Surgical Endoscopy

, Volume 30, Issue 3, pp 1073–1077 | Cite as

Taxonomy of instructions given to residents in laparoscopic cholecystectomy

  • Yuanyuan Feng
  • Christopher Wong
  • Adrian Park
  • Helena Mentis
Article

Abstract

Background

Although simulation-based training allows residents to become proficient in surgical skills outside the OR, residents still depend on senior surgeons’ guidance in transferring skills accumulated from simulators into the operating room. This study aimed to identify and classify explicit instructions made by attending surgeons to their residents during laparoscopic surgery. Through these instructions, we examined the role gaze guidance plays in OR-based training.

Methods

A total of ten laparoscopic cholecystectomy cases being performed by PGY4 residents were analyzed. The explicit directional instructions given by the mentoring attending surgeons to their residents were identified and classified into four categories based on their locations in the coordinate system. These categories were further combined into two classes, based on the target of instructions. The frequencies of instructions in the two classes were compared, and effect size was calculated.

Results

There were 1984 instructions identified in the ten cases. The instructions were categorized into instrument guidance (38.51 %) and gaze guidance (61.49 %). The instrument guidance focused on moving the instruments to perform surgical tasks, including directions to targets, instrument manipulation, and instrument interaction. The gaze guidance focused on achieving common ground during the operation, including target identification and target fixation. The frequency of gaze guidance is significantly higher than instrument guidance in a laparoscopic cholecystectomy (p < 0.001) with a large effect size (r = 0.6).

Conclusions

Gaze guidance has become the main focus of OR-based training. The results show a tight connection between adopting expert gaze and performing surgical tasks and suggest that gaze training should be integrated into the simulation training.

Keywords

Surgical training Simulation-based training OR-based training Gaze training Instrument guidance 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Yuanyuan Feng
    • 1
  • Christopher Wong
    • 1
  • Adrian Park
    • 2
  • Helena Mentis
    • 1
  1. 1.Department of Information SystemsUniversity of Maryland, Baltimore CountyBaltimoreUSA
  2. 2.Department of SurgeryAnna Arundel Medical CenterAnnapolisUSA

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