Sequential Learning of Psychomotor and Visuospatial Skills for Laparoscopic Suturing and Knot Tying – Study Protocol for a Randomized Trial ... View Homepage


Ontology type: schema:MedicalStudy     


Clinical Trial Info

YEARS

2015-2015

ABSTRACT

As many operations begin to defer to the laparoscopic approach, or minimally invasive surgery (MIS), it has become imperative for trainees to demonstrate proficiency in basic, and procedural skills prior to operating. Training modalities e.g., virtual reality (VR) simulators, inanimate box or pelvi trainers, and cadaveric organ trainers can be used as a safe, ethical, and effective means to do this. Pelvi trainers are considered one of the best modalities to learn basic laparoscopy skills because they mimic the physical operating environment with real instruments. Since pelvi trainers uses an indirect view via an external monitor, the laparoscopic view, they provide a realistic platform for the learning of intracorporeal suturing and knot tying. This is an invaluable skill needed for minimally invasive operations. In fact, suturing skills learned during training via a pelvi trainer suture model have been shown to transfer to the operating room. Training within the pelvi trainer often involves using games, real cadaveric organs, or a standard suture pad, which familiarize trainees with the two major facets of laparoscopy: psychomotor control and visuospatial orientation. MIS involves learning a separate skill set from that of open surgery. Although some of the necessary qualities are the same e.g., bimanual dexterity and steadiness, many of the basic skills must be learned for the first time or anew e.g., the fulcrum effect, 2D-3D coordination, pivot effect, limited degrees of freedom for tissue grasping, needle manipulation, suturing and knot tying, etc. These basic skills give surgeons the tools necessary to complete full operations; therefore the learning of these skills has become one of the cornerstones of laparoscopic training curricula. Psychomotor learning and visuospatial orientation are the two major aspects of laparoscopy that should be learned prior to going into the operating theater. Laparoscopy utilizes an indirect view, necessitating surgeons to be familiar with depth perception and 2D-3D spatial understanding. However, it remains to be determined if the learning of psychomotor and visuospatial skills concurrently is optimal, as in a pelvi trainer with laparoscopic view. Learning these two skills separately and sequentially may offer a more effective training alternative that reduces the overall training time of novices. This would lower the workload of tutors and learning curve of trainees, and save valuable time in a training center. Therefore, we explore here whether sequential learning with a transparent shoebox, where one learns the psychomotor movements, followed by training with a pelvi trainer with laparoscopic view, expedites the learning of the surgical C-loop technique in comparison to training solely with a pelvi trainer, where one learns the psychomotor and visuospatial skills concurrently. The primary goal of this study is to identify if students in Group 1, who learn the surgeon’s surgical C-loop knot technique using a transparent shoebox before using a pelvi trainer have a shorter learning curve than students in Group 2, who learn the technique using solely a pelvi trainer. Secondary goals include examining number of attempts and gender aspects. Detailed Description As many operations begin to defer to the laparoscopic approach, it has become imperative for trainees to demonstrate proficiency in basic, and procedural skills prior to operating. Training modalities e.g., virtual reality (VR) simulators, inanimate pelvi trainer, and cadaveric organ trainers can be used as a safe, ethical, and effective means to do this. Pelvi trainers are considered one of the best modalities to learn basic laparoscopy skills because they mimic the physical operating environment with real instruments. Since pelvi trainers use an indirect view via an external monitor, they provide a realistic platform for the learning of intracorporeal suturing and knot tying, an invaluable skill needed for minimally invasive operations. In fact, suturing skills learned during training via a pelvi trainer suture model have been shown to transfer to the operating room. Training within the pelvi trainer often involves using games, real cadaveric organs, or a standard suture pad, which familiarize trainees with the two major facets of laparoscopy: psychomotor control and spatial orientation. MIS involves learning a separate skill set from that of open surgery. Although some of the necessary qualities are the same e.g., bimanual dexterity and steadiness, many of the basic skills must be learned for the first time or anew e.g., the fulcrum effect, tissue grasping, needle manipulation, knot tying, etc. These basic psychomotor skills give surgeons the tools necessary to complete full operations; therefore the learning of these skills has become one of the cornerstones of laparoscopic training curricula. Visuospatial orientation is the second major aspect of laparoscopy that should be learned prior to going into the operating theater. Laparoscopy utilizes an indirect view, necessitating surgeons to be familiar with depth perception and 2D-3D spatial understanding. However, it remains to be determined if the learning of psychomotor and visuospatial skills concurrently is optimal, as in a pelvi trainer with laparoscopic view. Learning these two skills separately and sequentially may offer a more effective training alternative that reduces the overall training time of novices. This would lower the workload of tutors and learning curve of trainees, and save valuable time in a training center. Therefore, we explore here whether sequential learning with a transparent shoebox, where one learns the psychomotor movements, followed by training with a pelvi trainer, which adds the use an indirect laparoscopic view, expedites the learning of the surgical C-loop technique in comparison to training solely with a pelvi trainer with lparoscopic view, where one learns the psychomotor and visuospatial skills concurrently. The primary goal of this study is to identify if students in Group 1, who learn the surgeon’s surgical C-loop knot technique using a transparent shoebox before using a pelvi trainer have a shorter learning curve than students in Group 2, who learn the technique using solely a box trainer. Secondary goals include examining gender aspects. This is a prospective, monocentric, randomized controlled trial. Tutors are specially trained medical students (n=3), who are not blinded to the training group status of the trainees. Participants are randomized to the intervention (group 1) or control group (group 2). After randomization the training is in pairs who rate each other with standardized checklists for knot tying technique and quality of knot tying, as well as time. The knot tying technique is evaluated with a modified 23-point-checklist designed by Munz Y et al.. The quality of knots is evaluated with a 5-point-checklist by Muresan et al.. For evaluation of precision the distance between needle entry and exit points on the standardized suture pads is measured in millimeters as well as the time. At the beginning of training all trainees receive a standardized video instruction to the knot tying technique, followed by a detailed explanation of the checklists for knot tying technique and knot quality. More... »

