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Randomized Controlled Trial
. 2020 Nov;34(11):4874-4882.
doi: 10.1007/s00464-019-07270-3. Epub 2019 Nov 25.

Simulator training and residents' first laparoscopic hysterectomy: a randomized controlled trial

Ewa Jokinen  1 , Tomi S Mikkola  2 , Päivi Härkki  2
Affiliations
Randomized Controlled Trial

Simulator training and residents' first laparoscopic hysterectomy: a randomized controlled trial

Ewa Jokinen et al. Surg Endosc. 2020 Nov.

Abstract

Background: Hysterectomy rates are decreasing in many countries, and virtual reality simulators bring new opportunities into residents' surgical education. The objective of this study was to evaluate the effect of training in laparoscopic hysterectomy module with virtual reality simulator on surgical outcomes among residents performing their first laparoscopic hysterectomy.

Methods: This randomized study was carried out at the Department of Obstetrics and Gynecology in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty residents and randomly signed half of them to train ten times with the laparoscopic hysterectomy module on a virtual reality simulator, while the rest represented the control group. Their first laparoscopic hysterectomy was video recorded and assessed later by using the Objective Structured Assessment of Technical Skills (OSATS) forms and Visual Analog Scale (VAS). The scores and surgical outcomes were compared between the groups.

Results: The mean OSATS score for the Global Rating Scale (GRS) was 17.0 (SD 3.1) in the intervention group and 11.2 (SD 2.4) in the control group (p = 0.002). The mean procedure-specific OSATS score was 20.0 (SD 3.3) and 16.0 (SD 2.8) (p = 0.012), and the mean VAS score was 55.0 (SD 14.8) and 29.9 (SD 14.9) (p = 0.001). Operative time was 144 min in the intervention group and 165 min in the control group, but the difference did not reach statistical significance (p = 0.205). There were no differences between the groups in blood loss or direct complications.

Conclusion: Residents training with a virtual reality simulator prior to the first laparoscopic hysterectomy seem to perform better in the actual live operation. Thus, a virtual reality simulator hysterectomy module could be considered as a part of laparoscopic training curriculum.

Keywords: OSATS; Resident education; Surgical education; VAS; Virtual reality simulator.

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Conflict of interest statement

Drs. Ewa Jokinen, Tomi S. Mikkola, and Päivi Härkki have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Procedure-specific OSATS form for laparoscopic hysterectomy
Fig. 1
Fig. 1
Procedure-specific OSATS form for laparoscopic hysterectomy
Fig. 2
Fig. 2
Flowchart of the participants
Fig. 3
Fig. 3
Learning curves in the hysterectomy module in virtual reality simulator. Line represents the mean and whiskers 95% confidence interval
Fig. 4
Fig. 4
OSATS and VAS scores in the study groups. Line represents the median value, boxes 50% of the cases, and whiskers the whole range. OSATS objective structured assessment of technical skills. VAS Visual Analog Scale. GRS Global Rating Scale, LH-OSATS laparoscopic hysterectomy specific OSATS
See this image and copyright information in PMC

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