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Eur J Pediatr Surg 2016; 26(05): 436-442
DOI: 10.1055/s-0035-1564712
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Training Significantly Improves Fetoscopy Performance: A Pilot Randomized Controlled Trial

Stefan Mietzsch
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Johannes Boettcher
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2   Institute of Psychology, University Kiel, Kiel, Germany
,
Sisi Yang
3   Hamburg University of Technology, Hamburg, Germany
,
Pierre Chantereau
3   Hamburg University of Technology, Hamburg, Germany
,
Philip Romero
4   Department of Surgery, Section of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
,
Robert Bergholz
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Konrad Reinshagen
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Michael Boettcher
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

19 May 2015

23 August 2015

Publication Date:
07 October 2015 (online)

Also available at
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Abstract

Background Implementation of complex fetoscopic procedures that included intracorporeal suturing has been limited due to technical difficulties that might be surmounted with adequate training. Evaluating the impact of laparoscopic or fetoscopic training on fetoscopic performance was the aim of this study.

Methods To evaluate fetoscopic performance after either laparoscopic or fetoscopic training, subjects were asked to perform four surgeon's square knots fetoscopically prior and post 2 hours of hands-on training. All subjects were medical students and novice in laparoscopic and fetoscopic interventions. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality, and fetoscopic performance were assessed.

Results Forty-six subjects were included in the study; after simple randomization, 24 were trained fetoscopically and 22 laparoscopically. Both groups had comparable baseline characteristics and improved after training significantly regarding all aspects assessed in this study. Subjects who trained fetoscopically were superior in terms of suturing and knot-tying performance.

Conclusion Training significantly improves fetoscopic performance and may indeed be the keystone for future complex fetoscopic interventions. It seems advisable to train rather fetoscopically than laparoscopically resulting in higher suture and knot-tying quality.

Keywords

laparoscopy - fetoscopy - training

Contributors' Statement

Stefan Mietzsch: Mr Mietzsch acquired data, acted as course instructor, and approved the final manuscript as submitted.


Johannes Boettcher: Mr Boettcher acquired data, conceptualized the questionnaire, validated statistics, and approved the final manuscript as submitted.


Sissi Yang: Ms Yang performed tensile strength measurement and approved the final manuscript as submitted.


Pierre Chantereau: Mr Chantereau performed tensile strength measurement and approved the final manuscript as submitted.


Philip Romero: Dr Romero conceptualized and designed the study, and approved the final manuscript as submitted.


Robert Bergholz: Dr Bergholz conceptualized and designed the study, and approved the final manuscript as submitted.


Konrad Reinshagen: Prof Dr Reinshagen conceptualized and designed the study, and approved the final manuscript as submitted.


Michael Boettcher: Dr Boettcher conceptualized and designed the study, acquired data, acted as course instructor, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted.


All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


 

