Humm, Gemma Louise; (2025) Supporting laparoscopic cholecystectomy training with digital technology. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Complications of laparoscopic cholecystectomy include iatrogenic injuries that carry patient morbidity and mortality. Appropriate training and technical proficiency reduce errors and improves patient outcomes. Following training reforms there is a need to maximise surgical trainees’ education in the operating theatre. Therefore, my aim was to extract data from laparoscopic cholecystectomy videos to develop training insights and digital training tools. I used manual and automated delayed analysis of laparoscopic cholecystectomy videos, deep learning, meta-analysis, and reflexive thematic analysis to assess the feasibility of the digitalisation of existing performance metrics, measure the effectiveness of virtual reality training in laparoscopic cholecystectomy for junior surgical trainees and to explore surgeon and patient’s opinions of recording and analysis of laparoscopic surgical video. I have shown that there is a likely training need in the intraoperative phase “dissection of the hepatocystic triangle” in low-to medium-complexity cases and that surgeon’s interpretations of surgical errors likely reflects their training needs. Additionally, virtual reality training compared to no additional training improves performance in junior trainees when measured by Objective Structured Assessment of Technical Skills and operative time. Furthermore, surgeons and patients perceive benefit in recording and analysing laparoscopic surgical video for the development of digital technology for training and improving surgical performance. Developing deep learning to identify surgical error was not successful this time. In conclusion, the current findings support that surgical training could be focussed on “dissection of the hepatocystic triangle”, and that may confer an overall training benefit in the remaining phases, that identifying surgical error can support reflection feedback and direct training but may require a training-level specific error framework and that virtual reality training is probably beneficial to junior trainees. Furthermore, surgeons and patients support the development of digital training tools and have identified barriers and improvements to improving laparoscopic video data collection and analysis.

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