ImpactU Versión 3.11.2 Última actualización: Interfaz de Usuario: 16/10/2025 Base de Datos: 29/08/2025 Hecho en Colombia
Development of the CVLT simulator and its evaluation of the transfer of surgical skills from an advanced training program for laparoscopic gastropexy in dogs in an inanimate box model using ex vivo swine stomach
ABSTRACT: Minimally invasive surgery (MIS) is one of the most rapidly developing branches of surgery in veterinary practice worldwide, and its application in live patients requires strict training protocols. This implies a growing demand for devices to simulate and acquire basic and advanced MIS skills. Technical differences such as loss of depth perception due to two-dimensional vision, impaired hand-eye coordination, leverage, use of long instruments, tendency not to use the non-dominant hand, and limitations in haptic feedback are some challenges to venture into MIS. For this reason, the traditional teaching and learning method, according to the principles of Halsted, "see one, do one, teach one, " is ineffective for training MIS. This is characterized by immersing students in a supervised clinical setting with increasing levels of responsibility and subjective assessments by a tutor. Simulation accompanied by a previously validated training micro-curriculum improves the acquisition of basic laparoscopic skills. It is specific for advanced surgical techniques, providing a faster and safer training solution for patients. Laparoscopic skills can be learned on simulation-in-box models, but advanced skills currently require training on cadavers and experimental models. Currently, legal limitations restrict the use of production animals and carcasses, avoiding deliberate practice, which are fundamental for MIS skills acquisition. To date, there is no known advanced laparoscopic skills training program for veterinarians that encourages and involves training in extracorporeal and intracorporeal suturing surgical techniques. Therefore, our purpose was to develop an MIS training simulator for acquiring basic and advanced laparoscopic surgical skills in veterinary surgery with their respective validated training programs. The CALMA Veterinary Lap-trainer simulator (CVLTS) was developed to allow training of basic and advanced laparoscopic skills and to provide an ergonomic cast taken from the abdomen of a large breed dog, tilted to the left side, for surgical approaches to be performed on the right side of the patient, including simulation of right laparoscopic ovariectomy (SRLOE) and total laparoscopic gastropexy (TLG). This Thesis presents the methods for the design and development of the CVLTS, and the protocols developed for the experimental testing of the hypotheses, which included the assessment of skills in 48 veterinarians showing different degrees of MIS experience, including experts and novices before and after training. Surgical skill acquisition was assessed using surgical performance scales such as the Global Assessment of Laparoscopic Skills (GOALS), which includes a Global Rating Scale (GRS) and a Specific Rating Scale (SRS), and by a Hand Movement Assessment System (HMAS) that assessed time, number and smoothness of movements, and angular displacement. The use of CVLTS in its three facets (basic and advanced skills acquisition and actual laparoscopic surgery training) showed a good acceptance for its face and contents. Also, in all schedules, apprentices significantly improved their surgical skills after training compared to initial (pre-training) evaluation and with no statistically significant differences compared to experts. Finally, training in total laparoscopic gastropexy with intracorporeal suturing resulted in a significant transfer of learning to the actual surgical setting of total laparoscopic gastropexy in the in vivo porcine model. In conclusion, the CVLTS is the first composite veterinary laparoscopic simulator with good training programs and evaluation tools for developing basic and advanced skills in SLROE and TLG in veterinary surgery. Furthermore, it confers a significant transfer of skills to the surgical environment of total laparoscopic gastropexy.