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Virtual learning platform effective in teaching suturing

By Alice Goodman

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

Source: Ob.Gyn. News

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