Does caffeine consumption affect laparoscopic skills in a motion tracking analysis? A prospective, randomized, blinded crossover trial

Background Coffee can increase vigilance and performance, especially during sleep deprivation. The hypothetical downside of caffeine in the surgical field is the potential interaction with the ergonomics of movement and the central nervous system. The objective of this trial was to investigate the influence of caffeine on laparoscopic performance. Methods Fifty laparoscopic novices participated in this prospective randomized, blinded crossover trial and were trained in a modified FLS curriculum until reaching a predefined proficiency. Subsequently, all participants performed four laparoscopic tasks twice, once after consumption of a placebo and once after a caffeinated (200 mg) beverage. Comparative analysis was performed between the cohorts. Primary endpoint analysis included task time, task errors, OSATS score and a performance analysis with an instrument motion analysis (IMA) system. Results Fifty participants completed the study. Sixty-eight percent of participants drank coffee daily. The time to completion for each task was comparable between the caffeine and placebo cohorts for PEG transfer (119 s vs 121 s; p = 0.73), precise cutting (157 s vs 163 s; p = 0.74), gallbladder resection (190 s vs 173 s; p = 0.6) and surgical knot (171 s vs 189 s; p = 0.68). The instrument motion analysis showed no significant differences between the caffeine and placebo groups in any parameters: instrument volume, path length, idle, velocity, acceleration, and instrument out of view. Additionally, OSATS scores did not differ between groups, regardless of task. Major errors occurred similarly in both groups, except for one error criteria during the circle cutting task, which occurred significantly more often in the caffeine group (34% vs. 16%, p < 0.05). Conclusion The objective IMA and performance scores of laparoscopic skills revealed that caffeine consumption does not enhance or impair the overall laparoscopic performance of surgical novices. The occurrence of major errors is not conclusive but could be negatively influenced in part by caffeine intake.

Effect of video games playing on surgical simulation training: a systematic review.

Introduction: Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. Aim: This study aims to systematically review the existing evidence. Materials and methods: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. Results: Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). Conclusions: Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.

Associations Between Binocular Depth Perception and Performance Gains in Laparoscopic Skill Acquisition

The ability to perceive differences in depth is important in many daily life situations. It is also of relevance in laparoscopic surgical procedures that require the extrapolation of three-dimensional visual information from two-dimensional planar images. Besides visual-motor coordination, laparoscopic skills and binocular depth perception are demanding visual tasks for which learning is important. This study explored potential relations between binocular depth perception and individual variations in performance gains during laparoscopic skill acquisition in medical students naïve of such procedures. Individual differences in perceptual learning of binocular depth discrimination when performing a random dot stereogram (RDS) task were measured as variations in the slope changes of the logistic disparity psychometric curves from the first to the last blocks of the experiment. The results showed that not only did the individuals differ in their depth discrimination; the extent with which this performance changed across blocks also differed substantially between individuals. Of note, individual differences in perceptual learning of depth discrimination are associated with performance gains from laparoscopic skill training, both with respect to movement speed and an efficiency score that considered both speed and precision. These results indicate that learning-related benefits for enhancing demanding visual processes are, in part, shared between these two tasks. Future studies that include a broader selection of task-varying monocular and binocular cues as well as visual-motor coordination are needed to further investigate potential mechanistic relations between depth perceptual learning and laparoscopic skill acquisition. A deeper understanding of these mechanisms would be important for applied research that aims at designing behavioral interventions for enhancing technology-assisted laparoscopic skills.

SP2.1.14Remote examination of surgical skills is feasible and desirable during COVID crisis and beyond

Aims We aimed to investigate the feasibility of employing Zoom technology to undertake structured remote examination of surgical skill during the COVID-19 crisis and beyond as a mean to complement remote training and supervision of basic laparoscopic skills. Methods We have adapted a previously reported method of remote training and supervision of laparoscopic skills training successfully used with 7 trainees. Five consultant surgeons with established expertise in surgical education participated in remote mock examination of LapPass skills using Zoom technology. We assessed the feasibility of remote examination by assessing image quality on Maryland visual comfort scale and undertook a trainers’ survey using a 5 point Lembert scale. Result The remote examiners recorded excellent quality of views, identical in clarity and detail to the source images. Conclusions We demonstrated the feasibility and the benefit of using modern internet technology in delivering a flexible approach to examination of surgical skills met with strong satisfaction by established trainers and trainees alike. All trainers supported the idea of introduction of remote examination as beneficial for all stakeholders and ready to replace face-to-face examination in specific settings. The surgical community should embrace, on a larger scale, the concept of remote supervision and examination whenever possible.

