Learning efficacy between a 30 degree rigid scope and a flexible scope in newly educated medical personnel for laparoscopic colorectal procedure: a prospective, comparative study

Young-Jae Lee, MD, Seon-Hahn Kim, MD, PhD. Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Background: During laparoscopic surgery, the scope is often maneuvered by novice in operation. This study was designed to find out which of the two types of scopes (30° rigid scope and flexible scope) is easier to learn and manipulate on the operating table.

Methods: Twenty interns, sub-interns and medical students who were new to laparoscopic surgery were involved. Prior to surgery, handling of the two different scopes, the 10-mm 30° rigid videoscope (EndoEye WA50013A, Olympus) and the flexible laparoscope (LTV-VH, Olympus), were briefly educated and instructed how to manipulate. The first scope to be used was randomly selected between the two and the scopes were changed 3 times alternatively during the entire procedure. After surgery, the participants were given five parameters to score, from 0 (the hardest) to 5 (the easiest); (1) understandability of initial scope handling instructions, (2) easiness to attain proficiency, (3) feasibility of scope operation, (4) convenience of providing adequate views for colonic procedures, and (5) convenience of providing adequate views for rectal procedures. The ratings were collected and analyzed by Kruskal-Wallis test. 

Results: Understandability scores for the 30° rigid and the flexible scope were 69 and 73 respectively (p=0.450), proficiency scores were 58 and 72 (p=0.039), feasibility scores were 57 and 63 (p=0.198), convenience scores for colonic field visualization were 65 and 74 (p=0.044), and convenience scores for rectal field visualization were 61 and 68 (p=0.172), respectively. The total sum of all 5 parameters was 310 for the 30° scope and 350 for the flexible scope (p=0.001).

Conclusions: The flexible scope obtained higher score totals on all 5 learning efficacy parameters. A flexible scope seems easier than a 30° rigid scope for novice surgeons to use during laparoscopic colorectal procedures.

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