Pablo A Achurra, MD, Ruben Avila, MD, Rodrigo Tejos, Richard Castillo, MD, Erwin Buckel, MD, Felipe Leon, MD, Fernando Pimentel, MD, Fernando Crovari, MD, Nicolas Jarufe, MD, Julian Varas, MD. Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile
Introduction: Minimally invasive surgery is currently the gold standard approach for many abdominal procedures but is associated to a long learning curve. As an answer to growing patient safety concerns, advancing technology and working hour restrictions, simulation-based training is becoming the recommended method to acquire basic and advanced surgical skills.
Objective: To present the results of a 5-years experience of a validated advanced laparoscopy simulation-based training program.
Methods: Assessment: All participants had to perform a hand-sewn laparoscopic jejuno-jejunostomy in a validated ex-vivo simulation model before and after the training course. Time, Global and Specific rating scales (GRS and SRS), permeability and leakage of the anastomosis were recorded in both evaluations. Data was analyzed using Wilcoxon and Mann-Whitney tests.
Simulation Based Training Program: The training program included 14 sessions of ascending difficulty, where the trainees learned to perform the hand-sewn jejunojejunostomy in a progressive cumulative manner in an ex-vivo bowel model. In each session the trainees learned through explicative videos, deliberate practice and effective feedback given by expert teachers. In order to complete the course the trainees had to perform the anastomosis in less than 30 minutes, with good permeability, no leakage and optimal rating scores (GRS>20; SRS>15). If the trainees didn’t achieve this outcomes, they had two additional training/assessment sessions before failing the program.
Results: Between the years 2010 and 2015, 174 trainees underwent the simulation program, 77% male gender and 19% of other Latin-American countries. At the end of the study period, 135 (78%) trainees had finished the training course and were considered for analysis. In the initial assessment the mean time was 38 min (range: 20,4 – 60min), mean GRS 11,8 (range: 5-20) and SRS 9,2 (range: 4-15). Leakage was observed in 84% of the anastomosis.
After the training, mean time was 19,8 min. (range: 10,4- 33min), mean GRS 23,1 (19-25), SRS 18,3 (15-20) and 100% permeable and without leakage. Statistical difference was found for all variables when compared to initial evaluation (p<0,001). Two trainees failed the course (1,1%).
Twenty laparoscopic experts surgeons were measured in the same task, mean time was 22 min (15,8-27,4 min); mean GRS 24 (23-25); and SRS 19 (18-19). No statistical difference was found between experts and trainees’ final evaluation.
Conclusion: A structured advanced laparoscopy simulation program based on deliberate practice and effective feedback is able to train a great number of surgeons with low failure rates and standards similar to experts.