USING A NOVEL PELVITRAINER A PILOT STUDY BY Dr. Hany Mohamed El-Barbary, MD, FRCS Lecturer in General Surgery Ain Shams Faculty of Medicine 2009 ABSTRACT Introduction: Simulators (Lap trainers) are essential for training surgeons on the basic and advanced laparoscopic skills. However, it is not available in most of our hospitals. The high cost and the difficulty in attending hands on training courses for the majority of surgeons in developing countries is reflected on the level of practice and on the patient's safety. In this study, there is an introduction and evaluation of a novel and cheap pelvitrainer, which could be an aid for training on laparoscopy in developing countries, as well as a brief account on the importance of having a structured training program. Key words: pelvitrainer, laparoscopic training. Materials & Methods: Thirty (n=30) general surgical residents, years 1 & 2 in training, at Ain Shams University hospital, Cairo, Egypt, were enrolled in a prospective, randomized, controlled, double blind study. In the first -study- group (n=15), residents were randomly assigned to have one hour training using the new pelvitrainer for 3 consecutive days. The training exercises were composed of three levels of difficulty, starting with pick & place exercise, then precision cutting and lastly laparoscopic suturing. Following this, their ability to perform efficient laparoscopic dissection of the gall bladder bed during laparoscopic cholecystectomy in the operating theater under supervision, was assessed by an independent observer who was a surgery consultant. Following this, the trainees were given questionnaires to evaluate the process. On the other hand, concurrently, a comparable number of residents -controls- (n=15), who have not been trained on the pelvitrainer, were also evaluated during performing the same operative procedure, under supervision. The results of the evaluations and questionnaires were subjected to statistical analyses. Results: There was a statistically significant difference in the performance of surgical residents who have been trained on the new pelvitrainer in the study group compared to controls, which was reflected by the time spent to perform the procedure and the number of mistakes. This was more apparent with residents who successfully completed the three levels of pelvitrainer exercises than those who didn't. Residents in the study group showed increased interest in pelvitrainer exercises. Conclusion: The new pelvitrainer might be a useful and cheap adjunct to surgical resident training in our hospitals as well as others in developing countries.

1. AIN SHAMS UNIVERSITY
FACULTY OF MEDICINE
BY
Dr. Hany Mohamed El-Barbary, MD, FRCS
Lecturer in General Surgery
Ain Shams Faculty of Medicine
2009

3.  LAP TRAINING
 PELVITRAINERS
 THE INNOVATION
 THE EVALUATION
 CONCLUSION

4.  Training on skill-based behavior :
Laparoscopy combines unusual hand-eye
coordination & use of complex instruments;
2-3 days courses.
 Rule based behavior :
L ectures, textbooks and videos.

5.  Knowledge based behavior : in the OR
How to deal with complications and
emergencies ?
 A living animal model : the only outside the OR
Government regulations?!

6. EITS/ IRCAD LRC-CAIRO UNIVERSITY

7.  Virtual Reality : surgeons compared to pilots.
 Patients’ safety : the training objectives ?
 Competence: after training in a residency program.

8. ST MARK‘S , LONDON VR SIMULATOR IN LRC,
WOLFSON ENDOSCOPY CAIRO UNIVERSITY
UNIT
ENDOSCOPY LAPAROSCOPY

9.  Fulfilling all training needs by only one method ??
A highly complex and very expensive trainer!
 The complexity and cost of a training means are reduced if the
objective is skill based behavior i.e.
Simple pelvitrainers!

11.  Simulators (Lap trainers) are essential for training on the
basic and advanced laparoscopic skills.
 Pelvitrainer exercises are focused on the
Skill-based learning of tasks as laparoscopic suturing.

12. 1. It is not available in most of our hospitals.
2. High cost of pelvitrainers.(EGP1000-6000)
3. Limited hands-on courses.
4. Lack of a structured training program.
 Example: A 2-3 days course in Strasbourg:
EUR 1700 i.e. EGP 14000 !!!
excluding air tickets !!!

13.  “ Homemade
multipurpose Lap-Trainer
with integrated Web
camera & simple light
source”
Patent No: 1978/2008 in 4/12/2008
Academy of Scientific Research and
Technology - Egyptian Patent Office-
( 2008 1978) ‫مسجل برقم‬ 
‫8002مكتب براءات‬ ‫في‬
‫الختراع , أكاديمية البحث العلمي‬
. ‫و التكنولوجيا‬

14. 1. Acrylic box
2. Opaque roof
3. Rubber port sites
4. Web cam (zoom)
5. Electric light source
6. Connect to PC …
Star t training on model!

