Significant transfer of surgical skills acquired in an advanced laparoscopic training program for total laparoscopic gastropexy assessed in a live porcine model

Abstract

Abstract Background. Currently, legal limitations avoid repetition and deliberate practice on cadavers and experimental models, which are fundamental for minimally invasive surgery skills acquisition. The CALMA Veterinary Lap-trainer (CVLTS) simulator is an ergonomic canine abdominal model developed to allow training of basic and advanced laparoscopic skills for total laparoscopic gastropexy (TLG) in dogs. This study aimed to evaluate an advanced curriculum using the CVLTS to simulate TLG with intracorporeal suturing and to evaluate the transfer of surgical skills to a live porcine model. Veterinarians trained in basic laparoscopic surgical skills (experimental group, n=10) practiced TLG in 15 training sessions. Performances before and after training were videotaped and compared to veterinary surgeons with intermediate (n=10) or advanced (n=6) laparoscopic skills, including a Hand Movement Assessment System (HMAS). Video records performed before and after training were evaluated by external experts using the Global Operative Assessment of Laparoscopic Skills (GOALS) and TLG-specific scales (SRS) and quantitatively by evaluating HMAS performance. Skill transfer was assessed by performing TLG in fattening pigs under operating room conditions using barbed sutures. Three months after surgery, a postmortem biopsy of the gastropexy site was evaluated by histopathology. Results GOALS and SRS scores (P<0.05) time, movements, and angular displacement during TLG significantly improved after training within the Experimental group (P>0.01) and when compared to expert and intermediate groups (P<0.05). The learning curve for intracorporeal suture stabilized since the tenth (out of 15) training session. Besides, trainees achieved significant skill transfer for TLG in the in vivo model, with no significant difference from the expert group. Histopathology findings of the gastropexy site showed mature collagen (100% of cases), cartilage and bone metaplasia, and foreign body reaction (25% of cases), indicating a strong healing process. Conclusion The advanced laparoscopic training program for total laparoscopic gastropexy resulted in a statistically significant improvement in surgical skills, as supported by objective assessment score (GOALS - SRS), metrics (HMAS), and postmortem findings at the gastropexy site. Training in the CVLTS simulator resulted in the successful transfer of surgical skills for TLG.