Contribution of simulation in paediatric laparoscopic surgery: improving suturing skills before performing a laparoscopic procedure in children

Abstract

Introduction Mastering paediatric laparoscopic surgery competency (PLSC) is technically challenging. The present study aimed to determine whether the inter-academic PLSC degree (IAD_PLSC) practical training program enables trainees to improve their skills. Methods This retrospective study included trainees enrolled in the IAD_PLSC program in 2021 and 2022 which included two separate 12 h-sessions. Trainees practiced to perform intracorporeal laparoscopic knots (ILK) using 5- and 3-mm instruments on a pelvi-trainer simulator; Peg Transfer (PT) was used as a dexterity test; final marks added the adapted Objective Structured Assessment of Technical Skills (OSATS) score (out of 40) and time to complete ILK. ILK was considered a success in case the OSATS score > 27/40. Results A total of 43 trainees completed the IAD_PLSC program. N = 37 (86.0%) mastered the ILK (OSATS score > 27/40) using 5-mm instruments at the end of session 1 and N = 33 (76.7%) at the end of session 2 ( p = 0.41). There was no significant improvement in the median [interquartile range, IQR] OSATS score (32 [30–36] vs. 32 [28–34], p = 0.19), but the median [IQR] knot completion time improved significantly (184 s [161–268] vs. 166 s [128–218], p = 0.002). There was a significant correlation between the knot completion time and PT time at the end of session 1 (ρ = 0.58, 95% confidence interval, CI [0.31;0.76], p < 0.0002) and session 2 (ρ = 0.78, 95%CI [0.62;0.87], p < 0.0001). When using 3-mm instruments, N = 34 (79.1%) of trainees mastered the ILK at the end of session 2. The median [IQR] OSATS score significantly improved between the end of the two sessions (22 [21–24] vs. 31 [28–33], p < 0.0001), but there was no significant correlation between OSATS score or knot completion time and PT time, at the end of both sessions. Conclusion A nation-wide training program in paediatric laparoscopic surgery provides valuable practical training of intracorporeal suturing for residents in pediatric surgery and urology.