  • References

  • 1 Bergholz R, Krebs T, Wenke K , et al. Fetoscopic management of gastroschisis in a lamb model. Surg Endosc 2012; 26 (5) 1412-1416
    CrossrefPubMedGoogle Scholar
  • 2 Bergholz R, Krebs T, Wenke K , et al. Abdominal wall incision with or without exteriorization of bowel: results from a fetal lamb model for the embryogenesis of gastroschisis. Fetal Diagn Ther 2013; 33 (1) 55-60
    CrossrefPubMedGoogle Scholar
  • 3 Adzick NS, Thom EA, Spong CY , et al; MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011; 364 (11) 993-1004
    CrossrefPubMedGoogle Scholar
  • 4 Krebs T, Boettcher M, Schäfer H , et al. Gut inflammation and expression of ICC in a fetal lamb model of fetoscopic intervention for gastroschisis. Surg Endosc 2014; 28 (8) 2437-2442
    CrossrefPubMedGoogle Scholar
  • 5 van Mieghem T, Baud D, Devlieger R , et al. Minimally invasive fetal therapy. Best Pract Res Clin Obstet Gynaecol 2012; 26 (5) 711-725
    CrossrefPubMedGoogle Scholar
  • 6 Flake AW. Stem cell and genetic therapies for the fetus. Semin Pediatr Surg 2003; 12 (3) 202-208
    CrossrefPubMedGoogle Scholar
  • 7 Kohl T, Ziemann M, Weinbach J, Tchatcheva K, Gembruch U, Hasselblatt M. Partial amniotic carbon dioxide insufflation during minimally invasive fetoscopic interventions seems safe for the fetal brain in sheep. J Laparoendosc Adv Surg Tech A 2010; 20 (7) 651-653
    CrossrefPubMedGoogle Scholar
  • 8 Luks FI, Deprest J, Marcus M , et al. Carbon dioxide pneumoamnios causes acidosis in fetal lamb. Fetal Diagn Ther 1994; 9 (2) 105-109
    CrossrefPubMedGoogle Scholar
  • 9 Danzer E, Sydorak RM, Harrison MR, Albanese CT. Minimal access fetal surgery. Eur J Obstet Gynecol Reprod Biol 2003; 108 (1) 3-13
    CrossrefPubMedGoogle Scholar
  • 10 Romero P, Brands O, Nickel F, Müller B, Günther P, Holland-Cunz S. Intracorporal suturing—driving license necessary?. J Pediatr Surg 2014; 49 (7) 1138-1141
    Google Scholar
  • 11 Brace RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol 1997; 40 (2) 280-289
    CrossrefPubMedGoogle Scholar
  • 12 Muresan III C, Lee TH, Seagull J, Park AE. Transfer of training in the development of intracorporeal suturing skill in medical student novices: a prospective randomized trial. Am J Surg 2010; 200 (4) 537-541
    Google Scholar
  • 13 Munz Y, Almoudaris AM, Moorthy K, Dosis A, Liddle AD, Darzi AW. Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 2007; 193 (6) 774-783
    Google Scholar
  • 14 Dorsey JH, Sharp HT, Chovan JD, Holtz PM. Laparoscopic knot strength: a comparison with conventional knots. Obstet Gynecol 1995; 86 (4, Pt 1) 536-540
    Google Scholar
  • 15 Goldenberg EA, Chatterjee A. Towards a better laparoscopic knot: using knot quality scores to evaluate three laparoscopic knot-tying techniques. JSLS 2009; 13 (3) 416-419
    Google Scholar
  • 16 Hibbeler B, Korzilius H. Arztberuf: Die Medizin wird weiblich, doch gilt dies nur bis zu einer bestimmten Hierarchiesrufe. Dtsch Arztebl 2008; 105: 609
    PubMedGoogle Scholar
  • 17 Peiró JL, Carreras E, Guillén G , et al. Therapeutic indications of fetoscopy: a 5-year institutional experience. J Laparoendosc Adv Surg Tech A 2009; 19 (2) 229-236
    CrossrefPubMedGoogle Scholar
  • 18 Vrecenak JD, Flake AW. Fetal surgical intervention: progress and perspectives. Pediatr Surg Int 2013; 29 (5) 407-417
    CrossrefPubMedGoogle Scholar
  • 19 Spruit EN, Band GP, Hamming JF. Increasing efficiency of surgical training: effects of spacing practice on skill acquisition and retention in laparoscopy training. Surg Endosc 2015; 29 (8) 2235-2243
    CrossrefPubMedGoogle Scholar
  • 20 Connolly M, Seligman J, Kastenmeier A, Goldblatt M, Gould JC. Validation of a virtual reality-based robotic surgical skills curriculum. Surg Endosc 2014; 28 (5) 1691-1694
    CrossrefPubMedGoogle Scholar
  • 21 Dawe SR, Windsor JA, Broeders JA, Cregan PC, Hewett PJ, Maddern GJ. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg 2014; 259 (2) 236-248
    CrossrefPubMedGoogle Scholar
  • 22 Gershuni V, Woodhouse J, Brunt LM. Retention of suturing and knot-tying skills in senior medical students after proficiency-based training: Results of a prospective, randomized trial. Surgery 2013; 154 (4) 823-829 , discussion 829–830
    CrossrefPubMedGoogle Scholar
  • 23 Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 2007; 141 (4) 442-449
    CrossrefPubMedGoogle Scholar
  • 24 White MT, Welch K. Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training?. Am J Surg 2012; 203 (3) 397-400 , discussion 400
    CrossrefPubMedGoogle Scholar
  • 25 Adams BJ, Margaron F, Kaplan BJ. Comparing video games and laparoscopic simulators in the development of laparoscopic skills in surgical residents. J Surg Educ 2012; 69 (6) 714-717
    CrossrefPubMedGoogle Scholar
  • 26 Rosser Jr JC, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R. The impact of video games on training surgeons in the 21st century. Arch Surg 2007; 142 (2) 181-186 , 186
    CrossrefPubMedGoogle Scholar
  • 27 Boyd T, Jung I, Van Sickle K, Schwesinger W, Michalek J, Bingener J. Music experience influences laparoscopic skills performance. JSLS 2008; 12 (3) 292-294
    PubMedGoogle Scholar
  • 28 Sabbagh R, Chatterjee S, Chawla A, Hoogenes J, Kapoor A, Matsumoto ED. Transfer of laparoscopic radical prostatectomy skills from bench model to animal model: a prospective, single-blind, randomized, controlled study. J Urol 2012; 187 (5) 1861-1866
    CrossrefPubMedGoogle Scholar
  • 29 Bjerrum F, Sorensen JL, Konge L , et al. Procedural specificity in laparoscopic simulator training: protocol for a randomised educational superiority trial. BMC Med Educ 2014; 14: 215
    CrossrefPubMedGoogle Scholar
  • 30 Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering fidelity in simulation-based training. Acad Med 2014; 89 (3) 387-392
    CrossrefPubMedGoogle Scholar
  • 31 Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L. Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc 2014; 28 (6) 1821-1829
    CrossrefPubMedGoogle Scholar
  • 32 Dawe SR, Pena GN, Windsor JA , et al. Systematic review of skills transfer after surgical simulation-based training. Br J Surg 2014; 101 (9) 1063-1076
    CrossrefPubMedGoogle Scholar
  • 33 Verdaasdonk EG, Dankelman J, Lange JF, Stassen LP. Incorporation of proficiency criteria for basic laparoscopic skills training: how does it work?. Surg Endosc 2008; 22 (12) 2609-2615
    CrossrefPubMedGoogle Scholar
  • 34 Larsen CR, Soerensen JL, Grantcharov TP , et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 2009; 338: b1802
    CrossrefPubMedGoogle Scholar
  • 35 Strandbygaard J, Bjerrum F, Maagaard M , et al. Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized trial. Ann Surg 2013; 257 (5) 839-844
    CrossrefPubMedGoogle Scholar
  • 36 Stefanidis D, Scott DJ, Korndorffer Jr JR. Do metrics matter? Time versus motion tracking for performance assessment of proficiency-based laparoscopic skills training. Simul Healthc 2009; 4 (2) 104-108
    CrossrefPubMedGoogle Scholar