Can Therapeutic Minimally Invasive Trauma Be Taught?

Heidi Ryan, MD, Shawn Tsuda, MD, FACS, Timothy Browder, MD, FACS

University of Nevada School of Medicine

The principles of minimally invasive surgery are the same in trauma as they are in any other specialty of general surgery. Laparoscopy in the trauma patient may reduce non-therapeutic laparotomies and its 41% short-term complication rate. Recent literature has confirmed the utility of laparoscopy as a diagnostic and therapeutic tool in trauma. There is still a paucity of prospective research in the area of therapeutic minimally invasive trauma (MIT) surgery. This study assessed the efficacy of a proficiency based simulation course in teaching minimally invasive skills in the management of trauma.

A MIT course was offered to surgical residents and fellows (n=11). A didactic and proficiency based simulation lab covered four topics: diagnostic laparoscopy, hemostasis and energy, mechanical stapling, and intra-corporeal suturing. A live porcine lab with standardized injuries assessed newly acquired skills. Pre- and post-course surveys were obtained. Blinded experts reviewed videos of animate procedures.

All participants achieved proficiency in didactic and dry simulated evaluations, and completed diagnostic laparoscopy in the porcine models. The following are percentage of participants recognizing and repairing standardized injuries in the animate lab with a maximum of 120 minutes.

Injuries% recognized% repaired
Liver laceration10082
Gastric injury8264
Small bowel injury (<1cm)8282
Small bowel injury (>2cm)6464

User impressions were favorable for didactic (5 ± 0.0), dry-lab (4.89 ± 0.32), and animate (4.91 ± 0.42) portions of the course.

The applications of MIT surgery are evolving and require further investigation. A didactic, dry simulation, and animate lab may provide trainees with basic acquisition of diagnostic and therapeutic skill. Advance therapeutic maneuvers such as identification and repair of hollow viscus injuries may require further training.

Session: Poster Presentation

Program Number: P163

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