Correlation between Progress in Box Trainers and Application in Animal Models for Laparoscopic Suturing

Abstract

Over the past decade laparoscopic surgery has become the golden choice for many surgical procedures providing a safe alternative to conventional open surgical methods because of its ability to minimize surgical trauma, decrease postoperative surgical pain and reduce the length of the hospital stay. Within the field of urology, laparoscopy has evolved from its early use purely for diagnostic purposes, to the ability to perform advanced surgery for solid organ tumors, complex reconstructive urologic procedures which is performed completely intracorporeally using laparoscopy. An example for this evolution; laparoscopic pyeloplasty now is considered an effective treatment for patients with ureteropelvic junction obstruction that offers quicker convalescence, decreased postoperative pain and improved cosmoses compared with the conventional open pyeloplasty. With success rates greater than 90%, laparoscopic pyeloplasty has equivalent outcomes to those of open pyeloplasty and superior outcomes to those of endopyelotomy. Although the increase in the rate of laparoscopic surgery, there are many obstacles hinder the expansion of laparoscopic procedures as the high cost of laparoscopic procedures and the steep learning curve required for mastering laparoscopic skills compared to open surgery. This is attributed to the great difference between skills required in laparoscopy and that required in open conventional surgery, for example; the lack of tactile feedback, precise hand eye coordination and a change from 3D to 2D visualization as well as adaption to the fulcrum effect. Acquiring these skills is challenging, needs a lot of effort and takes a long time, particularly for postgraduate urologists who have not been exposed to laparoscopic procedures during their residency training. An advanced laparoscopic skills like intracorporeal suturing is required to be mastered, as it has been applied to more extensive reconstructive procedures such as laparoscopic enterocystoplasty, gastrocystoplasty, sacrocolpopexy, ileal ureter interposition, ureteral reimplant, and the creation of urinary diversion, both noncontinent and continent following radical cystectomy. These skills cannot be taught easily in the real life environment. Historically, laparoscopic training has been divided into animate (Animal models) and inanimate training methods (box trainers, virtual reality simulators), each training method has advantages and disadvantages. Laparoscopic simulation trainers and skills education are now being integrated into resident and medical school curricula. Laparoscopic simulation exercises allow deliberate practice at convenient times and have even been demonstrated to increase surgical skills proficiency. In our study, we tried to investigate the ability of laparoscopic suture training on box trainer and animal model in acquiring intracorporeal suturing skills for laparoscopic novice urologists. Our study included 20 postgraduate urologist members of urology department of Ain-shams University, their age's ranges from 26 to 33 years with a mean of 28.8 ±1.96; none of the participants had any previous clinical laparoscopic experience or any laparoscopic suturing training. The trainees received a laparoscopic suture training on box trainer (12 sutures), then undergo an assessment for their laparoscopic suturing skills for 3 suture trials using a standardized evaluation form, followed by practicing 3 sutures on animal model to get familiar with working on animal models, then they practiced 3 more sutures on the same animal model to be assessed using the same evaluation form and the both scores compared.