Endoscopic Painting as Pelvic Box Training Exercise

Michael Dennis I dela Paz, MD. AMOSUP Seamen’s Hospital, Intramuros, Manila

It is proven that the use of simulators in laparoscopy such as that of laparoscopic trainer box exercise have significant advantage to skills development in supplement to standard preceptorship program.  Various tasks such as bead transfer, grape peeling, shape cutting and rope running develops hand eye coordination, depth perception, spatial coordination instrumental tactile feedback, tissue handling skills and improvement of skills of non-dominant hand.  The strength of these exercises is that it lessen the steep learning curve in laparoscopic surgery.  The weakness of these exercises is that the sequence of being repetitive and the absences of aim of achievement makes it boring that most of the trainee surgeon in a basic surgical workshop would just spend just a few minutes to the exercise.  In an international study, they found out that at least 30-minutes a day or at least 3 hours a week of laparoscopic box exercise is needed to significantly acquire the needed skills in laparoscopic surgery.

It is the above mentioned weakness factors of standard laparoscopic box trainer exercises that  modification  of the exercise was done in a creative and enthusiastic way through endoscopic painting during the laparoscopic preceptorship training of the author. The purpose of this paper is to introduce an innovative, creative, and enthusiastic way of skill exercise in Laparoscopic Box Trainer through Endoscopic Painting for the improvement of learning curve in basic laparoscopic skills of the trainee surgeon. Innovation and recycling of an old disposable laparoscopic dissector was done replacing it’s tip with the tip of the paint brush.  A makeshift laparoscopic box trainer with a horizontal metal bar was used for the attachment of a miniature canvas.  Using the tools of children in their art class such as set of acrylic or oil paint and the mixing/washing container, the author was able to create his first miniature masterpiece entitled “the Biliary Tree” for around one hour, a disastrous painting as of that of a Pre-school student but the experience proved that the exercise procedure is feasible and rewarding.  Further modification of the instrument specifically creating the long shaft paintbrush which mimics the laparoscopic hook dissector made the painting exercise as if the trainee is dissecting the peritoneum of the gallbladder from the liver bed or cauterizing the bleeder in the liver bed using the hook.  With time I was able to develop author trainee developed his endoscopic skills as well as enjoyed painting.

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