Continuous training system for developing highly competent endoscopic surgeons

• Project/Area Number: 17K08897
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Medical sociology
• Research Institution: Hokkaido University
• Principal Investigator: Abe Takashige 北海道大学, 医学研究院, 准教授 (10399842)
• Co-Investigator(Kenkyū-buntansha): 南須原 康行 北海道大学, 大学病院, 教授 (30322811) ; 篠原 信雄 北海道大学, 医学研究院, 教授 (90250422)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2019: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2017: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
• Keywords: 腹腔鏡手術 / トレーニングモデル / シミュレーショントレーニング / ウェットラボ / VR手術シミュレーター / シミュレーション / validation study / 内視鏡外科手術 / 外科教育

Outline of Final Research Achievements

We develop a wet-lab training model for learning laparoscopic surgical skills and evaluating learners’ competency level outside the operating room, using swine organs. 45 participants (experts [≧50 laparoscopic surgeries]: n=13, intermediates [11-49]: n=8, novices [0-10]: n=33) completed 3 tasks (Task 1: tissue dissection around aorta, Task 2: tissue dissection and divide renal artery, Task 3: renal parenchymal closure). Each performance was video-recorded and later evaluated by two experts, according to Global Operative Assessment of Laparoscopic Skills. We observed good construct validity in all 3 tasks. The subjective mental workload was also assessed (NASA Task Load Index [NASA-TLX]), and higher NASA-TLX scores were observed in novices.
We also evaluated the validity of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator. 33 subjects performed training, and we observed good construct validities for the nephrectomy module.

Academic Significance and Societal Importance of the Research Achievements

ブタ臓器を用いた実践的腹腔鏡手術トレーニングモデルを開発できた。とくにブタ大動脈モデルは、血管周囲組織剥離トレーニングとして極めて有用なモデルであると考えている。参加者の精神労働負荷に関しても手術経験数により差を認めており、本モデルを用いることで修練医の習熟度を手術場の外で多面的に評価可能である。また、VRシミュレーターについて、腹腔鏡下左腎摘除という複雑なシナリオにおいてconstruct validityを確認できた。
これらのトレーニング方法を、従来のドライボックストレーニングと生体ブタ腹腔鏡手術トレーニングに組み込むことで、さらに手術トレーニングを拡充できる可能性を示した。

