Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator

Abstract

The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand-eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparoscopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.

Training in laparoscopic surgery: From the lab to the or

“…At T3, all the groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups ( Figure 5) [22].…”

“…Laparoscopic camera navigation, hand-eye coordination and bimanual coordination are the specific LPS aimed to be trained and measured using the LASTT model [22].…”

“…When any objectives were accomplished, a value of 0.5 was assigned. Since some participants may not complete the task in the assigned time, the final score was obtained by dividing the actual time taken by the number of objectives effectively accomplished [22].…”

“…We have hypothesised that mastering basic LPS will facilitate the acquisition of more advanced LPS and have conducted a study to test this logical hypothesis using 60 gynaecologists with no experience in laparoscopy. HEC was used to assess the basic LPS, while laparoscopic intra-corporeal knot tying (LICK) was used to assess advanced LPS [22]. HEC was performed and scored as described above.…”

“…HEC was performed and scored as described above. LICK was performed using a soft pad with premounted sutures using the gladiator technique and scored as described elsewhere [22]. The participants were randomly allocated to three different groups to follow different HEC training programs and similar LICK training programs.…”