Construction and employment of a low cost laparoscopic simulator. Test on General Surgery residents

Based on studies that confirm the usefulness of simulators in laparoscopic surgical training, we designed and tested a cost-effective solution to improve the skills of surgeons training in the operating room. The goal was to exercise the basic gestures of laparoscopic surgery.

The initial budget of € 500 was sufficient for this project. We spent only € 360 on the majority of the components, which included buying a laptop. The project was performed with material that was readily available online, and the assembly did not require special tools. The goal was to make the product easily replicable. The test was performed using a simulator on 9 doctors in specialist training in general surgery at the University Hospital of Parma distributed, who were equally distributed among the six years of school in general surgery.

The first exercise, which was the simplest, had as its objective the acquisition of familiarity with the vision monocular feature of VL and coordination between the two hands. We observed statistically significant improvement between the first and second (2.52 to 2.17 min, p = 0.006) tests and between the first and third (from 2.52 to 1.57 min, p = 0.001) tests with a non-significant correlation between the time of year and the achieved specialty. In the second exercise, there was a statistically significant improvement due to the excessive excursion of the confidence intervals (remarkable variability with overlap of the same features). This exercise, which consisted of two parts, explored the ability to use two hands independently. The third and final exercise involved the packaging of a laparoscopic ligation and was the most complex because it required skill in the use of instruments with both hands as well as considerable coordination. The t-test for paired data showed a significant improvement in all tests with p = 0.0008 between the average time for the first and second tests, p = 0.001 between the second and third tests, and p = 0.01 between the first and third tests (from 10.09 min to 3.52 min).

The simulator that we constructed will never replace the experience gained in the operating room, and it was not our intention to replace the normal process of learning for young surgeons. Instead, we aimed to provide an inexpensive tool for refining the basic skills of laparoscopic surgery, such as the use of instruments in monocular vision, coordination between two hands and ambidexterity.