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Simulation-trained junior residents perform better than general surgeons on advanced laparoscopic cases

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Abstract

Background

Multiple simulation training programs have demonstrated that effective transfer of skills can be attained and applied into a more complex scenario, but evidence regarding transfer to the operating room is limited.

Objective

To assess junior residents trained with simulation performing an advanced laparoscopic procedure in the OR and compare results to those of general surgeons without simulation training and expert laparoscopic surgeons.

Methods

Experimental study: After a validated 16-session advanced laparoscopy simulation training program, junior trainees were compared to general surgeons (GS) with no simulation training and expert bariatric surgeons (BS) in performing a stapled jejuno-jejunostomy (JJO) in the OR. Global rating scale (GRS) and specific rating scale scores, operative time and the distance traveled by both hands measured with a tracking device, were assessed. In addition, all perioperative and immediate postoperative morbidities were registered.

Results

Ten junior trainees, 12 GS and 5 BS experts were assessed performing a JJO in the OR. All trainees completed the entire JJO in the OR without any takeovers by the BS. Six (50 %) BS takeovers took place in the GS group. Trainees had significantly better results in all measured outcomes when compared to GS with considerable higher GRS median [19.5 (18.8–23.5) vs. 12 (9–13.8) p < 0.001] and lower operative time. One morbidity was registered; a patient in the trainees group was readmitted at postoperative day 10 for mechanical ileus that resolved with medical treatment.

Conclusion

This study demonstrated transfer of advanced laparoscopic skills acquired through a simulated training program in novice surgical residents to the OR.

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Acknowledgments

The authors thank Oslando Padilla for his support with the statistical analysis of the data.

Funding

This study was financed and supported by Chilean Research Grant FONDECYT REG.1141196 from CONICYT and by the Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile. Dr. Rajesh Aggarwal is consultant for Applied Medical and supported by grant funding from the Montreal General Hospital Foundation and from the Fonds de Recherche Sante Quebec.

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Authors and Affiliations

  1. Experimental Surgery and Simulation Center, Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile

    Camilo Boza, Felipe León, Erwin Buckel, Fernando Crovari, Jorge Martínez, Nicolás Jarufe & Julián Varas

  2. Experimental Surgery and Simulation Center, Department of Gastroenterology, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Arnoldo Riquelme

  3. Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada

    Rajesh Aggarwal

  4. Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, Canada

    Rajesh Aggarwal

  5. Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Teodor Grantcharov

Authors
  1. Camilo Boza
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  2. Felipe León
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  3. Erwin Buckel
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  4. Arnoldo Riquelme
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  5. Fernando Crovari
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  6. Jorge Martínez
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  7. Rajesh Aggarwal
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  8. Teodor Grantcharov
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  9. Nicolás Jarufe
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  10. Julián Varas
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Corresponding author

Correspondence to Julián Varas.

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Disclosures

Drs. Camilo Boza, Felipe León, Erwin Buckel, Arnoldo Riquelme, Fernando Crovari, Jorge Martínez, Teodor Grantcharov, Nicolás Jarufe and Julián Varas have no conflicts of interest or financial ties to disclose.

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Boza, C., León, F., Buckel, E. et al. Simulation-trained junior residents perform better than general surgeons on advanced laparoscopic cases. Surg Endosc 31, 135–141 (2017). https://doi.org/10.1007/s00464-016-4942-6

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  • DOI: https://doi.org/10.1007/s00464-016-4942-6

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