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Skills Acquisition for Laparoscopic Gastric Bypass in the Training Laboratory — an Innovative Approach

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Background

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure, with a long learning curve.The aim of this study was threefold: to develop a task-based approach to training in LRYGBP, define a tool for objective technical skills assessments, and objectively determine the efficacy of this approach.

Methods

Videos of expert and novice surgeons performing LRYGBP on patients and anesthetised porcine models were analyzed to define an appropriate task for skills assessment. Subsequently, a jejunojejunostomy model was developed using cadaveric porcine small bowel, placed into a video-box trainer. 27 surgeons of varying experience levels in advanced laparoscopic procedures performed the task. Assessments of technical skill were by hand motion analysis and video-based scoring. A further 16 surgeons inexperienced in LRYGBP attended a taskbased hands-on training course and performed the jejuno-jejunostomy task at start and end of the course.

Results

The jejuno-jejunostomy model differentiated between surgeons of varying experience levels for time taken (P<0.001), economy of movement (P=0.001) and video scores (P<0.001). Surgeons attending the training course made significant improvements in time taken (P=0.002) and economy of movement (P=0.006), although not for generic video scores (P=0.243) by the end of course.

Conclusions

The structured, task-based approach for commencement of training in LRYGBP leads to objective improvements in the technical skills of inexperienced surgeons at the end of a short course. The next stage of the curriculum should be to achieve proficiency in the complete procedure on an anesthetised porcine model, prior to preceptorship on human cases.

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Authors and Affiliations

  1. Department of Biosurgery & Surgical Technology, Imperial College, London, UK

    Rajesh Aggarwal MRCS, Julian Hance MRCS, Julian Leong MRCS & Ara Darzi MD

  2. Department of Digestive Surgery, Hospital Clinico, Pontificia Universidad Catolica de Chile, Santiago, Chile

    Camilo Boza MD

  3. Gastrointestinal Surgery Unit, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Antonio Lacy MD

  4. Clinical Research Fellow, Dept. of Biosurgery & Surgical Technology, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother Building, St. Mary’s Hospital, Praed Street, London, W2 1NY, United Kingdom

    Rajesh Aggarwal MRCS

Authors
  1. Rajesh Aggarwal MRCS
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  2. Camilo Boza MD
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  3. Julian Hance MRCS
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  4. Julian Leong MRCS
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  5. Antonio Lacy MD
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  6. Ara Darzi MD
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Correspondence to Rajesh Aggarwal MRCS.

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Aggarwal, R., Boza, C., Hance, J. et al. Skills Acquisition for Laparoscopic Gastric Bypass in the Training Laboratory — an Innovative Approach. OBES SURG 17, 19–27 (2007). https://doi.org/10.1007/s11695-007-9001-x

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  • DOI: https://doi.org/10.1007/s11695-007-9001-x

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