surgeons and registrar education 1
TRANSCRIPT
KNOWLEDGE AND ATTITUDE OF SURGEONS AND REGISTRAR IN NORTH QUEENSLAND ABOUT THE DIFFERENT TECHNIQUES FOR TEACHING LAPAROSCOPIC SURGERY.
Dr. Alfred Oghenemano Egedovo
Principal Advisor Professor Yik-Hong Ho
Co- Advisor A/Prof. Sarah Larkins
Content Outline
Introduction
Aims/ Objectives
Materials And Methods
Results
Conclusion
INTRODUCTION
What is
laparoscopic Surger
y
• Keyhole Surgery• Endoscopic Surgery• Minimally Invasive
Surgery(MIS)• Minimal Access
Surgery
abdomenCannulae/PortsVideo camerasOperating Field InsufflatedInternal Organs
INTRODUCTION
TECHNIQUES LAPAROSCOPIC SURGERY
INTRODUCTION
WHY LAPAROSCOPIC
SURGERY
There are a number of advantages versus Open;• Less post-operative
scarring• Reduced pain• Short recovery time• Less Time Spent in
hospital to recover• Reduce risk of exposing
internal organs to external contaminants
• Quicker return to normal activities
• Quicker return to work• Reduced wound
complications
Historical Trend 1902-
Georg Kelling , on dogs.
1910 – Hans
Christian on human
1980 – Patrick Steptoe OR
sterile conditions.
1982 – video-
laparoscopy
1987- Philipe
Mouret -laparoscopic cholecystect
omy.
1994- A robot arm .
1996- first
Telepresence
.
Trend - Surgical Trainings From Operating Rooms To Video/Simulation Centres
TECHNIQUES OF TEACHING LAPAROSCOPIC SURGERYTwo types traditional & modern
Traditional Apprenticeship
Model Of Training
Technical Skills
Nontechnical SkillsEmerging changes to:
Surgical Skill Laboratory
Use Of Simulation
Current Surgical Simulation Modalities
Bench –Top Model
Laparoscopic
Simulators
Simulator For New Surgical
Technologies
Simulation For
Nontechnical Surgical
Skills
Current Surgical Simulation Modalities
Bench-top Model
Lap Simulator
Simulator For New Surgical TechnologiesSimulation For Non
technical Surgical Skills
Laparoscopic Surgery Teaching Techniques
Teaching Techniques %
operating room Animal Lab Video Virtual reality
54computer 19% Dadictic
IntroductionLaparoscopic Surgery Teaching Techniqueso Usefulness
o Operating room (100%)o Virtual simulator(91%)o Animal lab (88%)o Computer software (42%)o Didactic lectures (16 %)
Used in Training
Operating room VRTAnimal LabComputer softDadactic
Aim
Educational value of a web-based video training.
Whether there is Psychomotor skill development.
Technical skill benefit.
If it is a choice for training surgeons and Registrars.
Material and methodsBackground Literature Review Author Type of
LaparoscopicTraining
Interven/Task
outcome result
Methods
Coment
1. Shetty et.al (2014
Live animal Explanted tiss.Video boxVRTInanimate Her
EducationalValue,
preference High-fidelity live animal prefer
Cross-sectional survey
2. Chan et.al (2009)
Basic ORAnimal LabsBlack boxAdvance ORDidactic Lec.Lap SimLap VideoComp SoftVRTVT
LaparoscopyEducation effectiveness
OpinionPrefer was based on surgeons
92%85%77%69%65%54%54%19%
Method;Survey
Most effective in 5years VRT simulator
3. Soares et.als(2012)
FLSVBLasT
Haptic &peg transfer task
Dexerity RCT
Material and methodsBackground Literature Review Author Type of
LaparoscopyTraining
Interven/Task
outcome result comments
4. Palter et.als 2010
VRTFLS boxPorcine-jejSyn. nissen
Suturing Dexterity
5.Hamilton et.als (2002)
VRTVT
Performance
Psychomotor skills
6. Zhang et.als
FLSVBLasT
Haptic &peg transfer task
Dexterity
Material and methodsLiterature Review on Teaching Laparoscopic SurgeryAuthor Type of
LaparoscopeTraining
Interven/Task
outcome Result Method
7. Aggarwal et.als 2010
VRTVideolapsim
Learning CurveSuturingDiathermycutting
Transfer of skills
RCT
8.Seymour et.als (2007)
VRTOR
Performance
Psychomotor skills
RCT
9.Fried et.als 2014 MISTELS
Haptic &peg transfer task
Dexterity RCT
Material and methods
Study Design
Simple Descriptive Study
Using Survey
Questionnaire
Setting
Population - Surgeons and trainees in NQ
Institute of surgery TVS Hospital an affiliate JCU
Townsville and Mackay
Participants and sampling
25 Consultant surgeons and 6 trainees ( postgraduate 1- 5years) in Townsville and Mackay
Completed training in basic laparoscopic surgery and had used a web-based training video with or other techniques
Performed 10 -60 laparoscopic surgery within last two years
Age 47 to retirement ( active surgeons
Data Collection
The collection of information will not involve patient data, Surgeon demographic Information - Coded
low risk no clinical sample to be collected JCU research Ethic committeeInformed from participants
Qualitative - interview of participants of topic questions
Do you know of web-based training video, where?, cost , how you rate it, what you prefer ?
