Laparoscopic Suturing Training Research Articles

How to Evaluate the Effectiveness of Simulation Training in Surgery?

Simulation training in surgical procedures is an important part of the training of surgeons. The goal of simulation training is to develop the ability of physicians to perform surgical procedures in real practice. The assessment of simulation training programs is needed to analyze to improve outcomes; requirements for assessment of simulation training include an assessment of the application of surgical procedures in practice, in the general population of students. A method of assessment of surgical procedures has been developed by means of a structured interview of listeners with an assessment of practical results. The method revealed the high efficiency of the laparoscopic intracorporeal suture training program.

ThTP3.1 Development and early validation of ‘SuturePal’: a novel mixed reality laparoscopic suturing training module

Abstract Aims Laparoscopic suturing is a challenging skill to acquire, requiring extensive training. This study aims firstly to develop a novel self-directed mixed reality laparoscopic suturing training module using the Microsoft Hololens 2 headset and secondly to assess the feasibility of this training tool and advantages over conventional training methods. Methods SuturePal is a self-directed mixed reality training module which combines didactic videos, text, and bespoke interactive 3D models. Ten medical students and surgical trainees participated in a single-blinded prospective randomised feasibility study. Participants received baseline teaching for laparoscopic intracorporeal knot tying and were subsequently randomised to either SuturePal (n=5) or conventional training (n=5). Baseline and post-training knots were recorded and assessed by two blinded examiners for time taken, precision, errors, and proficiency according to two previously validated objective assessment tools. Cognitive load was measured via the validated NASA-TLX tool and participant feedback was recorded. Results SuturePal users reported higher confidence levels (p=0.0476) and lower mental demand (p=0.0397) following training compared to those taught by conventional means. No statistical differences, however, were shown between groups when comparing objective measures of knot tying performance. Conclusions SuturePal provides evidence for how mixed reality technology may enhance engagement in surgical skill acquisition by improving user experience and lowering mental demand. This contributes to the growing body of evidence that mixed reality may have a role in enhancing surgical training. However, further research in the form of larger scale studies is required to determine whether mixed reality improves objective performance of surgical trainees.

Simulation training of laparoscopic pancreaticojejunostomy and stepwise training program on a 3D-printed model

AimLaparoscopic pancreaticojejunostomy is among the most difficult and high-risk operations. Surgeons with low or moderate seniority rarely are allowed to perform this surgery in clinics. Therefore, there is an urgent need to develop a reliable simulation training model focused on laparoscopic pancreaticojejunostomy and an effective stepwise training program. MethodsSurgeons with different working experiences or exposure to different training programs at Sir Run Run Shaw Hospital were divided into four groups. Each was required to perform laparoscopic pancreaticojejunostomy using a designed three-dimensional dry lab model. All surgeons' baseline characteristics and surgical performance, including operation time and score, were recorded and analysed. The authenticity of the model was evaluated by four senior surgeons. ResultsThe surgeon group with higher seniority had an older average age, longer working time, and had completed more laparoscopic cholecystectomy and laparoscopic common bile duct exploration procedures. Meanwhile, the surgeon group with higher seniority presented better operation performance, including shorter operation time and higher operation score in their initial simulation training. Resident surgeons who underwent stepwise training with the laparoscopic biliary-enteric anastomosis training program showed better initial performance than resident surgeons who underwent stepwise training with the laparoscopic basic suture training program. After repeated training, the surgeons showed improved surgical performance. ConclusionOur pancreaticojejunostomy model showed a good degree of discernibility, as surgeons with more experience performed better with the model for their initial simulation training in laparoscopic pancreaticojejunostomy. Stepwise training of the laparoscopic biliary-enteric anastomosis training program helped surgeons obtain a better initial performance, and repeated simulation training on this model improved the surgeon's operative performance.

