Laparoscopic skills training.

BACKGROUND The purpose of this study was to quantify the learning curve of a previously validated laparoscopic skills curriculum. METHODS Second-year medical students (MS2, n = 11) and second (PGY2, n = 11) and third (PGY3, n = 6) year surgery residents were enrolled into a curriculum using five video-trainer tasks. All subjects underwent baseline testing, training (30 minutes per day for 10 days), and final testing. Scores were based on completion time. The relationship between task completion time and the number of practice repetitions was examined. Improvement (the difference in baseline and final performance) amongst groups was compared by one-way analysis of variance using the baseline score as a covariate; P <0.05 indicated significance. RESULTS Baseline scores were not significantly different. Final scores were significantly better for MS2s versus PGY3s. Adjusted-improvement was significantly larger for the MS2s compared with PGY2s and PGY3s, and for PGY2s compared with PGY3s. The mean number of repetitions corresponding to a predicted 90th percentile score was 32. CONCLUSION Inexperienced subjects benefit the most from skills training. For maximal benefit, we recommend that each task be practiced for at least 30 to 35 repetitions.

[1]  Daniel B. Jones,et al.  Improving operative performance using a laparoscopic hernia simulator. , 2001, American journal of surgery.

[2]  Ronald C Merrell,et al.  Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer system. , 2002, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[3]  R. Rege,et al.  Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation. , 2000, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[4]  R. M. Satava,et al.  Evaluation of structured and quantitative training methods for teaching intracorporeal knot tying , 2001, Surgical Endoscopy And Other Interventional Techniques.

[5]  E. Frezza,et al.  Competency-based instruction in critical invasive skills improves both resident performance and patient safety. , 1998, Surgery.

[6]  A. García-Ruiz,et al.  Robotic surgical instruments for dexterity enhancement in thoracoscopic coronary artery bypass graft. , 1997, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[7]  A. Darzi,et al.  Skill transfer from virtual reality to a real laparoscopic task , 2001, Surgical Endoscopy.

[8]  D. Jones,et al.  The influence of three-dimensional video systems on laparoscopic task performance. , 1996, Surgical laparoscopy & endoscopy.

[9]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[10]  G. Fried,et al.  The effect of practice on performance in a laparoscopic simulator , 1998, Surgical Endoscopy.

[11]  Daniel B. Jones,et al.  Laparoscopic training on bench models: better and more cost effective than operating room experience? , 2000, Journal of the American College of Surgeons.

[12]  T. Mori,et al.  Significance of ``hands-on training'' in laparoscopic surgery , 1998, Surgical Endoscopy.

[13]  E. DeMaria,et al.  Training the novice in laparoscopy , 2002, Surgical Endoscopy And Other Interventional Techniques.

[14]  N J Soper,et al.  Suturing and knot tying in laparoscopy. , 1992, The Surgical clinics of North America.

[15]  Reznick Rk,et al.  Virtual reality surgical simulators: feasible but valid? , 1999 .

[16]  A. Cuschieri,et al.  Comparison of orthodox versus off-optical axis endoscopic manipulations , 2001, Surgical Endoscopy And Other Interventional Techniques.

[17]  A Cuschieri,et al.  Objective assessment of endoscopic knot quality. , 1997, American journal of surgery.

[18]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[19]  R. Bergamaschi,et al.  Instruction Versus Passive Observation: A Randomized Educational Research Study on Laparoscopic Suture Skills , 2000, Surgical laparoscopy, endoscopy & percutaneous techniques.

[20]  W. McGaghie,et al.  Simulation technology for health care professional skills training and assessment. , 1999, JAMA.

[21]  B. Hannaford,et al.  Skills evaluation in minimally invasive surgery using force/torque signatures , 2000, Surgical Endoscopy.

[22]  M. Gagner.  Objective evaluation of a laparoscopic surgical skill program. , 1998, Archives of surgery.

[23]  D. Fenner,et al.  Development of a Bench Station Objective Structured Assessment of Technical Skills , 2001, Obstetrics and gynecology.

[24]  A. Gallagher,et al.  Objective Psychomotor Skills Assessment of Experienced, Junior, and Novice Laparoscopists with Virtual Reality , 2001, World Journal of Surgery.

[25]  M. Bridges,et al.  The financial impact of teaching surgical residents in the operating room. , 1999, American journal of surgery.

[26]  J. Fleiss.  The design and analysis of clinical experiments , 1987 .

[27]  R. Reznick,et al.  Assessment of technical skills transfer from the bench training model to the human model. , 1999, American journal of surgery.

[28]  A. Darzi,et al.  Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator , 1998, The Lancet.

[29]  S. Edge,et al.  Incorporation of laparoscopy into a surgical endoscopy training program. , 1992, American journal of surgery.

[30]  J. Rosser,et al.  Skill acquisition and assessment for laparoscopic surgery. , 1997, Archives of surgery.

