Laparoscopic Suturing Skills Research Articles

Comparing Laparoscopic suturing skill and endurance between ot trained Resident and endotrainer trained Resident

Comparing Laparoscopic suturing skill and endurance between ot trained Resident and endotrainer trained Resident

Developing a robust suturing assessment: validity evidence for the intracorporeal suturing assessment tool

BackgroundAssessment tools specific to intracorporeal suturing are lacking. The purpose of this study was to validate a novel Intracorporeal Suturing Assessment Tool (ISAT) by comparing it with existing measures that have been reported to have validity evidence. MethodsVideos of laparoscopic suturing were assessed by 3 blinded laparoscopic experts using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) scale and the ISAT. Correlations between these instruments were calculated, and sensitivity analyses compared both tools with objective suturing scores. A factor analysis was also performed. ResultsThe ISAT and GOALS ratings were significantly correlated with the objective suturing score (r = 0.58 and 0.61, respectively; P < .0001), and with each other (r = 0.92, P < .0001). A weighted κ test indicated significantly higher agreement than expected between these instruments (P < .0001). All ISAT items had a factor loading approaching or greater than 0.50. ConclusionThe ISAT accurately assessed laparoscopic suturing skill related to other instruments. ISAT was highly correlated with GOALS, which is often used for laparoscopic performance assessment. Unlike the generic GOALS, ISAT includes specific information that can provide feedback on trainee suturing ability and targeted performance improvements. ISAT may provide a better alternative for intracorporeal suturing assessment.

Mental skills training effectively minimizes operative performance deterioration under stressful conditions: Results of a randomized controlled study

BackgroundStress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress. MethodsTwenty-four residents were stratified then randomized to receive mental skills and FLS training (MSC group), or only FLS training (control group). Laparoscopic suturing skill was assessed on a live porcine model with and without external stressors. Outcomes were compared with t-tests. ResultsTwenty-three residents completed the study. The groups were similar at baseline. There were no differences in suturing at posttest or transfer test under normal conditions. Both groups experienced significantly decreased performance when stress was applied, but the MSC group significantly outperformed controls under stress. ConclusionsThis MSC enabled residents to perform significantly better than controls in the simulated OR under unexpected stressful conditions. These findings support the use of psychological skills as an integral part of a surgical resident training.

Innovative Economical Surgical Suture Board.

The aim of this study is to develop an economical suture board for practising suturing skills and techniques. Suture boards were made by using local electric boards, small leather patch, four suction buttons, six screws and a hook. These suture boards are multipurpose boards which are economical and available all the time in department for practicing. This board can also be placed in endotrainer for laparoscopic suturing skills. This economical suture board is cheap, easily available and helps in practicing various suturing and knot tying techniques.

The Effectiveness of a Simulation-Based Flipped Classroom in the Acquisition of Laparoscopic Suturing Skills in Medical Students—A Pilot Study

To evaluate the effectiveness of a simulation-based flipped classroom in gaining the laparoscopic skills in medical students. An intervention trial. Taipei Medical University Hospital, an academic teaching hospital. Fifty-nine medical students participating in a 1-hour laparoscopic skill training session were randomly assigned to a conventional classroom (n = 29) or a flipped classroom approach (n = 30) based on their registered order. At the end of the session, instructors assessed participants' performance in laparoscopic suturing and intracorporeal knot-tying using the assessment checklist based on a modified Objective Structured Assessment of Technical Skills tool. Students in the flipped group completed more numbers of stitches (mean [M] = 0.47; standard deviation [SD] = 0.507) than those in the conventional group (M = 0.10; SD = 0.310) (mean difference: 0.37; 95% CI: 0.114-582; p = 0.002). Moreover, students in the flipped group also had higher stitch quality scores (M = 7.17; SD = 2.730) than those in the conventional group (M = 5.14; SD = 1.767) (mean difference = 2.03; 95% CI: 0.83-3.228; p = 0.001). Meanwhile, students in the flipped group had higher pass rates for the second throw (p < 0.001), third throw (p = 0.002), appropriate tissue reapproximation without loosening or strangulation (p < 0.001), needle cut from suture under direct visualization (p = 0.004), and needle safely removed under direct visualization (p = 0.018) than those in the conventional group. Comparing with traditional approach, a simulation-based flipped classroom approach may improve laparoscopic intracorporeal knot-tying skill acquisition in medical students.

Establishing meaningful benchmarks: the development of a formative feedback tool for advanced laparoscopic suturing.

