“Skilled Surgeon Safer Surgery”
May 28th, 2009
Skill Acquisition and Assessment for Laparoscopic Surgery
Laparoscopic surgery affords opportunities for access and surgical manipulation that may replace traditional surgical approaches and permit new approaches previously impossible because of mechanical, anatomical, or physiologic considerations. Training in laparoscopy is still a challenge for the surgeons community. Surgeons in training must learn the laparoscopic techniques, possibly without having ever performed the conventional procedure. In the present study,weprovide a non structured literature review per taining to laparoscopic training and discuss the training design and the modular concept. Skills that permit competence and mastery in laparoscopic procedures are not directly derivative from skills used in open surgery. The effective acquisition of those skills by trainees is a matter of some importance to abbreviate the training period, minimize reliance on animal models, decrease operating room time, equip surgeons for independent operations, and reduce complications. Intracorporeal suturing is perhaps the most difficult of advanced laparoscopic skills and allows the surgeon to perform almost any maneuver through the laparoscope that can be achieved through an open incision. Suturing requires depth perception in the 2-dimensional image of the laparoscopy screen, accuracy with instruments beyond that necessary for dissection, and dexterity. In this study, dexterity drills, which correlate with incremental skill acquisition and the ability to perform intracorporeal suturing, were standardized.
The mechanical skills needed for successful laparoscopic surgery are fundamentally different from those required for open surgery. Laparoscopic surgery relies on a 2-dimensional image, minimal tactile feedback, and reliance on instruments operated at a distance. Open surgery relies heavily on hand-eye coordination with depth perception, palpation, and reliance on simple instruments used by the surgeon who is physically in the operative field. The public1 and profession2 in concert call for objective evidence that surgeons, regardless of their previous accomplishments, have acquired the needed skills for new procedures. When surgeons are equipped with the proper skills, they are more confident and more likely to apply newer techniques.
Due to increasing time constraints, cost, stress, and ethical considerations, the modern operating room is not the ideal learning environment. Various simulators and models for laparoscopic training in gynecology and general surgery with different levels of validity and reliability are available. Wide acceptance of the use simulators has been hampered by the lack of standard and valid methods to measure and certify competence in basic psychomotor skills. Besides, it is unclear if trainees have enough access to these programmes and if they are sufficient enough to develop the required skills. Whether complex surgical procedures can be performed by beginners without open surgical expertise and whether experience in open surgery is definitely required before mastering laparoscopic techniques are still matters of issue.
The lack of a standardised, evaluated training procedure needs to be overcome. Structured training programmes and transference of gained experience into daily practice are essential to provide skill
with expert laparoscopists.
Categories: Laparoscopy
