Assessment of Comparative Skills Between Hand-Assisted and Straight Laparoscopic Colorectal Training on an Augmented Reality Simulator

PURPOSE: The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. METHODS: Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid colectomies on a simulator: group A (n = 15) performed hand-assisted then straight procedures; group B (n = 14) performed straight then hand-assisted procedures. Groups were compared according to prior laparoscopic colorectal experience, performance (time, instrument path length, and instrument velocity changes), technical skills, and operative error. RESULTS: Prior laparoscopic colorectal experience was similar in both groups. Both groups had better performances with the hand-assisted approach, although technical skill scores were similar between approaches. The error rate was higher with the hand-assisted approach in group A, but similar between both approaches in group B. CONCLUSIONS: These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.

[1]  C. Delaney,et al.  Evaluation of the Learning Curve in Laparoscopic Colorectal Surgery: Comparison of Right-Sided and Left-Sided Resections , 2005, Annals of surgery.

[2]  Gregory D Kennedy,et al.  Laparoscopy Decreases Postoperative Complication Rates After Abdominal Colectomy: Results From the National Surgical Quality Improvement Program , 2009, Annals of surgery.

[3]  V. Fazio,et al.  Hand‐assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy , 2010, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[4]  Sudip K. Sarker,et al.  Assessing Operative Performance in Advanced Laparoscopic Colorectal Surgery , 2010, World Journal of Surgery.

[5]  D. Sargent,et al.  Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. , 2007, Archives of surgery.

[6]  B. Champagne,et al.  A novel end point to assess a resident's ability to perform hand-assisted versus straight laparoscopy for left colectomy: is there really a difference? , 2008, Journal of the American College of Surgeons.

[7]  Anthony G. Gallagher,et al.  Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons , 2008, Surgical Endoscopy.

[8]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[9]  F. Leblanc,et al.  Long‐term wound advantages of the laparoscopic approach in rectal cancer , 2008, The British journal of surgery.

[10]  R. Beart,et al.  Laparoscopic-assisted colectomy learning curve , 1995, Diseases of the colon and rectum.

[11]  J. Dankelman,et al.  The influence of experience and camera holding on laparoscopic instrument movements measured with the TrEndo tracking system , 2007, Surgical Endoscopy.

[12]  J. Fleshman,et al.  A comparison of laparoscopically assisted and open colectomy for colon cancer. , 2004, The New England journal of medicine.

[13]  B. Dousset,et al.  The Clinical Outcome of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon Cancer. N Engl J Med 2004;350:2050-2059 , 2004 .