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Design and validation of an assessment tool for open surgical procedures

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Abstract

Background

Laparoscopy is currently the gold standard for cholecystectomy. Recent literature suggests surgical trainees have limited exposure to open cholecystectomy, which may result in suboptimal performance in the event of conversion. Furthermore, most training and assessment models are designed for laparoscopic cholecystectomy, with limited opportunities for open simulator training. The present study’s purpose was to design an inexpensive model for open cholecystectomy and to validate a performance assessment tool.

Methods

The simulator comprises a porcine liver and gallbladder in a mock human abdomen with silicon skin. The assessment tool utilizes inexpensive infrared (IR) cameras to provide tracking of participant hand motions. Eleven novice general surgery trainees (<20 cholecystectomies) and five expert surgeons (>100 cholecystectomies) completed an open cholecystectomy using the simulator. Procedures were recorded and assessed by a blinded evaluator using a global rating scale. Tracking data analysis was based on number of movements and total path length.

Results

Novices (t = 36.18 min) completed the procedure significantly slower than did experts (t = 19.53 min) (Mann–Whitney test U = 20, p < 0.05) and had significantly more hand movements (Mann–Whitney test U = 20, p < 0.05). Analysis of the total global rating scale scores showed a significant difference between novice (14/35) and expert (24/35) performance in all categories (Mann–Whitney test U = 58, p < 0.05).

Conclusion

The present model presents a realistic, low-cost tool for training and assessment of procedural skills in open cholecystectomy. The study demonstrated the validity of the IR tracking device as an objective assessment tool for open surgical skills training. Future training should incorporate this low-cost, highly effective training device into surgical curricula.

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Acknowledgments

The following people provided support related to the surgical environment: Lisa Satterthwaite, Marina Romanova, and Dezan Rego. Thomas Sun and Shunne Leung provided technical support towards the development of the IR system. Project supported by National Sciences and Engineering Research Council CGS M Scholarship and the Network for Excellence in Simulation for Clinical Teaching and Learning.

Disclosure

Ranil Sonnadara has, in the past, received a grant and travel reimbursement from the Network for Excellence in Simulation for Clinical Teaching and Learning. He is also employed at Mount Sinai Hospital consults on educational research on an ongoing basis for the University of Toronto. Teodor Grantcharov carries out ongoing consulting work for Covidien Canada and Ethicon Canada. Authors, Neil Rittenhouse, Bharat Sharma, and Alex Mihailidis have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Neil Rittenhouse & Alex Mihailidis

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Bharat Sharma, Ranil Sonnadara & Teodor Grantcharov

  3. Division of General Surgery CC16, St. Michael’s Hospital, 30 Bond St, Toronto, M5B 1W8, ON, Canada

    Neil Rittenhouse, Bharat Sharma & Teodor Grantcharov

  4. Mount Sinai Hospital, Toronto, ON, Canada

    Ranil Sonnadara

  5. Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada

    Alex Mihailidis

  6. Toronto Rehabilitation Institute, Toronto, ON, Canada

    Alex Mihailidis

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  1. Neil Rittenhouse
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  2. Bharat Sharma
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Correspondence to Neil Rittenhouse.

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Rittenhouse, N., Sharma, B., Sonnadara, R. et al. Design and validation of an assessment tool for open surgical procedures. Surg Endosc 28, 918–924 (2014). https://doi.org/10.1007/s00464-013-3247-2

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  • DOI: https://doi.org/10.1007/s00464-013-3247-2

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