Short Communication
How to Learn Gynecological Surgery?
Carolin Spüntrup1,2*, Elmar Spüntrup1,3 and Marc Banerjee2,4
1Pelvic School Saarbrücken, Germany
2University of Witten Herdecke, Germany.
3Hospital Saarbrücken, Winterberg, Germany
4Media Park Clinic, Germany
*Corresponding author: Carolin Spüntrup, Pelvic School Saarbrücken, Hohe Wacht 77, 66119 Saarbrücken, Germany
Published: 03 Nov, 2017
Cite this article as: Spüntrup C, Spüntrup E, Banerjee M.
How to Learn Gynecological Surgery?.
Clin Surg. 2017; 2: 1715.
Short Communication
During the last decade surgical education using the classical learning-by doing apprenticeship
model in real patients came under criticism for ethical and practical factors. In accordance to the
benefits of pilot training, several alternatives have been described-starting with simple skill training
up to high tech virtual reality trainers.
The diversity of trainings systems might be classified using the terms organic trainers, inorganic
trainers and combined trainers.
Organic trainers summarize human cadavers, living animals or animal cadavers/parts of animal
cadavers. Surgical training in human cadavers has the highest quality concerning the operation
specific recapitulation of anatomic and topographic facts. Education in living animals underlies
strict ethical rules, thus the operation in parts of animal cadavers is more common. Disadvantages
of organic trainers are a certain odor, the limitation of planned pathological conditions and the risk
of infections.
Inorganic trainers are classical box trainers, advanced trainers and virtual reality systems (VRT)
including the subgroup of robotic assisted VRT´s.
Box trainers are a classical tool for e.g. skill training, admittance training or suture training.
They are associated with low costs and should be the classical trainings tool of the young surgeon.
Advanced trainers allow parts or complete operations e.g. surgery of a kind of artificial foam
hysterectomy etc. In advanced system organic imitations are in general not perfused and cannot
be coagulated. These systems are rather expensive for the daily clinical routine and therefore more
useful in courses.
Virtual reality trainers (VRT) can be compared to a wii-system, imitating a specific underlying
problem which should be resolved by a specific operative procedure. Defined pathways are
programmed. Meanwhile some haptic systems are available.
VRT`s have a large potential, as operations with different reproducible pathologies and degrees
of difficulty are available. They are also available for robotic systems. A disadvantage is the high cost
of VRT which limit the general use.
Combined organic/inorganic trainers such as the Realsimulator system combine the advantages
of organic material (bipolar/monopolar coagulation, realistic preparation of layers, complete operative situs) with inorganic systems (reproducibility, reproducible pathologies, realistic haptic, no odor). Gynecological basic surgery
(e.g. ovarian cyst enucleation, hysterectomy), descensus surgery
(sacropexy (compare Figure 1), pectopexy, lateral repair) as well as
incontinence surgery (colposuspension) and skill training moduls
are available. The imitation of reproducible, anatomical correct
complete operation with classical landmarks and the possibility to
use all instruments realistic-even coagulation or morcellation- makes
this system interesting for young surgeon up to advanced surgeons.
The costs for the basic station and refill material are comparable to
box trainers. Complete systems including instruments and optical
systems are available.
The different educative possibilities of organic, inorganic and
combined trainings systems should not be considered as competitive
systems, but rather as complementary trainings opportunitiesdepending
on the trainee’s operative level and his specific trainings
aim. The tripartitude into novice, junior and expert reflect different
trainings aims depending on the educative level:
Novices: are inexperienced in all fields. Their education should
focus on hand eye coordination, skill training, guiding of instruments
and theoretical knowledge (anatomic landmarks, operative steps etc.).
Juniors: start to get a certain survey on operative procedures.
Their education should focus on the implementation of automatisms
concerning the single steps of a certain operative procedure and the
routinized control of instruments. On their way to become an expert,
they will also learn how to handle difficult intraoperative situations,
complications etc.
Experts: developed automatisms for operative basics, a founded
knowledge and internalized pathways for many intraoperative
situations. Intraoperative movements are economic. Their educative
aims should focus on the guidance and supervision of novices and
juniors.
In accordance to this tripartitude of training levels findings
of behavioral sciences guided surgical education from the former
favorised focus on manual dexterity to modern trainings aims such
as operative survey and automatisms concerning intraoperative
decisions. This means that surgical education does not stop at the
level of a trained novice with a certain manual dexterity and fact
knowledge, but continues until the expert level with a good operative
survey and a large fund of automatisms is generated.
Concerning the different subordinated trainings aims repeated
interval training seems to be more useful concerning longterm
trainings success than a single shot training.
Using the theoretical knowledge and the existing, valuable
practical tools of surgical education, it would be eligible that young
surgeons get the opportunity to pass through a guided educative
system comparable to pilot training. It is in our responsibility to create
such a system – on department level as well as on superordinated
levels.