Research Products

• [Journal Article] Validity assessment of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator (2020)
  • Author(s): Miyata Haruka、Abe Takashige、Hotta Kiyohiko、Higuchi Madoka、Osawa Takahiro、Matsumoto Ryuji、Kikuchi Hiroshi、Kurashima Yo、Murai Sachiyo、Shinohara Nobuo
  • Journal Title: Surgery Open Science Volume: 2 Issue: 1 Pages: 51-56
  • DOI: 10.1016/j.sopen.2019.08.003
  • Peer Reviewed / Open Access
• [Journal Article] Cognitive training for technical and non-technical skills in robotic surgery: a randomised controlled trial. (2018)
  • Author(s): Raison N, Ahmed K, Abe T, Brunckhorst O, Novara G, Buffi N, McIlhenny C, van der Poel H, van Hemelrijck M, Gavazzi A, Dasgupta P.
  • Journal Title: BJU Int. Volume: 122 Issue: 6 Pages: 1075-1081
  • DOI: 10.1111/bju.14376
  • Peer Reviewed
• [Journal Article] Establishing objective benchmarks in robotic virtual reality simulation at the level of a competent surgeon using the RobotiX Mentor simulator. (2018)
  • Author(s): Watkinson W, Raison N, Abe T, Harrison P, Khan S, Van der Poel H, Dasgupta P, Ahmed K.
  • Journal Title: Postgrad Med J. Volume: 94 Issue: 1111 Pages: 270-277
  • DOI: 10.1136/postgradmedj-2017-135351
  • Peer Reviewed
• [Journal Article] The Validation of a Novel Robot-Assisted Radical Prostatectomy Virtual Reality Module. (2018)
  • Author(s): Harrison P, Raison N, Abe T, Watkinson W, Dar F, Challacombe B, Van Der Poel H, Khan MS, Dasgupa P, Ahmed K.
  • Journal Title: J Surg Educ. Volume: 75 Issue: 3 Pages: 758-766
  • DOI: 10.1016/j.jsurg.2017.09.005
  • Peer Reviewed
• [Journal Article] The Effect of Visual-Spatial Ability on the Learning of Robot-Assisted Surgical Skills. (2018)
  • Author(s): Abe T, Raison N, Shinohara N, Shamim Khan M, Ahmed K, Dasgupta P.
  • Journal Title: J Surg Educ Volume: 75 Issue: 2 Pages: 458-464
  • DOI: 10.1016/j.jsurg.2017.08.017
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Outcome and prognostic factors in metastatic urothelial carcinoma patients receiving second-line chemotherapy: an analysis of real-world clinical practice data in Japan. (2018)
  • Author(s): Matsumoto R, Abe T, Ishizaki J, Kikuchi H, Harabayashi T, Minami K, Sazawa A, Mochizuki T, Akino T, Murakumo M, Osawa T, Maruyama S, Murai S, Shinohara N.
  • Journal Title: Jpn J Clin Oncol. Volume: 48 Issue: 8 Pages: 771-776
  • DOI: 10.1093/jjco/hyy094
  • NAID: 120006539251
  • Peer Reviewed / Open Access
• [Journal Article] Validation of the nomogram for predicting 90-day mortality after radical cystectomy in a Japanese cohort. (2018)
  • Author(s): Osawa T, Abe T, Takada N, Ito YM, Murai S, Shinohara N.
  • Journal Title: Int J Urol Volume: 25 Issue: 7 Pages: 699-700
  • DOI: 10.1111/iju.13584
  • Peer Reviewed / Open Access
• [Journal Article] Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection. (2018)
  • Author(s): Abe T, Kondo T, Harabayashi T , Takada N, Matsumoto R, Osawa T, Minami K, Nagamori S, Maruyama S, Murai S, Tanabe K, Shinohara N
  • Journal Title: Jpn J Clin Oncol Volume: 48 Issue: 11 Pages: 1001-1011
  • DOI: 10.1093/jjco/hyy128
  • NAID: 120006551593
  • Peer Reviewed / Open Access
• [Journal Article] Characteristics of Medical Adverse Events/Near Misses Associated With Laparoscopic/Thoracoscopic Surgery: A Retrospective Study Based on the Japanese National Database of Medical Adverse Events. (2017)
  • Author(s): Abe T, Murai S, Nasuhara Y, Shinohara N.
  • Journal Title: J Patient Saf. Volume: - Issue: 4 Pages: 343-351
  • DOI: 10.1097/pts.0000000000000422
  • Peer Reviewed / Open Access
• [Journal Article] Perioperative morbidity and mortality of octogenarians treated by radical cystectomy-a multi-institutional retrospective study in Japan. (2017)
  • Author(s): Abe T, Takada N, Kikuchi H, Matsumoto R, Osawa T, Murai S, Miyajima N,
  • Journal Title: Jpn J Clin Oncol. Volume: 47 Issue: 8 Pages: 755-761
  • DOI: 10.1093/jjco/hyx062
  • NAID: 120006352214
  • Peer Reviewed / Open Access
• [Journal Article] Validation of the Advanced Scope Trainer for Flexible Ureterorenoscopy Training. (2017)
  • Author(s): Al-Jabir A, Aydin A, Abe T, Raison N, Khan MS, Dasgupta P, Ahmed K.
  • Journal Title: Urology Volume: 110 Pages: 45-50
  • Peer Reviewed
