Establishment of animal lab for the evaluation and training of advanced laparoscopic surgery

Yo Kuashima, MD, PhD, Yuma Ebihara, MD, PhD, Toru Nakamura, MD, PhD, Eiji Tamoto, MD, PhD, Souichi Murakami, MD, PhD, Joe Matsumoto, MD, PhD, Takahiro Tsuchikawa, MD, PhD, Toshiaki Shichinohe, MD, PhD, Satoshi Hirano, MD, PhD. Hokkaido University.

INTRODUCTION: The use of trainer box for the training of fundamental laparoscopic skills has spread widely, however, the training tools and the system of advanced laparoscopic surgery have not yet been common in the residency curriculum due to the lack of environment and instruction method. Although animal lab using porcine model is one of the best places to practice advanced procedures with similar anatomy capability of encompassing all the aspects of a real surgical experience outside of the operating room, there are few institutes that use animal lab for the training of surgical residents in Japan. We established animal lab in our institute for the training of advanced laparoscopic surgery and started the evaluation and training for surgical residents from 2012. In this study, we describe our initial experience of animal lab and demonstrate its educational potential for the evaluation and training of laparoscopic surgery in residency curriculum.

METHOD: The training sessions of advanced laparoscopic surgery were held 3 times at the animal lab in Hokkaido University from April 2012 to January 2013. Residents and practicing surgeons took part in the training session. The contents of the training were Nissen Fundoplication, gastrectomy and dissection of regional lymph node around the stomach using porcine model. Each task time and individual performance was measured using Global Operative Assessment of Laparoscopic Skills (GOALS), which was developed and validated, and was used widely as a scale of the laparoscopic surgery skills. The learners were queried about their impression of the value of the training and assessment on a scale of 1 to 5 after their training session.

RESULTS: Total 9 surgeons participated in the program. Learners level were postgraduate year (PGY) 5 to 8. The mean number of their experiences for endoscopic surgery was 98 (30-156) cases, and mean hour of previous simulation training using trainer box was 8 (1-24). The GOALS score of lymph node dissection and case number had good correlation (r = 0.6). On a scale of 1 to 5, 9 learners evaluated the animal lab session to be very useful for training (4.8 ± 0.5), excellent teaching and feedback (4.4 ± 0.5). They considered that the training sessions of advanced laparoscopic surgery might have most educational impact for the resident level PGY 3 to5.

CONCLUSION: We established animal lab for the training of advanced laparoscopic surgery. The training of laparoscopic surgery using porcine model has potential of implementation into surgical training curriculum and may better prepare residents to start advanced laparoscopic surgery.

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