Simulation and computer-animated devices: the new minimally invasive skills training paradigm.
ABSTRACT Complex surgical technologies, restricted resident work hours, and limited case volumes in surgical practice have created new challenges to surgical education. At the same time, maintenance of established skills and development of new skills are becoming increasingly important for surgeons, especially skills related to technically challenging minimally invasive surgical therapies. In addition, minimally invasive therapies are highly dependent on uniquely specialized teams of health care workers. For all of these reasons, simulation is gaining attention in surgical education for the development and refinement of minimally invasive surgical skills and technique. This article summarizes developments and challenges related to simulation in surgical education, especially as it relates to minimally invasive surgical therapies in the field of urology.
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ABSTRACT: Introduction: Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods: Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results: By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions: This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.International braz j urol: official journal of the Brazilian Society of Urology 04/2011; 39(5):712-719. DOI:10.1016/j.juro.2011.02.1453 · 0.96 Impact Factor
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ABSTRACT: We are in the midst of a paradigm shift in the surgical management of benign prostatic hyperplasia (BPH). After decades of decline, there is a recent surge in the rate of BPH surgeries—largely represented by laser prostatectomy and office-based thermotherapies. In the United States, the number of transurethral resections of the prostate (TURP) continues to decline, now representing a minority of all procedures performed. We reflect on how such changes may affect resident training. We review education models that strive to maintain TURP proficiency amongst urology residents, despite fewer opportunities for training on live patients. Furthermore, we review how proposed changes in the structure of urology education might impact training in office-based procedures, such as prostate thermotherapy.Current Prostate Reports 02/2009; 7(1):19-24. DOI:10.1007/s11918-009-0004-z
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ABSTRACT: Learning laparoscopic urethrovesical anastomosis is a crucial step in laparoscopic radical prostatectomy. Previously we noted that practice on a low fidelity urethrovesical model was more effective for trainees than basic suturing drills on a foam pad when learning laparoscopic urethrovesical anastomosis skills. We evaluated learner transfer of skills, specifically whether skills learned on the urethrovesical model would transfer to a high fidelity, live animal model. A total of 28 senior residents, fellows and staff surgeons in urology, general surgery and gynecology were randomized to 2 hours of laparoscopic urethrovesical anastomosis training on a urethrovesical model (group 1) or to basic laparoscopic suturing and knot tying on foam pads (group 2). All participants then performed timed laparoscopic urethrovesical anastomosis on anesthetized female pigs. A blinded urologist scored subject videotaped performance using checklist, global rating scale and end product rating scores. Group 1 was significantly more adept than group 2 at the laparoscopic urethrovesical anastomosis pig task when measured by the checklist, global rating scale and end product rating (each p <0.05). Time to completion was similar in the 2 groups. No statistically significant difference was noted in global rating scale and checklist scores for laparoscopic urethrovesical anastomosis performed on the urethrovesical model vs the pig. Training on a urethrovesical model is superior to training with basic laparoscopic suturing on a foam pad for performing laparoscopic urethrovesical anastomosis skills on an anesthetized female pig. Skills learned on a urethrovesical model transfer to a high fidelity, live animal model.The Journal of urology 03/2012; 187(5):1861-6. DOI:10.1016/j.juro.2011.12.050 · 3.75 Impact Factor