[31]  V. Shayani,et al.  Determination of the learning curve of the AESOP robot , 1997, Surgical Endoscopy.

[32]  J. Bigger,et al.  The intern and sleep loss. , 1971, The New England journal of medicine.

[33]  G. Ahlberg,et al.  Does training in a virtual reality simulator improve surgical performance? , 2001, Surgical Endoscopy And Other Interventional Techniques.

[34]  B. Wolfe,et al.  Laparoscopic suturing evaluation among surgical residents. , 2000, The Journal of surgical research.

[35]  T. Bigger,et al.  Psychological problems associated with sleep deprivation in interns. , 1973, Journal of medical education.

[36]  J. Jakimowicz,et al.  The Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) objectifying subjective psychomotor test performance , 2002, Surgical Endoscopy And Other Interventional Techniques.

[37]  A Cuschieri,et al.  Assessment of innate ability and skills for endoscopic manipulations by the Advanced Dundee Endoscopic Psychomotor Tester: predictive and concurrent validity. , 1999, American journal of surgery.

[38]  C. D. Smith,et al.  A computer-based laparoscopic skills assessment device differentiates experienced from novice laparoscopic surgeons , 2001, Surgical Endoscopy.

[39]  P J Baldwin,et al.  Validity of surgical simulation for the assessment of operative skill , 2001, The British journal of surgery.

[40]  T. Dent.  Training, credentialing, and evaluation in laparoscopic surgery. , 1992, The Surgical clinics of North America.

[41]  Daniel B. Jones,et al.  Comparison of video trainer and virtual reality training systems on acquisition of laparoscopic skills , 2002, Surgical Endoscopy And Other Interventional Techniques.

[42]  Nathaniel J Soper,et al.  The effect of robotic assistance on learning curves for basic laparoscopic skills. , 2002, American journal of surgery.

[43]  A. Park,et al.  Transfer of training in acquiring laparoscopic skills. , 2001, Journal of the American College of Surgeons.

[44]  H. Lönroth,et al.  The transfer of basic skills learned in a laparoscopic simulator to the operating room , 2002, Surgical Endoscopy And Other Interventional Techniques.

[45]  G. Fried,et al.  Development of a model for training and evaluation of laparoscopic skills. , 1998, American journal of surgery.

[46]  S. Horgan,et al.  An objective scoring system for laparoscopic cholecystectomy. , 1999, Journal of the American College of Surgeons.

[47]  A. Gallagher,et al.  Virtual Reality Training in Laparoscopic Surgery: A Preliminary Assessment of Minimally Invasive Surgical Trainer Virtual Reality (MIST VR) , 1999, Endoscopy.

[48]  J. Rosser,et al.  Telementoring , 1997, Surgical Endoscopy.

[49]  R. Reznick,et al.  Teaching and testing technical skills. , 1993, American journal of surgery.

[50]  A. Gallagher,et al.  A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition. , 2000, American journal of surgery.

[51]  A. Darzi,et al.  Practice distribution in procedural skills training , 2002, Surgical Endoscopy And Other Interventional Techniques.

[52]  A. García-Ruiz,et al.  Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks. , 1998, Archives of surgery.

[53]  A. Gallagher,et al.  An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. , 1998, Endoscopy.

[54]  G. Fried,et al.  Comparison of laparoscopic performance in vivo with performance measured in a laparoscopic simulator , 1999, Surgical Endoscopy.

[55]  K. Brasel,et al.  Teaching anatomy with surgeons' tools: Use of the laparoscope in clinical anatomy , 2001, Clinical anatomy.

[56]  L. Kavoussi,et al.  Telesurgical mentoring , 1997, Surgical Endoscopy.

[57]  C D Smith,et al.  Assessing laparoscopic manipulative skills. , 2001, American journal of surgery.

[58]  E. Stephenson,et al.  Initial United States clinical trial of robotically assisted endoscopic coronary artery bypass grafting. , 2000, The Journal of thoracic and cardiovascular surgery.

[59]  R. Reznick,et al.  Testing technical skill via an innovative "bench station" examination. , 1997, American journal of surgery.

[60]  Benjamin R. Lee,et al.  Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? , 2002, Urology.

[61]  J. Rosser,et al.  Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. , 1998, Archives of surgery.

[62]  J. Rosser,et al.  Surgeon-specific factors in the acquisition of laparoscopic surgical skills. , 2001, American journal of surgery.

[63]  D A Rogers,et al.  Improving Continuing Medical Education for Surgical Techniques: Applying the Lessons Learned in the First Decade of Minimal Access Surgery , 2001, Annals of surgery.

[64]  R. Reznick,et al.  Reliability and construct validity of a structured technical skills assessment form. , 1994, American journal of surgery.

[65]  J. Sackier,et al.  A method of objectively evaluating improvements in laparoscopic skills , 1998, Surgical Endoscopy.

[66]  W. Melvin,et al.  Laparoscopic skills enhancement. , 1996, American journal of surgery.