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.

Survival after Laparoscopic Radical Surgery for Early-stage Cervical Cancer in 1316 Consecutive Cases from a National Laparoscopic Training Center in China

Background: A major concern about the Laparoscopy Approach to Cervical Cancer trial is the disparities in laparoscopic radical hysterectomy experience between the participating centers and the potential effects of the learning curve of minimally invasive surgery on the oncologic outcomes of patients. Thus, it is necessary to assess the survival of cervical cancer patients undergoing laparoscopy in a minimally invasive gynecology center.Methods: A consecutive series of patients undergoing first laparoscopic radical hysterectomy (LRH) for cervical cancer from May 2008 to December 2017 at a national laparoscopic training center were retrospectively analyzed. The overall survival (OS) and progression-free survival (PFS) were compared between groups.Results: In total, 1316 women with FIGO (2009) stage IA-IIB cervical cancer received LRH. Among them, 1114 (84.7%) were followed-up for 3 months or longer; the median follow-up period was 48 months (range, 3-144 months). In patients with stage IA, IB1 (≤ 2 cm), IB1 (> 2 cm), IB2, IIA1 and IIA2-IIB tumors, the 4-year PFS rates were 98.6%, 94.5%, 87.4%, 65.6%, 80.0% and 67.4%, respectively, and the 4-year OS rates were 98.6%, 96.8%, 91.1%, 77.4%, 85.6% and 76.2%, respectively. The 4-year PFS and OS were as high as 96.2% and 97.5%, respectively, in patients with squamous cell carcinoma of 2 cm or smaller in diameter. A stable high 4-year OS and PFS was achieved after completing 100 LRHs. In patients operated on by the same surgeon, an improvement in survival was observed after 40 LRHs. Conclusion: Favorable oncologic outcomes can be achieved in patients with IA-IB1 cervical cancer after LRH in a center with a high surgery volume.

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.

Objective Measurement of Impact of Bench Laparoscopic Training in Novices

Background: We are currently in the era of laparoscopic surgery. It has gained popularity in the last few decades because of its well- known advantages. Laparoscopy requires different skills from those of open surgery. In a paradigm shift, learning basic surgical skills is now performed more in the skills laboratory than in the operation theater. However, there is a lack of reliable training and assessment tools for laparoscopic surgical skills. This study aimed to objectively assess the effect of bench laparoscopic training in novices. Methods: This prospective study was conducted at the Clinical Skills Centre of Bangalore Medical College and Research Institute (BMCRI) in Bangalore, India. Sixty interns with no previous experience in laparoscopy were included. They underwent supervised training on the box trainer for 3 days, 2 hours a day, in basic surgical tasks, including pointing dots, joining straight lines, joining curved lines, picking objects, peg transfer, and circle cut. All participants were assessed objectively in a virtual reality (VR) simulator before and after training. The objective outcomes measured were time taken, distance traveled, and error scores given by the VR simulator metrics. Results: The novices showed statistically significant improvement in all the tasks after the training compared with their skill levels before the training. Conclusion: Structured short-term training significantly improves basic laparoscopic surgery skills.

RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING

INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.

P15: EVALUATING THE INTERNATIONAL USABILITY OF A LOW-COST LAPAROSCOPIC TRAINER IN LOW- AND HIGH-INCOME SETTINGS

Introduction Limited access to equipment and trained personnel restrict the adoption of laparoscopic surgery globally. There are a wide range of laparoscopic trainers available; however, most of these are not affordable. We propose an ultra-low-cost laparoscopic trainer (Lap-Pack), designed for portability, ease of assembly and compatibility with smart devices. The study aims to evaluate the usability of Lap-Pack as a training tool in low- and high-income settings. Method An international usability study was conducted in India and the UK in 2019. The participants (n=60), consisting of senior surgeons (n=18), junior trainees (n=20) and medical students (n=22), were asked to complete two tasks using Lap-Pack. Participants then scored Lap-Pack in a 25-point questionnaire, including a pre-established Face-Validity Criteria and four major evaluation categories – Usability, Camera, View, Material. Result Lap-Pack scored highly in Face-Validity with a combined mean score of 4.63 (95%CI: 4.31, 4.95, p <0.05) of a possible 6. In both cohorts, the Usability and Camera categories scored highest, with combined values respectively of 6.10 (95%CI: 6.01, 6.19, p <0.05) and 6.09 (95%CI: 5.88, 6.31, p <0.05) of a possible 7. For both centres, the highest-scoring individual criteria were its light weight and portability. Conclusion Overall, Lap-Pack was received positively by medical students and consultants alike, suggesting it is a suitable device for development of skills as part of a larger laparoscopic training curriculum. Its ease of assembly, portability and versatility show promise of increasing access to training opportunities worldwide. Take-home message Lap-Pack is an ultra-low-cost, portable laparoscopic simulator featuring compatibility with smart devices designed to help increase access to laparoscopic training worldwide. An international usability study found medical students, junior trainees and senior surgeons rated its usability and camera features highly, suggesting its employability as a laparoscopic training tool on a global scale.