Training in Laparoscopic Common Bile Duct Exploration: Role of Simulation and Its Impact on Clinical Outcomes
Given the current healthcare environment, optimization of patient outcomes and maximization of limited financial resources are prerequisites for the adoption of any surgical procedure. Laparoscopic common bile duct exploration (LCBDE) is an example of a safe, cost-effective strategy for managing patients who present with choledocholithiasis. However, despite the currently available evidence highlighting the clinical value of LCBDE, utilization has continued to decline, while the use of endoscopic retrograde cholangiopancreatography (ERCP) continues to increase. Commonly cited reasons for this trend include the advanced technical demands of the LCBDE procedure in addition to a lack of exposure to the procedure during surgical training. In the current era of graduate medical education (GME), restrictions on resident work hours have limited the amount of time that resident physicians can spend directly involved in patient care activities. In the field of surgical education, the practical consequence of this development is reduced time spent in the operating room under the guidance of a supervising surgeon, which has traditionally formed the foundation of surgical training. The emergence of simulation-based mastery learning (SBML) has provided surgical educators with a strategy for providing trainees with exposure to certain procedures prior to implementation in the clinical setting or as a way to teach techniques that are rarely encountered. This chapter describes the development of a low-cost simulator for teaching surgical residents the necessary knowledge and skills to perform LCBDE in the appropriately selected patient. Included is a brief discussion of the impact of implementing a simulation-based mastery learning curriculum for LCBDE with a focus on clinical outcomes for patients presenting with choledocholithiasis.
KeywordsGraduate medical education Laparoscopic common bile duct exploration Surgical education Competency-based education Mastery learning Simulation-based education Simulation-based mastery learning Translational science
The video demonstrates the key steps for transcystic common bile duct exploration in both a real case and in the simulator. Steps include (1) cholangiogram, (2) wire access, (3) cystic duct dilation, (4) choledochoscope insertion and maneuvering, (5) stone capture, (6) stone extraction, (7) completion cholangiogram, and (8) cystic duct ligation (MP4 212302 kb)
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