Abstract
Introduction:
Advances in technology have led to laparoscopic surgery becoming a common part of surgical practice. The main benefits of laparoscopic surgery include decreased length of postoperative ileus; decreased postoperative pain and narcotic use, improved cosmesis and higher patient satisfaction (1).
The main constraints of laparoscopy include loss of depth perception and haptic feedback (2).
The fulcrum effect and the use of instruments with limited range of motion (3).
Adverse patient outcomes can occur if surgeons are not given adequate training and this is constrained further by the medicolegal, fiscal and time limitations of teaching operative skills in the clinic setting (4).
The covid-19 pandemic has been particularly disruptful for surgical trainees as can be demonstrated by a recent review of UK surgical trainee logbooks comparing 2019 with 2020 which showed a 50% reduction in operations with trainees as the
primary operating surgeons (5)
Methodology:
Utilising a high-fidelity laparoscopic simulator (the LapAR by Inovus Medical (6), we validated efficacy through multiple studies targeting level 1 and 2 evidence. We then performed a health economics paper satisfying level 4 evidence alongside an appropriate systematic review of literature.
Results:
A pilot benchmarked (7) two appendicectomies or vaginal cuff’s with two rounds of intervening LapPass . One hour on the simulator found ‘time’ savings of 19% and 36.9%, and ‘distance(m)’ savings of 25% and 56.5% respectively. A multi-centre has shown that 10 appendectomy benchmarks, with three LapPass rounds in two weeks can reduce ‘time’ by 55-66% and ‘distance’ by 39-72%. Self-confidence scores on a day course indicated that all areas improved by amean of 3.82 (likert, p=0.018).
A BMJ peer-reviewed health economics review was then performed using estimated costs. The potential ROI for the NHS was deduced. At 100% translation rate with validation data, we save £455 per patient through reduced anaesthetic time and shorter inpatient stay.
Finally, a SR (n=26) of literature on the main four (AR vs VR vs traditional vs cadaveric) demonstrated that AR is preferred, improves procedural success & faster skill acquisition.
Conclusion:
Reduced complication rates, anaesthetic time and ability to reduce waiting list burden would form future scopes of study.
However, we can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more
effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential
new gold standard.
References:
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5. Joint Committee of Surgical Training, Association of Surgeons in Training, British Orthopaedics Trainees’ Association, Confederation of Postgraduate Schools of Surgery. Maximising training: making the most of every training opportunity. 2021.
6. Health Education England. Guidance and principles for managing extensions to training during covid-19 (ARCP outcomes 10.1and 10.2). 2020. Spiliotis AE, Spiliotis PM, Palios IM. Transferability of Simulation-Based Training in Laparoscopic
Surgeries:
A Systematic Review. Minim Invasive Surg. 2020;2020:5879485. Published 2020 Aug 25. doi:10.1155/2020/5879485
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