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Title

The role of whole body video monitoring and feedback in a laparoscopic simulation laboratory

Theme

9BB Simulation 1

Authors

Deepa Shah
Daniel Torrent
Wiley L. Nifong

Institutions

East Carolina University - Surgery - Greenville - United States of America

Background

Few surgeons are attentive to posture and ergonomics in the midst of surgery, particularly during laparoscopy, yet 100% of laparoscopic surgeons report mental fatigue and musculoskeletal problems related to the operating room. Technique and positioning is imperative for proficiency with laparoscopic instruments and needs to be stressed early in training during residency as technique evolves. Videography holds promise in providing feedback on a surgeon’s posture during the procedure, but has not yet been assessed for benefit. We performed a randomized, prospective study to assess the benefits of videography feedback in a laparoscopic simulation laboratory.

Summary of Work

After a short introductory laparoscopic instrument and handling teaching session, medical were randomized into a videography and non-videography group to practice their skills and perform a peg transfer skill, based on the Fundamentals of Laparoscopic Surgery (FLS) developed by the Society of American Gastrointestinal and Endoscopic Surgeons. The students returned after 3 weeks after their initial session. The videography group reviewed their individual video and received corrective feedback.  Both the control and videography groups then performed the timed task again at the interval assessment. The time difference for task completion was calculated between interval and initial times. A univariate analysis was performed for our outcome and possible confounders.

Summary of Results

A total of 18 participants with 36 assessment times were studied. Age and gender were similar between the two groups (p= 0.66, 0.63 respectively). There was no association between gender and time difference (p=0.38). The time difference for the videography and non-videography group was significantly different at a mean time = 49.00+/-6.4, and 29.11+/-6.4 seconds respectively (p = 0.034).

 

Mean or n

Percentage or STE

  Gender

Male

Female

 

25

22

 

46.8%

53.2%

  Group

Video

Non-Video

 

22

24

 

47.8%

52.2%

  Age (y)

26.4

0.493

  Initial Time (s)

85.0

4.63

  Interval Time (s)

56.7

3.06

  Change (s)

27.4

2.75

 

 

 

Video

Non-Video

P value

Mean or N

Percentage or STE

Mean or N

Percentage or STE

  Age (y)

25.0

0.9

24.22

0.9

0.63

  Gender

Male

Female

 

5

4

 

55.6%

44.4%

 

6

3

 

66.7%

33.3%

0.38

  Change (s)

49.0

6.4

29.1

6.4

0.03

 

Take-home Messages

Ergonomics play an important role in the decreasing the physical symptoms associated with muscular fatigue due to prolonged awkward surgical postures, and increase a surgeon’s speed to complete a procedure.

 

The group receiving video postural feedback was able to perform the timed task twenty seconds faster on average, as compared to those without ergonomic feedback. This demonstrates that coaching on ergonomics with this inexpensive format can achieve measureable improvement at low cost.

 

Limitations of the study include a small size, and the student population that may not translate to a practicing surgeon. We targeted the medical student population as they would be less likely to have developed maladaptive habits for laparoscopic surgery and may be more amenable to change in technique. Age and initial time were not different between the two groups, and gender was not associated with time difference. This eliminated these 3 variables as possible confounders.

Conclusion

Video feedback can increase the efficiency of laparoscopic teaching, and may be a useful tool in resident education and training.

References

 S. B. Issenberg, W. C. McGaghie, I. R. Hart, J. W. Mayer, J. M. Felner, E. R. Petrusa, R. A. Waugh, D. D. Brown, R. R. Safford, I. H. Gessner, D. L. Gordon, and G. A. Ewy, “Simulation technology for health care professional skills training and assessment,” JAMA, vol. 282, no. 9, pp. 861–866, Sep. 1999.

R. A. Agha and A. J. Fowler, “The Role and Validity of Surgical Simulation,” Int. Surg., vol. 100, no. 2, pp. 350–357, Feb. 2015.

J. H. Peters, G. M. Fried, L. L. Swanstrom, N. J. Soper, L. F. Sillin, B. Schirmer, K. Hoffman, and SAGES FLS Committee, “Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery,” Surgery, vol. 135, no. 1, pp. 21–27, Jan. 2004.

K. Miller, M. Benden, A. Pickens, E. Shipp, and Q. Zheng, “Ergonomics principles associated with laparoscopic surgeon injury/illness,” Hum. Factors, vol. 54, no. 6, pp. 1087–1092, Dec. 2012.

“FLS Program Description,” Fundamentals of Laparoscopic Surgery. [Online]. Available: http://www.flsprogram.org/index/fls-program-description/. [Accessed: 10-May-2015].

Background
Summary of Work
Summary of Results
Take-home Messages
Conclusion
References
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