Development and Validation of a Laparoscopic Simulation Model for Suturing the Vaginal Cuff.

Abstract

To create a novel surgical simulation model for training laparoscopic suturing of the vaginal cuff and to present evidence regarding its validity as a training and assessment tool. The three phases of this study included model construction, validity and reliability testing, and evaluation of the model as an assessment tool. The model was created using corduroy, quilt batting, and neoprene. Construct validity was determined by comparing the scores on the Global Operative Assessment of Laparoscopic Skills scale (25 points) between "expert" and "novice" groups. Experts included gynecologic surgeons (n=5) experienced in total laparoscopic hysterectomies, and novices (n=20) included gynecology trainees (postgraduate year [PGY]-2 to PGY-7). Three additional novel metrics were added to the Global Operative Laparoscopic Assessment of Laparoscopic Skills scale for a total of 40 points. The contrasting groups method was used to determine the minimum passing score. More than 90% of the participants "agreed" that the model resembled live surgery. Advanced novices (PGY-5 to PGY-7) performed similarly to the experts with similar median times (experts 7.3 minutes compared with advanced novices 6.3 minutes, P=.40) and total score (experts 36.5 compared with advanced novices 35.5, P=.34). In contrast, early novices (PGY-2 to PGY-4) tended to take significantly longer than experts (11.8 compared with 7.3 minutes, P<.01) and had a significantly lower total score (27 compared with 36.5, P<.01). Prior surgical experience was strongly correlated with total scores (ρ=0.68). The passing total score was 32 out of 40. This novel laparoscopic surgical simulation model allows novice surgeons to practice techniques of laparoscopic suturing to achieve competence before entering the operating room.