15. NEW PELVITRAINER TRADITIONAL PELVITRAINERS
CHEAP & LOCALLY MANUFACTURED EXPENSIVE & IMPORTED
NO LAPAROSCOPE NEEDED (WEB CAM) LAPAROSCOPE ESSENTIAL
REQUIRES A COMPUTER TO FUNCTION REQUIRES LAP PROCESOR
USED A SIMPLE ELECTRIC SOURCE USED LAP LIGHT SOURCE
LAPAROSCOPIC INSTRUMENTS LAPAROSCOPIC
INSTRUMENTS
WET & DRY LAB WET & DRY LAB
CAN BE USED AS OFFICE BASED DEDECATED TRAINING
AREAS

16.  PICK & PLACE TEST
 EXTRACORPOREAL KNOT-TYING
 LAPAROSCOPIC SUTURING

17. AIM
 Evaluation of the new pelvitrainer.
STUDY DESIGN
 Prospective, randomized, controlled, double blind study.
MATERIALS & METHODS
 Thirty newly appointed surgical residents at ASU hospital,
Cairo, years 1 & 2 in training. (limited laparoscopic
experience)

18.  Study: 15 residents 1 hr training ×3d. (Pick & Place ex.,
Precision cutting & lap suturing)
 The ability to do adequate laparoscopic dissection of the gall
bladder bed assessed independently.
 Controls: 15 residents who have not been trained on
pelvitrainers supervised during performing the same procedure.

19. 1. THE POSSIBILITY TO TRAIN USING THIS PELVITRAINER?
USELESS REASONABLE USEFULL GOOD
EXCELLENT
3. THE TIME GIVEN TO TRAIN USING THIS PELVITRAINER? (1HR):
TOO SHORT LONG ENOUGH TOO LONG
5. IF AVAILABLE IN YOUR HOSPITAL, HOW MANY HRS/W WOULD YOU
NEED TO TRAIN USING THIS PELVITRAINER?
1 HR 2-5 HRS > 5 HRS
SHOULD TRAINING ON PELVITRAINERS BECOME PART OF YOUR
FINAL ASSESSMENT? YES NO DN
O SHOULD TRAINING ON PELVITRAINERS BECOME REQUIRED
BEFORE OPERATING ON PATIENTS? YES NO DN

20. 1. ACCORDING TO NO. OF MISTAKES: (RATED 1-5)
• PRECISION
• COORDINATION
• ORIENTATION
• HANDLING
• FORCE / TENSION
7. TIME IN MINUTES
• ALL RESULTS WERE STATISTICALLY ANALYSED USING SPSS
17.0 SOFTWEAR

21.  There was a statistically significant
difference in the performance of surgical
residents (Proficiency) who have been
trained on the new pelvitrainer in the
study group compared to controls, which
was reflected by the time spent to
perform the procedure and the number of
mistakes.

22. 4
3,5
3
2,5
2
1,5
1
0,5
0
Cases Controls
Comparison between studied residents and controls as regards Proficiency.

23. 20
18
16
14
12
10
8
6
4
2
0
Cases Controls
Comparison between studied residents and controls as regards
Time.

24. 35
r=-0,886**
30
25
20
Time
15
10
5
0
0 1 2 3 4 5 6
Profficiency
Correlation between Proficiency and Time.

25.  As regards residents in the STUDY group;
showed increased interest in new pelvitrainer.
 7% found it useful, 40% good & 53% excellent
 All residents (100%) agreed that training on
pelvitrainers should become required before
operating on patients.
 67% of studied residents found 1hr/d
enough.
 53% needed 2-5hrs/w, 47% needed>5hrs
 73% thought that pelvitrainer ex : part of final
assessment.

26.  The benefit of having available a simple pelvitrainer was
apparent in this study.
 Residents who practiced training prior to applying the
acquired skills on humans surpassed their counterparts in
the control group in proficiency

27.  The cost of this new pelvitrainer is
incomparable to others i.e. EGP 200= EURO
25, which is less than the cheapest homemade
training box.
 The webcam system is an cheap and
effective laparoscopic training device.
 The webcam system also allows instant
recording and review of techniques

28.  The study group agreed upon the importance
of having pelvitrainers available in their
institute in conjunction with proctor
supervision.
 More than 20 residents & ass Lecturers have
been trained till now on this pelvitrainer.

29. Meetings
Books &
VIDEOS reviews
Simulators -
Clinical practice, Internet, Robots
Fellowships
E-Learning
Residents in Strasbourg University
Ann Chir 2004 Oct; 129(8); 395-8

30.  The ideal training in laparoscopy:
• Firstly; trainees have to watch videos
• Secondly; if they have no laparoscopic
experience, they should spend time on a
pelvitrainer.
• Thirdly; attending a hands-on course.
• Fourthly; arrange for an experienced
surgeon to act as a proctor supervising
the first procedure.

31.  The need for a structured and validated
training program in laparoscopy could
not be overemphasized.
 The new pelvitrainer might be a useful
and cheap adjunct to surgical resident
training in our hospitals as well as
others in developing countries.

33. drhelbarbary69@yahoo.com