Proposal For Randomized Validation Of Minimally Invasive Esophagectomy App
Joseph A.R. Ojah1, Ahmad S Ashrafi2.
1University of British Columbia, Vancouver, BC, Canada, 2Fraser Health Authority, Surrey, BC, Canada.
BACKGROUND - Minimally Invasive Esophagectomy (MIE) is a complex (cervico)-thoracoabdominal operation associated with a steep learning curve portending moderate morbidity rates in the hands of less experienced thoracic surgeons. Teaching this challenging procedure to surgical trainees is similarly complicated requiring significant structured exposure. Currently, online video MIE preparation is experienced through non-validated platforms (YouTube) or virtual video programs (Touch Surgery). Such applications tend to overlook critical operative setup strategies and focus, instead, on highly edited intra-operative video. Alternative high-fidelity training opportunities are expensive and resource intensive. Prior to disseminating this practical tool to aid surgeons and trainees across Canada, the objective of this study is to prospectively validate the practical and educational implementation of a novel, mobile, locally-developed, multimodel MIE teaching app.
METHODS - General Surgery residents will be randomized into App-trained (APP) or no-App exposure (noAPP) groups. The convenience sample will be stratified across trainee level, if adequate participant numbers are obtained. Participants with prior MIE surgical experience of MIE App exposure will be excluded. Dedicated proctored computer labs will be used for uninterrupted MIE App exposure period of 2 hours duration. Scores on tests embedded within the App automaticaly transfer to our study database for confidential and protected analysis. Comparison of performance metrics assessing appropriate port placement and instrument dynamics will be performed. Independent T-test (alpha 0.05) will compare numerical outcomes between groups. A secondary subjective survey will be completed to assess procedural familiary and anxiety levels.
RESULTS - We expect to detect a significant >30% improvement in performance metrics on MIE App tests in the APP vs noAPP groups. Important reductions in trainee anxiety and improved comfort and the ability to assist in an effective manner during MIE are also anticipated.
CONCLUSIONS - Surgical trainees benefit significantly from convenient, high-yield, pre-operative preparation through utilization of this App. This represents a mobile, novel, pragmatic, cost-effective, validated teaching resource to accelerate the learning curve for MIE which will facilitate nationwide adoption of MIE and contribute, ultimiately, to enhanced patient outcomes. Further randomized iterations of validation iwll continue, including survey and assessment of thoracic surgeons using the MIE App.
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