Dr Daniel Scott and colleagues from New Orleans developed a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness of the curriculum.
The researchers included 17 surgical residents proficient in basic skills, but with minimal laparoscopic suturing experience.
| Mean time to simulator proficiency was 151 minutes and 37 attempts
|Journal of American College of Surgeons|
The research team conducted a randomized controlled protocol.
Subjects viewed an instructional video and were pretested on a live porcine laparoscopic Nissen fundoplication model.
The team instructed the subjects to place 3 gastrogastric sutures tied in an intracorporeal fashion.
A blinded rater objectively scored each knot based on a previously published formula.
The team reported that the formula used was 600 minus completion time in seconds minus penalties for accuracy and knot integrity errors.
The researchers stratified subjects according to pretest scores.
The trained group practiced on a videotrainer suturing model until an expert-derived proficiency score of 512 was achieved on 12 attempts.
The team reported that the control group received no training and both groups were posttested on the porcine Nissen model.
The researchers found that for the training group, mean time to demonstrate simulator proficiency was 151 minutes and a mean number of attempts was 37.
The team observed that both the trained and control groups demonstrated significant improvement in overall score from baseline.
However, the trained group performed significantly better than the control group at posttesting, confirming curriculum effectiveness.
Dr Scott's team concludes, “These data suggest that training to a predetermined expert level on a videotrainer suture model provides trainees with skills that translate into improved operative performance.”
“Such curricula should be further developed and implemented as a means of ensuring proficiency.”