Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment

Background. Our aim was to determine if a newly designed Najar needle holder (NNH) shortens the time for novices to improve advanced laparoscopy (AL) techniques (suturing/knot tying), compared with a conventional macro needle holder (MNH) in a simulator. Furthermore, we aimed to validate a new video scoring system determining AL skills. Methods. Forty-six medical students performed identical surgical tasks in a prospective, crossover study evaluating AL skills (NNH vs MNH). All subjects performed a double-throw knot, 2 single-throw knots following 3 running sutures in the Simball Box (SB) simulator. After resting, subjects switched needle holders. All tasks were videotaped and analyzed using SB software and by 2 independent reviewers using the Objective Video Evaluation Scoring Table (OVEST). Trial performance expressed as SB Overall Score (SBOS) and OVEST. Results. In the group starting with NNH (followed by MNH) OVEST was consistently high during both trials (median = 12.5, range = 6.5-18.0, and median = 13.5, range = 6.5-21.0; P = .2360). However, in the group starting with MNH, OVEST improved significantly when the participants changed to NNH (median = 10.0, range = 2.5-19.5, vs median = 14.5, range = 4.5-18.0; P = .0003); an improvement was also found with SBOS (median = 37%, range = 27% to 92%, vs median = 48%, range = 34% to 70%; P = .0289). In both trials, both independent reviewers’ OVEST measures correlated well: Trial 1: β = 0.97, P < .0001; and Trial 2: β = 0.95, P < .0001. A correlation also existed between SBOS and OVEST in both trials (β = 2.1, P < .0001; and β = 1.9, P = .0002). Conclusions. This study indicates a significantly higher improvement in laparoscopic suturing skills in novices training AL skills using NNH compared with MNH. Starting early, AL training in novices using NNH is a feasible option. Furthermore, OVEST used in experimental settings as an evaluation tool is comparable with the validated SBOS.

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The Use of Different Technological Methods for Teaching Basic Suturing Skills to Medical Students: A Literature Review

Education in Medicine Journal ◽

10.21315/eimj2021.13.4.1 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1-18

Author(s):

Helen Xinyi Cai ◽

◽

Sarah Yew ◽

Qi Rou Yap ◽

Sherry Seah ◽

...

Keyword(s):

Medical Students ◽

Teaching Methods ◽

Good Alternative ◽

Knot Tying ◽

Instructional Videos ◽

Self Reflection ◽

Conventional Teaching ◽

Key Terms ◽

Technological Methods ◽

Suturing Skills

Suturing skills are usually acquired by medical students through observation and then practice. There is a pressing need to develop more efficient teaching methods as students are often unprepared to perform suturing in clinical practice. This study therefore aims to investigate the benefits and limitations of different technological teaching methods and determine if technological methods are superior to conventional teaching. The search was conducted using ScienceDirect, PubMed and Scopus with different combinations of the key terms “suturing”, “suture”, “knot-tying”, “suturing skill”, “surgical skill”, “teaching methods” and “medical students”. Overall, 19 relevant articles were shortlisted, discussing the use of virtual reality, augmented reality, videos and programmes in teaching suturing skills. The use of instructional videos is a good alternative to the traditional lab-based method while video self-reflection was found to be an effective enhancement. Integration of these methods could be a valuable addition to the current curriculum.

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The Spaced Learning Concept Significantly Improves Acquisition of Laparoscopic Suturing Skills in Students and Residents: A Randomized Control Trial

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1721041 ◽

2020 ◽

Author(s):

Johannes Boettcher ◽

Stefan Mietzsch ◽

Julia Wenkus ◽

Nariman Mokhaberi ◽

Michaela Klinke ◽

...

Keyword(s):

