Presentation of preclinical gastrointestinal anatomy via laparoscopic simulation

Abstract

In this report, the authors examine the integration of teaching anatomical science with clinical implications in minimally invasive surgery. The authors hypothesized that implementation of integrated laparoscopic simulation during undergraduate medical education would improve student learning of anatomical structures from in situ, laparoscopic orientations; and subsequently improve student preparation for clinical rotations and clerkships. During the fall of 2020 and 2021, 260 (130 students/year) second year medical students at the University of Nebraska Medical Center participated in a six-week gastrointestinal curriculum. Following a traditional anatomy dissection experience, students completed a laparoscopic event consisting of narrated laparoscopic videos and hands-on laparoscopic simulation. To examine the integrated curricular event, outcome measures focused on technical performance using grasping forceps, anatomical knowledge, and perception of the educational innovation. Outcomes were analyzed via timed performance and a pre and post assessment that was designed to assess student anatomical knowledge and perception. Completion of the technical performance assessment ranged from 1 min, 17 s to 6 min. Student knowledge of anatomical structures from in situ, laparoscopic orientations following the laparoscopic simulation sessions was significantly improved (53.3% pre vs 81.0% post), and almost all students (98.9%) agreed that the simulation sessions improved their understanding of laparoscopic anatomy and procedures. This report demonstrates the implementation of a multidisciplinary, integrated simulation that satisfied basic science anatomy teaching objectives, while enhancing student enthusiasm for the content. Future studies will examine the subsequent impact of the innovation on student preparedness for clinical rotations and clerkships.

Keywords: anatomy; laparoscopic surgery simulation; undergraduate medical education.

FIGURE 1

Study design. (A) During the first 2 weeks, students completed a traditional anatomy dissection experience of the anterior and posterior abdominal wall, peritoneal cavity, and abdominal viscera. A traditional anatomy practical examination was administered at the end of the second week to assess student learning. Three weeks later, week 5, students were provided with a novel educational innovation involving a laparoscopic simulation event that was presented as three subsequent sessions designed to build upon one another. (B) The three novel education sessions were framed by immediate pre and post assessments.

FIGURE 2

Laparoscopic simulation sessions. (A) Session 1 consisted of seven laparoscopic videos that included instruction on port‐insertion and a visual review of abdominal anatomy from a laparoscopic view (video still frame). The videos were taken during a training session for MIS at UNMC using a lightly embalmed cadaveric donor and were captured specifically for this activity. (B) Session 2 consisted of a hands‐on student activity, practicing the basic operation of laparoscopic grasping forceps using a commercial FLS laparoscopic trainer (Limbs & Things, #50302). (C) Session 3 consisted of a hands‐on student activity that included a visual review of abdominal anatomy from a laparoscopic perspective while using a commercial laparoscopic simulator to practice fundamental skills of laparoscopic surgery: Trocar insertion via laparoscope guidance, camera operation and navigation skills, and fundamentals of viscera manipulation. Two anatomically embalmed human cadaveric donors and laparoscopic simulators (Inovus Medical Pyxus Pro Move, Laparoscopic Simulators) were utilized.

FIGURE 3

Student technical performance of laparoscopic skill for consecutive years. Students took from 1 min, 17 s to 6 min to complete all 12 peg transfers, 6 forward and 6 back. The median time in 2020 was 2 min, 35 s and in 2021 was 2 min 33 s.

FIGURE 4

Student anatomical knowledge. (A) Open field view performance. Student gross baseline performance (mean 2020–2021: 86.0%) was significantly better than pre assessment performance (mean 2020–2021: 74.0%), and student post assessment performance (mean 2020–2021: 84.4%) was significantly better than pre assessment performance (p < 0.05, *). (B) Laparoscopic view performance. Student gross baseline performance (mean 2020–2021: 86.0%) was significantly better than pre assessment performance (mean 2020–2021: 53.3%), and student post assessment performance (mean 2020–2021: 81.0%) was significantly better than pre assessment performance (p < 0.05, *). Additionally, student pre assessment performance on open field view questions (mean 2020–2021: 74.0%) was significantly better than pre assessment performance on laparoscopic view questions (mean 2020–2021: 53.3%) (Panels A and B, #)

FIGURE 5

Student perception of the educational innovation. Almost all students (98.9%, 196/198) agreed (68.1%, 135/198, strongly agreed and 30.8%, 61/198, agreed) with the statement, “The laparoscopic simulation sessions improved my understanding of laparoscopic anatomy and procedures.” Two students neither agreed nor disagreed that the simulation sessions improved their understanding, and no students disagreed with the statement.