Time and accuracy are commonly used metrics to assess laparoscopic skills in a simulated environment. However, they do not provide trainees with meaningful information about how to improve their skills. The objective of this study was to provide preliminary validity evidence for the creation a formative feedback tool (FFT) for advanced laparoscopic suturing skills. Videotapes of senior surgical residents (PGY3-5; SRs) and minimally invasive surgeons (MIS) performing 3 advanced laparoscopic suturing tasks were analyzed: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). A FFT was created based on a grounded theory analysis of interviews with MIS surgeons about the key technical aspects of each task. The FFT was used to assess the videotaped performances of SRs and MIS surgeons by two blinded independent raters. The FFT is composed of three parts: NH contains 10 items, UT 18, and CS 20. Each item was classified according to seven key surgical principles: depth perception, safety, bimanual dexterity, exposure, tissue handling, instrument manipulation, and forward planning. The videotaped performance of SR and MIS surgeons was graded on a 3-point Likert scale ("does well," "needs some improvement," and "does poorly") and scores were calculated as a sum of the points. ICCs for all three tasks were high (NH 0.90, UT 0.87, and CS 0.90). FFT score correlated strongly with combined time and accuracy measurements for UT (0.82, p<0.01) and CS (0.81, p<0.01), and moderately for NH (0.65, p<0.01). MIS surgeons performed significantly better than SRs on UT (p=0.02) and CS (p=0.05), while scores on NH were similar (p=0.57). A comprehensive tool for providing feedback about advanced laparoscopic suturing skills was developed. The FFT demonstrates evidence for validity as a measure of suturing skills and experience, and provides meaningful information to trainees about how to improve their skills and engage in more deliberate and efficient practice.

What are the Training Gaps for Acquiring Laparoscopic Suturing Skills?

Advanced laparoscopic suturing is considered a challenging skill to acquire. The aim of this study was to investigate the learning process for advanced laparoscopic suturing in the operating room to understand the obstacles trainees face when trying to master the skill. A qualitative methodology using semistructured interviews and field observations was used. Data were analyzed using a Grounded Theory approach. Participants were general surgery residents and surgeons with advanced minimally invasive surgery (MIS) experience. Ten MIS surgeons across different institutions and 15 local general surgery residents were interviewed. The semistructured interviews and field observations of 9 advanced MIS operations (27h) yielded the following 6 themes around the acquisition of laparoscopic suturing skills for residents: complexity, training misalignment, variability of opportunities, inconsistency of techniques, lack of feedback, and differing expectations. There are several unmet training needs around laparoscopic suturing skills. Training for advanced laparoscopic skills requires more emphasis on coaching and the development of advanced models. This study heralded the need to incorporate advanced laparoscopic skills into the surgical simulation curriculum.

Intracorporeal anastomoses in emergency laparoscopic colorectal surgery from a series of 59 cases: where and how to do it - a technical note and video.

Laparoscopy offers the benefits of minimally invasive surgery and faster recovery. Acute surgical patients may potentially benefit from the great advantages of emergency laparoscopy, which is more clinically relevant in acute than elective patients. Fashioning a laparoscopic intracorporeal anastomosis (ICA) after emergent colorectal resection, whenever technically feasible and not contraindicated by the patient's general and haemodynamic condition, is a most challenging technical skill. During the period 2010-2016, 59 patients underwent a laparoscopic procedure for colorectal emergency in an acute care setting by a single operating surgeon with advanced laparoscopic skills and specific expertise in both colorectal surgery and acute care surgery. This series includes 32 laparoscopic right colectomies (12 for obstruction and 20 for perforation/peritonitis) and 27 left colectomies (6 for obstruction and 21 for perforation/peritonitis). Twenty-eight ileocolic side-to-side ICA, and 27 left colonic ICA (3 colocolic, 24 colorectal) were performed. Reasonably good postoperative outcomes were observed in the entire series of 59 laparoscopic colectomies performed in an urgent setting. Overall, the major morbidity rate in the entire group was 16.9% (10/59) with an incidence of intra-abdominal abscess of 11.8% (7/59); the overall leak rate was 3.4% (2/59). The re-operation rate was 3.4% (2/59). A video included in the Supporting Information shows five different sites and techniques for ICA and describes technical details with tips and tricks. All patients shown in the video had an uneventful postoperative recovery and were managed postoperatively according to enhanced recovery after surgery protocols. This case series illustrates all possible sites and techniques for colonic ICA in an emergency setting. All colorectal and acute care surgeons should have laparoscopic suturing skills.

Intracorporal knot tying techniques – which is the right one?

