Simple and highly efficient laparoscopic training methods

Abstract

Laparoscopic procedures demand skills, which necessarily have to be trained in ex vivo models. The main challenge for novice laparoscopists is the absence of the third dimension and the narrowed depth perception in the predominantly used two- dimensional (2D) imaging systems. Handling of laparoscopic instruments has to be trained as well, but normally causes fewer problems. In the current study an inexpensive box trainer was developed. The box trainer was designed as a prototype for laparoscopic training courses in Yemen. The training courses were intended to advance laparoscopic surgery in Yemen. Using simple and inexpensive materials a durable box trainer was constructed. The box trainer was suitable for learning and practicing of basal laparoscopic skills in a dry lab setting, as well as the training of laparoscopic procedures in a wet lab setting. Applying electrocautery was practicable as well. The box trainer allowed practicing with direct view to the training field. Additionally the training field could be covered by an opaque lid and by means of a 2D camera and screen it was suitable for training with 2D vison. A randomized controlled trial was conducted to evaluate if the efficiency of laparoscopic skills training increases when the training curriculum allows direct view to the training site at certain points. 32 medical students devoid of experiences in minimally invasive surgeries were included in the study. The participants were randomized and stratified into two almost equal groups. Group A performed the whole training using a 2D- camera transmitted monitor image. Group B similarly realized cycle 1, 3 and 5 of the training using the 2D imaging systems but was allowed to direct view to the training site in cycle 2 and 4. The curriculum scheduled two simple tasks (bead transfer, needle guidance) and a pair of complex tasks (placement of cylinders, intracorporeal knotting). Performance time was recorded for each task. The box trainer was well-accepted by the participating laparoscopic novices. Furthermore, participants expeditiously ameliorated their performance of simple laparoscopic skills. In this trial the training of simple laparoscopic skills (bead transfer and needle guidance) did not benefit from additional glances to the training site. The students improved the performance of simple laparoscopic tasks, irrespective of the opportunity to direct view to the training site. However, direct view to the training site benefited the training of complex laparoscopic skills like placement of cylinders and intracorporeal knots. Durable box trainers can be self- made at low costs and nevertheless offering multiple training opportunities. Laparoscopic skills training in this simple box trainer is well accepted and effective. Training of complex laparoscopic skills, benefits from the combination of training with a 2D system and intermittent direct view to the training site. Most likely the improvement of the hand-eye coordination under direct view to the training site increases the effectivity of skills training.