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RESEARCH ARTICLE
Comparison Objective Structured Assessment of Camera

Navigation Skills Score—Pre- and Post-training Intervention

2
1
Hariyono Winarto , Kade Yudi Saspriyana , Aria Kekalih 3
AbstrAct
Aim: Inexperienced operating assistants are often tasked with the important role of handling camera navigation during laparoscopic surgery.
Incorrect handling can lead to poor visualization and increased operating time. The objective of this research was to examine benefit of camera
navigation training in laparoscopic used pelvic box based on Objective Structured Assessment of Camera Navigation Skills (OSA CNS) assessment
and explore factors correlated to difference skill after training.
Materials and methods: An experimental study (pre–post interventional study) was conducted at the training room of Indonesia Clinical
Training and Education Centre (ICTEC) Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital (CMH), on December
2018 to January 2019. Participants were Obstetrics and Gynecology resident Medical Faculty of Universitas Indonesia. We did evaluation before
training and 1, 2, 3 weeks after training used OSA CNS. Data analysis used paired-t test.
Results: There were significant increasing OSA CNS score after camera navigation training used pelvic box. Average OSA CNS score before
training and 1, 2, 3 weeks after training were 15.00 ± 2.03, 17.60 ± 2.69, 16.36 ± 1.84, 17.80 ± 2.26, respectively. Optimum duration of OSA CNS
evaluation was 3 weeks after the training. Female gender and low experience were two factors influence camera navigation skill after the training.
Conclusion: Laparoscopy camera navigation training used pelvic box could be applied to support residency program curriculum and there
were increasing camera navigation skills after training used pelvic box. Female gender and low experience were factors significant correlate to
training outcome of camera navigation skill used pelvic box.
Clinical significance: Camera navigation training used pelvic box is a critical component for teaching safe endoscopic practices in our Ob/Gyn
residency training program.
Keywords: Camera navigation in laparoscopy, Objective structured assessment of camera navigation skills, Training.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1405

IntroductIon
1,2 Department of Obstetrics and Gynecology, Oncogynecology
Laparoscopy surgery was becoming as one of the alternatives in Division, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine
gynecology surgery and have more benefits compared to open Universitas Indonesia, Jakarta, Indonesia
laparotomy. Laparoscopy technique needs specific skills rather 3 Department of Community Health Program, Faculty of Medicine
than open laparotomy: camera navigation, orientation and depth Universitas Indonesia, Jakarta, Indonesia
of object in two dimension, hand–eye coordination, and good Corresponding Author: Hariyono Winarto, Department of Obstetrics
tissue handling. 1,2 and Gynecology, Oncogynecology Division, Dr. Cipto Mangunkusumo
Curriculum guidance for Obstetrics and Gynecology residents Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia,
emphasize that all off the members must be proficient to a number of Phone: +62 81319399189, e-mail: hariyono.winarto@ui.ac.id
laparoscopic procedures. But in other situation, they faced problems How to cite this article: Winarto H, Saspriyana KY, Kekalih A.
of teaching hospital condition related to restrict of services in the Comparison Objective Structured Assessment of Camera Navigation
operating theater due to efficiency of hospital budget, decrease Skills Score—Pre- and Post-training Intervention. World J Lap Surg
medical error based on hospital accreditation programs, and also 2020;13(2):69–73.
related to ethical issue due to direct training to the patient. 3–5 Source of support: Medical Faculty Universitas Indonesia

Laparoscopic surgery demands very specific skills and capabilities Conflict of interest: None
that require initial learning of cognitive and motor skills followed by
refinement of those skills. The prerequisite for skilled laparoscopic work
includes: (1) Depth perception. The surgeon is required to maneuver, lead to longer operating time; surgeon frustration; and can, most
tissues and instruments in a three-dimensional environment with importantly, compromise patient safety. An assessment tool
two-dimensional view. (2) Adjustment to fulcrum effect. This creates was created, inspired by the Objective Structured Assessment of
conflict between visual and proprioceptive feedback. (3) Hand–eye Surgical Skills (OSATS) assessment tool, with five items scored on
coordination; (4) Bimanual manipulation; (5) Handling of laparoscopic 5-point scales with anchors in the middle and at the ends. The tool
instruments; and (6) Ambidexterity. Training in pelvic box can be used named as Objective Structured Assessment of Camera Navigation
to fulfill all of those prerequisites’ laparoscopic skills. 6–8 Skills (OSA CNS). The evaluation cover view completion, horizontal
Camera navigation in laparoscopy is often considered as a alignment, scope orientation, instrument collision, and autonomy.
simple task and is handled by the less experienced, such as medical Nilsson stated that minimally score of OSA CNS was 14 to achieve
students or junior residents. It is, however, a complicated task, good result in camera navigation. 4,6
requiring specific psychomotor and visuospatial skills. Inappropriate Several factors could influence laparoscopic training outcome,
handling of the camera results in poor visualization, which can such as age, gender, and interest to laparoscopy itself. Level of
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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