Thesis supervisor: Andrea Szabó
co-supervisor: Jorge Correia-Pinto
Location of studies (in Hungarian): SZAOK Sebészeti Műtéttani Intézet Abbreviation of location of studies: SZAOK
Description of the research topic:
Co-Tutor: Prof. Jorge Correia-Pinto, Hospital of Braga, University of Minho, ICVS, Braga, Portugal
The aim of the study
In the present studies, learning curves of pediatric residents with different level of laparoscopic experience are compared: an advanced group, where pediatric surgery fellows has previous experience of basic laparoscopic procedures in humans and a beginner group which did not have any previous experience with minimally invasive surgery, but underwent a basic systematic box-trainer training in a preparatory period. Using a multimodal evaluation approach, we examine (1) how a pediatric surgery-oriented standardized training performed in-vivo on laboratory animals influences the learning curve of the participants, (2) how the improvement in these skills can be quantified and (3) how many repetitions of these in vivo surgery tasks will enable the participants to carry out complex advanced laparoscopic procedures in humans (translation).
Background
The number of novel minimally invasive approaches being developed to treat pediatric diseases is continuously increases, but conduction of these rather complex procedures represent a demanding challenge. Studying and the practicing of these special surgical skills, however, require special training laboratories. Pediatric residents have different kinds of potential training options including plastic models, computer simulators, ex-vivo preparations and living, anaesthetized animal models. The scientific literature of this field is rather poor and the results often controversial. Pediatric surgery, however, has special features (different anatomical situations, small surgical site and space, small surgical instruments, special surgical materials), therefore we believe that surgical trainings on anaesthetized rabbits provide the most realistic approaches for these purposes.
References:
1. Kirlum H-J, Heinrich M, Tillo N, Till H. Advanced Paediatric Laparoscopic Surgery: Repetitive Training in a Rabbit Model Provides Superior Skills for Live Operations. Eur J Pediatr Surg. 2005;15(3):149-52.
2. Heinrich M, Tillo N, Kirlum H-J, Till H. Comparison of different training models for laparoscopic surgery in neonates and small infants. Surg Endosc. 2006;20(4):641-4.
3. Valdivieso JP,Contador M. The Rabbit: Good Animal Model for Teaching and Training in Pediatric Laparoscopic Surgery. Ped Edosurg Inn Tech 2003;7:3:303-307
4. Jones VS, Wood JG, Godfrey C, Cohen RC. An Optimal Animal Model For Neonatal Thoracoscopy. J Laproend Adv Surg Tech 2008;18:5:759-762
5. Esposito C, Escolino M, Draghici I, Cerulo M, Farina A, De Pascale T, Cozzolino S, Settimi A. Training Models in Pediatric Minimally Invasive Surgery: Rabbit Model Versus Porcine Model: A Comparative Study. J Laparoend Adv Surg Tech 2016;26:1:1-6
6. Najmaldin A. Skills Training in Pediatric Minimal Access Surgery. J Ped Surg 2007;42:284-289
7. Buckley CE, Kavanagh DO, Traynor O, Neary PC. Is the skillset obtained in surgical simulation transferable to the operating theatre? Am J Surg 2014;207:146-157
Hypotheses
We hypothesized that (1) a multimodal evaluation method can effectively be used at repetitive, uniform, standardized laparoscopic training programs. (2) Using this complex approach, information showing when the participants are able to perform the same complex pediatric procedure also at the clinical practice can be obtained. (3) When groups with different previous laparoscopic experience are compared we suppose that beginners who underwent uniform and standardized training sessions will provide a more favorable learning outcome than those who get their experience through more conventional means without standardized approaches.
Materials and Methods
The studies were performed based on a local ethical and national licence (Univesidade do Minho; SECVS 004/2016 and DGAV 0421/000/000/2017, respectively) in Portugal. The laparoscopic pediatric surgical procedures were performed on tracheotomized anaesthetized New Zealand rabbits. The following participants were enrolled:
Groups 1 (“advanced group”): pediatric surgery fellows with previous experience (>20) of laparoscopic procedures
Group 2 (“beginner groups”): with no previous experience with minimally invasive surgery
The latter group underwent a basic systematic box-trainer training for at least 12 hrs with the same supervisor in a preparatory period.
Tasks of the “beginner group” in the preparatory period:
1. eye-hand coordination exercises in a box-trainer
2. dissecting exercises on silicone models
3. surgical closure exercises on plastic models
Both groups performed the same test surgery exercises 8 times in vivo under the guidance of the same supervisor. The test surgery is a particularly advanced and challenging task: execution of a laparoscopic Kimura-diamond shaped anastomosis which serves as a standard method of duodenum atresia in newborns.
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