Morimasa Tomikawa, MD, PhD, FACS, Munenori Uemura, MMedSci, Yoshihiro Nagao, MD, Norifumi Tsutsumi, MD, PhD, Ryuichi Kumashiro, MD, Ryota Souzaki, MD, PhD, Kenoki Ohuchida, MD, PhD, Satoshi Ieiri, MD, PhD, Takeshi Ohdaira, MD, PhD, Makoto Hashizume, MD, PhD, FACS
Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Kyushu University
Aim: To evaluate the effectiveness of an integrated 2-day standardized laparoscopic surgery training course at a single center in Kyushu University. The skills assessments at the beginning and at the end of the course were analyzed.
Methods: The 2-day standardized laparoscopic surgery training course that is composed of lectures, box training, virtual reality simulator training and live tissue training has been held on a monthly basis since the minimally invasive surgery training center was established in January 2004. The backgrounds of the trainees were subject to analyses. The skills for laparoscopic surgery of the trainees were assessed by our originally-developed skills assessment task based on laparoscopic suturing and knot-tying in box trainer. The manipulation time of the needle holders such as time spent holding the needle, knot-tying time, and the number of completed sutures , etc. were recorded. To assess the precise handling of the needle holders, errors such as the numbers of sutures out of the targets, and the rubber sheet injuries, etc. were recorded. A three-dimensional electromagnetic tracking system (AURORA; Northern Digital Inc. Canada) was used to analyze the spatial path length and average tip speed of the needle holders. The recorded data of the tasks at the beginning of the course were compared with those at the end of the course.
Results: From January 2004 to July 2012, the 2-day standardized courses were held total of 73 times and a total of 817 trainees attended in the course. The trainees were consisted of 718 males and 99 females, with the mean age of 35.1 ± 7.3 years old. The postgraduate period was 9.4 ± 7.2 years and the median number of the experiences of operators of laparoscopic surgery was 30 times. Some far-experienced surgeons who have postgraduate period of over 40 years have also attended as trainees. The trainees had wide variety of specialties such as general surgery in 600 (73.4%), gynecological surgery in 58 (7.1%), pediatric surgery in 37 (4.5%), urological surgery in 20 (2.4%), and so on. Except time spent holding the needle, the manipulation times of the needle holders were significantly shorter, and the number of completed sutures was significantly more at the end of the course than at the beginning. Except the events that a needle drops out of sight from the laparoscopic view, precise handling at the end of the course showed significantly poor results compared with the beginning of the course. As for the spatial path length and the average tip speed of the needle holders, the wide deviations of right hand paths decreased, and both the spatial path length and the average tip speed of the needle holders of the left hand at the end of the course significantly increased.
Conclusions: We have developed an integrated training program and gathered the most cumulative trainees which have never been seen. While suturing and knot-tying can get faster within a short space of time, mastering precise techniques for fundamentals of laparoscopic surgery may further be needed a consecutive training.
Session: Poster Presentation
Program Number: P155
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