Low-hanging fruit: a clementine as a simulation model for advanced laparoscopy.
BACKGROUND
Low-cost, high-fidelity models for training in advanced laparoscopic surgery techniques are not currently available. The objective of this study was to evaluate a model and assessment protocol for developing associated fine, precise laparoscopic dissection skills with accompanying surgical decision making.


METHODS
Novice to expert laparoscopists (n = 41) were asked to remove the peel of a clementine in as few pieces as possible, separate and remove all albedo from and between all fruit segments, and return the clementine to as close to its natural state as possible with completely closed skin (sutured). Clinical decision making included deciding when unacceptable segment damage would result by removing difficult-to-extract albedo, analogous to treating lesions or metastases through other methods, rather than risking damage to vital anatomic structures. Faculty assessed deidentified video-recorded performances. Data analyses included analysis of variance with Bonferroni post hoc.


RESULTS
A single-performance construct (operative ability) with 2 scoring dimensions (surgical skills and clinical judgment) was confirmed through factor analysis. There were significant performance differences between all experience levels (F2,41 = 59.175, P < 0.000). There were no statistical time differences between the groups.


CONCLUSIONS
Validation of this low-cost, easily facilitated model for developing advanced laparoscopic surgical skills may support the preparation of residents and fellows and provide a platform for skill acquisition, assessment, and basic critical thinking for performing laparoscopic tasks.
From the Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI.
Pamela
P
Andreatta
David A
DA
Marzano
Diana S
DS
Curran
Jessica J
JJ
Klotz
Charlotte R
CR
Gamble
R Kevin
RK
Reynolds
D002957:Citrus; D002983:Clinical Competence; D006176:Gynecology / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008495:Medical Oncology / Q000193:education*; D008824:Michigan; D013647:Task Performance and Analysis; D014741:Video Recording