Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators

Tuangsit Wataganara; Arundhati Gosavi; Katika Nawapun; Pradip D. Vijayakumar; Nisarat Phithakwatchara; Mahesh Choolani; Lin Lin Su; Arijit Biswas; Citra N. Z. Mattar

doi:10.3791/57328

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Method Article

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators

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DOI:

10.3791/57328

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March 21st, 2018

Tuangsit Wataganara¹ , Arundhati Gosavi² , Katika Nawapun¹ , Pradip D. Vijayakumar² , Nisarat Phithakwatchara¹ , Mahesh Choolani²^,³ , Lin Lin Su²^,³ , Arijit Biswas²^,³ , Citra N. Z. Mattar²^,³

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, ²Department of Obstetrics and Gynaecology, National University Health Systems, ³Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore

Summary

Practicing the specific skills required for fetoscopic laser coagulation of monochorionic placental anastomoses on realistic models can aid less experienced surgeons in overcoming the steep learning curve associated with this procedure that is now regarded as the standard of care for twin-twin transfusion syndrome.

Abstract

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously. Here we describe realistic simulators designed to allow the user familiarity with the equipment and specific steps required in the surgical treatment of TTTS, including fetoscopic handling, approaches to anterior and posterior placenta, recognition of anastomoses, and efficient coagulation of vessels. We describe the skills that are especially important in conducting placental laser coagulation that the surgeon can practice on the model and apply in a clinical case. These models can be adapted easily depending on the availability of materials and require standard fetoscopy equipment. Such training systems are complementary to traditional surgical apprenticeships and can be useful aids for fetal medicine units that provide this clinical service.

Introduction

The acquisition of a new, minimally-invasive surgical technique often employs the traditional surgical apprenticeship model in which an individual learns from observing an expert surgeon operate on a live patient and eventually performs the technique under close supervision¹. This time-honored model often limits the passage of knowledge from mentor to individual trainee and relies heavily on the availability of resources such as training funds and patient case-load². Fetoscopic surgery is an example of a high-risk minimally-invasive surgery, performed on a preterm individual during pregnancy in which there are risks to b....