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DATA

An Observation of Laparoscopic Surgery as an Assessment Tool in Gynecology

Hye-Chen Hur M.D., Deborah Arden M.D., Laura E. Dodge M.D., Bin Zheng M.D., Hope A. Ricciotti M.D.

July 31, 2017
Emma Holt

What is Laparoscopic Surgery?

Before we even get into the research, I’m sure we could all benefit from knowing what this surgery even is. Laparoscopic surgery can also be referred to as bandaid surgery or keyhole surgery because it’s performed through a tiny incision usually about 0.5-1.5 centimeters from elsewhere in the body. That doesn’t sound so scary, huh?

What’s the point?

Researchers Hye-Chen Hur, Deborah Arden, Laura E. Dodge, Bin Zheng, and Hope A. Ricciotti set out to describe their experience with the Fundamentals of Laparoscopic Surgery program (I’ll refer to this as FLS) as a teaching and assessment tool for basic laparoscopic competency among gynecology residents. Their research was published on the Journal of the Society of Laparoendoscopic Surgeons (JSLS).  Additionally, he FLS program was developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in 2004. To break this down, Laparoscopic surgery is a particular focus for simulation training that allows trainees to learn new techniques, instruments, and procedures before actually operating on the patients. This reduces valuable time in the operating room whereas a traditional apprentice approach doesn’t. While general surgical residency training programs have successfully integrated simulation for training and assessment, gynecology training programs have lagged behind, yet to embrace simulation training and assessment programs. The objective of this observational study was to overall confirm that the FLS test could be used as an assessment tool for basic laparoscopic competency for Ob/Gyn residents and the impact of it on the FLS test.

What the researchers observed and how

Now that we understand why we’re looking at the FLS test as an assessment tool for laparoscopic adequacy we can dive into the research. All Ob/Gyn residents at all levels of training and 4 division directors of of gynecologic surgical specialties were invited to participate in baseline FLS testing in 2006. This examination consisted of 2 parts: a computer-based cognitive examination with 75 multiple-choice questions, and a manual skills test with 5 tasks. A score of 356 was needed to pass this test and become certified in FLS. 

Prior to the FLS  testing, examinees had to complete a pretest to report their level of training, number of years performing laparoscopic surgery, and level of endoscopic surgical experience. It’s important to note that none of the participants were familiar with the FLS program at the start of the study but were formally introduced to it after the baseline testing. Residents also were given unlimited access to an on-site simulation center at BIDMC to independently practice 5 technical tasks.

Ultimately, the FLS program was incorporated into the Ob/Gyn curriculum after obtaining baseline FLS testing at BIDMC for the academic year 2006-2007. A formal 2 year minimally invasive surgical curriculum was established and by the academic year 2008-2009, BIDMC made FLS certification a requirement for all Ob/Gyn residents before completing their 4-year training program. The curriculum included the following components:

- Didactic lectures 

- 3-hour Simulation Workshop twice a year

- Monthly 1-hour simulation laboratory sessions

- 24-hour access to on-site simulation laboratory

-FLS examination

Finally, the results

20 Ob/Gyn residents were offered the FLS examination and 19 chose to participate. 18 completed the cognitive examination, 16 completed the skills examination, and 15 fulfilled both portions for complete testing.  The pass rates for skills testing for first year residents were 0%, second year residents had a 50% pass rate, and third and fourth year had a 75% pass rate. For the baseline cognitive testing, first and second year residents had a 60% pass rate, third year residents had a 67% pass rate, and fourth year residents had just a 40% pass rate.  Obviously, there was no significant difference in pass rates for the skills test, but a noticeable difference for the cognitive test. All 4 of the gynecologic division directors at BIDMC, which included, 2 oncologists, 1 reproductive infertility specialist, and 1 minimally invasive gynecologic surgeon, participated and successfully completed the FLS test, obtaining certification. Performing greater numbers of laparoscopic hysterectomies, ovarian cystectomies, and salpingo-oophorectomies was significantly correlated with higher test scores. 

Based on this study, the FLS manual skills component may be a valuable training and assessment tool for gynecologists. The level of training and surgical experience positively correlate with pass rates for the PLS skills but not the cognitive examination. The researchers have concluded that slight modifications may be necessary to make the cognitive portion more universally applicable to gynecologists.

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