Medical Students ◽

Training Programs ◽

Analysis Of Covariance ◽

Long Term Results ◽

Knot Tying ◽

Laparoscopic Suturing ◽

Spaced Learning ◽

Complex Motor ◽

Learning Concept

Abstract Introduction Spaced learning consists of blocks with highly condensed content that interrupted by breaks during which distractor activities, such as physical activity, are performed. The concept has been shown to be superior in complex motor skill acquisition like laparoscopic suturing and knot tying. Preliminary studies have solely been conducted with medical students. Therefore, it remained unanswered if the spaced learning concept would also work for pediatric surgery residents. Materials and Methods The study aimed to evaluate the effectiveness of spaced learning, students, and residents were asked to perform four surgeons' square knots on a bowel model within 30 minutes prior and post 3 hours of hands-on training. To examine the long-term skills, the same subjects were asked to perform a comparable, but more complex task 12 months later without receiving training in the meantime. Total time, knot stability, suture accuracy, knot quality, and laparoscopic performance were assessed. Additionally, motivation was accessed by using the questionnaire on current motivation. Differences were calculated using mixed analysis of variance, Mann–Whitney U test, and multivariate analysis of covariance. Results A total of 20 medical students and 14 residents participated in the study. After randomization, 18 were trained using the spaced learning concept and 16 via conventional methods. Both groups had comparable baseline characteristics and improved significantly after training in all assessed measures. The spaced learning concept improved procedure performance as well as knot quality and stability in both students and residents. However, residents that trained via spaced learning showed significantly better long-term results regarding knot quality and speed in comparison to students. Although anxiety was significantly reduced in both training groups over time, residents were significantly more interested regarding knot tying than students. Conclusion This study dispels any remaining doubt that the spaced learning concept might only work for medical students. It appears that the spaced learning concept is very suitable for residents in acquiring complex motor skills. It is superior to conventional training, resulting in improved procedural performance as well as knot quality and speed. Hence, tailored training programs should not only be integrated early on in students' curricula but also in surgical training programs.

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Telementoring of Open and Laparoscopic Knot Tying and Suturing Is Possible: A Randomized Controlled Study

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1741542 ◽

2022 ◽

Author(s):

Julia Elrod ◽

Johannes Boettcher ◽

Deirdre Vincent ◽

David Schwarz ◽

Tina Trautmann ◽

...

Keyword(s):

Medical Students ◽

Cognitive Load ◽

Controlled Trial ◽

Controlled Study ◽

Knot Tying ◽

Laparoscopic Suturing ◽

Continuous Training ◽

Educational Approach ◽

Intracorporeal Suturing ◽

Randomized Controlled

Abstract Aim Several motor learning models have been used to teach highly complex procedural skills in medical education. The aim of this randomized controlled trial was to assess the efficiency of telementoring of open and laparoscopic suturing of medical students compared to conventional in-person teaching and training. Methods After randomization, 23 medical students were assigned to either the telementoring or the in-person training group. Both groups were taught by surgically trained residence with a student–teacher ratio of 1:1 (teacher–student). Open suturing was assessed in a model of congenital diaphragmatic hernia and laparoscopic suturing in a model of bowel anastomosis. All subjects were trained according to the spaced learning concept for 3 hours. Primary end points were time, knot quality, precision, knot strength, and overall knotting performance/competency. Furthermore, we utilized the Surgery Task Load Index to evaluate the cognitive load of both teaching techniques. Students' subjective progress regarding skill acquisitions and acceptance of telementoring was assessed using a nine-item questionnaire. Results All 23 trainees significantly improved after training in all knot attributes. More than 90% of all subjects reached proficiency in both groups. In-person training and telementoring were similarly practical, and no significant differences regarding speed, knot quality, precision, knot stability, and procedure performance/competency were found. Students perceived no difference in acquisition of factual or applicational knowledge between the two groups. General acceptance of telementoring was moderate in both groups before training, but increased during training in students actually assigned to this group, in comparison to students assigned to conventional teaching. Conclusion The current study shows that telementoring of open and laparoscopic suturing is an ideal answer to the current coronavirus disease 2019 pandemic, ensuring continuous training. On-site training and telementoring are similarly effective, leading to substantial improvement in proficiency in intracorporeal suturing and knot tying. Likewise, students' subjective progress regarding skill acquisitions and cognitive load does not differ between teaching methods. Skepticism toward telementoring decreases after exposure to this learning method. Given our results, telementoring should be considered a highly effective and resource-saving educational approach even after the current pandemic.

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The Effectiveness of a Simulation-Based Flipped Classroom in the Acquisition of Laparoscopic Suturing Skills in Medical Students—A Pilot Study

Journal of Surgical Education ◽

10.1016/j.jsurg.2017.07.007 ◽

2018 ◽

Vol 75 (2) ◽

pp. 326-332 ◽

Cited By ~ 10

Author(s):

Hsin-Yi Chiu ◽

Yi-No Kang ◽

Wei-Lin Wang ◽

Hung-Chang Huang ◽

Chien-Chih Wu ◽

...

