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The virtual colorectal surgical trainer-ileal pouch-anal anastomosis simulator shows evidence of validity
Sofia Garces-Palacios1, Alexis Desir1, Kaustubh Gopal1
1Department of Surgery & Department of Biomedical Engineering, Artificial Intelligence and Medical Simulation (AIMS) Lab, Center for Assessment of Surgical Proficiency, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9169, USA.
Background:
Ileal pouch-anal anastomosis (IPAA) is a key procedure to master in colorectal surgery. It is one task of the Colorectal Objective Structured Assessment of Technical Skill (COSATS) of the American Board of Colon and Rectal Surgery. The virtual colorectal surgical trainer-IPAA (VCoST-IPAA) was designed as an innovative platform for training and assessing performance in this procedure. Our aim was to establish the validity of the simulator by demonstrating its ability to distinguish between levels of surgical expertise.
Methods:
In this IRB-approved study, general surgery residents and colorectal surgeons from our institution performed the IPAA procedure on the VCoST simulator. Nineteen task-specific metrics developed by expert consensus were included and automatically recorded by the simulator. Participants were divided into novice (PGY 1-2) and experienced (PGY 3-5 and faculty) groups. The Messick's unitary framework was used to assess the validity. The Mann-Whitney U test was used to compare the performance between the groups.
Results:
A total of 22 equally distributed participants were included in this study. The Mann-Whitney U test showed significant differences in performance between the two groups on the assessment of J-pouch length (3.67 for experienced vs. 1.50 for novices; p = 0.01) and the gap indicator during trocar retraction (3.89 vs. 1.50; p = 0.04). No significant differences in completion time (670.1 vs. 826.3 s; W = 24; p = 0.09) nor the total score computed using 18 metrics (76.33 vs. 70.50; W = 65; p = 0.1) were found.
Conclusions:
Our VCoST-IPAA simulator showed that J-pouch length and the gap indicator during trocar retraction were important predictors of performance between experienced and novice participants. Participants in our study performed an Altemeier procedure on our validated VCoST-rectal prolapse simulator before the IPAA procedure, which may have had a positive effect on the performance on the VCoST-IPAA simulator.
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