Feedback based simulator training reduces superfluous forces exerted by novice residents practicing knot tying for vessel ligation - 02/12/19

Doi : 10.1016/j.amjsurg.2019.11.027

Imri Amiel ^a,^b,^c,^d,^{^{1
The first two authors contributed equally.}} , Roi Anteby ^a,^b,^{^{1
The first two authors contributed equally.},}^⁎ , Moti Cordoba ^a,^b, Shlomi Laufer ^e, Chaya Shwaartz ^a,^b, Danny Rosin ^a,^b, Mordechai Gutman ^a,^b, Amitai Ziv ^a,^b,^c, Roy Mashiach ^a,^b,^c
^a Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^b Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
^c Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
^d Talpiot Medical Leadership Program, Sheba Medical Center, Israel
^e Technion, Israel Institute of Technology, Haifa, Israel

^∗Corresponding author. Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel.Faculty of MedicineTel Aviv UniversityP.O. Box 39040Tel Aviv 6997801Israel

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 02 December 2019

Abstract

Background

Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation.

Methods

A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared.

Results

Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004).

Conclusions

Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons.

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Graphical abstract

Image 1

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Highlights

•	We developed a simulator for knot tying that incorporates a force feedback feature.
•	Novice residents applied 35% less force after simulation training.
•	A short period of practice is needed to avoid excessive use of force.
•	Residents achieved the same competence as experienced surgeons.
•	Basic surgical skill simulators can objectively evaluate and hone performance.