Effectiveness of the world’s first 1-Day online hands-on laparoscopic suturing training during COVID-19 pandemic

We aimed to investigate the effectiveness of an online laparoscopic suturing training course conducted via an online meeting program. The mean needle loading, stitching, and knot-tying times were 77.3 s, 63.0 s, and 140.3 s, respectively on the initial test. Total laparoscopic suture time before the course was 273.8 s. After the course, time measures across all parameters decreased significantly (p < .001). The mean needle loading, suture passing, and knot tying times were 25.0 s, 31.0 s, and 34.6 s on the final test. The total intracorporeal suture time after the course was 90.0 s. The Objective and Structured Assessment of Technical Skills Scores significantly increased from 16.8 at the initial test to 25.4 at the final test (p < .001). IMPACT STATEMENT What is already known on this subject? Training models like box trainers and virtual reality simulators have frequently been shown to significantly improve laparoscopic skills. What the results of this study add? A 1-day online laparoscopic suturing course significantly reduces the intracorporeal suturing time. What the implications are of these findings for clinical practice and/or further research? Basis the results, online laparoscopic suturing training might become the new norm for training over conventional training given the benefits of cost and time savings.

Time trial of dry box laparoscopic surgical training improves laparoscopic surgical skills and surgical outcomes.

The present study assessed the utility of a dry box time trial during laparoscopic surgical training to improve laparoscopic surgical skills and surgical outcomes. In a monthly time trial, surgeon trainees twice completed a set task that involved grasping a suture, aligning a needle with a needle holder, passing the suture, making three knots, and cutting the two tails of the suture. The mean suturing time was then analyzed. To assess the utility of this time trial, we analyzed the short-term outcomes of patients with stage I to III colon cancer who had undergone laparoscopic colectomy before and after the introduction of the time trial. The monthly time trial was introduced in October 2018, and 52 surgeon trainees participated in the trials examined in this study. Within 6months of the program's introduction, the mean suturing time had significantly declined to less than 70% of the time trial, while the standard deviations had declined to less than 30%. In comparisons of the short-term outcomes of laparoscopic colon cancer surgery before (n=49) and after (n=46) the introduction of the time trial, the operative time tended to decline (P=.074) after the introduction of the time trial, and blood loss was significantly reduced (P=.018). The rate of postoperative complications was similar before and after the introduction. Regular time trials of laparoscopic surgical suture training using a dry box can be useful for improving laparoscopic surgical skills and surgical outcomes. Moreover, time trials can keep trainees motivated.

Effect of structured training in improving the ergonomic stress in laparoscopic surgery among general surgery residents.

Minimal access surgery has fast become the standard of care for many operative procedures, but is associated with lot of ergonomic stress to the surgeons performing these procedures, which may result in reduction in surgeon's performance and work capacity. In this study, we evaluated the impact of structured training program in improving the ergonomic stress in trainee laparoscopic surgeons. Laparoscopic surgeons were divided in 2 groups: trainee surgeons (ten) and expert surgeons (three). Baseline surface electromyography (sEMG) data were collected from bilateral deltoid, biceps brachii, forearm extensors, and pronator teres during a predefined suturing task on Tuebingen trainer with integrated porcine organs in both the groups. Trainee surgeons underwent 20h of laparoscopic intra-corporeal suturing training and surface electromyography data were recorded at the end of training again and compared with baseline. Experts were found to have lower muscle activation (p < 0.05) and muscle work (p < 0.05) and better bimanual dexterity than the trainee surgeons at baseline. After training, the trainee surgeons showed significant improvement (p = 0.01), but still did not reach the values of the expert surgeons (p = 0.01). Right deltoid and pronator teres muscles were found to have maximal activity while performing intra-corporeal suturing. Structured and focused training outside operation theater can significantly reduce unnecessary muscle activation of trainee laparoscopic surgeons and better dexterity leading on to lesser ergonomic stress and thus possibly may reduce the risk of development of future musculo-skeletal disorders.

Handheld robotic needle holder training: slower but better.

