Blog review about laparoscopic Training

Dr R K Mishra World Laparoscopy Hospital Gurgaon

Laparoscopic techniques have proved to be beneficial for the surgical patient with respect to decreased post-operative pain, decreased postoperative hospital stay, less would complications, and overall faster recovery allowing return to work. In summary, trauma is markedly less than with open surgery. However, the effects of this stressful surgery on the laparoscopic surgeon rarely have been investigated. Minimally invasive surgery causes greater mental strain for laparoscopic surgeons than consecutive open surgical cases. Laparoscopic surgery causes higher mental strain for laparoscopic surgeons than conventional surgery and is significantly more stressful in consecutive few initial cases for beginners. One study was conducted at laparoscopy hospital, New Delhi aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skill and technical errors of the laparoscopic surgeon. Prof. Mishra performing laparoscopic surgeryFor this study specially designed human shape virtual reality simulator was used. Stress measurement was carried out for 20 trainee surgeons who have come for getting training at Laparoscopy Hospital, New Delhi. During their task performance harvested animal viscera is introduced inside the abdominal cavity and defferent task were assigned and activity of the sympathetic nervous system was evaluated by skin resistance with the help of a sympathicograph. The conclusion of this study was that the mental load of the laparoscopic surgeons is much more during tough tasks like intracorporeal suturing, coagulation of any active bleeder, and during dissection of any big vessel and this strain might be highly optimized by continuous activity of the sympathetic nervous system. This comes with repeated practice in lab environment. The question of what extent or quality of stress produces adverse effects remains unclear. Presently there is no valid data exist on the surgeon’s reactions in the face of complications and “crisis” situations with stress corresponding to that in a laparoscopic surgery in the operating room. In contrast, for a similar challenge, many years of simulation training in aviation has allowed air crews to coordinate and standardize recovery strategies. The use of laparoscopic endotrainer based simulators for evaluation of stress and the corresponding reaction to the operative situation have not been examined previously in any institute. Furthermore, publications on learning curve in laparoscopic simulation include only ideal situations and exclude specific stress and critical situations as they are frequently manifest in reality. Thus, laparoscopic simulation may not be able to imitate a “real” stress scenario completely, and the realism of the settings used remains limited. Laparoscopic surgeon’s mental strain in the laparoscopic operating room, obviously more important than stress, is difficult to define and to measure. The results of our study indicate that mental load might be highly optimized by activity of the sympathetic nervous system.Our lab setup laparoscopic operating room scenario identified different types of surgeon-specific stress reaction. Interestingly,  the subgroup with the highest activity of the sympathetic nervous system without recovery during the course of the procedure required the largest extensions of movement to cope with the laparoscopic task, but experienced fewer intraoperative failures and complications.  Varied age group and different experience range of surgeon were participated in the study group and due to the low number of test persons involved, validation of the conclusions drawn from this study must be regarded with care. Further studies involving larger subgroups are necessary to evaluate the relevance of our findings.