The Ideal Dimension of a Laparoscopic Box Trainer in Carrying Out Landmark Anatomical Measurements
Introduction
Laparoscopy was developed due to its minimal tissue incision during surgery. The initial laparoscopic cholecystectomy was developed in 1967, and its use has since rapidly spread in the medical field due to its numerous advantages. The laparoscopic technique has been widely accepted due to its numerous advantages such as minimal post-operative pain, improved anesthetic results, and hospitalization time (Martins & Ribeiro & Cavazzola 204). At the time of its introduction, the laparoscopic surgical procedures were associated with numerous complications. This is because when medical practitioners carried out similar surgical operations through laparoscopic means, their open surgical skills were not translated into the new procedures. Consequently, this necessitated the development of laparoscopic box training to facilitate the skills of medical students without putting the lives of the patients at risk. To prevent the occurrence of deadly surgical mistakes that may jeopardize the safety and lives of the patients, the laparoscopic box trainer is utilized to train medical students hence is essential in improving the overall health outcomes.
The laparoscopic box trainer was developed to aid in training medical students on the most sophisticated laparoscopy techniques. Numerous devices have been developed to facilitate laparoscopic training encompassing virtual reality simulators, animal models, and simple box trainers (Vitish-Sharma, Knowles & Patel 659). However, the box trainer remains the main method of teaching laparoscopic skills to medical students due to its flexibility. The laparoscopic box trainer aids in the improvement of the dexterity and surgical performance skills of the medical trainees. In addition, it improves their motor coordination expertise, accuracy, depth perception during surgery, and consistency in completing accurate landmark anatomical measurements.
The laparoscopic box trainer has specific dimensions that make the landmark anatomical measurements including the sagittal, frontal, and transverse anatomical planes. Moreover, the various landmark anatomical measurements made by the laparoscopic box trainer are done along the sagittal, frontal, and transverse anatomical planes with precision to minimize errors and unprecedented injuries. Furthermore, some of the main landmark anatomical areas measured by the laparoscopic trainer box include the coronal horizontal abdomen, coronal horizontal pelvis, coronal vertical midline abdomen, coronal vertical midline pelvis, sagittal horizontal abdomen as well as the coronal mid-vascular vertical line Abdomen. The accuracy of these measurements for patient populations of different ages, gender, and body mass indices results from the most ideal dimensions of the laparoscopic box trainer.
Problem under Discussion
Even though numerous laparoscopic box trainers have been developed in the medical field in the past to aid in surgical procedures and training of medical students, they hardly conform to the dimensions of diverse populations. Due to the rising significance of laparoscopy in facilitating modern surgery, a wide variety of laparoscopic box trainers have been developed to address the diverse needs of medical trainers and trainees. However, the numerous cases of surgical errors resulting from the trainees who utilize the available laparoscopic box trainers insinuate that they lack the ideal dimensions to make the correct anatomical landmark measurements. In this regard, there is a need to develop a laparoscopic trainer box with the ideal dimensions for diverse gender, age, and body mass index of individuals in a target population. The trainer box with the most ideal dimensions is essential in honing the skills of medical students, saving training durations, and resulting in medical practitioners who exhibit minimal errors and mistakes in their actual surgical operations. Besides, developing the laparoscopic box trainer is quite expensive, hence is it is not economically feasible to produce multiple quantities of them to measure landmark dimensions of individuals of different ages, BMI, or gender. In essence, developing a laparoscopic box trainer with ideal dimensions for diverse populations can help in reducing their costs of production as well as the overall cost of training medical students.
Purpose of the Study
The study aims at developing an effective laparoscopic box trainer with the most ideal dimensions and which can accurately make landmark anatomical measurements for individuals of diverse gender, ages, and body mass indices. Due to the lack of all-round laparoscopic box trainers usable for diverse populations, the study aims at filling this gap. This is because medical students require effective training equipment to successfully carry out surgical operations on diverse populations once they graduate. Moreover, by developing a box trainer with ideal dimensions for landmark measurements of diverse populations, the study is geared towards facilitating cost-effectiveness in developing the box trainers, since a few of them will be needed for large population size. Furthermore, this primary study aims at triggering more research to develop more efficient, cost-effective, and cost-effective surgical training equipment ideal for large population sizes.