Handheld robotic laparoscopic instruments fill the gap between robotic and conventional instruments, combining the advantages of degrees of freedom and low price. The difficulty and value in learning these new instruments require detailed investigation. Forty novice surgeons with no laparoscopic experience were randomly assigned to two groups: conventional instrument group (Group Conv) and robotic instrument group (Group Rob). The same training protocol was used in both groups: after viewing a standard operation film, laparoscopic suture training was administered using the corresponding instruments. After each training period, surgeons were tested using a force-sensing test platform. Maximum force (MF) and impulse (IMP) of operators through each ring were recorded. Learning curves based on MF and IMP for both instruments were compared. Institutional review board approval is not needed for this study. MF and IMP of both groups decreased with increased training time; the learning curve of Group Conv decreased faster than that of Group Rob. When training time reached 13h, the MF of Group Rob was significantly lower than that of Group Conv (P < 0.05), while IMP showed no significant difference between the two groups. Effective training reduces operator MF and IMP, possibly decreasing damage to tissues with both conventional and handheld robotic needle holders. Group Rob took longer to reach a plateau, but subsequently had lower suture tension than did Group Conv. MF is more sensitive than IMP for measuring performance progress.

The Impact of Systematic Laparoscopic Skills and Suture Training on Laparoscopic Hysterectomy Outcomes in a Brazilian Teaching Hospital.

To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program. A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p = 0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p = 0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p = 0.030), logistic regression did not find any association between uterine volume and surgical time (p = 0.103). The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.

Handheld laparoscopic robotized instrument: progress or challenge?

Handheld laparoscopic robotized instruments have been developed to combine the advantages of a robotic operation system and conventional laparoscopic instruments. Direct objective standards are needed to quantify surgeons' skill level and validate the advantages of new instruments. This study describes and objectively evaluates the use of a robotized instrument using a force-sensing test platform. The test platform consists of 12 rings on a hypersensitive force sensor. Forty volunteers were recruited: the expert group included 20 laparoscopic experts and the novice group included 20 medical students in their 4th year without laparoscopic skills. The baseline of the two groups was identified using a conventional needle holder. Participants then repeated the test with the robotized needle holder after training. The maximum force and impulse of each ring were analyzed for each group. Institutional review board approval is not needed for this study. Significantly lower maximum force and impulse were observed in the expert group than in the novice group during the baseline test (all P < 0.05). After training, a significant difference remained in maximum force and impulse between the two groups using the robotized needle holder (all P < 0.05). Within each group, there was no difference in maximum force or impulse using the robotized needle holder after training compared to that on using the conventional needle holder (all P > 0.05). The maximum force and impulse recorded by a test platform can accurately identify participants' laparoscopic skill level. Six hours' training can ensure that experts master the use of the robotized needle holder, but this training session is too short for novices to improve their performance with a new instrument. The force-sensing test platform can reflect the suturing characteristics of users based on the skill level and is useful for laparoscopic suture training.

Randomized Crossover Study in Novices to Evaluate Surrogate Variables for Stress Provoked by Laparoscopic Suture Training in a High Fidelity Simulator Using Different Laparoscopic Handles

Castegren, Markus MD, PhD; Georgiou, Konstantinos MD; Michalopoulos, Nikolaos V. MD, MSc, PhD; Larentzakis, Andreas MD, MSc, PhD; Enochsson, Lars MD, PhD Author Information

Laparoscopic suture training curricula and techniques.

With the development and ubiquitous use of minimally invasive surgery, the advanced laparoscopic skills such as suture is essential for performing gastrointestinal procedures. However, the steep learning curve and lack of standardized training make most residents underprepared for laparoscopic suture. Moreover, the current simulation-based training is inadequate for trainees to master these advanced skills. Thus, there is a need for laparoscopic suture training modeled with cognitive knowledge, approachable techniques and standardized steps. Here, we present a suture training curriculum with video demonstration. In this study, we developed a suture training curriculum, which are divided into two categories depending on its difficulty and application. Basic techniques are designed for novice to master the basic suture skills, and it also shortens the learning curve of advanced suture techniques. Advanced techniques focused on the application of suture in specific circumstances. Also, it could prepare residents for more complex procedures. In order to increase the efficacy of suture training, we recommend a learning method similar to Peyton's four-step approach, personalized video feedback and spaced learning in our curricula. This article demonstrates the various laparoscopic techniques and their applications from simple to complex, with a view to help residents in training. Also, the training curricula and recommendations will further help residents to improve efficiently. Thus, we recommend to incorporate the curricula into suture training courses and surgical programs.

