A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying

Abstract

BackgroundTraining of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1–G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T 1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T 2) in the same manner than at T 1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T 3) in the same manner than at T 1 and T 2. At each repetition, scoring was based on the time taken for task completion system.ResultsThe scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001).ConclusionsOur data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.Electronic supplementary materialThe online version of this article (10.1186/s10397-017-1031-3) contains supplementary material, which is available to authorized users.

A comparison of laparoscopic procedures performed by novice medical students using 8K ultra-high-definition/two-dimensional and 2K high-definition/three-dimensional monitors

“…Carlos et al [ 14 ] showed that pre-training in hand–eye coordination with both the dominant and non-dominant hands shortens the learning curve. When the 8K UHD image quality was utilized with both hands, decent hand–eye coordination was achieved, and “pseudo 3D imaging” was obtained.…”

Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery

“…Comparing with single-hand manipulation, double-hand manipulation of the instruments was relatively easier for the operator to establish the laparoscopic depth perception [ 13 ]. In order to separate the peritoneum from the vas deferens conveniently, an assistant dissecting forceps was necessary for laparoscopic extraperitoneal closure of the internal ring.…”

“…For the novices, they not only faced with depth perception difficulty, but also eye-hand coordination difficulty. And double-hand manipulation was beneficial for depth perception and orientation perception, which were the cornerstones for laparoscopic surgery [ 13 , 14 ]. Umbilical one site two-port laparoscopic method achieved the same cosmetic effect with that of the single-port laparoscopic one [ 15 , 16 ].…”

A narrative review of psychomotor abilities in medical sciences

“…In open surgery, for example, the most critical attributes that a surgeon should possess are hand–eye coordination and finger dexterity. [ 9 ] In medical ultrasound imaging, psychomotor skills (visuomotor and visuospatial) are central. [ 10 ] Core abilities (e.g., psychomotor skills, visuospatial ability, and depth perception) are vital for catheter-based interventions, natural orifice transluminal endoscopic surgery, robotic surgery, and other procedural interventions.…”

“…[ 7 ] Laparoscopic surgery requires both surgical and psychomotor skills (e.g., camera navigation, hands–eyes coordination, and bimanual coordination). [ 9 11 ]…”