Abstract
Background
Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon’s age, gender or learning method.
Methods
This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as ‘Skilled’ (high score in the pre-test), ‘Good Learner’ (increase from pre- to post-test) or ‘Others’ based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis.
Results
In the pre-training performance 11 candidates were categorised as ‘Skilled’ (15.7%), 35 participants as ‘Good Learners’ (50.0%) and 24 participants were classified as ‘Others’. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the ‘Skilled’ participants (p = 0.059), and multimedia training was most predictive for the ‘Good Learner’ (p = 0.006). Participants in the group of ‘Others’ who were neither ‘Skilled’ nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training.
Conclusion
The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
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References
Gallagher AG, Smith CD (2003) From the operating room of the present to the operating room of the future. Human-factors lessons learned from the minimally invasive surgery revolution. Semin Laparosc Surg 10(3):127–139
Pape-Koehler C, Immenroth M, Sauerland S, Lefering R, Lindlohr C, Toaspern J, Heiss M (2013) Multimedia-based training on internet platforms improves surgical performance: a randomized controlled trial. Surg Endosc 27(5):1737–1747
Buckley CE, Kavanagh DO, Gallagher TK, Conroy RM, Traynor OJ, Neary PC (2013) Does aptitude influence the rate at which proficiency is achieved for laparoscopic appendectomy? J Am Coll Surg 217(6):1020–1027
Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy. Surg Endosc 17(7):1082–1085
Boyd T, Jung I, Van Sickle K, Schwesinger W, Michalek J, Bingener J (2008) Music experience influences laparoscopic skills performance. JSLS 12(3):292–294
Donnon T, DesCoteaux JG, Violato C (2005) Impact of cognitive imaging and sex differences on the development of laparoscopic suturing skills. Can J Surg 48(5):387–393
White MT, Welch K (2012) Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training? Am J Surg 203(3):397–400 . doi:10.1016/j.amjsurg.2011.09.020 discussion 400
Thorson CM, Kelly JP, Forse RA, Turaga KK (2011) Can we continue to ignore gender differences in performance on simulation trainers? J Laparoendosc Adv Surg Tech A 21(4):329–333
Rosenberg BH, Landsittel D, Averch TD (2005) Can video games be used to predict or improve laparoscopic skills? J Endourol 19(3):372–376
Rosser JC Jr, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Klonsky MR (2007) The impact of video games on training surgeons in the twenty-first century. Arch Surg 142(2):181–186
Immenroth M, Burger T, Brenner J, Nagelschmidt M, Eberspaecher H, Troidl H (2007) Mental training in surgical education: a randomized controlled trial. Ann Surg 245(3):385–391
N.N. (2008) www.webop.de - all about surgical operations. [status:28 05 2016]
Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan, Hutchison C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84(2):273–278
Reznick R, Regehr G, MacRae H, Martin J, McCulloch W (1997) Testing technical skill via an innovative “bench station” examination. Am J Surg 173(3):226–230
Adams BJ, Margaron F, Kaplan BJ (2012) Comparing video games and laparoscopic simulators in the development of laparoscopic skills in surgical residents. J Surg Education 69(6):714–717. doi:10.1016/j.jsurg.2012.06.006
Madan AK, Frantzides CT, Park WC, Tebbit CL, Kumari NV, O'Leary PJ (2005) Predicting baseline laparoscopic surgery skills. Surg Endosc 19(1):101–104
Madan AK, Harper JL, Frantzides CT, Tichansky DS (2008) Nonsurgical skills do not predict baseline scores in inanimate box or virtual-reality trainers. Surg Endosc 22(7):1686–1689
Harper JD, Kaiser S, Ebrahimi K, Lamberton GR, Hadley HR, Ruckle HC, Baldwin DD (2007) Prior video game exposure does not enhance robotic surgical performance. J Endourol 21(10):1207–1210
Moglia A, Ferrari V, Morelli L, Melfi F, Ferrari M, Mosca F, Cuschieri A (2014) Distribution of innate ability for surgery amongst medical students assessed by an advanced virtual reality surgical simulator. Surg Endosc 28(6):1830–1837. doi:10.1007/s00464-013-3393-6
Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Müller-Stich BP (2015) Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 94(20):e764. doi:10.1097/MD.0000000000000764
Probst P, Knebel P, Grummich K, Tenckhoff S, Ulrich A, Büchler MW, Diener MK (2016) Industry bias in randomized controlled trials in general and abdominal surgery: an empirical study. Ann Surg 264(1):87–92. doi:10.1097/SLA.0000000000001372
Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236(4):458–463 discussion 463-4
Hasson HM, Kumari NV, Eekhout J (2001) Training simulator for developing laparoscopic skills. JSLS 5(3):255–265
Singh P, Aggarwal R, Tahir M, Pucher PH, Darzi A (2015) A randomized controlled study to evaluate the role of video-based coaching in training laparoscopic skills. Ann Surg 261(5):862–869. doi:10.1097/SLA.0000000000000857
Ritter EM, McClusky D 3rd, Gallagher AG, Enochsson L, Smith CD (2006) Perceptual, visuospatial, and psychomotor abilities correlate with duration of training required on a virtual-reality flexible endoscopy simulator. Am J Surg 192(3):379–384
Schijven MP, Jakimowicz JJ, Broeders IA, Tseng LN (2005) The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E. A E S accredited virtual reality trainings curriculum Surg Endosc 19(9):1220–1226
Schmidt-Tintemann U (1997) Women in surgery. Chirurg 68(6):583–585
Acknowledgements
This manuscript is dedicated to Prof. Dr. med. Dr. h. c. Hans Troidl, pioneer in endoscopic surgery.
This work was supported by KARL STORZ GmbH & Co. KG (Tuttlingen, Germany), which provided the laparoscopic equipment and the technical assistance. Furthermore, the study was financially supported by the European Surgical Institute (ESI, Norderstedt, Germany), which is part of Johnson & Johnson Medical GmbH (Norderstedt, Germany).
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Dr. M.M. Heiss is editor-in-chief (EDIC) of webop© and reports non-financial support from Karl Storz GmbH & Co KG (Tuttlingen, Germany), grants from European Surgical Institute (ESI, Norderstedt, Germany) during the conduct of the study and personal fees from www.webop.de, outside the submitted work. Dr. C. Pape-Köhler is the co-founder of webop© and reports personal fees from www.webop.de, outside the submitted work; Drs. R. Lefering, S. Saad and C. Lindlohr have no conflicts of interest or financial ties to disclose.
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Lindlohr, C., Lefering, R., Saad, S. et al. Training or non-surgical factors—what determines a good surgical performance? A randomised controlled trial. Langenbecks Arch Surg 402, 645–653 (2017). https://doi.org/10.1007/s00423-017-1567-8
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DOI: https://doi.org/10.1007/s00423-017-1567-8