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abstract

131 - A TRIAL OF SURGICAL TRAINING SYSTEM FOR LAPAROSCOPIC SACRAL COLPOPEXY

131

A TRIAL OF SURGICAL TRAINING SYSTEMFOR LAPAROSCOPIC SACRAL COLPOPEXY<!--EndFragment-->

M. TAKEYAMA, T. KUWATA, C. KATO;
Urogynecology center, First Towakai Hosp., Takatsuki city, Japan.

Introduction: LaparoscopicSacral Colpopexy (LSC) procedure requires several techniques forlaparoscopic operations including preparation of operative fields,tissue dissection, and anchoring and suturing of mesh. Surgeons mustrepeat hands-on training under the instruction of surgical experts inaddition to daily dry-box exercises.
Objective: Weformulated a LSC training system on the premise of the presence ofexpert trainers. Here we report the actual condition and importantpoints of the training system.
Methods: Materials were twomedical doctors, one was specialist urologist and the other wasspecialist gynecologist, both were at the entry level in laparoscopicsurgery fields. Their training period was 6 months between November2014 and April 2015.Training methods were as follows. The proceduresof our Laparoscopic Sacral Colpopexy were performed with the methodspreviously reported1, using four ports system. We dividedthe whole procedures into eight steps. The trainee performed eachstep five times as a chief operator. (Step1=suture the peritoneum,Step2=subtotal hysterectomy, Step3=preparation of operative fieldsplus dissection of retroperitoneum, Step4=dissection of anteriorvaginal wall from urinary bladder, Step5=anchoring the anterior meshto anterior vaginal wall, Step6=dissection of posterior vaginal wallfrom rectum, Step7=anchoring the posterior mesh to puborectal muscleand posterior vaginal wall, Step8=dissection of promontorium area andanchoring mesh to this region) Actual training in one operative caseincludes two steps operated by the trainee and the remaining sixsteps by the trainer in order to perform each the whole operationwithin 240 minutes. Each proficiency level of each the eight stepswas categorized into five levels and the definitions of each levelare as follows. Level 1: The chief operator switches from a traineeto a trainer during the operation. Level 2: A trainee performs thewhole operation after a great struggle under the instruction of atrainer. Level 3: A trainee completes the operation under theinstruction of a trainer. Level 4: A trainee completes the operationby himself (alone) with minor difficulty. Level5: A trainee completesthe operation by himself (alone) without difficulty. The trainerevaluated the proficiency of the trainees based on thecriteria.
Results: Each proficiency level of Step 5, Step7and Step 8 was 2. Hence it can be said that these steps are ratherdifficult for the trainees. The pictures of the Step 5 and Step 8 areshown in the Fig.1 and Fig 2 respectively. On the other hand theresult that each proficiency level of the other five steps was 4 or 5indicates these steps are rather easy.
Conclusions: Thestep-by-step training system suggests that the suturing techniquesare the rate-determining processes in LSC operation. It alsoindicates the importance of suturing training with the use ofdry-box.
References: 1. Curr OPin Obstet Gynecol 1995: 7:317-321