on surgical outcomes, especially in the field of laparoscopy. However, the effects of individual training models have not yet been explored in detail, particularly for Laparoscopic Colorectal Surgery (LCS). The aim of this systematic review is to compare the effect of different simulators in training for LCS.

Methodology: Two reviewers conducted this systematic review separately, through extensive search in databases such as PubMed, Embase, Ovid, Web of Science and Google Scholar. The key words used were (“training” OR “learning”) AND “simulator” AND “laparoscopic” AND “colorectal” AND “surgery”. Additional studies were obtained through manual searching of the reference lists of the retrieved studies and related articles section. The validated Preferred Reporting in Systematic Reviews and Meta-Analyses (PRISMA) method was used to report search results.

Results: Twelve original articles were included in this systematic review. These studies were heterogeneous in various aspects: type of the studies, the experience level of participants and nature of the training sessions. Virtual Reality (VR) and Augmented Virtual Reality (AVR) simulators reported significant results regarding technical skills when used alone and compared to cadaver models. However, overall satisfaction rate with cadavers as a training model was higher when compared to VR and AVR. While there was neutral satisfaction rate between cadaver and animal model, no studies were found assessing technical skills after training on animal models.

Conclusion: This systematic review demonstrated that no single simulator training model was superior in laparoscopic colorectal surgery. However, it has emphasized the role of AVR for teaching advanced technical skills. There is a need for more comparative studies and randomized trials in the future; comparing all simulator training models in similar training settings, involving participants of the same prior experience level. 

Key words: laparoscopy, colorectal, surgery, simulator, training

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