URL

http://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008668

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Laparoscopy utilizes an indirect view, necessitating surgeons to be familiar with depth perception and 2D-3D spatial understanding. However, it remains to be determined if the learning of psychomotor and visuospatial skills concurrently is optimal, as in a pelvi trainer with laparoscopic view. Learning these two skills separately and sequentially may offer a more effective training alternative that reduces the overall training time of novices. This would lower the workload of tutors and learning curve of trainees, and save valuable time in a training center. Therefore, we explore here whether sequential learning with a transparent shoebox, where one learns the psychomotor movements, followed by training with a pelvi trainer with laparoscopic view, expedites the learning of the surgical C-loop technique in comparison to training solely with a pelvi trainer, where one learns the psychomotor and visuospatial skills concurrently. The primary goal of this study is to identify if students in Group 1, who learn the surgeon’s surgical C-loop knot technique using a transparent shoebox before using a pelvi trainer have a shorter learning curve than students in Group 2, who learn the technique using solely a pelvi trainer. Secondary goals include examining number of attempts and gender aspects. Detailed Description As many operations begin to defer to the laparoscopic approach, it has become imperative for trainees to demonstrate proficiency in basic, and procedural skills prior to operating. Training modalities e.g., virtual reality (VR) simulators, inanimate pelvi trainer, and cadaveric organ trainers can be used as a safe, ethical, and effective means to do this. Pelvi trainers are considered one of the best modalities to learn basic laparoscopy skills because they mimic the physical operating environment with real instruments. Since pelvi trainers use an indirect view via an external monitor, they provide a realistic platform for the learning of intracorporeal suturing and knot tying, an invaluable skill needed for minimally invasive operations. In fact, suturing skills learned during training via a pelvi trainer suture model have been shown to transfer to the operating room. Training within the pelvi trainer often involves using games, real cadaveric organs, or a standard suture pad, which familiarize trainees with the two major facets of laparoscopy: psychomotor control and spatial orientation. MIS involves learning a separate skill set from that of open surgery. Although some of the necessary qualities are the same e.g., bimanual dexterity and steadiness, many of the basic skills must be learned for the first time or anew e.g., the fulcrum effect, tissue grasping, needle manipulation, knot tying, etc. These basic psychomotor skills give surgeons the tools necessary to complete full operations; therefore the learning of these skills has become one of the cornerstones of laparoscopic training curricula. Visuospatial orientation is the second major aspect of laparoscopy that should be learned prior to going into the operating theater. Laparoscopy utilizes an indirect view, necessitating surgeons to be familiar with depth perception and 2D-3D spatial understanding. However, it remains to be determined if the learning of psychomotor and visuospatial skills concurrently is optimal, as in a pelvi trainer with laparoscopic view. Learning these two skills separately and sequentially may offer a more effective training alternative that reduces the overall training time of novices. This would lower the workload of tutors and learning curve of trainees, and save valuable time in a training center. Therefore, we explore here whether sequential learning with a transparent shoebox, where one learns the psychomotor movements, followed by training with a pelvi trainer, which adds the use an indirect laparoscopic view, expedites the learning of the surgical C-loop technique in comparison to training solely with a pelvi trainer with lparoscopic view, where one learns the psychomotor and visuospatial skills concurrently. The primary goal of this study is to identify if students in Group 1, who learn the surgeon’s surgical C-loop knot technique using a transparent shoebox before using a pelvi trainer have a shorter learning curve than students in Group 2, who learn the technique using solely a box trainer. Secondary goals include examining gender aspects. This is a prospective, monocentric, randomized controlled trial. Tutors are specially trained medical students (n=3), who are not blinded to the training group status of the trainees. Participants are randomized to the intervention (group 1) or control group (group 2). After randomization the training is in pairs who rate each other with standardized checklists for knot tying technique and quality of knot tying, as well as time. The knot tying technique is evaluated with a modified 23-point-checklist designed by Munz Y et al.. The quality of knots is evaluated with a 5-point-checklist by Muresan et al.. For evaluation of precision the distance between needle entry and exit points on the standardized suture pads is measured in millimeters as well as the time. 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