• [Journal Article] Development and validation of a tool for non-technical skills evaluation in robotic surgery-the ICARS system. (2017)
  • Author(s): Raison N, Wood T, Brunckhorst O, Abe T, Ross T, Challacombe B, Khan MS, Novara G, Buffi N, Van Der Poel H, McIlhenny C, Dasgupta P, Ahmed K.
  • Journal Title: Surg Endosc. Volume: 31 Issue: 12 Pages: 5403-5410
  • DOI: 10.1007/s00464-017-5622-x
  • Peer Reviewed
• [Journal Article] Simulation training in upper tract endourology: myth or reality? (2017)
  • Author(s): Lovegrove CE, Abe T, Aydin A, Veneziano D, Sarica K, Khan MS, Dasgupta P, Ahmed K.
  • Journal Title: Minerva Urol Nefrol. Volume: 69 Pages: 579-588
  • Peer Reviewed
• [Journal Article] Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan. (2016)
  • Author(s): Abe T, Ishizaki J, Kikuchi H, Minami K, Matsumoto R, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Shinohara N.
  • Journal Title: Urologic oncology Volume: 35 Issue: 2 Pages: 38.e1-38.e8
  • DOI: 10.1016/j.urolonc.2016.08.016
  • Peer Reviewed / Open Access
• [Presentation] ウエットラボにおける腹腔鏡手術熟練課程の数値化の試み (2020)
  • Author(s): 安部崇重、海老名光希、樋口まどか、古御堂純、岩原直也、今雅史、堀田紀世彦、小水内俊介、倉島庸、村井祥代、近野敦、篠原信雄
  • Organizer: 第409回日本泌尿器科学会北海道地方会
• [Presentation] 周術期合併症を防ぐための工夫（腹腔鏡手術、ロボット支援手術）ラパロ手術の周術期合併症を防ぐ試み：シミュレーショントレーニング (2019)
  • Author(s): 安部崇重、樋口まどか、今雅史、古御堂純、岩原直也、篠原信雄
  • Organizer: 第33回日本泌尿器内視鏡学会総会
• [Presentation] Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma. (2018)
  • Author(s): Abe T, Ishizaki J, Minami K, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Chiba H, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, Murai S, Shinohara N.
  • Organizer: 2018 日本泌尿器科学会総会
• [Presentation] Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma. (2018)
  • Author(s): Abe T, Ishizaki J, Minami K, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Chiba H, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, Murai S, Shinohara N.
  • Organizer: 2018 AUA
  • Int'l Joint Research
• [Presentation] 上部尿路腫瘍の臨床 (2018)
  • Author(s): 安部崇重
  • Organizer: 第59回日本臨床細胞学会総会 春期大会
• [Presentation] 上部尿路上皮がんにおけるリンパ節郭清の意義：腹腔鏡によるリンパ節郭清の妥当性 (2018)
  • Author(s): 安部崇重、松本隆児、高田徳容、三浪圭太、原林透、菊地央、大澤崇宏、丸山覚、永森聡、近藤恒徳、 田邉 一成、篠原信雄
  • Organizer: 日本泌尿器科学会東部総会
• [Presentation] Intravesical BCG instillation for high-risk non-muscle-invasive bladder cancer patients: Contemporary management and clinical dilemmas (2018)
  • Author(s): Takashige Abe, Hiroshi Kikuchi, RyujiMatsumoto, Takahiro Osawa, Nobuo Shinohara
  • Organizer: 第56回日本癌治療学会学術集会
• [Presentation] 上部尿路癌に対する腹腔鏡下リンパ節郭清と開腹郭清との比較 (2018)
  • Author(s): 安部崇重、松本隆児、高田徳容、三浪圭太、原林透、丸山覚、大澤崇宏、田邉 一成、篠原信雄
  • Organizer: 第32回日本泌尿器内視鏡学会総会
• [Presentation] Update企画「上部尿路上皮癌：リンパ節郭清は予後を改善するか」パネルディスカッション 上部尿路上皮癌に対する腹腔鏡下腎尿管摘除術 (2017)
  • Author(s): 安部 崇重、篠原 信雄
  • Organizer: 第105回日本泌尿器科学会総会
• [Presentation] Characteristics of medical adverse events/ near-misses associated with laparoscopic/ thoracoscopic surgery (2017)
  • Author(s): 安部 崇重、村井 祥代、松本 隆児、菊地 央、大澤 崇宏、宮島 直人、土屋 邦彦、丸山 覚、篠原 信雄
  • Organizer: 第105回日本泌尿器科学会総会
• [Presentation] 統的所属リンパ節郭清が施行された上部尿路上皮癌症例における腹腔鏡下、あるいは開放腎尿管全摘除術後の予後に関する比較研究～後ろ向き国内共同研究 (2017)
  • Author(s): 安部崇重, 近藤恒徳, 原林 透, 高田徳容, 松本隆児, 佐澤 陽, 大澤崇宏, 三浪圭太, 永森 聡, 宮島直人, 土屋邦彦, 丸山 覚, 村井祥代, 田邊一成、, 篠原信雄
  • Organizer: 第401回日本泌尿器科学会北海道地方会
• [Presentation] 尿管鏡シミュレーショントレーニングは初心者の精神作業負荷を軽減させる (2017)
  • Author(s): 安部 崇重
  • Organizer: 第4回 Surgical Education Summit
• [Presentation] 精巣腫瘍病理の最新知見-精巣腫瘍診療におけるインパクト- (2017)
  • Author(s): 安部 崇重
  • Organizer: 日本泌尿器腫瘍学会第3回学術集会
• [Presentation] 初心者における尿管鏡シミュレーショントレーニングのメンタルワークロード軽減効果 (2017)
  • Author(s): 安部 崇重、篠原 信雄
  • Organizer: 第31回日本泌尿器内視鏡学会総会
• [Presentation] Comparative study of oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection (2017)
  • Author(s): Abe T, Kondo T, Harabayashi T, Takada N, Matsumoto R, Sazawa A, Osawa T, Minami K, Nagamori S, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Tanabe K, Shinohara N
  • Organizer: AUA 2017
  • Int'l Joint Research
• [Presentation] Ureteroscopy simulation training under full immersion environment decreases mental workload in novice operators. (2017)
  • Author(s): Abe T, Dar F, Amnattrakul P, Aydin A, Raison N, Shinohara N, Khan MS, Ahmed K, Dasgupta P
  • Organizer: WCE 2017
  • Int'l Joint Research