Keyword(s):

Medical Students ◽

Pilot Study ◽

Flipped Classroom ◽

Laparoscopic Suturing ◽

Simulation Based ◽

Suturing Skills

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Development of a Model for the Acquisition and Assessment of Advanced Laparoscopic Suturing Skills Using an Automated Device

Surgical Innovation ◽

10.1177/1553350618764221 ◽

2018 ◽

Vol 25 (3) ◽

pp. 286-290 ◽

Cited By ~ 2

Author(s):

Elif Bilgic ◽

Madoka Takao ◽

Pepa Kaneva ◽

Satoshi Endo ◽

Toshitatsu Takao ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Instructional Video ◽

Validity Evidence ◽

Laparoscopic Suturing ◽

Intraclass Correlation Coefficients ◽

Operative Assessment ◽

Suturing Skills

Background. Needs assessment identified a gap regarding laparoscopic suturing skills targeted in simulation. This study collected validity evidence for an advanced laparoscopic suturing task using an Endo StitchTM device. Methods. Experienced (ES) and novice surgeons (NS) performed continuous suturing after watching an instructional video. Scores were based on time and accuracy, and Global Operative Assessment of Laparoscopic Surgery. Data are shown as medians [25th-75th percentiles] (ES vs NS). Interrater reliability was calculated using intraclass correlation coefficients (confidence interval). Results. Seventeen participants were enrolled. Experienced surgeons had significantly greater task (980 [964-999] vs 666 [391-711], P = .0035) and Global Operative Assessment of Laparoscopic Surgery scores (25 [24-25] vs 14 [12-17], P = .0029). Interrater reliability for time and accuracy were 1.0 and 0.9 (0.74-0.96), respectively. All experienced surgeons agreed that the task was relevant to practice. Conclusion. This study provides validity evidence for the task as a measure of laparoscopic suturing skill using an automated suturing device. It could help trainees acquire the skills they need to better prepare for clinical learning.

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Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study

European Urology ◽

10.1016/j.eururo.2008.09.045 ◽

2009 ◽

Vol 56 (5) ◽

pp. 865-873 ◽

Cited By ~ 42

Author(s):

Stephanie G.C. Kroeze ◽

Erik K. Mayer ◽

Samarth Chopra ◽

Rajesh Aggarwal ◽

Ara Darzi ◽

...

Keyword(s):

European Study ◽

Laparoscopic Suturing ◽

Suturing Skills

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1005 Acquisition of Surgical Skills in Medical Students Via Telementoring: A Randomised Control Trial

British Journal of Surgery ◽

10.1093/bjs/znab259.888 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Feeley ◽

I Feeley ◽

D Hehir

Keyword(s):

Medical Students ◽

Rating Scale ◽

Significant Degree ◽

Randomised Control Trial ◽

Global Rating Scale ◽

Control Group ◽

Live Streaming ◽

Global Rating ◽

Post Test ◽

Suturing Skills

Abstract Aim To evaluate the use of telementoring in acquisition of basic suturing skills in medical students. Method This was a single blinded two- armed randomised control trial. Medical students undergoing clinical rotations in their penultimate and final years were invited to participate in this study. Informed consent was obtained. The control group underwent conventional suturing training, with the interventional group undergoing the tutorial in a remote learning setting via live streaming. Pre- and post-test assessment was carried out using validated Global Rating Scale tool. Results Eleven students were enrolled in this study. Participants were comparable at baseline (p=.18) and following the tutorial (p=.29). Participants improved to a statistically significant degree in both the virtual group (p=.02) and the in-person group (p=.001). Conclusions Telementoring is an effective tool in the provision of teaching basic suturing skills in medical students. Research on its use in more complex practical skills is warranted.

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Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying

Surgical Innovation ◽

10.1177/1553350618800148 ◽

2018 ◽

Vol 25 (6) ◽

pp. 625-635 ◽

Cited By ~ 3

Author(s):

Benjamin De Witte ◽

Franck Di Rienzo ◽

Xavier Martin ◽

Ye Haixia ◽

Christian Collet ◽

...

Keyword(s):

Cognitive Training ◽

Spatial Orientation ◽

Mental Workload ◽

Surgical Skills ◽

Training Period ◽

Control Group ◽

Surgical Skill ◽

Knot Tying ◽

Laparoscopic Suturing ◽

Skill Group

Mini-invasive surgery—for example, laparoscopy—has challenged surgeons’ skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

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