Significance of the Study
The study is essential since it facilitates the development of laparoscopic box trainer with ideal dimensions of making landmark measurements for diverse patient populations. The laparoscopic box trainer is majorly utilized to train medical students, and their competency after training not only depends on the efficacy of the trainer but also the effectiveness of the surgical instruments utilized in the demonstration. In particular, laparoscopic surgery success and safety mandate the acquisition of effective skills of handling the surgical instruments, comprehension of the three and two-dimension images, exhibiting minimal tactile feedback, and making accurate incisions. In this regard, when medical students are trained using the laparoscopic box trainer having the most relevant dimensions to cover diverse patient population characteristics, they gain better knowledge on handling different patients and upholding safety during surgery. It is noteworthy that long operation times and minimal safety during actual surgical operations are a major cause of preventable patient deaths and consequent high healthcare burden, hence training medical students with the best laparoscopic box trainer is prudent. Moreover, the utility of numerous surgical instruments in training medical students on handling diverse patient population surgery is costly. Consequently, this study is vital in reducing the costs of developing different trainer boxes for carrying out landmark anatomical measurements for different patient diversities, hence suppressing the overall training costs.
Research Question
What is the most ideal dimension of a laparoscopic box trainer when carrying out landmark anatomical measurements?
Hypothesis
A laparoscopic box trainer with ideal dimensions that can make diverse landmark anatomical measurements for high and low BMI, all ages and gender is essential in reducing training costs, improving the competency of medical students, and facilitating patient safety.
Objectives Aims of the Study
To elaborate the most ideal dimensions of the laparoscopic box trainer ideal for making landmark anatomical measurements.
Literature Review
In the present medical environment, arguably all surgical institutions with positive theatre outcomes and indications utilize laparoscopic surgery due to its reduced invasive scope, signifying its necessity. Moreover, a large number of medical procedures requiring laparoscopic involvement are on the rise. The laparoscopic skills majorly fall under minimally invasive surgical (MIS) procedures (Rodrigues 315). Moreover, the laparoscopic techniques are majorly taught outside the clinical environment to uphold the safety of the patients. The laparoscopic skills are mainly applied in gynecological, urological, and surgical initiatives. However, MIS learning poses numerous challenges for medical students. For instance, the students can lose spatial orientation and depth perception if they do not grasp the two-dimension (Vitish-Sharma, Knowles & Patel 659). Also, the fulcrum effect entailing the intuition of movement to the instrument’s working end from the handle is difficult to ascertain (Rodrigues 315). Additionally, the utility of long laparoscopic instruments is a vital obstacle towards successful surgical precision (Rodrigues 315). Moreover, the usage of long laparoscopic instruments results in reduced degrees of freedom as well as suppresses motion freedom (Rodrigues 315). These challenges necessitate that the laparoscopic trainer box dimensions need to be more ideal, accurate, and satisfactory for diverse surgical needs. Moreover, for novice medical students, constantly adjusting to these challenges can be tedious and can also lengthen the learning curve.
Moreover, a majority of medical students tend to encounter numerous laparoscopic procedures in the course of their training. However, unlike conventional surgery training, laparoscopic box training remains largely unavailable to a majority of medical students, primarily because of their high costs as well as the difficulty to access the construction materials and resources. In particular, the construction of the laparoscopic trainer box requires materials such as laparoscopic optics, tablets, webcams, and camcorders which can be costly (Martins & Ribeiro & Cavazzola 204). In addition, the image capturing components are costly since they ought to be lightweight, compact, and produce sharp and high-quality images.
Laparoscopic surgery also necessitates trainees to acquire specific cognitive and motor skills which are essential in maneuvering in the tissues and manipulating the surgical instruments accordingly. Some of the most vital skills include ambidexterity, operating laparoscopic instruments, bimanual manipulation, fulcrum effect adjustment, instrument, and tissue maneuver as well as depth perception (Vitish-Sharma, Knowles & Patel 659). Additionally, numerous medical students face the challenge of lacking 3-dimensional views, incapability to touch the required tissues, lack of dexterity of the fingers, and problematic fulcrum lead (Schreuder et a., 1576). As a result of the complexities of the laparoscopic operation, an effective laparoscopic box trainer is essential in aiding medical students to perfect in handling diverse patient scenarios before embarking on their actual surgical operations. Effective laparoscopic training boxes shortens the learning duration of the medical students, which in turn reduces their operating costs and time and minimizes their chances of making surgical mistakes (Martins & Ribeiro & Cavazzola 204). When the medical trainees are subjected to a viable laparoscopic trainer box, they are better suited at reducing operation stress and facilitating patient safety. In addition, the patient-based laparoscopy training of the patients is essential since it facilitates feedback sessions and improves clarity during learning.
