Standardizing Language in Laparoscopic Surgery

Study Overview
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Brief Summary
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Obstetrics and Gynecology residents, fellows and attending physicians will be randomized to view one of two educational presentations of equal duration. The intervention presentation will demonstrate the use of a standardized language for effective communication of laparoscopy commands. Both groups will be asked to perform a simulated laparoscopic task. Participants will be timed and use of the standardized language will be tracked and tabulated. The primary outcome of interest is whether the use of standard commands during a simulated laparoscopic task is associated with sooner completion of the task. This may translate into improved efficiency in the operating room.

Detailed Description
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Background Continuous communication between the primary surgeon and assistant(s) during laparoscopic surgery is essential. The primary surgeon is rarely in direct control of the laparoscope and visual field. The use of a standard vernacular during surgery to provide clear instructions across all surgical centers is currently not employed. As the theoretical benefits of this are clear, a national survey produced a lexicon of commands1. Despite making intuitive sense, there is presently no evidence to demonstrate a benefit from using this standardized language during laparoscopic surgery. We aim to show that in doing so, there will be a significant improvement in speed and efficiency when performing a complex laparoscopic task. Objective To explore whether standardization of communication between the primary surgeon and the assistant in a simulated laparoscopic environment decreases the time needed to perform a complex task. Materials and Methods All subjects will provide demographic data, which will be collected through a brief questionnaire. This questionnaire will collect information regarding level of training or years of practice, as well as handedness. Personal identifying information (PII) will not be collected. Subjects will be block randomized into control and intervention groups by random number generation. Block randomization will preserve equivalent distribution of level of training or years in practice into each group. Secondarily, handedness will be evenly distributed among groups, but not superseding level of training or years in practice. The intervention group will receive a presentation on the standardized laparoscopic lexicon (SLL) (Mehdizadeh et al). The presentation will focus on sections 1-3 (surgical roles, camera commands and instrument commands). The control group will receive no pre-task presentation. Members within each group will be assigned a laparoscopic trainer by random allocation (blinded selection of card denoting station assignment). Through this, each trainer will have 2 subjects of the same group randomly assigned to it. These subjects will be referred to as the primary surgeon and assistant. Assignment of initial roles will be done randomly. A member in each pair will be assigned the role denoted on a card he/she chooses blindly. Pairs will be provided the task of placing a ball into a bag and closing the opening through tensioning the drawstring. This task must be performed using only laparoscopic graspers and will be timed by invigilators. The ball will be approximately the same diameter as the bag opening and large enough to require camera adjustments. This task is not a commonly practiced laparoscopic skill such as suturing or knot tying (therefore should be less influenced by level of training) and should require communication between primary surgeon and assistant to accomplish in a timely fashion. The task is complex and should require sufficient time to detect a difference between groups. Data collection within each group will include each pair's time to completion of the task and level of training/years in practice of primary surgeon and assistant. Invigilators will track the usage of SLL during the task in both groups. After a break, the roles will be reversed and the task repeated. The same data will be collected.

Official Title
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Does Standardizing Language in Laparoscopic Surgery Improve Efficiency? A Randomized Controlled Trial

Conditions
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Procedure Time, Communication

Intervention / Treatment
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* Behavioral: SLL Presentation
* Behavioral: Control Presentation
* Other: Simulated laparoscopic task


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Obstetrics and Gynecology Residents OR fellows OR attending physicians Exclusion Criteria: Physical disability preventing the candidate from performing laparoscopic surgery

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SLL Presentation<br>Intervention: Standardized Language of Laparoscopy (SLL) Presentation and simulated laparoscopic task performed on a low-fidelity pelvis simulator Will witness a presentation on the use of a SLL for communication between the primary and assistant surgeons during laparoscopy as previously determined by a national survey of Canadian experts and a modified delphi technique. | Behavioral: SLL Presentation<br>* Educational presentation on the use of a standardized lexicon for communication between surgeon and assistant during laparoscopy<br>Other: Simulated laparoscopic task<br>* Using a low-fidelity pelvis simulator and laparoscopic instruments, pairs of each arm will be asked to perform a laparoscopic task (maneuver a ball into a nylon surgical bag). Use of SLL will be tabulated and task will be timed.<br>|
| Placebo Comparator: Control Presentation<br>Intervention: Surgical Anatomy (SA) Presentation and simulated laparoscopic task performed on a low-fidelity pelvis simulator Will witness a presentation of similar duration as the intervention group on laparoscopy but not related to communication (laparoscopic anatomy). The simulated laparoscopic task will be identical to the SLL group. | Behavioral: Control Presentation<br>* Educational presentation on relevant anatomy related to laparoscopy performed by a gynecologic surgeon.<br>Other: Simulated laparoscopic task<br>* Using a low-fidelity pelvis simulator and laparoscopic instruments, pairs of each arm will be asked to perform a laparoscopic task (maneuver a ball into a nylon surgical bag). Use of SLL will be tabulated and task will be timed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedure Time | The simulated laparoscopic task will be timed from initiation to completion | Recorded once per simulated laparoscopic task upon completion (one visit) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Communication | Tabulated instances of the use of SLL during simulated laparoscopic task from initiation to completion | Recorded during per simulated laparoscopic task (one visit) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Efficiency, Organizational, Simulation, Communication, Laparoscopy, Medical Education