IntroductionIntracorporal knot tying (ICKT) and suturing in minimal invasive surgery (MIS) represent a key skill for advanced procedures such as Nissen fundoplication. Suture placement under tension is particularly challenging during MIS. The aim of this study was to compare ICKT of the common surgical square knot and the slipping knot on a simulated suture placement under tension. Furthermore, we objectively assessed the surgical skill of ICKT following 3hours of hands-on training. MethodsA box trainer was used for laparoscopic knot tying with predefined openings. A 12cm suture was placed in central view. We used a standardized silicon suture pad with a defined wound dehiscence of 0.5cm and marked needle entrance and exit targets next to the incision. Twenty participants were divided among three groups in this study. The first group (n=5) consisted of senior physicians. The second group (n=5) was made up of surgical residents in the first to fourth year of residency training. The third group (n=10) contained medical students between their third and sixth year of study without any prior experience in laparoscopic surgery. Residents and students received a 3-hour hands-on training in surgical square and slipping knot tying. Each participant tied two of each knot types before and after the hands-on training. Knot quality, performance, total time and suture placement accuracy were the parameters for assessment in this study. ResultsThe knot quality was greater for the slipping knot compared with the square knot in all groups. There were no significant intragroup differences in knot tying performance, task time and accuracy of both suture methods. Students and residents improved in all categories for both ICKT techniques after training. DiscussionWe compared ICKT of the surgical square knot with the slipping knot on a simulated suture placement under tension during a standardized training program for medical students and surgical residents. In our study, the average quality of the slipping knot was significantly superior to the square knot in all participants. The knot tying performance, task time, and accuracy of students and residents after hands-on training were not significantly different between both suture methods. This suggests that the two ICKT techniques have similar properties except the quality advantages of the slipping knot. Although students and residents improved in all categories for both ICKT techniques after training, they did not achieve expert level for task times and accuracy. ConclusionsIn this pilot trail, the quality of the slipping knot was superior to the surgical square knot during intracorporal suturing under tension. Our 3-hour sequential training program improved laparoscopic suturing and knot tying skills in all participants. Our findings suggest that training centers for MIS using validated training programs should be a continuous and integral part of surgical education. Level of evidenceUSPSTF Level III: monocentric, prospective, pilot Trial.

Quick and Easy Acquisition of Laparoscopic Suturing Skills

To investigate the learning curve for surgeons acquiring laparoscopic suturing skills.

Impact of seductive details on the acquisition and transfer of laparoscopic suturing skills: Emotionally interesting or cognitively taxing?

A common strategy to increase learner engagement is to interweave educational material with interesting but slightly tangential tidbits of information (eg, "war stories" and funny anecdotes), known as seductive details. Our objective was to examine the impact of seductive details on initial acquisition and transfer of basic laparoscopic surgical skills. Novices (first- to fourth-year medical students) were randomized into control (N=47) or seductive details (N=42) groups. Curricula consisted of a baseline skills assessment (Fundamentals of Laparoscopic Surgery Task 1), instructional video on intracorporeal laparoscopic suturing (Fundamentals of Laparoscopic Surgery Task 5), multiple choice quiz, practice, and assessment on both primary and transfer tasks. Two separate instructional videos were used for Task 5; 20% of the seductive details group's instructional video consisted of seductive details, whereas the control group's video included no seductive details. Participants completed questionnaires of mental workload and task engagement after training. We also conducted a mediation analysis, which is a statistical approach to identify causal paths among a group of variables. Baseline skill scores (control: 112±52; standard deviation: 118±56; 0=lowest possible score; 600=highest possible score) and knowledge scores (control: 76±19; standard deviation: 74±16; 0=lowest possible score; 100=highest possible score) were similar for both groups. The control group demonstrated better (higher) performance on both the primary (434±193 vs 399±133, P<.05) and transfer (184±74 vs 149±91, P<.05) suturing tasks. Mental workload, as measured by the National Aeronautics and Space Administration-Task Load Index, was more demanding (higher) for the seductive details group (3.8±0.5 vs 3.4±0.7, P<.01; 1=low workload; 5=high workload) and was investigated as the possible mechanism by which group assignment impacted performance. Mediational paths using hierarchical regression were significant (P<.05), suggesting that trainees in the seductive details group performed worse because of their increased workload. Our findings suggest that the inclusion of seductive details may be detrimental to the acquisition and transfer of laparoscopic surgical skills due to increased mental workload for trainees.

Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying

To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying. We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process. In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents. Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001). Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills.