SP2.1.8Novel ultra low-cost laparoscopic trainer design and development

Aims The high cost of laparoscopic training kits is a major barrier for trainees of any level to learn basic laparoscopic skills. Research shows that consistent practice is more effective than intensive training sessions, therefore having access to an at-home training kit provides surgical trainees optimised learning opportunities. During the current pandemic when access to hospital training centres is limited, at-home training kits have become an increasingly vital component of surgical education. Methods A scoping review of current laparoscopic training kits was conducted and based on the results, medical students designed and built ultra low-cost laparoscopic graspers and training kits. Results The laparoscopic training kits were reviewed and approved by a surgical consultant and senior surgical registrars and are currently being trialled in a virtual training course at a tertiary care centre. Each kit cost £10 and was created using commonly available materials. Conclusions The ultra low-cost laparoscopic training kits were successfully created and remain one of the most cost-effective to date. These training kits provide a cost-effective solution for providing trainees with the opportunity for extended practice of basic laparoscopic skills, further improving surgical education worldwide.

EP.TU.153Face to face teaching in the covid era: Basic Surgical Skill Development

Aims According to literature,newly qualified doctors are at risk of being unable to perform practical procedures safely. This has been exacerbated by the disruptions to training and education which the covid-19 pandemic has caused. This intensive course has been developed to improve basic surgical skills and improve confidence in simple wound closure, to mitigate these disruptions. Methods Candidates attended a three-part course in small groups, where they learned hand ties, basic laparoscopic skills and wound closure on animal models. Self assessment data were collected pre and post workshop on a Likert scale. All data was assessed using basic descriptive analysis. Results Data was collected from 13 participants (M:F, 5:8) at the level of foundation year 1(61.5%,n=8) and foundation year 2(38.5%,n=5). Only 38.5% (n = 5) had previous basic surgical skills training. Our delegates reported an improvement in the following surgical skills: suturing (n = 11, 84.6%), hand tying (n = 10, 76.9%), laparoscopic skills (n = 10, 76.9%). Overall 61.5% (n = 8) of our delegates reported an improvement in all three domains. Conclusions Participants reported limited exposure prior to this course despite successfully completing an undergraduate curriculum. Overall, participants' self-scores improved in all three taught surgical skills. We believe ourcourse is a practical and reproducible solution to help bridge training gaps, which can be safely conducted with social distancing measures.

960 Is the Increase in Laparoscopy Leaving Medical Students Behind?

Introduction Laparoscopy use is exponentially increasing, rapidly becoming the gold standard for many procedures. It is technically demanding, requiring specialised training which is not accessible in early medical education. Studies have shown that interest can be stimulated by experiential learning. Our study evaluates current medical students’ interest and exposure to laparoscopy. Method Multiple-choice questionnaires were sent to London medical students assessing their interest and exposure to laparoscopic training in medical school. Results 231 medical students (86 pre-clinical, 145 clinical students) participated. 174 (75.3%) students reported receiving no laparoscopic training during their medical education. 32 (13.9%) students reported less than one hour of training, 21 (9.1%) students reported two to three hours of training, and 4 (1.7%) students reported receiving three to ten hours of training. 100% of students were interested in receiving further laparoscopic simulation training. Conclusions There is insufficient training and exposure of laparoscopy during medical school. The majority of current medical students receive minimal exposure to laparoscopy, despite wanting further training. Teaching basic laparoscopic skills to medical students may provide a feasible option of engaging students in laparoscopy.

Role of Virtual Training Lab in Enhancing Laparoscopic Skills of Residents Versus Consultants

Objective: To compare the role of virtual training lab in enhancing laparoscopic skills at training stage and at the level of qualified surgeons. Materials and Methods: In this comparative study, we included 70 participants of national and resident MIS workshops were included, 35 consultants and 35 residents were included. Participants were analyzed in the basic laparoscopic skills of instrument navigation on Lapsim. Data were collected on first day and on last day of workshop. Parameters included were left instrument time, right instrument time, tissue damage and maximum damage. Result: In 35 residents the left instrument time was improved mean of 27.99(Range 39.52-13.43) to 21.53 (Range 42.37-12.38) and right instrument time improved mean of 31.73(Range 52-48.19) to 23.365 (Range 48.19-11.46). The tissue damage decreased from mean of 3.2 to mean of 1.46. The maximum damage decreased from mean of 8.82 to mean of 3.408. Data of consultants showed that the left instrument time improved mean of 35.71 (Range 140.22-13.09) to 24.39 (Range 111.82-9.71) and right instrument time improved mean of 45.76 (Range 141.45-15.89) to 27.82 (Range 49.2-8.6). The tissue damage decreases from mean of 5.171 to mean of 2.228. The maximum damage decrease from mean of 13.67 to mean of 5.136. All the values at consultant level were greater than resident level. Conclusion: This study further confirmed that virtual lab has very important role in improving laparoscopic skills and in addition this study prove that enhancing of the laparoscopic skill at resident level is much better than the acquisition of laparoscopic skill at consultant level. Keywords: Virtual Training Lab, Laparoscopy, Simulation.

Aptitude and attitude: predictors of performance during and after basic laparoscopic skills training

Background Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on. Purpose To assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training. Method Thirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures. Results The statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks. Conclusion By focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.