Development and validation of a virtual teaching method for minimally invasive surgery skills: a prospective cohort study

Abstract

Introduction: The COVID-19 pandemic led to a significant reduction in operative exposure for surgical trainees, necessitating alternative training methods to mitigate the impact on surgical education. This study sought to evaluate whether minimally invasive surgery (MIS) skills could be taught remotely using widely available technology with objective assessments of proficiency.

Methods: This was a pilot observational study with a comparative assessment of face-to-face (F2F) and virtual training of novice learners in MIS skills. Performance and objective cognitive workload parameters [Surgical Task Load Index (SURG-TLX) score, heart rate, and pupil metrics] were evaluated. The assessments were peg transfer [McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS)] and suturing [Suturing Training and Testing (SUTT)] tasks performed using box trainers. Virtual teaching was conducted by expert trainers using a web-based streaming platform.

Results: Technical challenges of delivering a virtual MIS skills course were addressed after a pilot course. Participants ( n =20) in the final course had similar baseline characteristics and were randomly allocated to F2F ( n =8) and virtual ( n =12) teaching groups. Participants in the online group completed the peg transfer task faster than the F2F group (11.25 min vs. 16.88 min; P =0.015). There were no significant differences in all other MISTELS and SUTT performance measures between groups. Cognitive workload parameters (SURG-TLX score, heart rate, and pupil metrics) were also similar between groups.

Conclusion: This study has demonstrated that virtual teaching of MIS skills using a web-based streaming platform is feasible and effective, providing the foundation for low-cost, effective, and scalable MIS skills programs in the future.

Figure 1

Flowchart showing the challenges identified during a pilot virtual minimally invasive surgery skills course and proposed solutions. The images on the right show the final set-up for the peg transfer task.

Figure 2

Box and whisker plots showing McGill Inanimate System for Training and Evaluation of Laparoscopic Skills peg transfer task performance and cognitive load metrics comparing online and face-to-face teaching. A, Peg transfer time; B, Pegs dropped; C, Surgical Task Load Index score; D, Mean Heart Rate; E, Fixation frequency; F, Blinks per minute; G, Pupil size.

Figure 3

Violin plots and bar charts showing suturing training and testing assessment results comparing online and face-to-face teaching. A, Time to completion; B, Number of mistakes; C, Number of traumas; D, Tissue approximation; E, Knot tying.