Implementation & Validation of a Laparoscopic Retroperitoneal Dissection Curriculum
Aisha A. Yousuf1,2, MD FACOG, Helena Frecker1,3, MD FRCSC, Abheha Satkunaratnam1,2, MD FRCSC, Eliane M. Shore1,2, MD MSc FRCSC
1Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, 2Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON,
3Department of Obstetrics and Gynecology, Michael Garron Hospital, Toronto, ON.
• Competency-based education requires educators to use simulation
training to increase residents’ exposure to various procedures.1,2
• Technical training in a simulated environment leads to improved
operating room performance and better patient outcomes.3
• Integrating simulation models into formal and comprehensive
curricula increases surgical competency.4
• The American College of Obstetricians and Gynecologists has
initiated “ACOG Simulations Working Group” to develop and
implement standardized and validated simulation-based curricula.5
• Validated simulation is lacking in gynecologic laparoscopy training.6
• No Surgical Curricula or Simulation Models exist for Laparoscopic
Retroperitoneal Dissection to Identify the Ureter.
• A comprehensive curriculum to teach LRD was designed
encompassing didactic and technical skill components using a
previously developed pelvic model.
• Novice gynecologic surgeons (<10 previous LRD) were recruited.
• Participants underwent pre- and post- curriculum multiple-choice
questions (MCQ) to evaluate knowledge.
• Pre- and post-curriculum performance on model was videorecorded.
• Subjects were then video-recorded performing LRD in the
operating room within 3 months of the curriculum.
• All videos were blindly assessed by an expert using the objective
structured assessment of technical skills tool (OSATS).7
• To design a comprehensive curriculum for laparoscopic
retroperitoneal dissection (LRD) using our previously developed
• To implement the curriculum with OBGYN trainees.
• To evaluate the curriculum’s impact on surgical skills and
knowledge of ureteric anatomy and potential complications.
Figure 1A. Didactic Curriculum: PowerPoint lecture involving an
educational video on laparoscopic ureterolysis using operating room
Figure 1B. Technical Curriculum: One-on-one instruction using the
Figure 2. Study Flow Diagram
Table 1. Demographic Information (n=30)
Figure 3A. MCQ Knowledge Scores (n=29).
Figure 3B. Model OSATS Scores (n=30).
A positive statistically significant correlation exist between
Intraoperative OSATS scores & the post-curriculum Model
OSATS scores ( r = .46 , p = 0.03 ).
• A comprehensive retroperitoneal dissection curriculum
showed objective improvement in knowledge and
• Improvement in the simulation laboratory also translated
to competent performance in the operating room.
• Residents subjectively noted an improvement in skills
acquisition following curriculum completion.
1. Sanders, A. et al. Simulation Training in Obstetrics and Gynaecology Residency Programs in
Canada. Journal of Obstetrics and Gynaecology Canada 37, 1025-1032, (2015).
2. Caccia, N. et al. Competency-Based Medical Education: The Wave of the Future. Journal of
Obstetrics and Gynaecology Canada 37, 349-353, (2015).
3. Aggarwal, R. et al. An evidence-based virtual reality training program for novice laparoscopic
surgeons. Annals of surgery 244, 310-314, (2006).
4. Shore, E. M. et al. Gynecology resident laparoscopy training: present and future. Am J Obstet
Gynecol 212, 298-301, 298 e291, (2015).
5. Simulations Working Group- American College of Obstetrician and Gynecologists.
http://www.acog.org/About-ACOG/ACOG-Departments/Simulations-Consortium. Web.21 Apr.2017.
6. Burden, C. et al. Integration of laparoscopic virtual-reality simulation into gynaecology training.
BJOG: An International Journal of Obstetrics & Gynaecology 118, 5-10, (2011)
7. Martin, J. A. et al. Objective structured assessment of technical skill (OSATS) for surgical
residents. Br J Surg 84, 273-278 (1997).