The efficacy of robotic driven handheld instruments for the acquisition of basic laparoscopic suturing skills

ObjectiveTo evaluate the efficacy of robotic-driven handheld laparoscopic instruments for the acquisition and improvement of basic laparoscopic suturing skills.Study design: A prospective study was carried out on 15 physicians grouped by previous experience. They were evaluated on the completion of basic surgical laparoscopic skills. First, they used traditional non-articulating laparoscopic instruments, and later they used robotic-driven articulating instruments. ResultsSignificant time reduction was observed in the group of inexperienced physicians when they used robotic-driven instruments for needle loading and placing stitches. An 8.3% time reduction was observed in the same group when considering total times for the completion of all exercises. No significant differences for the experienced groups were found. ConclusionsRobotic-driven handheld instruments could help inexperienced physicians acquire basic skills in laparoscopic techniques. No benefit has been observed when previous laparoscopic experience is present.

クリニカルクラークシップ中の学生に対するドライボックスによる縫合実習：Suture to Ligation Timeに関連する因子の解析

クリニカルクラークシップ中の学生に対するドライボックスによる縫合実習：Suture to Ligation Timeに関連する因子の解析

Laparoscopic mesh procedures for the treatment of pelvic lorgan prolapse--review of the literature.

The main aim of the article was to describe laparoscopic mesh procedures for the treatment of pelvic organ prolapse, as well as evaluate their role, outcomes and limitations. In February 2014, online search of English-language literature in PubMed was performed. This paper presents the analysis of reports published over the last decade that included at least 50 patients with a minimum of 12 months of follow-up. Numerous laparoscopic techniques to restore proper anatomy in patients with pelvic organ prolapse have been described. Laparoscopy provides a number of important advantages, including enhanced visualization of the pelvic anatomy reduction of adhesion formation, lower morbidity and blood loss, decreased postoperative pain, smaller incision and quicker recovery Nonetheless, this access is technically more difficult than an open or vaginal surgery due to two-dimensional vision and decreased degrees of freedom. It requires high level of laparoscopic suturing skills and longer operative time, especially at the beginning of the learning curve. Laparoscopic sacrocolpopexy hysteropexy and lateral suspension are interesting and effective options for the treatment of pelvic organ prolapse, providing a number of important advantages characteristic for endoscopic techniques.

Does 3D imaging improve laparoscopic intracorporeal suturing skill acquisition in novices and trainee surgeons?

s / International Journal of Surgery 11 (2013) 686e745 706 ABSTRACTS 1447: DOES 3D IMAGING IMPROVE LAPAROSCOPIC INTRACORPOREAL SUTURING SKILL ACQUISITION IN NOVICES AND TRAINEE SURGEONS? Walid Elbakbak , Badriya Alaramim, Amina Bouhelal , Shah-Jalal Sarker , Bijendra Patel . Barts Cancer institue, London, UK; Royal London Hospital, London, UK. Aims: To objectively evaluate and compare the effects of 3D versus 2D vision system on novice and surgeons performing laparoscopic intracorporeal suturing in terms of performance times, number of repetitions and errors in standardised laboratory settings. Methods: Thirty novices (medical-students) and twenty four core surgical trainees (year 1 &2) were randomised between two vision systems (3D or 2D) stratified by gender. Candidates performed laparoscopic intracorporeal suturing according to the validated fundamentals of laparoscopic surgery (FLS) curriculum until task proficiency is achieved. Parameter measured were the total time to reach task proficiency, number of repetitions and task errors. Results: We concluded that the performance time and repetitions while performing laparoscopic suturing under 3D and 2D vision systems were similar but a trend towards fewer errors and better precision score was observed in 3D vision in both novices and trainees. The novice participant's error score was statically significant (P1⁄40.002). Conclusion: Acquiring laparoscopic suturing skills using 3D vision system is as effective as conventional 2D laparoscopy with no statistical difference in time, number of repetitions and measured error rates in reaching proficiency using FLS curriculum. However, there is a trend towards fewer errors and better precision score in candidates performing under 3D vision. 1449: IMPACT OF EWTD ON PATIENT CARE AND TRAINING e EXPERIENCE OF A DISTRICT GENERAL HOSPITAL Dilraj Bilku, David Andrew, Suresh Pillai. United Lincolnshire Hospitals NHS

Laparoscopic technique and safety experience with barbed suture closure for pelvic cavity after abdominoperineal resection