Laparoscopic suture training and technique—a resident’s experience

Laparoscopic suture training and technique—a resident’s experience

The Effect on Performance Time and Quality of the Knots after Mono or Bimanual Training of Laparoscopic Intracorporeal Knot Tying according to the Gladiator Rule Technique.

To assess whether the monomanual or bimanual training of laparoscopic suture following the same technique may interfere with the knots' performance time and/or quality. A prospective observational study involving 41 resident students of gynecology/obstetrics and general surgery who attended a laparoscopic suture training for 2 days. The participants were divided into two groups. Group A performed the training using exclusively their dominant hand, and group B performed the training using both hands to tie the intracorporeal knot. All participants followed the same technique, called Romeo Gladiator Rule. At the end of the course, the participants were asked to perform three exercises to assess the time it took them to tie the knots, as well as the quality of the knots. A comparative analysis of the groups showed that there was no statistically significant difference (p = 0.334) between them regarding the length of time to tie one knot. However, when the time to tie 10 consecutive knots was compared, group A was faster than group B (p = 0.020). A comparison of the knot loosening average, in millimeters, revealed that the knots made by group B loosened less than those made by group A, but there was no statistically significant difference regarding the number of knots that became untied. This study demonstrated that the knots from group B showed better quality than those from group A, with lower loosening measures and more strength necessary to untie the knots. The study also demonstrated that group A was faster than B when the time to tie ten consecutive knots was compared.

MP51-18 DEVELOPMENT AND VALIDATION OF A NOVEL COGNITIVE TRAINING TOOL FOR LAPAROSCOPIC SUTURING

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2017MP51-18 DEVELOPMENT AND VALIDATION OF A NOVEL COGNITIVE TRAINING TOOL FOR LAPAROSCOPIC SUTURING Nicholas Raison, Lauren Wallace, Takashige Abe, Fehmi Hafiz, Matin Sheriff, Christian Brown, Prokar Dasgupta, and Kamran Ahmed Nicholas RaisonNicholas Raison More articles by this author , Lauren WallaceLauren Wallace More articles by this author , Takashige AbeTakashige Abe More articles by this author , Fehmi HafizFehmi Hafiz More articles by this author , Matin SheriffMatin Sheriff More articles by this author , Christian BrownChristian Brown More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1627AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of cognitive training in the form of mental imagery (MI) to develop surgical skill has been previously demonstrated. However inconsistent results and the limited practical application of current cognitive training methods has limited its uptake. We have developed the first generic cognitive training tool for surgical skills development and validated its use for laparoscopic suturing training. METHODS The MI training tool was developed in conjunction with cognitive psychologists and expert laparoscopic surgeons. By providing a framework within which trainees develop a personalised MI script, the training tool enables participants to undertake independent cognitive training. Ongoing critical self-evaluation promotes further refinement and improvement in the quality of the MI. The training tool was validated with a randomised controlled trial comparing MI to standard lecture based training for laparoscopic suturing. Participants randomised to cognitive training used the training tool to compose a personalised MI script. All participants then underwent 7 training sessions. Each session was video recorded and technical performance was blindly assessed post-hoc using a validated laparoscopic suturing score. Following training participants' opinions of the MI training tool were collected. Quality of the MI was measured using the validated MI questionnaire (MIQ). RESULTS 27 novice participants completed the study. The MI training tool was found to be very effective, with mean ratings of 6.5/7 and 6.29/7 for content and effectiveness respectively compared to scores of 4.9/7 and 3.8/7 for standard training. The quality of MI was also rated highly with a mean MIQ score of 6/7. No significant differences in technical performance were found between the groups either at baseline assessment or during the 1st 4 training sessions. Cognitive training resulted in significantly better performance after the 5th training session with increasing divergence in scores between the two groups (Figure 1). CONCLUSIONS Our novel and highly adaptable cognitive training tool has been shown to effectively aid laparoscopic suturing training. Further validation of the cognitive training tool in more experienced robotic surgeons is now required to determine the optimal integration of cognitive training into surgical training. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e701 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nicholas Raison More articles by this author Lauren Wallace More articles by this author Takashige Abe More articles by this author Fehmi Hafiz More articles by this author Matin Sheriff More articles by this author Christian Brown More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Maintenance training for laparoscopic suturing: the quest for the perfect timing and training model: a randomized trial

