Comparative Evaluation of Simulator Based and Traditional In-surgery Laparoscopic Camera Training's Efficiency in Novices

• Progress of skills shown in test as assessed by rating scale [ Time Frame: After 3 weeks of individual training ] [ Designated as safety issue: No ]
  Students are sent to the OR to do two camera assessment tests involving a standardized set of tasks they had to accomplish operation. They had to center and hold for 5 seconds the following positions/organs and had to maintain the correct horizontal alignment during camera movement: 1. Left abdominal wall, 2. Descending colon, 3. Right lobe of liver, 4. Sigmoid colon 5. Caecum 6. Pelvis 7. Trocar entry site in the upper left quadrant 8. Desc. Colon. This assessment was video-taped. A rating scale quantifying target centring and horizon alignment from 1-4 each was used.
• Progress of time to completion of test [ Time Frame: After 3 weeks of individual training ] [ Designated as safety issue: No ]

• Total time effort spend for respective training time [ Time Frame: During 3 weeks of individual training ] [ Designated as safety issue: No ]

  Total time effort for OR group was defined as time used from receiving pager call (to go to OR) to leaving OR.

  Time effort for Skillslab group was defined as total time spend in Skillslab.

• Progress of time to completion of test [ Time Frame: After 3 weeks of individual training ] [ Designated as safety issue: No ]
• Progress of skills shown in test regarding horizon alignment as assessed by rating scale [ Time Frame: After 3 weeks of individual training ] [ Designated as safety issue: No ]
  Students are sent to the OR to do two camera assessment tests involving a standardized set of tasks they had to accomplish operation. They had to center and hold for 5 seconds the following positions/organs and had to maintain the correct horizontal alignment during camera movement: 1. Left abdominal wall, 2. Descending colon, 3. Right lobe of liver, 4. Sigmoid colon 5. Caecum 6. Pelvis 7. Trocar entry site in the upper left quadrant 8. Desc. Colon. This assessment was video-taped. A rating scale quantifying horizon alignment was used.

This prospective randomized study aims for determination whether focused simulator based laparoscopic camera training in novices can improve camera performance in an actual clinical situations in the same manner as traditional training in the OR does, especially considering efficient use of training time.

Medical students in their final years without any significant experience in handling an angled laparoscopic camera participate in the study and perform a camera guidance test in surgery. The participants are then randomized in two groups to receive either a simulator based or traditional in theatre training during three weeks. The camera test will be repeated, while both tests are going to be recorded. Videos of 14 camera tests carried out by laparoscopic experts are taped as well.

• Laparoscopy
• Clinical Competence

• Behavioral: Training on laparoscopic simulator in skills lab
  Laparoscopic camera training in a skills lab following training protocol for a total of 6 hours during 3 weeks.
• Behavioral: Training at actual laparoscopic surgery
  Assisting at 6 laparoscopic surgeries navigating the camera during 3 weeks
• Behavioral: Technical instruction
  Technical instruction on proper handling of an angled laparoscope before randomization for 1 hour

• Active Comparator: Operating room training
  Interventions:

  • Behavioral: Training at actual laparoscopic surgery
  • Behavioral: Technical instruction
• Active Comparator: Skills lab training
  Interventions:

  • Behavioral: Training on laparoscopic simulator in skills lab
  • Behavioral: Technical instruction

Inclusion Criteria:

• Medical students on a surgical clerkship rotation at the department of visceral and transplantation surgery of the university hospital of Zurich, Switzerland

Exclusion Criteria:

• Any experience in laparoscopic camera handling in the OR and/or simulator based laparoscopic training