MSSP769: THINKING INSIDE THE CARDBOARD BOX: A SIMPLE TOOL TO FIGHT LAPAROSCOPIC SKILL DEGRADATION FOR GENERAL SURGEONS DEPLOYED TO COMBAT ZONES
Torbjorg Holtestaul, MD1; Alex Dunaway, MD2; Gabrielle Falco, MD3; Zachary Taylor, DO4; William Sweeney, MD5; Christopher Dyke, MD6; 1Fort Campbell; 2Portsmouth Naval Medical Center; 3BAMC; 4ATAMMC; 5USUHS; 6WRNMMC
INTRODUCTION: As deployments for military general surgeons enter the third consecutive decade of combat or support missions in the middle east, degradation of surgical skills remains a high concern for the deployed surgeon. Work has been taken to mitigate this inevitable process including shortening deployment length, increasing awareness, and defining relevant knowledge, skills, and attitudes for readiness. However, deployed surgeons, regardless of subspecialty, must maintain both trauma skills as well as laparoscopic skills for when they return to elective clinical practice. Much of the literature on surgical simulation focuses on improving skills in the novice trainee, and there are few studies addressing simulation and skills maintenance for the deployed military surgeon. Additionally, there have been no lasting, tangible interventions to realistically address mitigation of skill fade. Here we present the first reported, self-made, laparoscopic box trainer in a deployed setting as a means of skill maintenance.
METHODS AND PROCEDURES: A portable laparoscopic skills trainer and practice models were built in a remote Role 2 hospital in Iraq and utilized by two deployed U.S. Army general surgeons. Construction materials included a cardboard box from a care package, a cell phone, a laptop, penrose drains, and Coban Wrap. Tasks were centered around the Advanced Training in Laparoscopic Suturing (ATLAS) curriculum, consisting of six tasks (needle handling, off-set camera forehand suturing, off-set camera backhand suturing, confined space suturing, tension suturing and running suture). Task completion times and error rates were recorded. Tasks were then expanded to simulated models for hiatal closure, enterotomy closure, and two-layer hand-sewn gastrojejunostomy.
RESULTS: Two deployed surgeons, both with primarily elective minimally invasive surgery (MIS) practices, utilized the laparoscopic skills trainer to sequentially perform the ATLAS curriculum for skill maintenance. Both demonstrated time improvement in all tasks with progressively fewer errors. Skills relevant to common MIS procedures (hiatal and enterotomy closure) were practiced and a new skill of two-layer hand-sewn gastrojejunostomy was learned by one surgeon. Neither surgeon performed any laparoscopic or intra-abdominal operations during their deployment.
CONCLUSION: We describe the use of a portable, inexpensive, self-made laparoscopic trainer in a deployed environment to off-set degradation of surgical skills. With no end to continual deployments in sight and readily available hardened structures to house more expensive, commercially made trainers, this example offers a proof of concept that laparoscopic trainers can be used in an austere environment and should be made available to all deployed surgeons.
