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Laparoscopic through physical training simulator use and implementation in general surgical residency

Abstract

Introduction

Minimal invasive techniques are the gold standard for some surgical procedures. Benefits include a reduction in morbidity, and a faster return to daily activities.

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Content and methods

Experimental study, longitudinal, comparative, prospective, without blind. A 4 week training program was conducted with an experimental group of General Surgery residents in the first and second years and social service medical interns (group A); At the end of the training there was testing, compared to a series of exercises by the residents who took the training program with a control group (group B) involving fourth and fifth year residents who did not undertake this training.

Results

On analysis of the two groups, we saw a decrease in the average time of group A compared to group B. Overall, the 7 exercises showed a difference in average time, with group A completing in 5 minutes compared to group 12 B (p <0.05).

Discussion

This study shows that training in a physical simulator for laparoscopic surgery, for at least two hours a week for a month, is sufficient to improve laparoscopic surgical skills, reducing turnaround times by more than half. Compared to those who did not receive this training.

Introduction

 

Minimal invasive techniques are the gold standard for some surgical procedures. Benefits include a reduction in morbidity, reducing hospital stays, and a faster return to daily activities.

The term “learning curve” was introduced in surgery to refer to the number of surgeries that a surgeon must perform to achieve an experience level with a low incidence of difficulties. Depending on the type of surgery, the program needs to reach between 15 and 100 procedures to achieve the learning curve. Experienced laparoscopic surgeons have to revisit the learning curve when training for new laparoscopic techniques or instruments.

For a long time, surgical teaching and training is based on a teacher-student model, which has been applied primarily in the operating room. In recent years, however, there have been major changes in surgery. In addition, the time available to residents is their first shortened years, and new surgical techniques have emerged. These new techniques have led to new and major demands for surgical teaching and training, resulting in new methods of gaining experience and skills.

Using visual feedback base in monitors or other screen types offers a wide range of teaching and training possibilities for laparoscopy based computer systems.

Knitting and the incorporeal seam are among the most difficult tasks in laparoscopy, involving hand-eye coordination skills and knowledge of the right steps. Competency in laparoscopic sounds for surgeons wishing to progress on laparoscopy is an important requirement. A non-randomized study showed a significant improvement in incumbent weights by acquiring skills training in a laparoscopic training box.

Virtual reality simulators or laparoscopic training boxes are used for training, which aim to develop the necessary skills and understanding of the spatial-time reference framework and are required to manipulate instruments and tissue in vision two-dimensional, camera manipulation and the ability to control instruments with both hands; therefore be able to perform complex surgical procedures without much invasion.

The objective of this study is to prove that the implementation of a training program using a laparoscopic training box during a general surgeon’s residency will result in a time lag when applying laparoscopic techniques.

Content and methods

Experimental, longitudinal, comparative, prospective blind were studied. A 4 week training program was carried out by the Department of General Surgery in Hospital teaching. The program included an experimental group for general surgical residents in the first and second years, as well as interns doing their social service (group A). At the end of training, testing took place when they carried out a series of exercises comparing residents who completed the training program with those in the control group (group B), including fourth and fifth year residents who did not complete training. The program began when laparoscope skills testing was carried out in a training box, where 7 exercises were performed, a two-way transfer using beads towards a job, beads transfer from one container to another, a default cut, pull and anti-pull, simulate intestine inspection using twine, and points on the seam with incorporated and existing knots. This practice was carried out for a minimum of 2 hours per week for 4 weeks.

On completion of the four-week training program, participants in the experimental group (group A) must complete 90% of the specified hours previously (7.2 h) and have at least 90% of the specified time periods. . Comparative testing was carried out when the specified exercises were carried out by Group A and Group B residents, time was taken for stopping attention, and the times of the two groups were compared at the end of the study.

Results

A total of 20 residents were analyzed, 10 in each group. Men were 15 (75%) were female and 5 (25%).The average age was 28 years. On analysis of the two groups, we saw a decrease in average group A time compared to average group B times

In comparing times, according to the exercise undertaken, we found: in the practice of I (an incorporated knot), a greater time difference was shown between the two groups, and we found symmetry in group A materials and a small asymmetry. in group B materials. Difficulties made by Exercise II (counting 5/5) were the subjects. One group B content exceeded the time achieved, on average, for the remainder of the subjects in the same group. However, we observed a clear reduction in average A group time. In Practice III (10/10 accounts), a large difference was seen, where group A ended with an average of 4 minutes and ended with group B for 7 minutes. Exercise IV (default cut) shows the clear time difference between the two groups, where group A has a shorter period. Exercise V (string) indicates that this exercise had the shortest time for both groups. In group A, there was no reduction in time, with symmetry materials, contrary to group B, where it took longer and there is no asymmetry. Exercise VI (stereotyping of grape), group A is considered less time. Exercise VII (low knot knots), a shorter time in group A is observed compared to group B, while the second shows more asymmetry between subjects. Finally, we received significant statistical values in the 7 exercises between the two groups.

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