A Randomized Control Trial of Non-Surgical Methods of Non-Dominant Hand Training to Enhance Laparoscopic Skill

Abstract

Study Objective To determine if non-dominant hand training using task-specific exercises or everyday activities, would translate to improved laparoscopic ambidexterity amongst medical trainees. Design Single center non-blinded, randomized control trial. Setting University medical school. Patients or Participants Medical students. Interventions 100 medical students were block randomized to receive either 1) Task-specific exercises to train the non-dominant hand, 2) Directions to use their non-dominant hand to perform everyday activities, or 3) No training. Laparoscopic skills during completion of pre-defined tasks were assessed using a box-trainer fitted with motion tracking equipment. Three time points were measured; pre-training, post-training (t = 3 weeks), and retention (t = 6 weeks). A principal components analysis incorporating extreme velocity and acceleration events was performed to assess multidimensional hand movements and obtain a global metric of ability i.e. smoothness of motion. We compared smoothness between groups and across times using mixed-effect linear regression, controlling for pre-test ability. Measurements and Main Results There was a significant improvement in smoothness from the post-test phase to the retention phase for all groups (mean effect size d = 0.34), suggesting that smoothness was improving over time regardless of intervention. However, there was no difference in smoothness between the control group and either task-specific exercises or everyday activities for any task at any time point (all p > 0.05, mean task-specific effect size d = 0.14, mean everyday effect size d = 0.04). Conclusion While sound in theory, training of the non-dominant hand to improve ambidexterity does not translate to the laparoscopic surgical environment. Simulation based laparoscopic exercises remain the favored education modality.