Creating a Proficiency-Based Virtual Reality Simulation Training Programme for Laparoscopic Assisted Colectomy
NCT ID: NCT00752817
Last Updated: 2008-10-07
Study Results
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Basic Information
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UNKNOWN
NA
16 participants
INTERVENTIONAL
2008-09-30
2009-09-30
Brief Summary
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Minimally invasive surgery offers many advantages to the patients but exposes the surgeon to new challenges, many of which are human factor in nature. This in turn prolongs the learning curve and has delayed the widespread adoption of minimally invasive surgical techniques in the management of patients with colorectal disease.
Virtual reality simulation offers an effective way of training whereby surgical trainees can train repeatedly and achieve proficiency in a shorter time and a safe environment.
Detailed Description
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Minimally Invasive Surgery (MIS) has conferred considerable advantages on patient's post operative outcome and recovery when compared with open surgery.
Major clinical trials including; Clinical Outcomes of Surgical Therapy Study Group (COSTSG), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs. Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) have uniformly and consistently shown a significant reduction in the post operative pain, the use of narcotics and oral analgesics, and length of hospital stay, as well as a faster resumption of diet, return of bowel function when using a MIS approach.
Despite all these advantages to the patients, MIS imposed a significant difficulty on the surgeons. These difficulties were primarily human factor in nature.
The use of Virtual Reality (VR) simulation has been proven to help in the acquisition of MIS skills. The use of proficiency-based, virtual reality simulation should help training of MIS providers in a safe environment where complex tasks can be repeated as many times as needed to achieve a pre-set proficiency level. A well designed proficiency-based simulation curriculum should help the widespread use of the MIS approach.
Aims
Primary:
We aim to prove that subjects randomised to train under a proficiency-based progression simulation curriculum (SC) will learn to perform laparoscopic assisted colectomy faster, complete more surgical steps and commit fewer operative errors compared to subjects randomised to the current surgical training curriculum (CC)
Secondary:
We aim to set the institutional and national proficiency level for Laparoscopic Assisted Colectomy (LAC) using the ProMIS-LAC simulator from Haptica, Ireland.
Methods Randomised, controlled, single blinded, multicentre study. Primary Variable 8 centres, 8 co-investigators (expert consultant laparoscopic colorectal surgeons \> 300 MIS procedures) and 16 surgical trainees will be recruited for the study. Subjects (surgical trainees) will be randomised into;
* Simulator Curriculum (SC) group.
* Conventional Curriculum (CC) group.
Subjects randomised to the CC group will continue to have the conventional training programme offered at their respective hospitals. Subjects randomised to the SC group will complete a standardised laparoscopic skills training course followed by a training curriculum including the performance of simulated LAC procedures in nine predetermined steps on the simulator. Subjects must reach a predetermined proficiency level to complete the simulation training course before re-joining their training programme offered at their respective hospitals. .
Upon completion of the training courses, both groups' subject populations will perform a total of five LAC procedures on consecutive patients in the presence of a surgeon proctor.
Patients indicated for LAC procedure will be screened, consented, and enrolled as patients into this study. Each procedure will be recorded and forwarded to the chief investigator for analysis. The number of completed surgical steps and the incidence of intraoperative errors between the two SC and CC groups will be evaluated via blinded video review.
Secondary Variable
All participating co-investigators will participate in defining the proficiency level for LAC on the ProMIS-LAC simulator.
The average values of the recorded metrics which are obtained from the expert performance will be used to set the proficiency level.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
SINGLE
Study Groups
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SC
Subjects (surgical trainees) randomised to train under a proficiency-based progression virtual reality simulation curriculum
Proficiency-based virtual reality simulation training
Subjects (surgical trainees) will be trained under a proficiency-based virtual reality simulation training programme before performing their first live case
CC
Subjects (surgical trainees) randomised to the current surgical training curriculum
Training under the current surgical training programme
Subjects (surgical trainees) will continue to train under the current training methodology offered at their institution before they perform their first live case.
Interventions
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Proficiency-based virtual reality simulation training
Subjects (surgical trainees) will be trained under a proficiency-based virtual reality simulation training programme before performing their first live case
Training under the current surgical training programme
Subjects (surgical trainees) will continue to train under the current training methodology offered at their institution before they perform their first live case.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Completed their Basic Surgical Training programme.
* Completed at least 12 months period on a Higher Surgical Training programme.
* In an accredited surgical post at time of participation
* In a colorectal surgery rotation at time of participation
* Signed their own consent form
* Indicated for a laparoscopic assisted sigmoid colectomy or high anterior resection
* At least 18 years old upon date of signing the informed consent document (ICD)
* Sign their own ICD
Exclusion Criteria
* Performed, as primary surgeon, laparoscopic assisted colectomy procedures
* Performed, as primary surgeon, any hand-assisted laparoscopic colectomy procedures
* Did not sign their own consent form
* History or current diagnosis of synchronous colon cancer
* Indicated for urgent surgery
* Indicated for diverting stoma
* American Society of Anaesthesiologists (ASA) Classification of Physical Status IV-V
* Tumour classified as T4
* An obstructed colon
* Planned early conversion based on findings at operative visualisation.
* Pregnancy
* \< 18 years of age
* Mental disability
* Did not sign their own ICD
18 Years
ALL
Yes
Sponsors
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Health Service Executive
UNKNOWN
Royal College of Surgeons, Ireland
OTHER
Responsible Party
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Royal College of Surgeons in Ireland (RCSI)
Principal Investigators
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Paul Neary, MD, FRCSI
Role: PRINCIPAL_INVESTIGATOR
Royal College of Surgeons in Ireland
Locations
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Mercy University Hospital
Cork, , Ireland
AMNCH
Dublin, , Ireland
St. Vincent's University Hospital
Dublin, , Ireland
Beaumont Hospital
Dublin, , Ireland
AMNCH
Dublin, , Ireland
Tullamore general hospital
Tullamore, , Ireland
Antrim Area Hospital
Antrim, , United Kingdom
Gartnavel General Hospital
Glasgow, , United Kingdom
Leicester Royal Infirmary Hospital
Leicester, , United Kingdom
Freeman Hospital
Newcastle, , United Kingdom
Countries
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Central Contacts
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Facility Contacts
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Michael O'Riordain, MD, FRCS
Role: primary
Dairmuid O'Riordain, MD, FRCSI
Role: primary
Desmond Winter, MD, FRCSI
Role: primary
Deborah McNamara, MD, FRCSI
Role: primary
Paul Neary, MD, FRCSI
Role: primary
Dermot Hehir, FRCSI
Role: primary
Colman Byrnes, MD, FRCS
Role: primary
Richard Molloy, MD, FRCS
Role: primary
Andrew Miller, MD, FRCS
Role: primary
Alan Horgan, MD, FRCS
Role: primary
References
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Other Identifiers
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RCSI 3
Identifier Type: -
Identifier Source: org_study_id