Minimally invasive surgery (MIS) continues to transform the field of pediatric surgery by providing several advantages including reduced postoperative pain, shorter recovery times, and smaller incisions. A recent study led by Dominika Borselle at Wroclaw Medical University has shown how intensive simulator training can significantly improve suturing skills important for complex procedures such as esophageal atresia repairs.
The study involved 55 participants from various surgical specialties, including pediatric surgery, general surgery, and urology, who underwent intensive training over the course of three consecutive days. The training program commenced with single surgical knot exercises and progressed to more complex tasks, including performing end-to-end esophageal anastomosis.
The effectiveness of this intensive training was measured through several means, including evaluations by automated simulators equipped with specialized sensors. These devices provided objective data on various movement parameters, such as time taken to complete tasks, movement economy, and overall smoothness of instrument handling. After the required training exercises, participants were assessed using the Objective Structured Assessment of Technical Skills (OSATS) questionnaire by researchers who watched recorded performances.
Results indicated significant improvements across multiple metrics. By the final day of training, 70% of the 48 participants who attempted the end-to-end anastomosis were successful, achieving scores based on the refined techniques learned throughout the program. Specifically, movement economy and the distance covered by instruments emerged as key predictors for success during the final assessments.
"Intensive simulation training significantly enhances endoscopic suturing skills," Borselle stated, echoing the findings of the study. This emphasizes the growing recognition of simulation training as a fundamental component for developing technical skills necessary for complex surgeries.
Prior to the completion of their tasks, participants were first required to demonstrate their baseline ability by performing the single surgical knot, which allowed researchers to establish their initial proficiency. The data collected over the training indicated not only individual progress but also correlations between performance scores measured by the simulator and those assessed by trained human observers, which were statistically significant.
Interestingly, this study also highlighted some challenges inherent to surgical education. The complexity of procedures like thoracoscopic end-to-end esophageal repairs, especially relevant for long-gap esophageal atresia, emphasizes the need for optimal surgical training environments where skills can develop progressively.
Using simulators to prepare for such surgeries eliminates some barriers faced by novice surgeons, who may be limited by infrequent exposure to procedures required for specialization. "Movement economy and instrument distance covered emerged as the most relevant predictors of the anastomosis success," Borselle noted, underscoring the importance of precision and careful techniques during actual surgery.
One of the pivotal findings of the study is the correlation between the technological assessments and the skill evaluations performed by the human raters, showcasing the merits of both approaches. An automatic scoring system correlated strongly with the OSATS scores from the two observers, supporting the reliability of using machine assessments alongside traditional evaluation methods.
The training included daily exercises for honing skills, and these hands-on experiences allowed participants to improve gradually, from basic knot-tying to tackling more advanced suturing tasks. Despite the evident progress, the study found not all participants reached the desired proficiency level, with 29.2% attaining overall analytic scores above six out of ten, and only 16.7% scoring above seven.
These outcomes suggest the necessity for regular, structured training approaches and carve out the potential for innovative surgical education programs. "While the course was effective in suturing skills improvement, only a subset of trainees attained the anastomosis at an advanced level, emphasizing the relevance of regular practice and continuously repeated suturing maneuver," Borselle explained.
The study reinforces the idea of using simulation techniques to bridge the gap between theory and practical application, ensuring surgeons emerge from training prepared for real-life surgical challenges. Moving forward, emphasizing elements such as movement economy and efficiency should guide surgical educators as they develop curricula aimed at advancing minimally invasive surgical techniques.
The findings of this research fulfill a growing need to quantify and improve technical skills necessary for pediatric patients undergoing surgery, especially as the demand for minimally invasive approaches continues to rise. The study was approved by the Ethics Committee of Wroclaw Medical University and has been published in Scientific Reports, reiteratng once again the importance of rigorous training practices within surgical education.