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Comparison Objective Structured Assessment of Camera Navigation Skills Score—Pre- and Post-training Intervention
laparoscopic education, level of laparoscopic experience, and level level V. Experience level classified as low, average, and superior.
of laparoscopic knowledge were factors related to training outcome Laparoscopic knowledge was based on Websurg Winner Project
based on fundamental laparoscopic surgery curriculum. 5 questionnaire that focused on laparoscopic camera equipment
The aim of this study is to investigate the comparison of camera and anatomy landmark. The outcome is ≥90 (good) and <90 (poor).
laparoscopy navigation skill based on OSA CNS before and after Interest to laparoscopy measure by Intrinsic Motivation Inventory
the training, and to explore correlation between age, gender, (IMI) Scale, divided to interested in (score >6) and not interested
interest, level of laparoscopic education, level of laparoscopic in (score ≤6).
experience, and level of laparoscopic knowledge to difference of Initial camera navigation evaluation performed used adult
camera navigation skills after the training. It was novel research pelvic box; laparoscopy camera manufactured by B-Braun (Fig. 1). All
due to limited study focused on laparoscopy training program for these navigations were recorded. Laparoscopy camera navigation
residency curriculum, especially for camera navigation. In practical training done for about 2 hours. Samples train about laparoscopy
setting, camera navigation in teaching hospital often perform by camera equipment, how to do appropriate camera navigation,
resident and play an important role to support safety laparoscopic and practice used pelvic box. Post-training evaluation was used
procedure. the same task of pre-training evaluation (Fig. 2). Evaluation done
in 1 week, 2 weeks, and 3 weeks after training. Assessment tool
MAterIAls And Methods used OSA CNS, consist of five field of evaluation: view completion,

horizontal alignment, scope orientation, instrument collision, and
Study design was experimental study (pre–post interventional autonomy (Fig. 3). Each item with range score 1–5. This evaluation
study) conducted at the training room of Indonesia Clinical performed by two Oncology Gynecology Consultants who are
Training and Education Centre (ICTEC) Faculty of Medicine as advanced laparoscopy trainer. Data are tabulated and analysis
Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital (CMH), used paired-t test of SPSS statistics 20. Flowchart of the research
on November 2018 to January 2019. Participants were resident of is in Flowchart 1.
Obstetrics and Gynecology at basic level and work in operating
theater. Inclusion criteria were member of residents of Obstetrics results
and Gynecology, and willing to sign acceptance letter. Exclusion
criteria were unable to attend whole research procedure. Sample Patient characteristic shows in Table 1. Interest to laparoscopy
size was 23 samples, use formula: and level of laparoscopic knowledge are not further analysis for
Z SD 
 ( Z + ) 2 correlation to difference skill after training. It caused by homogeny
data.
n = n =  ± ² 
2
1
All of OSA CNS scores after training show significance difference
X
  ( X − )   , compared to before training score. Three weeks duration after
1
2
Z = 95% = 1.96; Z = 80% = 1.24; SD = 0.5 (Nilsson); X − X = training reveal best optimum time to evaluate camera navigation

2
1
β
α
0.3. Samples collection used consecutive technique method. skill after training (Table 2). Table 3 points out the difference score
All samples filling in questionnaire about personal data (age, between three times of evaluation. Table 4 presents gender and
gender, level of residency), level of laparoscopic education, level level experience are two factors correlated to difference skill after
of laparoscopic experience, and level of laparoscopic knowledge. training.
Level of laparoscopic education and laparoscopic experience were
based on fundamentals laparoscopic surgery criteria. Educational dIscussIon
level categorized as none, level I, level II, level III, level IV, and
Surgical simulation teaching has become an important training
component for many residency programs across all surgical
disciplines. After SAGES launched the FLS program in 2004, the
American College of Surgeons (ACS) joined SAGES in 2005 for a
joint educational effort to establish standards for fundamental
skills and knowledge necessary to care for patients undergoing
laparoscopic surgery. The growing number of minimally invasive
procedures and the need to teach and assess these procedures

Fig. 1: Pelvic box and laparoscopic camera Figs 2A and B: Camera navigation task in the pelvic box

70 World Journal of Laparoscopic Surgery, Volume 13 Issue 2 (May–August 2020)