Effectiveness of telesimulation for pediatric minimally invasive surgery essential skills training

Abstract

Background: In the context of the COVID-19 pandemic and social distancing rules, access to in-person training activities had temporarily been interrupted, speeding up the implementation of telesimulation for minimally invasive surgery (MIS) essential skills training (T-ESTM, Telesimulation - Essential Skills Training Module) in our center. The aim of this study was to explore the effectiveness of T-ESTM.

Methods: T-ESTM was scheduled into 2 sessions of 3 h through the Zoom® virtual meeting platform. The academic lectures, the tutorials for box-trainer set-up and 7 performance tasks were accessed through an online campus previous to the remote encounter for personalized guidance and debriefing. Initial (pre-telementoring) and final (post 6-hour telementoring) assessment scoring as well as timing for Task 2 (circle-cutting pattern), 3 (extracorporeal Roeder knot) and 5 (intracorporeal Square knot) were registered.

Results: 61 participants were recruited. The mean age was 31±5 years. 65% were surgical residents. 48% performed low complexity procedures. 52% had previous experience with simulation training. In Task 2, there was a 21% improvement in the final score obtained, as well as a significant decrease in time of 33%; in Task 3, there was an increase of 39% in the scoring and a decrease of 49% in the timing; and in Task 5, participants improved their technique a 30% and decreased the performance time a 47%. All the differences were statistically significant.

Discussion: Our data support T-ESTM as a reproducible and effective educational tool for remote MIS essential skills hands-on training.

Level of evidence: II.

Keywords: Minimally invasive surgery; Simulation based-training; Surgical education; Telesimulation.

Fig. 1

Training Box Assembly (A) 3D-printing adapted training box with smart device as a functional camera and screen. (B) Low cost endotrainer with smart device as a functional camera and screen. (C) Other option of 3D-printing endotrainer. (D) Workstation Assembly. A second device is used as an external camera for assessing ergonomics.

Fig 2

T-ESTM inanimate surgical models (A) Bead-into-string transfer for hand-eye coordination (Task 1) (B) Circle-pattern cutting for precision (Task 2) (C) Roeder-type extracorporeal knot for loop ligation and stereotaxic skills (Task 3) (D) Needle grabbing for haptics (Task 4) and Intracorporeal square knot for ambidexterity (Task 5) (E) Tubular Suturing for essential skill integration and strategy (Task 6) (F) Continuous Suturing for economy of movements (Task 7).

Fig. 3

Comparison between initial versus final score in task 2, 3 and 5. Comparison between initial and final score in intracorporeal square knot assessment (blue), extracorporeal knot assessment (green) and circle pattern cutting (purple). All the differences are statistically significant and all the groups had a more symmetric distribution after training.

Fig. 4

Comparison between initial versus final time in task 2, 3 and 5. Comparison between initial and final time in intracorporeal square knot assessment (blue), extracorporeal knot assessment (green) and circle pattern cutting (purple). All the differences are statistically significant and all the groups had a more symmetric distribution after training.