Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing in Naïve Learners after Training with Two Different Laparoscopic Simulators

Abstract

Study Objective To determine if a gynecology-specific laparoscopic simulation trainer better prepares learners to perform a gynecologic surgical task than the current standard laparoscopic simulation trainer. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology (EMIG) or Fundamentals of Laparoscopic Surgery (FLS) – then underwent training on relevant simulation tasks for 2.5 hours. Measurements and Main Results Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were then masked to simulator group and test phase (pre-/post-test). High-volume minimally invasive gynecologic surgeons graded the videos using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool. Composite GOALS scores were compared using two sample t-tests with unequal variances. The mean difference between post- and pre-composite GOALS scores was 6.50 for EMIG and 4.07 for FLS, p=0.34. Differences in individual GOALS domains were compared using Wilcoxon Rank-Sum tests. The mean EMIG post-pre difference was greater for six of eight individual GOALS domains, though all p-values > 0.05. A post-hoc power analysis revealed n=127 per simulation group was needed to obtain p-value=0.05. Conclusion Neither EMIG nor FLS was associated with better performance on the vaginal cuff suturing task with regard to statistical significance. However, when examining the raw data, EMIG-randomized participants had a larger mean difference between post- and pre-test GOALS scores across multiple domains. These results suggest that EMIG may better prepare surgically naive learners to complete a laparoscopic vaginal cuff suturing task; however, larger studies are needed to demonstrate this conclusively.