Bilal Khan, MD, Nova Szoka, MD, Timothy Perez, MD
University of New Mexico
Objective of the technology
During laparoscopic surgery the role of the assistant is vital to support the actions of the primary surgeon. Despite this critical role, neither the performance of the assistant individually nor the dynamics of the surgeon/assistant interaction has been the subject of vigorous study. Although current technical skills assessments measure performance of an individual, testing methodologies that incorporate an assistant have not been described. To address this need we have modified the Fundamentals of Laparoscopic Surgery ™ (FLS) skills tasks to include participation of an assistant. The objective of this technology is to create a prototype technical skills trainer suitable for team training and evaluation.
Description of the method of and its application
A standard FLS trainer box was modified to accommodate two test subjects. A second video monitor was added and a VGA splitter was used to project the image of the task area on both monitors. Two additional trocars are introduced at the left side of the covering membrane for assistant use (Figure 1).
The five FLS skills tasks were modified to incorporate participation of an assistant. These modifications were designed to reflect actions typical of a surgical assistant e.g. creating exposure or stabilizing tissue. These modifications also needed to meet the following criteria:
• Conduct of the five tasks remain essentially unchanged
• Surgeon performance is dependent on the quality of assistant performance
• The assistant’s actions are not static and are responsive to surgeon movements
This modified FLS skills setup is used in evaluating surgical team performance.
A feasibility study was undertaken to evaluate the utility of this surgical team skills assessment prototype. Our hypothesis is that skills task performance would be unchanged with the addition of an expert assistant. Five FLS certified 4th or 5th year surgical residents participated in the study. They first performed the five standard FLS tasks (sFLS) followed by the five assistant modified tasks (mFLS). The assistant role was performed by the same FLS certified laparoscopic surgeon. The time for task completion was measured and the preliminary results of our pilot study are summarized in Table 1.
Modifying an existing technical skills assessment to incorporate an assistant is feasible. Our preliminary data supports the hypothesis that an ideal assistant will not affect the time required to complete the FLS tasks.
In laparoscopic procedures the surgeon rarely functions in isolation. Training and testing modalities should reflect the reality of a surgical team dynamic. This prototype multi-participant skills trainer is a first step in developing a methodology to evaluate surgical team performance. Experience with this prototype raises research questions such as creation of unique skills tasks for team interaction and evaluation methodologies for multiple test takers.
Session: Poster Presentation
Program Number: ETP067