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Development of an evidence-based training program for laparoscopic hysterectomy on a virtual reality simulator

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Abstract

Background

Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum.

Methods

This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2–10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons’ performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores.

Results

Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p < 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p < 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p < 0.001) and second repetition (25.5, 19.5 and 14; p < 0.001).

Conclusions

The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.

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Acknowledgments

The authors thank Marine Alessandrini for her contribution to this project (Service de santé publique et d’information médicale, centre hospitalier universitaire Timone, 13385 Marseille, Aix Marseille université, France).

Funding

CERC (Centre d’Enseignement et de Recherche Chirurgicale), Aix Marseille Université, Assistance Publique - Hôpitaux de Marseille. Rajesh Aggarwal was funded by “Fonds de recherche santé Québec” and “Montréal General Hospital Foundation.”

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France

    Patrice Crochet, Sophie Knight, Léon Boubli & Aubert Agostini

  2. Department of Surgery, Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montreal, Canada

    Rajesh Aggarwal

  3. CERC, IFSTTAR, LBA UMR_T 24, Aix Marseille Université, 13916, Marseille, France

    Stéphane Berdah

Authors
  1. Patrice Crochet
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  2. Rajesh Aggarwal
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  3. Sophie Knight
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  4. Stéphane Berdah
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  5. Léon Boubli
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  6. Aubert Agostini
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Corresponding author

Correspondence to Patrice Crochet.

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Disclosure

Rajesh Aggarwal is a consultant for Applied Medical. Patrice Crochet, Sophie Knight, Stéphane Berdah, Léon Boubli and Aubert Agostini have no conflicts of interest or financial ties to disclose.

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Crochet, P., Aggarwal, R., Knight, S. et al. Development of an evidence-based training program for laparoscopic hysterectomy on a virtual reality simulator. Surg Endosc 31, 2474–2482 (2017). https://doi.org/10.1007/s00464-016-5249-3

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  • DOI: https://doi.org/10.1007/s00464-016-5249-3

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