Lap-Pack: a low fidelity laparoscopic box trainer

Lap-Pack: a low fidelity laparoscopic box trainer

Manish Chauhan , Noel Aruparayil, Jesudian Gnanaraj, Sukumar Maiti, Anurag Mishra, Aaron Quyn, William Bolton, Joshua Burke, David Jayne, Pietro Valdastri
University of York, York, United Kingdom; Leeds Institute of Medical Research, St. James’s University Hospital, Leeds; Association of Rural Surgeons of India, India; Calcutta Medical College, Kolkata, India; Maulana Azad Medical College, New Delhi, India

Need of an innovation: The requirement for high-quality training to maximize the benefits of laparoscopic surgery is well documented. Laparoscopic training for rural surgeons operating in low resource settings is limited due to access to expensive commercial training equipment, lack of training opportunities, poorly developed training program, financial constraints, and limited health system.

Innovation: ‘Lap-Pack’ is a low-fidelity, sturdy, lightweight, portable, low-cost laparoscopic trainer. It comprises a user-adjustable (slide back-forth, rotate, twist in an angular direction and be fixed in a suitable position) camera (compatible with phone, tablet, laptop etc.) for monitoring the operative field.

Utility: Lap-Pack has been evaluated to train 85 participants through a structured training program, the TARGET study through 2 stages. In stage, laparoscopic simulation training was based on the 5 domains of fundamentals of laparoscopic surgery, which assessed skill acquisition across 7 rural surgeons from North-East India. The MISTELS criteria was used to statistically analyse trainee performance between pretraining and post-training sessions. Also, Lap-Pack was qualitatively compared with a commercial box trainer, Inovus Pyxus HD. Stage II involved a multi-centre usability study in 2 centres of India and the United Kingdom (2019).

Impact: Stage I, the total post-training MISTELS score for Lap-Pack was higher, that is 773.37 (SD: 183.67) than the pretraining score, is 351.2 (SD: 471.5). The post-training scores showed laparoscopic skill acquisition with statistically significant (P< 0.05] out of a possible 6. It scored highest (scale: 1= low to 7=high) in Usability 6.14 (95% CI: 6.05–6.22, P< 0.05) and Camera 6.14 (95% CI: 6.01–6.27, P <0.05).

Conclusion: Lap-Pack allowed simulated skills acquisition that was at least as good as a commercially available laparoscopic trainer. The low-cost design and portability make it particularly attractive for low resource settings.

Future: Lofto Design, an Indian design organization is a proud partner of the University of Leeds in taking LapPack to the commercial market. Lap-Pack is proposed to integrate with a smartphone-based learning module that tracks the learning progress of the trainees.