RESUMO
BACKGROUND: Video surgery requires acquisition of psychomotor skills that are different from those required for open surgery. The aim of this study was to assess the EndoSuture Trainer Box Simulator (ESTBS), a new bariatric laparoscopic skills simulator, as a tool for surgical education, comparing it with a standard laparoscopic trainer (SLT). METHODS: A randomized prospective crossover study was designed to compare ESTBS versus SLT as a tool for training bariatric laparoscopic skills. Participants were assigned to perform a task simulating Nissen fundoplication operation. All subjects evaluated the simulators concerning to their performance on simulating laparoscopic procedures by the use of a questionnaire comparing: triangulation, resistance and resilience, spatial perception (stereotaxy), ergonomics and positioning, inverted movements, visibility, design, technical and technological resources for training and education. The overall score was defined as the median value obtained. A total of 37 participants were enrolled in the study, including 29 experienced surgeons (78.37%) and 08 surgical residents (21.63%). RESULTS: A superior performance was observed with ESTBS as compared to SLT upon 7 of the 10 items evaluated in the questionnaire. Additionally, the overall score of ESTBS (median of 4, very good) was significantly higher (P < 0.0001) than that of SLT (median of 3, good). For the items, triangulation, resistance and resilience, ergonomics, design, training, technology and teaching, the evaluation for the ESTBS was very good and excellent, which was significantly higher than obtained by SLT. Also, ESTBS was cheaper. CONCLUSIONS: The ESTBS was shown to present excellent technical and technological performances and appears to constitute a useful cost-effective promising instrument for teaching and training bariatric surgical laparoscopic skills.
Assuntos
Cirurgia Bariátrica/educação , Laparoscopia/educação , Treinamento por Simulação/métodos , Adulto , Competência Clínica , Custos e Análise de Custo , Estudos Cross-Over , Feminino , Fundoplicatura/educação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cirurgiões , Inquéritos e QuestionáriosRESUMO
BACKGROUND: A significant gap presently exists between box-lap and virtual-reality simulators and live surgery. Live animal and cadaver use has significant downsides. We have developed a high fidelity, real tissue simulator that allows training in laparoscopic foregut operations. METHODS: Our foregut surgery model is based on porcine tissue blocks that include lungs, heart, aorta, esophagus, diaphragm, stomach, duodenum, liver, and spleen. The tissue block is mounted in a human mannequin and perfused with artificial blood. The anterior abdominal wall is constructed so as to allow for laparoscopic or robotic surgical training. We sought to test the model with procedures performed by expert surgeons. After completing the procedures, face validity was measured by surgeon responses to a questionnaire defining the perceived relationship to real surgery. RESULTS: Five expert foregut surgeons performed laparoscopic Heller myotomy, Nissen fundoplication, and sleeve gastrectomy on the model. The simulator was rated as highly realistic in terms of tissue feel, instrument usage, and conduct of the operation for all three procedures. In addition, all surgeons felt the model could significantly shorten the learning curve for performing these procedures. CONCLUSIONS: The results of this study show that our simulation model, based on animal tissue blocks, offers a very realistic representation of laparoscopic foregut operations, thus achieving a high level of face validity. The model should be very useful for training surgeons in laparoscopic foregut procedures.