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Zhu A, Louridas M, Cleary SP, Jayaraman S. Advancing excellence: a national peer-coaching program for advanced laparoscopic HPB techniques. HPB (Oxford) 2025; 27:206-213. [PMID: 39567297 DOI: 10.1016/j.hpb.2024.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/05/2024] [Accepted: 11/04/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Surgical coaching is valuable for disseminating knowledge, refining skills, and fostering continuous professional development for surgeons in practice. This work aims to implement a national coaching program for Canadian HPB surgeons, emphasizing advanced laparoscopic techniques, and to assess subsequent adoption. Secondary objectives include evaluating surgeon perceptions, barriers, and experiences. METHODS Mid-to-late career HPB surgeons across Canada joined a peer surgical coaching program for advanced laparoscopic skills. The program included didactic sessions followed by practical coaching with case observation, simulation labs, and real-time coaching in the operating room. One lead surgeon from each center was invited to participate in the exit interview. RESULTS Eight centers across four provinces completed the program, and one lead surgeon from each site was interviewed. Surgeons reported a 34.9 % increase in self-perceived comfort levels in laparoscopic HPB surgeries, with a 24.2 % and 56.7 % increase in laparoscopic liver and pancreas resections, respectively. Participants acknowledged challenges in implementing surgical coaching, citing barriers related to surgeon and societal factors. Overcoming these challenges required mutual respect, openness to learning, and building sustained change through team collaboration and long-term coach relationships. DISCUSSION This work demonstrated the practicality of a nationwide coaching program and its capacity to effect substantial, long-term change in clinical practice.
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Affiliation(s)
- Alice Zhu
- Division of General Surgery, University of Toronto, Toronto, Canada
| | - Marisa Louridas
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Department of Surgery, St. Michaels' Hospital, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Sean P Cleary
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, University Health Network, Toronto, Canada
| | - Shiva Jayaraman
- Division of General Surgery, University of Toronto, Toronto, Canada; HPB Surgery Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.
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Beyer-Berjot L, Patel V, Sirimanna P, Hashimoto DA, Berdah S, Darzi A, Aggarwal R. Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery. World J Surg 2020; 44:696-703. [PMID: 31659411 DOI: 10.1007/s00268-019-05242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients' management. A common disease was chosen: acute appendicitis. METHODS All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured. RESULTS All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2-20) vs. 4 (4-6); P = 0.004, and 17 h (4-48) vs. 6 (4-24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30-264) vs. 44 (21-145); P = 0.22]. CONCLUSIONS CPA training is feasible in abdominal surgery. In the current study, it improved patients' management in terms of earlier oral intake.
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Affiliation(s)
- Laura Beyer-Berjot
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK. .,Centre for Surgical Teaching and Research (CERC), Faculté de Médecine Secteur Nord, Aix-Marseille University, 51 Boulevard Pierre Dramard, 13015, Marseille, France.
| | - Vishal Patel
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Pramudith Sirimanna
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | | | - Stéphane Berdah
- Centre for Surgical Teaching and Research (CERC), Faculté de Médecine Secteur Nord, Aix-Marseille University, 51 Boulevard Pierre Dramard, 13015, Marseille, France
| | - Ara Darzi
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Rajesh Aggarwal
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK.,Division of Minimally Invasive, Metabolic, and Bariatric Surgery, Department of Surgery, Thomas Jefferson University and Jefferson Health, Philadelphia, USA
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3
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The effect of laparoscopy courses in laparoscopy practice after urology resident training: A questionnaire-based observational study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.559559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tejos R, Avila R, Inzunza M, Achurra P, Castillo R, Rosberg A, Cordero O, Kusanovich R, Bellolio F, Varas J, Martínez J. IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY. ACTA ACUST UNITED AC 2019; 32:e1436. [PMID: 31038561 PMCID: PMC6488269 DOI: 10.1590/0102-672020190001e1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
Background: A General Surgery Residency may last between 2-6 years, depending on the
country. A shorter General Surgery Residency must optimize residents’
surgical exposure. Simulated surgical training is known to shorten the
learning curves, but information related to how it affects a General Surgery
Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated
training program in abdominal procedures performed by residents in a
three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of
graduated surgeons were included. Only abdominal procedures in which the
graduated surgeons were the primary surgeon were described and analyzed. The
control group was of graduated surgeons from 2012 without the laparoscopic
simulated training program. Surgical procedures per program year, surgical
technique, emergency/elective intervention and hospital-site (main/community
hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5;
laparoscopic simulated training program=23). Graduated surgeons performed a
mean of 372 abdominal procedures, with a higher mean number of
medium-to-complex procedures in laparoscopic simulated training program
group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic
simulated training program performed a higher number of total abdominal
procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148,
p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the
number and complexity of total and laparoscopic procedures in a three-year
General Surgery Residency.
