The evaluation of fundamental ability in acquiring minimally invasive surgical skill sets

226 Pages·2017·5.43 MB·English

Royal College of Surgeons in Ireland
e-publications@RCSI
MD theses Theses and Dissertations
1-1-2012
The evaluation of fundamental ability in acquiring
minimally invasive surgical skill sets
Emmeline Nugent
Royal College of Surgeons in Ireland
Citation
Nugent E. The evaluation of fundamental ability in acquiring minimally invasive surgical skill sets [MD Thesis]. Dublin: Royal College
of Surgeons in Ireland; 2012.
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The Evaluation of Fundamental Ability in Acquiring Minimally
Invasive Surgical Skill Sets
A thesis submitted to the Royal College of Surgeons in Ireland, in fulfillment of
the requirements for the degree of Medical Doctorate (Surgery)
RCSI
by
Dr. Emmeline Nugent
MB BCh BAO (Hons.), MRCS
Supervised by
Mr. Paul Neary, MD, FRCSI
Vice Dean of Dublin Region, Postgraduate Surgical Training, RCSI
&
Professor Oscar Traynor, MCh, FRCSI
Dean of Postgraduate Surgical Training, RCSI
Table of Contents
Table of Contents ii
Declaration xi
Acknowledgements xii
List of Figures xiii
List of Tables xiv
List of Appendices xv
Abbreviations xvi
Abstract xvii
Table of Contents
Chapter 1 Introduction 01
1.1 Minimally Invasive Surgery 02
1.2 A Brief History of Minimally Invasive Surgery 02
1.2.1 The History of Endoscopy 02
1.2.2 The History of Laparoscopy 05
1.2.3 The History of Endovascular Surgery 07
1.3 The Advantages of Minimally Invasive Surgery 08
1.4 The Difficulties Associated with Minimally Invasive Surgery 10
1.4.1 The Learning Curve in Minimally Invasive Surgery 10
1.4.2 Visual-spatial, Psychomotor & Perceptual Aspects of MIS 14
1.4.3 The Current Training Environment 16
1.5 The Role of Simulation in MIS Training 20
1.6 Addressing the Difficulties Associated with Minimally Invasive Surgery 21
1.6.1 Aptitude Assessment for Minimally Invasive Techniques 21
1.6.2 Visual Spatial Ability 22
1.6.3 Psychomotor Ability 23
1.6.4 Perceptual Ability 24
1.6.5 Human Factors Influencing Surgical Performance 25
1.6.6 Non-surgical Skills in MIS 29
1.7 Objectives 31
1.7.1 Hypothesis Underlying the Obj ectives 31
1.7.2 Detailed Objectives 32
iii
Table of Contents
Chapter 2 Materials & Methods 34
Ethical Considerations
2.1 35
Recruitment of Participants
2.2 35
Participant Demographics
2.3 35
Aptitude Assessment
2.4 36
2.4.1 Visual-spatial Aptitude 36
2.4.2 Visual-spatial Aptitude Assessment 37
2.4.3 Spatial Orientation Assessment 38
2.4.4 Spatial Visualisation Assessment 38
2.4.5 Spatial Scanning Assessment 38
2.4.6 Psychomotor Aptitude 39
2.4.7 The Grooved Pegboard 40
2.4.8 Assessment Using the Grooved Pegboard 41
2.4.9 The Grooved Pegboard Scoring 41
2.4.10 Depth Perception Aptitude 41
2.4.11 Pictorial Surface Orientation (PicSOr) 42
2.4.12 Assessment Using PicSOr 42
2.4.13 Scoring PicSOr 43
The Attentional and Interpersonal Style Inventory (TAIS)
2.5 44
2.5.1 TAIS: What it Measures 44
2.5.2 Assessment Using the TAIS 45
2.5.3 Scoring the TAIS 46
Table of Contents
2.6 Surgical Skills Assessment 46
2.6.1 Laparoscopic Skill 46
2.6.2 Endoscopic Skill 48
2.6.3 Endovascular Skill 50
2.7 Statistical Analysis 51
Chapter 3 Aptitude Assessment: Comparing Surgical Trainees to Controls 53
