Mentoring a surgical team towards procedural competence in the early learning curve for selective fetoscopic laser photocoagulation.

Natarajan, Lalitha; Gosavi, Arundhati T.; Wataganara, Tuangsit; Lin Lin Su; Amin, Zubair; Tak Yeung Leung; Choolani, Mahesh; Biswas, Arijit; Mattar, Citra N. Z.; Su, Lin Lin; Leung, Tak Yeung; Mattar, Citra Nz

<bold>Introduction: </bold>Selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS) is challenging for new surgeons at the start of their learning curve. We described an approach utilising telementoring and team-based training to facilitate rapid attainment of the skills required for safe and efficient practice with a limited caseload.<bold>Methods: </bold>We conducted a prospective observational study of SFLP performed by the novice primary surgical team in three stages: under direct on-site supervision from an expert mentor (Group 1), with remote tele-guidance from that mentor (Group 2) and independently (Group 3), at an academic tertiary hospital in Singapore. The primary team undertook regular training on high-fidelity tissue models to accelerate skills acquisition and complement the surgical performance.<bold>Results: </bold>Nine patients diagnosed with Stage 2 TTTS were assessed for procedural characteristics, surgical outcomes and perinatal survival following SFLP. There were no significant differences in operative duration, anastomoses ablated, gestational age or birth weight at delivery. The complications observed were: recurrent TTTS (22.2% of pregnancies), twin anaemia polycythaemia sequence (33.3%), preterm prelabour membrane rupture (22.2%) and delivery at < 32 weeks (44.4%). At least one twin was live-born in 88.9% of cases, while postnatal survival to six months of at least one twin occurred in 77.8%.<bold>Conclusion: </bold>Systematic mentoring and specialised skills training are useful in aiding new surgeons to negotiate the steep learning curve and achieve good outcomes at the start of a new practice, particularly in the setting of low patient numbers. This is best paired with dedicated model training to achieve and maintain surgical dexterity for this complex procedure.

PREMATURE rupture of fetal membranes; FETOFETAL transfusion; MENTORING; LASER photocoagulation; BIRTH weight; GESTATIONAL age; FETAL surgery

Singapore Medical Journal, 2022, Vol 63, Issue 5, p274

0037-5675

Academic Journal

10.11622/smedj.2020137