Although excellent training programs exist for acquiring the challenging skill required in laparoscopic suturing, without subsequent reinforcement, performance is prone to decay. Therefore, maintenance training is proposed to ensure better skill retention. This study aimed to elucidate the ideal timing and frequency of maintenance training as well as the best model to be used for this training. After completing a proficiency-based laparoscopic suturing training, 39 medical students attended different maintenance programs represented by four groups: a control group without additional training (group 1), a massed training group with one supervised training session (150min) after 2.5months (group 2), and two distributed training groups with five monthly unsupervised training sessions of 30min on a box trainer (group 3) or the LapMentor(®) (group 4). Retention testing, after 5months, included suturing on a box trainer and on a cadaver porcine Nissen model. Performance scores (time and errors) were expressed in seconds. Afterward, time needed to regain proficiency was measured. On the box trainer, the median performance scores were 233s (interquartile range [IQR] 27s) for group 1, 180s (IQR 55s) for group 2, 169s (IQR 26s) for group 3, and 226s (IQR 66s) for group 4 (p=0.03). No difference was seen between groups 2 and 3, both of which significantly outperformed groups 1 and 4. On the porcine Nissen model, no differences were detected between the groups (p=0.53). Group 3 reached proficiency more quickly than the other groups. Maintenance training is a valuable and necessary addendum to proficiency-based training programs for laparoscopic suturing. A maintenance-training interval of 1month with unsupervised training sessions on simple box trainers seems ideal. The LapMentor(®) did not show any benefit. Performance differences between groups did not translate to a clinically relevant model, indicating that transfer of training is not perfect.

The Optimal Frequency of Endoscopic Skill Labs for Training and Skill Retention on Suturing: A Randomized Controlled Trial

To determine, given a fixed amount of training, the optimal distribution of sessions needed to acquire intracorporeal endoscopic suturing skills and to retain said skills for 1 to 6 months. A randomized controlled trial consisted of 6 study groups who received identical laparoscopic suturing training but at differing frequencies of sessions. The faculty of medicine of the KULEUVEN is the largest medical faculty in Belgium. Medical students without experience in laparoscopy (n = 145). After baseline assessments, the students were randomized into 6 groups to receive 6 training sessions of 1.5 hours each. Training Groups were as follows: 3 sessions daily (TD), bidaily sessions, 1 session daily (OD), 1 session on alternative days, 1 session weekly, and 1 session weekly with an optional "deliberate practice" in between sessions (WD). All exercises and feedback given were identical. One and 6 months after the final session, an evaluation was performed where a 5-cm chicken-skin incision had to be closed with 3 laparoscopic knots. The cumulative time to approximate the skin edges adequately was used for qualitative and quantitative analysis. There were no significant differences amongst the groups at baseline concerning ambidexterity, motivation, or spatial abilities. The group OD outperformed the massed groups (TD and bidaily sessions) and the weekly groups (1 session weekly and WD) significantly (p = 0.003). After 1 month there was still a significant advantage for regular training groups (OD, 1 session on alternative days, and WD) over massed training groups (TD) (p = 0.004). After 6 months only a statistical difference (p = 0.04) between group OD and group TD was observed. Group WD's score remained stable after 6 months. Short-term, once daily 1.5-hours session seems most beneficial for learning intracorporeal endoscopic suturing. After 6 months, distributed shorter training still remains better than massed practice but weekly training and daily training are comparable. "Optional Deliberate Practice" between the official training sessions reduces skill decay.