Survey Questionnaires - using survey Monkey , repeat Twice
Timeframe 2 months
Analysis
Quantitative methods would be used to determine attitudes Surgeons and Registrar.
• Survey data coded• Survey database• Questionnaire coded Analysis of data – Using STATA
12.1( stata Corp, College station, TX)
Likert Scale – Five Response Options• Range from 1( Strongly disagree)• 5 ( strongly agree) Likert scale Calculation
• Agree = 4• Strongly agree =5
ResultsPerception of Various Laparoscopic teaching techniques .
Perspective of the Laparoscopic Teaching Methods used other institution(chair/educator) and their opinion on Effective laparoscopic Teaching Methods using Likert scale response of 4 (agree) and 5 (strongly agree)
Chan et.al 2010
comp Soft
Lap Video
Lap Sim
Didactic Lect
Advance OR
Black Box
Animal lab
Basic OR
0 1 2 3 4 5 6
Series 21
Zhang et.al / The Added Value Of Virtual Reality TechnologyRating of VBlaST relative to FLS and actual Laparoscopic surgery on 5-point Likert scale ( 1= not realistic/useful ; 5 = very realistic /useful)
Mean Rating
SE
1. Realism of instrument handling compare to FLS
2.95 0.23
2. Realism of instrument handling compare to actual laparoscopic surgery
2.89 0.28
3. Overall Realism compared to FLS 3.14 0.20
4. Quality of force feedback 3.05 0.29
5. Usefulness of force feedback6. Usefulness for hand –eye coordination skills compare to FLS
3.90
3.43
0.30
7. Usefulness for ambidexterity with skills compared to FLS
3.43 0.26
8. Overall Usefulness for skills learning compared to FLS9. Trustworthiness in quantifying performance
3.14
2.86
0.24
0.27
ResultsRanking of Reasons for using the simulation laboratory ( attitude)
Rank Reason Mean Rank Score
Standard Error
Standard Deviation
1. Skill development 2.48 0.28 2.22
2. Interest in laparoscopic surgery 4.23 0.32 2.54
3. Mandatory or protected time4. Practice before a case
4.354.48
0.350.26
2.732.06
5. Requirement for a rotation 5.32 0.30 2.38
6. Recommendation of an attending surgeon
5.39 0.26 2.11
7. Proximity to the simulation lab 8. Free time
5.565.57
0.280.28
2.232.15
9. Peer Pressure 7.11 0.32 2.49
Result Ranking of Reasons for Not Using the Simulation laboratory
Ranking Of Time for Using a simulation laboratory.
Rank Reason Mean Rank Score
Standard error
Standard Deviation
1. Lack of time 1.61 0.12 0.97
2. Off campus /off site rotation3. Not necessary
1.883.02
0.090.09
0.700.70
4. Not interested 3.42 0.12 0.96
Rank Timing Mean Rank Score
Standard Error
Standard Deviation
1. During work hours2. Postcall
1.921.94
0.120.08
0.950.67
3. Off duty/ on vacation 2.12 0.10 0.81
Ranking of Preferred Simulation Models
Ranking of commonly practiced simulation Tasks
Rank Simulation Model Mean Rank Score
Standard Error
Standard Deviation
1. Live animal model 2.14 0.20 1.64
2. Explanted tissue 3.00 0.13 1.08
3. Video box trainer 3.00 0.17 1.38
4. Virtual Reality simulation 3.00 0.16 1.32
5. Inanimate hernia model 3.58 0.15 1.21
Rank Simulation Task Mean Rank Score
Standard Error
Standard Deviation
1. intracorporeal knot tying 1.89
2. Peg transfer 1.37
3. Extracoporeal knot tying 1.73
4. Pattern cutting 1.26
5.Virtual reality simulator-based curri
1.84
6. Virtual reality simulator –based op .
1.73
Participants` Opinions as rated on a Likert- type scale
Simulation training improve laparoscopic skills
skill leraned in a stimulation environment transfer to the OR
sim. Training good sub. OR
Proficiency prior OR
0% 50% 100%
DisagreeNeutralAgree
Alternative Plans
Plan to work on a project to
1. Compare training in basic Operating room training to laparoscopic skill lab in Townsville hospital
2. Learning Curve problem FLS , Animal Lab
which is better?
Conclusion
The techniques of teaching laparoscopic surgery need to be assess to know the adaptability and its benefits to various settings
Opinion of Surgeons and Registrars is needed.
References;
1. Shetty S, Zevin B, Grantcharov TP, Roberts KE, Duffy AJ. Perceptions, Training Experiences, and Preferences of Surgical Residents Toward Laparoscopic Simulation Training: A Resident Survey. Journal of surgical education. (0).
2. Soares MM, Jacobs K, Zhang L, et al. The added value of virtual reality technology and force feedback for surgical training simulators. Work. 2012;41:2288-2292.
3. Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov T. Resident perceptions of advanced laparoscopic skills training. Surgical Endoscopy. 2010/11/01 2010;24(11):2830-2834.
4. Fried GM, Feldman LS, Vassiliou MC, et al. Proving the Value of Simulation in Laparoscopic Surgery. Annals of Surgery. 2004;240(3):518-528.
5. Seymour NE. VR to OR: A review of the evidence that virtual reality simulation improves operating room performance. World Journal of Surgery. 2008;32(2):182-188.