BackgroundBetween April 2005 and December 2012, we performed laparoscopic colorectal resection with regional lymph node dissection on 273 cases of colorectal cancer patients. However, Laparoscopic rectal cancer surgery requires a high degree of skill. Any surgeon who is going to embark on these difficult resections should have at a minimum laparoscopic suturing skills in order to be able to close the peritoneal defect.MethodsIn laparoscopic surgery for rectal cancer, the intracorporeal suture technique required to close the pelvic cavity is very difficult. Barbed sutures have recently been proposed to facilitate laparoscopic suturing. Two patients with rectal cancer who underwent laparoscopic abdominoperineal resection (APR) with intracorporeal closure of the pelvic cavity from September to October 2012 were enrolled in this study.ResultsWe present our initial experience of two consecutive cases of intracorporeal closure of the pelvic cavity by totally laparoscopic APR. After clinical follow-up, the two patients have no complaints and have shown no signs of recurrence.ConclusionsWe hypothesized that barbed sutures could potentially improve the efficiency of intracorporeal closure of the pelvic cavity after laparoscopic APR. Further, we expect that use of the V-Loc™ will reduce intra-operative stress on the endoscopic surgeon.

Using simulation to improve the cognitive and psychomotor skills of novice students in advanced laparoscopic surgery: A meta-analysis

Advances in simulation technologies have enhanced the ability to introduce the teaching and learning of laparoscopic surgical skills to novice students. In this meta-analysis, a total of 18 randomized controlled studies were identified that specifically looked at training novices in comparison with a control group as it pertains to knowledge retention, time to completion and suturing and knotting skills. The combined random-effect sizes (ESs) showed that novice students who trained on laparoscopic simulators have considerably developed better laparoscopic suturing and knot tying skills (d = 1.96, p < 0.01), conducted fewer errors (d = 2.13, p < 0.01), retained more knowledge (d = 1.57, p < 0.01) than their respective control groups, and were significantly faster on time to completion (d = 1.98, p < 0.01). As illustrated in corresponding Forest plots, the majority of the primary study outcomes included in this meta-analysis show statistically significant support (p < 0.05) for the use of laparoscopic simulators for novice student training on both knowledge and advanced surgical skill development (28 of 35 outcomes, 80%). The findings of this meta-analysis support strongly the use of simulators for teaching laparoscopic surgery skills to novice students in surgical residency programs.

Extracorporeal versus intracorporeal ileocolic anastomosis

This nonsystematic review was performed to evaluate the literature that pertains to laparoscopic right colectomy, focusing on extracorporeal versus intracorporeal ileocolic anastomosis. The literature search was performed using PubMed to investigate the current status of research on 3 topics: (1) laparoscopic right colectomy with extracorporeal anastomosis, (2) laparoscopic right colectomy with intracorporeal anastomosis, and (3) comparisons of the 2 techniques. Each topic was reviewed, and the most relevant articles were selected for each subheading. Current literature is bringing to the forefront new evidence that laparoscopic right colectomy with intracorporeal anastomosis can be performed within a comparable time frame as extracorporeal anastomosis and with similar complication rates. Recent reports have presented evidence in which the entire operation is performed intracorporeally by a medial-to-lateral approach with comparable results to those observed in the surgery performed with extracorporeal anastomosis. The advantages of intracorporeal anastomosis are that mobilization of the transverse colon is not necessary, the anastomosis is performed away from the abdominal wall, and there is decreased potential for adhesion formation and a smaller extraction site. Potential disadvantages include intra-abdominal colotomy, requirement of laparoscopic suturing skills, and longer operative time.

Three-Step Model Course to Teach Intracorporeal Laparoscopic Suturing

Laparoscopy requires a set of skills such as intracorporeal stitching and knotting. The aim of this study is to present an effective specialized training course for the laparoscopic suturing technique. We designed a specialized 5-day training course for laparoscopic suturing skills with theoretical and practical sessions on inanimate pelvic training. The "gladiator rule" was the method used to teach intracorporeal suturing using the right and left hand from a lateral and suprapubic access. Data on sense of depth, coordination, dexterity, traction power, and posture at the beginning and at the end of the course were compiled. Three practical evaluations were performed by each course participant. Follow-up on subsequent live laparoscopic application of intracorporeal suturing was obtained. We enrolled 44 consecutive trainees: 33 men and 11 women. We found a significant statistical improvement during the course in coordination (P=.001), dexterity (P=.000), traction power (P=.002), and posture (P=.003). Men were better than women in coordination (P=.002), dexterity (P=.000), and traction power (P=.014). No significant statistical difference in suturing skill was found in relation to age, gender, previous courses, surgical training (surgeon or resident), and dominant hand. Twenty-nine of 40 (72.5%) trainees after the course began to apply intracorporeal sutures in vivo. The present study demonstrates the utility of a 5-day suturing course in teaching laparoscopic suturing technique. The "gladiator rule" is a useful and reproducible theory to teach intracorporeal knotting. The three-step model allows the majority of the trainees to apply laparoscopic suturing in vivo.