Novel Inanimate Training Model for Urethrovesical Anastomosis in Laparoscopic Radical Prostatectomy

We developed a novel ex vivo training model for advanced laparoscopic suturing techniques necessary in laparoscopic radical prostatectomy (LRP). An inanimate model was developed to approximate real-life conditions in laparoscopic urethrovesical anastomosis. A segment of porcine ovarian tube inserted through a hard piece of cardboard (urethral stump) in a small open box and a part of pig stomach with a 2-cm hole (bladder neck) were placed in a specially designed setup in a traditional pelvic trainer, while the trocars were arranged in the usual five-port style during an LRP. The trainees practised suturing the "bladder neck" to the "urethral stump" with intermittent or continuous sutures according to their preferences. The setup successfully mimicked the spatial relationships of the organs to be anastomosed during live surgery. The directions of the trocars and the angles of the instrumentations in the training model also imitated those during LRP. After practising on our models, the surgeons spent significantly less time (65 ± 24 min vs. 36 ± 12 min, p = 0.035) performing actual urethrovesical anastomosis. This inanimate laparoscopic suturing training model for urethrovesical anastomosis is a novel, effective, convenient and economic training tool, especially for beginners of LRP.

How much do we need experts during laparoscopic suturing training?

Because of the complex nature of laparoscopic suturing, numerous curricula have been developed to overcome the steep learning curve in a patient-free environment. Distributed training leads to better acquisition and retention of skill compared with massed training. However, this requires considerable time commitment of experts that supervise these training sessions. This study investigates the possibility of replacing expert supervision by structured training with video demonstrations and peer feedback. The study population consisted of two balanced groups of ten senior medical students with minimal experience in laparoscopy. The control group trained with continuous expert feedback while for the experimental group only video demonstrations and external feedback from peers were available. Training was completed when a previously determined expert level was achieved on two consecutive attempts (proficiency criterion). Students were tested on their suturing skills 1 week after the training as well as after 4 months. A composite score assessing quality and quantity of suturing performance was used. Data are shown as median (interquartile range, IQR). Students' performance improved more than 200% after training. Learning curves did not differ between groups (p = 0.28). One week after training, scores were 192 s (IQR 65 s) for the control and 190 s (IQR 27 s) for the experimental group (p = 0.63). After 4 months this was 223 s (IQR 88 s) and 220 s (IQR 37 s), respectively (p = 0.60). Both training methods are very efficient at improving laparoscopic suturing skills and provide excellent skill retention. We therefore conclude that structured training with video demonstrations and peer feedback can replace expert supervision to teach laparoscopic suturing skills to novices. This will facilitate practical organization of skills training.

Meaningful assessment method for laparoscopic suturing training in augmented reality.

BackgroundTo be an effective training tool, a laparoscopic simulator has to provide metrics that are meaningful and informative to the trainee. Time, path length and smoothness are often used parameters, but are not very informative on the quality of the performance. This study aims to validate a newly developed assessment method for laparoscopic suturing on the ProMIS augmented reality simulator, and compares it with scores of objective observers.MethodsTwenty-four participants practised their suturing skills on the augmented reality suturing module: experienced participants (n = 10), >50 clinical laparoscopic suturing experience; and novice participants (n = 14), without laparoscopic experience. The performances were recorded and assessed by two unrelated observers and compared with the assessment scores. The assessment score was a calculation of time spent in the correct area and quality (strength) of the knot. To test the accuracy of the individual assessment parameters, we compared these with each other.ResultsThe experienced participants had significantly higher performance scores than the novice participants in the beginner-level mode (mean 95.73 vs. 60.89, standard deviation 2.63 vs. 17.09, p < 0.001, independent t-test). The performance scores of the assessment method (n = 43) correlated significantly with the scorings of the objective observers (Spearman’s rho 0.672; p < 0.001).The parameter time spent in correct area had a calculated significant correlation with the strength of the knot (n = 229, Spearman’s rho 0.257, p < 0.001), but this was clinically irrelevant.ConclusionThis assessment method is a valid tool for objectively assessing laparoscopic suturing skills. Although assessment parameters can correlate, to provide informative feedback it is important to combine meaningful measurements in the assessment of suturing skills.

MP-6.09: How Much Do We Need Experts During Laparoscopic Suturing Training?

Because of the complex nature of laparoscopic suturing, numerous curricula have been developed to overcome the steep learning curve in a patient-free environment. Distributed training leads to better acquisition and retention of skill compared to massed training. This, however, requires considerable time commitment of experts that supervise these training sessions. This study investigates the possibility of replacing expert supervision by video demonstrations and peer feedback.