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Affiliation(s)
- Rodrigo Tejos
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Avila
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Richard Castillo
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anne Rosberg
- International Internship, School of Medicine, Albert-Ludwigs-University of Freiburg, Baden-Württemberg, Germany
| | - Octavio Cordero
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Kusanovich
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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De León Valdez J, Salgado Cruz L, Chapa Lobo A, Rangel Ríos H, Villanueva Herrero J, García Gómez M, Enciso Pérez D. Transanal-total mesorectal excision in cadaveric model. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Torricelli FCM, Barbosa JABA, Marchini GS. Impact of laparoscopic surgery training laboratory on surgeon's performance. World J Gastrointest Surg 2016; 8:735-743. [PMID: 27933135 PMCID: PMC5124702 DOI: 10.4240/wjgs.v8.i11.735] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/02/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.
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Beyer-Berjot L, Patel V, Acharya A, Taylor D, Bonrath E, Grantcharov T, Darzi A, Aggarwal R. Surgical training: Design of a virtual care pathway approach. Surgery 2014; 156:689-97. [PMID: 25081233 DOI: 10.1016/j.surg.2014.04.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/18/2014] [Indexed: 01/13/2023]
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Development and Initial Assessment of a Training Program for Laparoscopic Radical Prostatectomy. First Module: The Urethrovesical Anastomosis. J Endourol 2014; 28:854-60. [DOI: 10.1089/end.2014.0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Beyer-Berjot L, Palter V, Grantcharov T, Aggarwal R. Advanced training in laparoscopic abdominal surgery: a systematic review. Surgery 2014; 156:676-88. [PMID: 24947643 DOI: 10.1016/j.surg.2014.04.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/18/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Simulation has spread widely this last decade, especially in laparoscopic surgery, and training out of the operating room has proven its positive impact on basic skills during real laparoscopic procedures. Few articles dealing with advanced training in laparoscopic abdominal surgery, however, have been published. Such training may decrease learning curves in the operating room for junior surgeons with limited access to complex laparoscopic procedures as a primary operator. METHODS Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles. RESULTS Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series and one fifth were purely descriptive, but there were eight randomized trials. Pig models and video trainers as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainee satisfaction with improvement after training, but the improvements were mainly on the training tool itself. Some tools have been proven to be construct-valid. CONCLUSION Higher-quality studies are required to appraise educational value in this field.
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Affiliation(s)
- Laura Beyer-Berjot
- Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK; Center for Surgical Teaching and Research (CERC), Aix-Marseille Université, Marseille, France.
| | - Vanessa Palter
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Teodor Grantcharov
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rajesh Aggarwal
- Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Sánchez-Margallo FM, Pérez FJ, Azevedo AM, Sánchez-Margallo JA, Sánchez MA, Díaz-Güemes I. An Analysis of Skills Acquisition During a Training Program for Experienced Laparoscopists in Laparoendoscopic Single-Site Surgery. Surg Innov 2013; 21:320-6. [DOI: 10.1177/1553350613510611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background. Laparoendoscopic single-site surgery has been presented in the past few years as an innovative minimally invasive approach, one which despite its advantages is also challenging and requires specific training. We propose to analyze the performance of attendants in a specific LESS training course. Methods. Following the LESSCAR 2010 guidelines, we focused on level 1 hands-on simulator tasks and level 2 hands-on training on animal model for skills acquisition during a LESS-specific training course. Each attendant completed coordination and cut tasks on simulator, followed by a cholecystectomy on an ex vivo porcine liver. Hands-on animal model each trainee performed 1 cholecystectomy and at least 2 nephrectomies (N1, N2). Performance was analyzed through video recording and reviewed by 3 independent observers. Each result was registered according to a modified objective structured assessment of technical skills. Total task or procedure completion time was also determined. Results. Regarding coordination and cut tasks, attendants improved on their performance from first to third attempts with an accompanying decrease in completion time. Surgeons completed the cholecystectomy on animal model significantly faster than on simulator, although with lower performance quality. Regarding N1 and N2, attendants showed improvement both in quality and total completion time. Conclusions. A gradual and positive evolution of attendants was observed throughout the training course. Thus, we believe a structured program for the acquisition of basic skills in new minimally invasive surgical approaches should be recommended. Considering that this is a small study, it would be advisable to increase the number of study subjects on future opportunities.
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Affiliation(s)
| | | | - Ana M. Azevedo
- Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain
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