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ABSTRACT
Currently, surgical trainees have reduced surgery practice due to legal limits and hourly restraints. Also, it is currently estimated that more complex techniques such as laparoscopy are affected by surgeons. Simulation becomes a complementary learning tool in laparoscopic surgery, through training in a safe, controlled and standardized environment, without compromising patient safety. The purpose of the simulation is that the skills acquired should be transferred to the operating room, thus reducing learning curves. The use of simulation has increased worldwide, becoming an important tool in various surgical residential programs and laparoscopic training courses. For some countries, approval of these training courses is a prerequisite for obtaining surgical title certificates. This article reviews the most important aspects of simulation in laparoscopic surgery, including the most used simulators and the training programs, as well as the various learning methodologies and ways of assessing learning in the simulation.
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Background
Currently, the world faces a challenge in surgical training. Currently, surgical residential programs around the world have to deal with a number of problems which make the learning of surgical trainees more complex. Residents had restrictions on operating room hours due to reduced working hours, low incidence of certain diseases in some centers, and the quality and safety policies of patients’ medical care.
Laposcopic surgery is currently needed among the basic skills that a surgeon needs to have. However, learning this technique is limited by higher complexity compared to open surgery and the fewer cases a surgeon is exposed to during training, and they are required to complete the learning curve during their specialist career. In addition to the above, an increasing number of laparoscopic procedures and new technologies are now available, resulting in new surgeons being trained by practicing surgeons, without compromising patient safety.
The traditional paramm of surgical learning is based on the performance of procedures under the supervision of a more experienced instructor, under “first watch, then help and then works”. This training model, along with all its strengths, is inconvenient to rely on the technical level of the tutor and the pace of skills transferred from the professor. In addition, early exposure by trainee surgeons to more complex procedures, taking into account their technical level of training, without the potential consequences for the patient and the patient, may result in early satisfactory experience for the apprentice and his / her teacher to mention the related ethical aspects.
Simulation, a valuable learning tool in laparoscopic surgery
The simulation emerges as a complementary tool to traditional training to acquire surgical skills, allowing for learning curves to be reduced in a safe and controlled environment. The aviation industry has a long history of research on simulation and transfer of skills in real life. It showed that about 2h of virtual simulation program (obtained from virtual reality, which gives the feeling that it really exists) equal to 1h of a real flight. This effective experience could largely be recommended for teaching surgery, particularly with regard to minimal invasive procedures.
Training simulations provide an opportunity to learn in a structured and efficient environment, without compromising patient safety. It provides equitable access for all students to imaginary clinical cases that deliberately and repeatedly practice the procedure, as well as standardized assessment and monitoring, with clear and defined objectives. Finally, the simulation provides effective feedback from the teacher.
Simulation is incorporated in a number of medical areas, including undergraduate teaching through simulated patients, imaginary clinical cases, and training in procedures such as venom, cricothyroidotomies, and pleurostomies. In our area, a training program was put in place to make laparoscopic bowel anastomoses, which can be carried out at any time by residents and surgeons during their training. The
This is how, in laparoscopic surgery, simulation in surgical training, trainee residents and surgeons who wish to train in new low invasive techniques play a key role prior to their application in patients, such as laparoscopy individual ports, natural transcondic endoscopic surgery, or incorporate new laparoscopic technologies and incorporate instrument sets. Laparoscopic simulation can be used even for basic training during medical school. As a result of the long learning curve shown by this technique, as well as the high risks and costs associated with learning complex techniques as an incorporated device in patients, specialized simulation centers have been developed, enabling surgeons to learn on safe and effective way. Surgical skills training prior to surgical procedures showed more effective learning in the operating room, allowing the apprentice to focus on the technical details of the procedure, without the need for them to learn all for the first time in a patient.
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