Comparative study to determine the proper sequence of simulation training, pelvic trainer versus virtual reality simulator: a pilot study

Abstract Background Increased surgical efficacy has led to a remarkable increase in the usage of minimally invasive surgical procedures since their inception. The use of simulation in surgical teaching has grown significantly during the past 10 years. Several laparoscopic simulators have been built. Virtual reality (VR) simulators and box trainers (BTs), often known as pelvic trainers, are the two primary training modalities used in hospitals and clinical training institutes for the development and acquisition of laparoscopic skills. Our study aimed to evaluate the proper sequence of pelvic trainers and VR simulator training to improve laparoscopic gynecological skills. Methodology We carried out this pilot study at the Virtual Endoscopic Simulation and Skills Acquisition Laboratory at the Obstetrics and Gynecology Department in the Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Egypt, from February to August 2022. All residents with minimal or without laparoscopic experience (twenty residents) were divided into two groups and classified as (group A versus group B). Group A’s training began with a pelvic trainer, which was tested using a checklist. Later, the group trained on a virtual reality simulator, which tested them using an electronic autoassessment. After training on a virtual reality simulator and passing an electronic autoassessment test, group B moved on to pelvic trainers and had a checklist-based assessment. Results We compared pelvic trainer tasks between the training groups, and detected no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.646, 0.341, 0.179, and 0.939 respectively); when we compared VR simulator tasks between the training groups, there were no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.79, 0.3, 0.33, and 0.06, respectively). Conclusion There was no difference in training, between residents who started on a pelvic trainer or the VR simulator; therefore, both could be used in laparoscopic training with no preferred order. Trial registration The trial was registered at clinicaltrials.gov with the name “Pelvic trainer vs VRS” and the identifier “NCT05255614.” The registration date was January 19, 2022, and the trial was prospectively registered. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=22&sid=S000BR5D&cx=t6mc1

First experience of the Egyptian National Cancer Institute using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer

Aim of work: Robotics in surgery led to an improvement of visualization, a better handling of tissues and better suturing. This study aimed to document the first experience of the Egyptian National Cancer Institute (NCI) using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer and to highlight observed advantages, disadvantages, morbidity and oncological outcomes. Patients and methods: Data of cases that had either early cervical cancer (stage IB-IIA1 with a tumor ≥2 cm) or locally advanced cervical cancer (Stage IIA2-IIB after chemo-radiotherapy) were collected prospectively. Study patients underwent robotic radical hysterectomies for their cervical cancers at the NCI, Cairo University, between January 1, 2015 and December 31, 2016. For each patient, duration of surgery, amount of blood loss, and intra-operative complications were recorded. Similarly, the duration of postoperative hospital-stay, analgesia used and post-operative gastrointestinal recovery were documented. Pathological assessment of safety margins and the lymph nodes number yield were also assessed. Results: Twenty patients underwent robotic radical hysterectomy during the study period. Twelve cases had early cervical cancer while 8 suffered locally advanced disease. The mean procedure time was 319 (range 240–560) minutes; the mean blood loss was 309 (range 150–600) ml. Three cases had bladder injuries during their procedures. The median hospital stay was 6 (range 4–10) days. One case had a positive margin. The median of lymph nodes yield number was 15 (range 10–25). Follow-up ranged 9–31 months, with only one case developing local recurrence. Conclusion: Robotic radical hysterectomy is a feasible approach with a tolerable rate of complications. Keywords: Robotic, Minimally invasive, Cervical cancer, Radical hysterectom