525 Automated Continuous Instrument Tracking in Laparoscopic Box Trainers Predicts Performance at Assessment: A Prospective Cohort Study in Core Surgical Trainees

Introduction Box-trainers enable deliberate practice of laparoscopic skills and can be equipped with instrument tracking metrics to provide feedback. However, the relationship between metrics, assessment outcomes and practice are unclear. Method Core surgical trainees were provided take-home box trainers with SurgTrac™ instrument tracking metrics for practice (eoSurgical Ltd., Scotland, UK). Practice was incentivised by certification and video assessment of a basic task, peg capping. Assessment was by consultant general surgeons, using objective structured assessment of technical skills (OSATS). The following metrics were analysed: task duration, distance moved by instruments, average instrument speed, average instrument acceleration, left- or right-handedness and instrument smoothness. Metrics were correlated to OSATS scores using regression analysis. Threshold for significance was p = 0.05. Results During the study period, there were 1639 peg capping performances by 85 trainees; 103 video recordings were submitted for assessment. All metrics were significantly associated with OSATS score, except instrument acceleration. The multiple linear regression model was highly correlated with actual scores (Pearson correlation 0.658; p < 0.001). Practice was positively correlated with regression model predicted OSATS score (regression analysis; ANOVA p < 0.001). Conclusions Instrument tracking metrics reliably predict OSATS performance and practice improves predicted score. Trainees can use metrics in unsupervised practice and gauge whether they are improving as expected.

Do ‘standard laparoscopic box trainers’ represent real-life conditions during transperitoneal laparoscopical interventions of the upper tract?

Background: The purpose of this study is to investigate the representativeness of the conventional laparoscopic standard box trainers in terms of real-life circumstances in transperitoneal laparoscopical interventions of the upper tract, using questionnaire inquiries with experienced surgeons. Materials and methods: The study was conducted with 44 laparoscopists, whose level of renal surgery experience was either high (primary surgeon in >100 cases), moderate (primary surgeon in >50 cases) or basic (primary surgeon in >20 cases). We used the box widely preferred in international training courses, which consists of a 10-mm 30° laparoscope, real endoscopic instruments, light source, monitor and chicken bone materials. Participants were asked whether they represent real-life situations while performing tasks by means of standard box trainers. Results: The medians of ‘restrained body posture of the surgeon’, ‘position of monitor’, ‘trocars entry slots’, ‘tissue distance and region’ and ‘limited field of movement and restricted working space’ were analysed on their difference from the ideal value. All the variables were shown to be significantly different from the ideal value of 5 (p < 0.001). These results suggest that experienced surgeons in our study did not find the box simulation conditions similar to real surgery conditions. Conclusion: Conventional laparoscopic trainer box, which is currently being used, is far from representing for the real situation in transperitoneal laparoscopical interventions of the upper tract.

A laparoszkópos készségfejlesztés eszközei – elérhető trénerek és szimulátorok

The laparoscopic minimally invasive surgical technique is widely employed on a global scale. However, the efficient and ethical teaching of this technique requires equipment for surgical simulation. These educational devices are present on the market in the form of box trainers and virtual reality simulators, or some combination of those. In this article, we present a systematic overview of commercially available surgical simulators describing the most important features of each product. Our overview elaborates on box trainers and virtual reality simulators, and also touches on surgical robotics simulators, together with operating room workflow simulators, for the sake of completeness. Apart from presenting educational tools, we evaluated the literature of laparoscopic surgical education and simulation, to provide a complete picture of the unfolding trends in this field. Orv Hetil. 2017; 158(40): 1570–1576.