Advertisement

Obesity Surgery

, Volume 23, Issue 5, pp 589–593 | Cite as

A Cadaveric Porcine Model for Assessment in Laparoscopic Bariatric Surgery—a Validation Study

  • Camilo Boza
  • Julian Varas
  • Erwin Buckel
  • Pablo Achurra
  • Nicolás Devaud
  • Trystan Lewis
  • Rajesh Aggarwal
Original Contributions

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective surgical therapy for morbid obesity. It is an advanced laparoscopic surgical procedure and has a protracted learning curve. Therefore, it is important to develop innovative ways of training and assessing surgeons. The aim of this study is to determine if a cadaveric porcine jejuno-jejunostomy model is an accurate way of assessing a surgeon's technical skills by determining if a correlation exists with how he performs in the operating room.

Methods

Eight surgeons of varying experience performed a side-to-side stapled jejuno-jejunostomy on a cadaveric bench model before proceeding to perform the procedure on a real patient scheduled for LRYGBP. Performance was assessed using a motion tracking device, the Imperial College Surgical Assessment Device. Each procedure was recorded in video and scored by two blinded expert surgeons using procedure-specific rating scales.

Results

The cadaveric bench model demonstrated concurrent validity with significant correlations between performance on the cadaveric model and patient for dexterity measures. Left-hand path length, r = 0.857 (median, 27, 41.3; P = 0.007), right-hand path length, r = 0.810 (median, 31.5, 60; P = 0.015) and total number of movements, r = 0.743 (median, 422, 637; P = 0.035). This correlation in performance was also demonstrated in the video rating scales, r = 0.727 (median, 13.2, 14.8; P = 0.041). No correlation was found in operative time (median, 541, 742; P = 0.071).

Conclusions

This study demonstrates the concurrent validity of the cadaveric porcine model, showing similar performances in surgeons completing a jejuno-jejunostomy on the cadaveric model and the patient.

Keywords

Simulation Gastric bypass Laparoscopy Bariatric surgery Education Surgery Training/courses 

Notes

Acknowledgments

Rajesh Aggarwal is funded by a Clinician Scientist Award from the National Institute for Health Research, Department of Health, UK.

Conflict of Interest

The authors report no conflict of interest. The authors are responsible for the content and writing of the article.

References

  1. 1.
    Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22(9):925–35.PubMedCrossRefGoogle Scholar
  2. 2.
    Olbers T, Fagevik-Olsen M, Maleckas A, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity. Br J Surg. 2005;92(5):557–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–24.PubMedCrossRefGoogle Scholar
  4. 4.
    Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg. 2001;11(3):284–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Aggarwal R, Boza C, Hance J, et al. Skills acquisition for laparoscopic gastric bypass in the training laboratory: an innovative approach. Obes Surg. 2007;17(1):19–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Nguyen NT, Ho HS, Palmer LS, et al. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg. 2000;191(2):149–55. discussion 155–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89. discussion 289–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Nguyen NT, Lee SL, Goldman C, et al. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg. 2001;192(4):469–76. discussion 476–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Nguyen NT, Hinojosa M, Fayad C, et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg. 2007;205(2):248–55.PubMedCrossRefGoogle Scholar
  10. 10.
    Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Pellegrini CA, Warshaw AL, Debas HT. Residency training in surgery in the 21st century: a new paradigm. Surgery. 2004;136(5):953–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17(2):212–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Integrating advanced laparoscopy into surgical residency training. Surg Endosc. 1998;12(4):374–6.CrossRefGoogle Scholar
  16. 16.
    Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the SAGES Bariatric Task Force. Guidelines for institutions granting bariatric privileges utilizing laparoscopic techniques. Surg Endosc. 2003;17(12):2037–40.CrossRefGoogle Scholar
  17. 17.
    Rattner DW, Apelgren KN, Eubanks WS. The need for training opportunities in advanced laparoscopic surgery. Surg Endosc. 2001;15(10):1066–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Jackson CR, Gibbin KP. ‘Per ardua…’ Training tomorrow's surgeons using inter alia lessons from aviation. J R Soc Med. 2006;99(11):554–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Vara J, Mejía R, Riquelme A et al. Significant transfer of surgical skills obtained with an advanced laparoscopic training program to a laparoscopic jejunojejunostomy in a live porcine model: feasibility of learning advanced laparoscopy in a general surgery residency. Surg Endosc. 2012:1–9.Google Scholar
  20. 20.
    McDougall EM, Corica FA, Boker JR, et al. Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg. 2006;202(5):779–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Datta V, Mackay S, Mandalia M, et al. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg. 2001;193(5):479–85.PubMedCrossRefGoogle Scholar
  22. 22.
    Aggarwal R, Darzi A. Technical-skills training in the 21st century. N Engl J Med. 2006;355(25):2695–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Cuschieri A, Francis N, Crosby J, et al. What do master surgeons think of surgical competence and revalidation? Am J Surg. 2001;182(2):110–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Aggarwal R, Grantcharov TP, Darzi A. Framework for systematic training and assessment of technical skills. J Am Coll Surg. 2007;204(4):697–705.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Camilo Boza
    • 1
  • Julian Varas
    • 1
  • Erwin Buckel
    • 1
  • Pablo Achurra
    • 1
  • Nicolás Devaud
    • 1
  • Trystan Lewis
    • 2
  • Rajesh Aggarwal
    • 2
  1. 1.Department of Digestive Surgery, Hospital ClinicoPontificia Universidad Católica de ChileSantiagoChile
  2. 2.Department of Biosurgery and Surgical TechnologyImperial College LondonLondonUK

Personalised recommendations