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METC improves surgical tech training with new laparoscopy standard

Image of Surgical team in operating room. Click to open a larger version of the image. Navy Petty Officer 1st Class Wesley Middleton (left) and Navy Petty Officer 2nd Class Domenick Llanda (right), instructors in the Medical Education and Training Campus Surgical Technologist program, conduct a mock laparoscopic procedure while Navy Petty Officer 1st Class Forest Stewart (center), also an instructor, assists the team. (Photo by Lisa Braun, Medical Education and Training Campus Public Affairs.)

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Army, Navy and Air Force Surgical Technologist (ST) students at the Medical Education and Training Campus (METC) located aboard Joint Base San-Antonio-Fort Sam Houston in Texas are becoming more familiar with laparoscopic procedures thanks to a curriculum update and new laparoscopic equipment that was added to the surgical training simulators.

A laparoscopy is a low-risk, non-invasive surgical procedure used to examine organs inside the abdomen and repair or remove tissue. It requires only small incisions and utilizes an instrument called a laparoscope, a long, thin tube with a high-intensity light and a high-resolution camera at the front. The surgeon inserts the laparoscope through an incision in the abdominal wall and views the images on a video monitor while conducting the procedure.

Laparoscopic surgery was introduced to the METC ST program in May 2020 to familiarize all students with the procedures and equipment as part of the program’s consolidated Phase I, or didactic, training. Army Sgt. 1st Class Merle Nalder, the program director, explained how it was time to move away from the open appendectomy surgery that had been the standard used to evaluate students for roughly 25 years.

“The open appendectomy is not the standard out in the surgical world anymore,” stated Nalder. “More and more they’re going to laparoscopic procedures. Even in the military field environment we’re moving toward laparoscopies. The military medical services all recognized the need to change.”

Nalder explained that all ST students receive blocks of instruction on the minimally invasive laparoscopic surgery. At the culmination of Phase I, students are evaluated on their ability to perform, from start to finish, an exploratory laparotomy, or open belly case, which is a low-fidelity simulated surgery.

Updates were made to convert a simulated general operating room, previously used for mock open appendectomies, into a laparoscopic simulator by adding a laparoscopic tower, which includes a camera and light source, specialized laparoscopic instruments, and reusable devices.

Surgical team in operating room
Navy Petty Officer 1st Class Wesley Middleton (left) removes a "liver" during a mock laparotomy assisted by Navy Petty Officer 2nd Class Domenick Llanda (right).  (Photo by Lisa Braun, Medical Education and Training Campus Public Affairs.)

Also added were sophisticated mannequins which provide more realism to the mock open laparotomy and laparoscopy cases, helping to better prepare the students. The mannequins can support up to 50 different types of laparoscopic procedures and allow for life-like scenarios. “The parts are a little more realistic, the skin feels much more realistic, and they have a blood pump which causes blood to flow throughout the mannequin’s system,” explained Nalder. “The blood fills the cavity very quickly and the flow will then actually rupture a blood vessel or artery, depending on the scenario, lending that realism to the simulation.”

With the blood pump, Nadler said, instructors can simulate different types of situations causing organ damage or distress, whereas in the past they could only simulate one type of procedure with the open appendectomy.

“Our new curriculum requires us to evaluate our students on an open laparotomy, and with these mannequins we can choose which cases we want the students to experience,” stated Nalder. “This gives instructors the latitude to expose students to multiple types of surgeries in comparison to what we had before.”

Nalder said that aspect has changed this portion of the training from a passive to an active type of learning where students are more involved. “I feel that the students appreciate it more and they get more out of it rather than the simple step by step open appendectomy scenario.”

Not only has the standard surgical procedure been updated in the consolidated portion of the training, but the Navy has updated its service-specific training as well.

“We updated the curriculum based on direct feedback from the fleet to ensure the training courses align with fleet requirements,” stated Navy Lt. Cmdr. Rachel Bradshaw, the program’s Navy service lead.

Twenty-one hours of laparoscopic surgery training was added to the Navy-specific curriculum.  The training includes a mock laparoscopic surgery and a didactic test which are not part of the consolidated training.

Navy students may good candidates to receive the additional training because enlisted sailors arrive with prior medical training. “Before they arrive in the Surgical Technologist program, or any enlisted medical program, Navy students have to go through the METC Hospital Corpsman Basic program where they learn basic medical knowledge consisting of pre-hospital, inpatient and outpatient medical care,” Bradshaw explained.

Navy students are taught how to assemble and process complex laparoscopic instruments, recognize thoracic surgery pathologies, and safely prepare for minimal invasive clinical procedures.

According to Bradshaw, the added benefit of implementing the new curriculum is that the students are exposed to laparoscopic surgery prior to entering the clinical portion of the program. “This exposure allows for our students to enter the operating room with some familiarity to laparoscopic procedures, to include the equipment and setup.

“Additionally,” she continued, “adding the laparoscopic curriculum is in line with the Navy Surgeon General's 2020 priorities of optimizing our people, platforms, performance, and power; specifically performance, because we are very much ensuring that we are meeting and exceeding military medical knowledge, skill, and ability standards in order to use data driven decisions to optimize a medically ready force and prepare a ready medical force.” 

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