3.1 Introduction 54
3.2 Objectives 55
3.2.1 Hypothesis Underlying the Objectives 55
3.2.2 Detailed Objectives 55
3.3 Materials & Methods 56
3.3.1 Recruitment of Participants 56
3.3.2 Participant Demographics 57
3.3.3 Assessment Procedure 58
3.3.4 Aptitude Assessment 59
3.3.5 Surgical Skills Assessment 59
3.3.6 Statistical Analysis 60
3.4 Results 60
3.4.1 Participant Demographics 60
3.4.2 Aptitude Results: Surgical Trainees versus Controls 63
3.4.3 Aptitude Distribution across the Surgical Specialties 64
Table of Contents
3.4.4 Correlation between Aptitude and Surgical Skill Performance 68
3.5 Discussion 71
Chapter 4 Aptitude Assessment & Performance Outcomes in Basic 74
Minimally Invasive Surgical Tasks
4.1 Introduction 75
4.2 Objectives 76
4.2.1 Hypothesis Underlying the Objectives 76
4.2.2 Detailed Objectives 77
4.3 Materials & Methods 78
4.3.1 Recruitment of Participants 78
4.3.2 Participant Demographics 78
4.3.3 Aptitude Assessment 78
4.3.4 Surgical Skills Assessment 80
4.3.5 Setting Proficiency Levels 80
4.3.6 Assessing Proficiency 81
4.3.7 Statistical Analysis 81
4.4 Results 82
4.4.1 Participant Demographics 82
4.4.2 Aptitude Distribution across Experience Levels 84
4.4.3 Performance Distribution across Experience Levels in MIS Tasks 85
4.4.4 Medical Students Visual Spatial Aptitude & Surgical Skill Performance 88
Table of Contents
4.4.5 Medical Students Psychomotor Aptitude & Surgical Skill Performance 89
4.4.6 Medical Students Depth Perception Aptitude & Surgical Skill Performance 89
4.4.7 BST Visual Spatial Aptitude & Surgical Skill Performance 90
4.4.8 BST Psychomotor Aptitude & Surgical Skill Performance 91
4.4.9 BST Depth Perception Aptitude & Surgical Skill Performance 91
4.4.10 HST Visual Spatial Aptitude & Surgical Skill Performance 92
4.4.11 HST Psychomotor Aptitude & Surgical Skill Performance 93
4.4.12 HST Depth Perception Aptitude & Surgical Skill Performance 93
4.4.13 Assessing Proficiency in Surgical Novices 94
4.4.14 Impact on Aptitude on Ability to Reach Proficiency 96
4.4.15 Learning Pathways in Basic MIS Tasks 104
4.5 Discussion 104
Chapter 5 Aptitude Assessment and Performance Outcomes in Advanced 108
Minimally Invasive Surgical Tasks
5.1 Introduction 109
5.2 Objectives 111
5.2.1 Hypothesis Underlying the Obj ectives 111
5.2.2 Detailed Objectives 112
5.3 Materials & Methods 113
5.3.1 Recruitment of Participants 113
5.3.2 Participant Demographics 113
Table of Contents
5.3.3 The Simulator Used 114
5.3.4 Aptitude Assessment 115
5.3.5 Course Procedure 115
5.3.6 Performance Assessment 116
5.3.7 Statistical Analysis 116
5.4 Results 117
5.4.1 Participants Demographics 117
5.4.2 Aptitude & Basic Laparoscopic Skills Performance 121
5.4.3 Aptitude & Laparoscopic Sigmoid Colectomy Performance 122
5.4.4 Correlation between Basic Laparoscopic Skills & Laparoscopic Colectomy 123
5.4.5 MCQ Result & Laparoscopic Colectomy Performance 123
5.4.6 Tray Errors & Laparoscopic Colectomy Performance 123
5.4.7 Prior Experience & Laparoscopic Colectomy Performance 124
5.4.8 Assisting/Observing & Laparoscopic Colectomy Performance 124
5.4.9 Trainee Insight & Laparoscopic Colectomy Performance 124
5.5 Discussion 125
Chapter 6 TAIS as a Tool for Determining Performance Outcomes in 130
Surgical Tasks
6.1 Introduction 131
6.2 Objectives 132