Systematic Review on Mentoring and Simulation in Laparoscopic Colorectal Surgery (vol 252, pg 943, 2010)
ABSTRACT To identify and evaluate the influence of mentoring and simulated training in laparoscopic colorectal surgery (LCS) and define the key components for learning advanced technical skills.
Laparoscopic colorectal surgery is a complex procedure, often being self-taught by senior surgeons. Educational issues such as inadequate training facilities or a shortfall of training fellowships may result in a slow uptake of LCS. The effectiveness of mentored and simulated training, however, remains unclear.
We conducted a systematic search, using Ovid databases. Four study categories were identified: mentored versus nonmentored cases, training case selection, simulation, and assessment. We performed a meta-analysis and a mixed model regression on the difference of the main outcome measures (conversion rates, morbidity, and mortality) for mentored trainees and expert surgeons. We also compared conversion rates of mentored and nonmentored. Meta-analysis of risk factors for conversion was performed using published and unpublished data sets requested from various investigators. For studies on simulation, we compared scores of surveys on the perception of different training courses.
Thirty-seven studies were included. Pooled weighted outcomes of mentored cases (n = 751) showed a lower conversion rate (13.3% vs 20.5%, P = 0.0332) compared with nonmentored cases (n = 695). Compared to expert case series (n = 5313), there was no difference in conversion (P = 0.2835), anastomotic leak (P = 0.8342), or mortality (P = 0.5680). A meta-analysis of training case selection data (n = 4444) revealed male sex (P < 0.0001), previous abdominal surgery (P = 0.0200), a BMI greater than 30 (P = 0.0050), an ASA of less than 2 (P < 0.0001), colorectal cancer (P < 0.0001) and intra-abdominal fistula (P < 0.0001), but not older than 64 years (P = 0.4800), to significantly increase conversion risk. Participants on cadaveric courses were highly satisfied with the teaching value yet trainees on an animal course gave less positive feedback. Structured assessment for LCS has been partially implemented.
This review and meta-analysis supports evidence that trainees can obtain similar clinical results like expert surgeons in laparoscopic colorectal surgery if supervised by an experienced trainer. Cadaveric models currently provide the best value for training in a simulated environment. There remains a need for further research into technical skills assessment and the educational value of simulated training.
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ABSTRACT: Mentoring has been used extensively in the business world to enhance performance and maximise potential. Despite this, there is currently a paucity of literature describing mentoring for surgical trainees. This study examined the current extent of mentoring and investigated future needs to support this.World Journal of Surgery 10/2014; 39(2). DOI:10.1007/s00268-014-2774-x · 2.35 Impact Factor
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ABSTRACT: To evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). This prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up. Four variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0-100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed. An interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool.Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:141-9. DOI:10.2147/OPTH.S69970
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ABSTRACT: To critically review the learning curve, safety issues and outcome of a single surgeon while starting up minimally invasive mitral valve surgery (MIMVS). We performed a descriptive, retrospective study of 138 patients with minimally invasive mitral valve surgery between March 2004 and December 2010. The learning curve was assessed using a logarithmic curve-fit regression analysis of the cardiopulmonary bypass parameters and defined as the end of the steepest part. Complexity was assessed by the number of different techniques performed on the mitral valve and the number of concomitant procedures. Follow-up was obtained for embolic events, endocarditis, bleeding, reintervention, echocardiographic data and NYHA class. The learning curve was found in the last 30 cases. There was a significant reduction in aortic cross-clamp time before and after the end of the learning curve [Patients 1-30: 120.77 (±28.28); Patients 31-138: 97.57 (±5.66); P <0.0001]. Operations during the learning curve did not correlate with intensive care unit (ICU) [1.77 (±0.97) vs 2.06 (±1.38)] and hospital stay [10.00 (±2.74) vs 9.10 (±3.36)]. In 104 patients, the valve was reconstructed, whereas in 34 it was replaced. The complexity of mitral valve reconstruction gradually increased and proportion of mitral valve replacement decreased, partly by expanding minimally invasive mitral valve surgery indications. Eighteen patients underwent 25 concomitant procedures and four conversions were necessary (after Patient 30). Minimal follow-up was 1 year with a mean follow-up of 1211 ± 651 days. No procedure-related mortality was encountered and mitral regurgitation after mitral valve repair was classified as Grade 1 or less in 101 of 104 patients at the end of follow-up. Implementation of new equipment and techniques is challenging. However, minimally invasive mitral valve surgery with the endoclamp system is safe even during the learning curve. During our evolution from simple reconstructions/replacements to complex valve surgery with concomitant procedures, we could safely optimize our technique without mortality. A longer aortic cross-clamp time during the learning curve did not result in longer ICU and hospital stay. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.Interactive Cardiovascular and Thoracic Surgery 11/2014; DOI:10.1093/icvts/ivu394 · 1.11 Impact Factor