Furthermore, due to financial considerations and patient safety concerns, attaining surgical proficiency via clinical experience has become challenging for medical students and practitioners. According to research, there has been a rise in errors and injury rates during laparoscopic surgery. For instance, trocar injuries have been associated with the initial penetration of the laparoscopic box trainer, with visceral perforation being the most common (Gaar 156). Due to the common utility of electro-surgical instruments during the laparoscopic procedures, there has been a high incidence of electrical perforation or burn outside the region covered by the landmark anatomical measurement (Gaar 155). Although some surgery errors and injuries can be attributed to patient characteristics, the extent of the accuracy, grasp of the correct 3-D dimension and interpretation, and the motor skills of the surgeon, as well as the precision in measuring the landmark anatomical distance also play a part. The happening of a medical error in laparoscopy can also be attributed to the failure to interpret three-dimensional images into two-dimensional images.
The dimensions of a laparoscopic trainer box need to be ideal enough to complete accurate landmark anatomical measurements of numerous ages, BMI, and gender. For instance, obesity has widely been perceived as a global pandemic, and they mostly have an increased probability of developing endocrinological and cardiovascular diseases (Berlit et al., 125). Furthermore, considering that laparoscopic hysterectomy makes up a significant percentage of most gynecological surgery for overweight individuals worldwide, it is essential to establish the impact of BMI on surgical adversities and develop mitigation measures. However, laparoscopic surgery in overweight individuals has constantly faced complications worldwide. In particular, in obese patients, difficulty in anatomical structure visualization, instrument handling, pneumoperitoneum maintenance, and abdominal cavity access makes laparoscopic surgery hard to achieve owing to the elevated intraabdominal fat and expanded abdominal wall diameter (Berlit et al., 126). In this regard, when designing the ideal dimensions of the laparoscopic box trainer, it is vital to consider landmark anatomical measurements that take care of individuals with both high and low BMI.
In addition, due to the significant percentage of surgical requirements for the aging, population, the ideal laparoscopic box trainer dimensions need to consider the landmark anatomical measurements for the elderly. In particular, the correct trainer box dimensions and application results in minimal abdominal, thrombotic, and pulmonary complications, reduced length of hospital admission, minimal postoperative pain, and suppressed loss of blood for elderly patients (Chesney & Acuna 321). However, safety concerns still linger for elder patients intending to undergo laparoscopic surgery. This is because the physiological demands for the elderly patients supersede that of the younger times. Moreover, the increased physiological demands for pneumoperitoneum by the elderly patients also puts their safety at risk. Also, the general laparoscopic procedures on the elderly may be technical and can also necessitate longer operation times (Chesney & Acuna 322). Despite this, laparoscopy has been essential in carrying out specialized surgical operations in the elderly such as appendectomy and colorectal procedures. To achieve maximal success in the surgery, the laparoscopic surgery in adults requires accuracy in dimensions of the landmark anatomical measurements to improve their safety and reduce post-operative pain.
Materials and Methods
Design of Study
Sample
Method of Data Collection
Procedures Followed
Results
Discussion
Conclusions and Future Proposals
References
Berlit S, Hornemann A, Sütterlin M, Weiss C, Tuschy B. Laparoscopic hysterectomy in the overweight and obese: does 3D imaging make a change?. Archives of gynecology and obstetrics. 2017 Jan 1;295(1):125-31.
Chesney T, Acuna SA. Do elderly patients have the most to gain from laparoscopic surgery? Annals of Medicine and Surgery. 20 154(3): 321-323.
Gaar E. Errors in laparoscopic surgery. Journal of surgical oncology. 2004 Dec 1;88(3):153-60.
Martins JM, Ribeiro RV, Cavazzola LT. White box: low cost box for laparoscopic training. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2015 Sep;28(3):204-6.
Rodrigues SP, Horeman T, Blomjous MS, Hiemstra E, Van den Dobbelsteen JJ, Jansen FW. Laparoscopic suturing learning curve in an open versus closed box trainer. Surgical Endoscopy. 2016 Jan 1;30(1):315-22.
Schreuder HW, Van Den Berg CB, Hazebroek EJ, Verheijen RH, Schijven MP. Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG: An International Journal of Obstetrics & Gynecology. 2011 Dec; 118(13):1576-84.
Vitish-Sharma P, Knowles J, Patel B. Acquisition of fundamental laparoscopic skills: is a box really as good as a virtual reality trainer?. International Journal of Surgery. 2011 Jan 1;9(8):659-61.
Appendices