Surgical Endoscopy

, Volume 23, Issue 1, pp 161–165 | Cite as

Simulation in laparoscopic surgery: a concurrent validity study for FLS

Article

Abstract

Background

Current assessments using the fundamentals of laparoscopic surgery (FLS) tasks are labour intensive and depend heavily on expert raters. Hand motion analysis may offer an alternative method of objective evaluation of FLS performance.

Purpose

The aim of this study was to assess whether a correlation exists between the expert rated assessments of the FLS tasks and computer-based assessment of motion efficiency using the Imperial College surgical assessment device (ICSAD).

Methods

We recruited 26 volunteer subjects who were stratified into three experience groups: juniors (PGY1–3) (N = 13), seniors (PGY4,5) (N = 7) and staff surgeons (N = 6). All subjects performed four FLS tasks: (1) peg transfer, (2) pattern cut, (3) endoloop and (4) intracorporeal suturing. Performance was assessed by both standard FLS expert rating and motion analysis using ICSAD. Group differences were analyzed using the Kruskal–Wallis test, and Spearman coefficient analyses were employed to compare FLS and ICSAD scores.

Results

FLS expert-derived scores discriminated effectively between experience groups for all tasks (p < 0.05). Motion efficiency scores discriminated between experience groups for tasks 1, 3 and 4 for number of movements (p < 0.05), tasks 1 and 4 for total distance (p < 0.05) and tasks 1, 2, 3 and 4 for total time (p < 0.005). There was a significant correlation between total FLS expert scores and the motion efficiency metrics of total distance, number of movements and total time (Spearman coefficient and p values of 0.81, < 0.001; 0.76; < 0.001; and 0.93, < 0.001, respectively).

Conclusion

There is a high correlation between FLS standard scoring and motion efficiency metrics. The use of ICSAD for the objective assessment of FLS tasks may in the future offer an adjunctive method of evaluation. ICSAD metrics are potentially less labour intensive due to the instant and fully automated computerized scoring that it provides.

Keywords

Education Training Endoscopy 

References

  1. 1.
    Feldman LS, Sherman V, Fried GM (2004) Using simulation to assess laparoscopic competence: ready for widespread use? Surgery 135:28–42PubMedCrossRefGoogle Scholar
  2. 2.
    Fried GM (2004) Simulators for laparoscopic surgery: a coming of age. Asian J Surg 27:1–3PubMedGoogle Scholar
  3. 3.
    Fried GM, Feldman LS, Vasiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew C (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 243(3):518–528CrossRefGoogle Scholar
  4. 4.
    SAGES FLS program. Available at www.flsprogram.org. Accessed September 10, 2007
  5. 5.
    McCluney AL, Cao J, Polyhronopoulos GN, Stanbridge DD, Feldman LS, Fried GM (2007) Automated ProMIS Simulator metrics predict readiness for FLS certification SAGES 2007 Education/Outcomes - P279Google Scholar
  6. 6.
    Datta V, Mackay S, Mandalia M, Darzi A (2001) The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 193:479–485PubMedCrossRefGoogle Scholar
  7. 7.
    Xeroulis GJ, Park J, Moulton C, Reznick RK, Leblanc V, Dubrowski A (2007) Teaching basic surgical skills: a randomized trial comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 141(4):442–449. Epub 2007 Jan 25PubMedCrossRefGoogle Scholar
  8. 8.
    Brydges R, Classen R, Larmer J, Xeroulis G, Dubrowski A (2006) Computer assisted assessment of one-handed knot tying skills at varying complexity levels: construct validity study. Am J Surg 192(1):109–113PubMedCrossRefGoogle Scholar
  9. 9.
    Datta V, Chang A, Mackay S, Darzi A (2002) The relationship between motion analysis and surgical technical assessments. Am J Surg 184:70–73PubMedCrossRefGoogle Scholar
  10. 10.
    Taffinder NJ, Smith S, Mair J (1999) Can a computer measure surgical precision? Reliability, validity and feasibility of the ICSAD. Surg Endosc 13(suppl 1):81Google Scholar
  11. 11.
    Taffinder N, Smith S, Huber J, Russell RC, Darzi A (1999) The effects of a second generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surg Endosc 13:1087–1092PubMedCrossRefGoogle Scholar
  12. 12.
    Aggarwal R, Moorthy K, Darzi A (2004) Laparoscopic skills training and assessment. Br J Surg 91:1549–1558PubMedCrossRefGoogle Scholar
  13. 13.
    Aggarwal R, Hance J, Darzi A (2004) Surgical education and training in the new millennium. Surg Endosc 18:1409–1410PubMedCrossRefGoogle Scholar
  14. 14.
    Porte MC, Xeroulis G, Reznick RK, Dubrowski A (2007) Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Am J Surg 193(1):105–110PubMedCrossRefGoogle Scholar
  15. 15.
    Jowett NT, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A (2007) Self-assessment of surgical skill learning with computer-based video training and the impact on self-directed training. Am J Surg 193(2):237–242PubMedCrossRefGoogle Scholar
  16. 16.
    Fitts PM, Posner MI (1967) Learning and skilled performance in human performance. Brock-Cole, BelmontGoogle Scholar
  17. 17.
    McCluney AL, Feldman LS, Fried GM (2006) Validation of the ProMIS hybrid simulator using a standard set of laparoscopic tasks. SAGES 2006 Education/Outcomes-P237Google Scholar
  18. 18.
    Ritter EM, Kindelan TW, Michael C, Pimentel EA, Bowyer MW (2007) Concurrent validity of augmented reality metrics applied to the fundamentals of laparoscopic surgery (FLS). Surg Endosc 21(8):1441–1445PubMedCrossRefGoogle Scholar
  19. 19.
    Rogers DA, Regehr G, Yeh KA, Howdieshell TR (1998) Computer-assisted learning versus a lecture and feedback seminar for teaching a basic surgical technical skill. Am J Surg 175:508–510PubMedCrossRefGoogle Scholar
  20. 20.
    Custers EJ, Regehr G, McCulloch W, Peniston C, Reznick R (1999) The effects of modeling on learning a simple surgical procedure: see one, do one or see many, do one? Adv Health Sci Educ Theory Pract 4:123–143PubMedCrossRefGoogle Scholar
  21. 21.
    Smith CD, Farrell TM, McNatt SS, Metreveli RE (2001) Assessing laparoscopic manipulative skills. Am J Surg 181:547–550PubMedCrossRefGoogle Scholar
  22. 22.
    Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R (2006) Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg 244(3):400–409PubMedGoogle Scholar
  23. 23.
    Dubrowski A, Larmer JC, Leming JK, Brydges R, Carnahan H, Park J (2006) Quantification of process measures in laparoscopic suturing. Surg Endosc Oct 9 [Epub ahead of print] Avaliable at http://www.springerlink.com/content/100368/ Accessed September 5 2007
  24. 24.
    Dosis A, Aggarwal R, Bello F, Moorthy K, Munz Y, Gillies D, Darzi A (2005) Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 140:293–299PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Surgery, Division of General SurgeryUniversity of Western OntarioLondonCanada
  2. 2.MIS Fellow UofTTorotnoCanada
  3. 3.Department of Nursing EducationUniversity of TorontoTorontoCanada

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