Simulator training for laparoscopic suturing using performance goals translates to the OR

Abstract

Abstract Introduction: The purpose of this study was to test the effectiveness (transferability) of a performance-based laparoscopic suturing curriculum using simulators. Methods: Surgical residents (R3-R5, n=10) proficient in basic skills but with minimal laparoscopic suturing experience were enrolled in an IRB-approved, randomized, controlled protocol. Subjects viewed an instructional video and were pre-tested on a live porcine laparoscopic Nissen fundoplication model by placing three gastrogastric sutures tied in an intracorporeal fashion. A blinded rater objectively scored each knot based on a previously published formula (600 minus completion time (sec.) minus penalties for accuracy and knot integrity errors). Subjects were stratified according to pre-test scores and randomized. The training group practiced on a videotrainer suturing model until a predetermined proficiency score (512) was achieved on 12 attempts. The control group received no training. Both the training and control groups were post-tested on the porcine Nissen model. Analysis was by t-Test (significance for p Results: For the training group, mean time to demonstrate simulator proficiency was 119 min. (range 95–165) and mean number of attempts was 34 (range 20–51). The training group demonstrated significant improvement in total score whereas the control group did not. At post-testing, the training group achieved significantly better total scores compared to the control group. Pre-testPost-testp ValueTraining174 ± 162417 ± 240.03Control118 ± 135216 ± 1570.2P value0.60.02 Conclusions: These data suggest that training to a predetermined proficiency level on a videotrainer suture model provides trainees with skills which translate into improved operative performance. Such curricula should be further developed and implemented.