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Zhang, et al.
incubate esophagus with 44F bougie tube and perform efficacy of model training (Figure 3). Assessment method
fundoplication through shoeshine maneuver of the fundus was the same as mentioned above.
before making a ~3 cm wrap around the esophagus by 3–4
interrupted sutures (Figure 2H-I). 2.8. Statistics analysis
In this study, t-test was used in parametric test. No
2.4. Training method
non-parametric test was used in this study. SPSS 20.0.0
Pathogenesis mechanism, symptoms, Nissen and GraphPad Prism 8.3.0 were used for statistical
fundoplication, and surgical indications of GERD were analysis and figure plotting. P < 0.05 was considered
introduced and explained to all participants at the beginning statistically significant.
of the trial through recorded video. Questions from
participants were answered by two experts. All participants 3. Results
were required to recap the surgical procedure and details 3.1. Model assessment
after the introductory demonstration. No further training
was given to control group in addition to their rotations. The validity of the model used by the experimental
Participants in the experimental group were trained group was assessed by experts (Table 2). All experts
using the 3D-printed anti-reflux surgery model under confirmed that (i) the model organs or tissues are similar
a laparoscopic platform twice a week, and the training to the real ones, the model training for anti-reflux surgery
concluded after eight sessions. Videos were recorded for is reasonable, and (iii) the model can be applicable to anti-
evaluation by two experts using OSATS score system. reflux surgery. This model was considered easy to handle,
able to reduce the risk to patient, and able to improve skill,
2.5. Face validity and content validity boost confidence, and tactile feedback of participants.
The validity of model was assessed using the 3.2. OSATS score and procedure duration in
5-grade Likert scale by five experts and the experimental different training sessions
group (5: strongly agree; 4: agree; 3: neither agree nor
disagree; 2: disagree; and 1, strongly disagree). This All participants of the experimental group had
assessment involved nine parameters as follows: (i) The successfully completed eight training sessions. OSATS
model is similar with real tissue or organ (experimental score was increasing whereas the procedure duration was
group skipped this parameter); (ii) the model is easy reducing as the training was progressing (Figure 4). The
to use; (iii) using the model in surgical training is OSATS score was improved and the procedure duration
reasonable (experimental group skipped this parameter); was shortened as the training progressed (Table 3).
(iv) training using the model can help reduce surgical risk
to patient; (v) the model can help participants concentrate 3.3. Model training validity and efficacy assessment
in learning; (vi) the model can help boost confidence Participants of the experimental and control groups
in future surgery; (vii) the model can enhance tactile performed Nissen fundoplication on ex vivo swine organs
feedback; and (viii) the model is recommended for use after 8 weeks of training. All participants (eight out of
in the training of anti-reflux surgery (experimental group eight) of the experimental groups successfully finished
skipped this parameter). the surgery while six out of eight participants of the
control group completed the surgery with the helps from
2.6. Construct validity experts. OSATS of the experimental group (26.25 ± 1.67)
Performance of the experimental group was was higher than that of the control group (17.50 ± 2.07,
assessed by two experts who independently evaluated t = 9.31). Procedure duration of the experimental group
the recorded video using the global surgical and technical (76.25 ± 2.49) was lower compared to the control group
skills assessment tool (OSATS). Faces and voices of (110.13 ± 3.36, t = 22.92) (Table 4 and Figure 5).
participants were not recorded in video. Seven aspects
with five different levels each (35 points in total) were 4. Discussion
included in OSATS. The average of scores given by In China, it is very common that surgeons learn how
the two experts was the final score, and duration of the to perform laparoscopic anti-reflux surgery by watching
procedure was recorded at the same time. video or observing during surgery. Furthermore, the lack
2.7. Evaluation of efficacy of 3D model training of practice is attributed to very limited number of medical
centers that are equipped to perform this type of surgery.
After 4 weeks of training, we compared the Laparoscopic fundoplication is a expertise demanding
performances of laparoscopic anti-reflux surgery on procedure, and surgeons who perform laparoscopic
ex vivo swine organs between two groups to assess the fundoplication should be sufficiently trained given the
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