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Grand Rounds

Is Laparoscopy Simulation Performance Correlated with Surgical Volume?

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BACKGROUND AND PURPOSE:

  • Simulation is an effective training method for surgical residents, including gynecologists
  • There is less data on the use of surgical simulation for attending surgeons
  • Mathews et al. (AJOG, 2017) sought to determine if simulation performance for validated laparoscopic virtual simulation tasks correlated with surgical volume, demographics and self-perception data of practicing ObGyns

METHODS:

  • Most physicians who participated in this study were ‘low volume’ practitioners (0-1 laparoscopic/robotic procedure per month)
  • 347 gynecologists with laparoscopic privileges were required to complete a laparoscopic surgery simulation assessment
  • Average monthly laparoscopic procedures were divided up into 0-1/2-5/6-10/≥11
  • Assessment included:
    • Pre-simulation survey gathering self-reported characteristics
    • 3 basic skills tasks on a virtual reality laparoscopic simulator (enforced peg transfer (PT), lifting and grasping (LG), and cutting (CT))
  • Association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category), were examined with regression models

RESULTS:

  • Laparoscopic volume was a significant predictor of
    • Total time on all three tasks
    • Two efficiency scores in PT, and all four efficiency scores in CT
    • Errors in LG and CT
  • Self-rated laparoscopic skill level was a significant predictor of
    • total time in all tasks
    • nearly all efficiency scores and errors scores in all 3 tasks

CONCLUSION:

  • High volume physicians and those with fellowship training were more confident and scored significantly higher in objective performance measures
  • ObGyns were good at assessing their skills
  • The authors suggest that busier surgeons with a high initial simulation score followed by ongoing high volume practice may not require yearly testing
  • For gynecologists who have less volume, or if volume fluctuates, using virtual reality simulation may be helpful to maintain and improve skills

Learn More – Primary Sources:

Predictors of Laparoscopic Simulation Performance among Practicing Obstetrician Gynecologists

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Related ObG Topics:

Traditional vs. Simulation Training for Laparoscopic Salpingectomy
Which are the Most Safe and Effective Female Sterilization Surgeries?
TLH vs. TAH for Endometrial Cancer – Results from the LACE trial  

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