Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs

SIMPLE SUMMARY: In veterinary surgery, there is a growing demand for devices and curricula for laparoscopic surgery training which requires more realistic and low-cost training plans and simulators. There is still a lack of didactic training models providing a controlled and safe environment for the acquisition of advanced skills for specific surgical techniques. This work aims to evaluate the acquisition of advanced surgical skills training laparoscopic ovariectomy (LOE) using an ergonomic simulator obtained from a canine abdomen combined with real ovarian and uterine tissues freshly reconstituted from female reproductive tracts. All participants were evaluated using quantitative metrics and objective rating scales which resulted in significant improvements in surgical skill after training. We conclude that the proposed training curriculum and simulation device were appropriate for the acquisition of laparoscopic skills for simulated ovariectomy in female dogs. Training in ergonomic models of the canine abdomen combined with fresh reconstituted tissues improves surgical skills for LOE. ABSTRACT: This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey’s contrast test. No statistically significant differences were found between the novice group’s performance after training and the expert group’s performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.