Structured feedback and operative video debriefing with critical view of safety annotation in training of laparoscopic cholecystectomy: a randomized controlled study

Amila Cizmic; Frida Häberle; Philipp A Wise; Felix Müller; Felix Gabel; Pietro Mascagni; Babak Namazi; Martin Wagner; Daniel A Hashimoto; Amin Madani; Adnan Alseidi; Thilo Hackert; Beat P Müller-Stich; Felix Nickel

doi:10.1007/s00464-024-10843-6

Structured feedback and operative video debriefing with critical view of safety annotation in training of laparoscopic cholecystectomy: a randomized controlled study

Surg Endosc. 2024 Apr 23. doi: 10.1007/s00464-024-10843-6. Online ahead of print.

Authors

Amila Cizmic¹, Frida Häberle², Philipp A Wise², Felix Müller², Felix Gabel², Pietro Mascagni^{3

4}, Babak Namazi⁵, Martin Wagner⁶, Daniel A Hashimoto⁷, Amin Madani⁸, Adnan Alseidi⁹, Thilo Hackert¹, Beat P Müller-Stich¹⁰, Felix Nickel^{11

12

13}

Affiliations

¹ Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
² Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
³ Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁴ Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.
⁵ Center for Evidence-Based Simulation, Baylor University Medical Center, Dallas, USA.
⁶ Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁷ Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory, Department of Surgery, Department of Computer and Information Science, University of Pennsylvania, Philadelphia, USA.
⁸ Surgical Artificial Intelligence Research Academy (SARA), Department of Surgery, University Health Network, Toronto, Canada.
⁹ Department of Surgery, University of California - San Francisco, San Francisco, USA.
¹⁰ Department of Surgery, Clarunis - University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.
¹¹ Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany. f.nickel@uke.de.
¹² Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. f.nickel@uke.de.
¹³ HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany. f.nickel@uke.de.

PMID: 38653899
DOI: 10.1007/s00464-024-10843-6

Abstract

Background: The learning curve in minimally invasive surgery (MIS) is lengthened compared to open surgery. It has been reported that structured feedback and training in teams of two trainees improves MIS training and MIS performance. Annotation of surgical images and videos may prove beneficial for surgical training. This study investigated whether structured feedback and video debriefing, including annotation of critical view of safety (CVS), have beneficial learning effects in a predefined, multi-modal MIS training curriculum in teams of two trainees.

Methods: This randomized-controlled single-center study included medical students without MIS experience (n = 80). The participants first completed a standardized and structured multi-modal MIS training curriculum. They were then randomly divided into two groups (n = 40 each), and four laparoscopic cholecystectomies (LCs) were performed on ex-vivo porcine livers each. Students in the intervention group received structured feedback after each LC, consisting of LC performance evaluations through tutor-trainee joint video debriefing and CVS video annotation. Performance was evaluated using global and LC-specific Objective Structured Assessments of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores.

Results: The participants in the intervention group had higher global and LC-specific OSATS as well as global and LC-specific GOALS scores than the participants in the control group (25.5 ± 7.3 vs. 23.4 ± 5.1, p = 0.003; 47.6 ± 12.9 vs. 36 ± 12.8, p < 0.001; 17.5 ± 4.4 vs. 16 ± 3.8, p < 0.001; 6.6 ± 2.3 vs. 5.9 ± 2.1, p = 0.005). The intervention group achieved CVS more often than the control group (1. LC: 20 vs. 10 participants, p = 0.037, 2. LC: 24 vs. 8, p = 0.001, 3. LC: 31 vs. 8, p < 0.001, 4. LC: 31 vs. 10, p < 0.001).

Conclusions: Structured feedback and video debriefing with CVS annotation improves CVS achievement and ex-vivo porcine LC training performance based on OSATS and GOALS scores.

Keywords: CVS annotation; Laparoscopic cholecystectomy; Minimally invasive surgery; Structured feedback; Training; Video debriefing.