Introduction: Laparoscopic skills training outside the operating room is becoming the standard for educating surgical residents. Because of the specific procedure, and the difference from open surgery, it is imperative to establish unique training system to promote efficiency of learning laparoscopic skills. Recently in Japan, Japanese Society for Endoscopic Surgery (JSES) authorized technical experts who were certificated their laparoscopic skills. The aim of this study was to evaluate the efficiency of learning laparoscopic skills with or without authorized experts of JSES during “Hands on training” and “Step by step training”
Methods: Among patients who underwent laparoscopic surgery for colo-rectal cancer from May 2004 to July 2008 at the Tokushima Univ., 30 patients during early period and 10 patients during late period of induction of laparoscopic surgery, 12 patients who underwent laparoscopic surgery by resident under the guidance of authorized technical experts of JSES, and 30 patients who underwent laparoscopic surgery by authorized technical experts of JSES were investigated. Preoperative simulation using virtual images with MD-CT, PET-CT and diffusion-weighted MRI (DW-MRI) were performed everytime to ensure the anatomy. Each procedure was then broken down into its key components (exposure internal approach, outer approach, isolation of the vascular pedicle, dissection of the lymph nodes, and anastomosis), operation time, amount of blood loss, intra- and post-operative complications, and conversion to open surgery were investigated. There was no significant difference between resident and expert in duration of each part of procedure, whereas there was significant prolongation in early period compared with late period, resident and expert.
Results: Operative procedure: colon resection: 12: 5: 5: 9 (early period: late period: resident: expert), high anterior resection: 2: 2: 4: 6, low anterior resection: 12: 2: 3: 12, Miles operation: 4: 1: 0: 3. Operation time: 477: 333: 262: 220min., amount of blood loss: 494: 73: 21: 20ml, and complications: ileus: 0: 1: 0: 0, leakage: 1: 1: 3: 0. neurologic disturbance: 2: 1: 0: 0.
Discussion: Instruction by authorized technical experts of JSES is helpful to avoid pitfalls which not seen in open surgery, such as a small working space, limited instrument movement, decreased tactile sensation, and counterintuitive manipulation of instruments in a 2-dimensional visual field.
Conclusions: Intra-operative step by step instruction by authorized technical experts of JSES is very helpful to learn laparoscopic skills more effectively than without expert.
Program Number: P252