Objective Evaluation of a Laparoscopic Surgical Skill Program for Residents and Senior Surgeons

Abstract

Background: Laparoscopic surgery adapts poorly to apprenticeship models for general surgical training. Standardized skill acquisition and validation programs, targeted performance goals, and a supervised, enforced, skill-based curriculum that readily can be shared between trainee and instructor must replace the observation and incremental skill-acquisition model used in an open surgical environment. The Yale Laparoscopic Skills and Suturing Program was used to develop a data bank for objective evaluation of dexterity and suturing skills for laparoscopic surgical training. The current study compares trainee and senior surgeon performance in this standardized training program. Objective: To compare objectively evaluated laparoscopic surgical skills and suturing capability of senior surgeons and of residents after they have completed the same standardized training regimen. Methods: Two hundred ninety-one trained surgeons performed 8730 standardized laparoscopic dexterity drills and 2910 intracorporeal suturing exercises in the Yale Laparoscopic Skills and Suturing Program. Their performance was supervised by an instructor who recorded performance and timing of the tasks in a 2 1 ⁄2-day program. Ninety-nine residents performed the same drills and exercises the same number of times and followed the same technique for intracorporeal suturing. Percentile graphs were prepared for each type of drill and suturing exercise to allow comparison of levels of achievement among different training groups. Results: The performance of the residents was the same as that of trained surgeons for the rope pass drill and the suturing exercise. Residents in comparison with trained surgeons performed the triangle transfer drill faster and the new cup drop drill and old cup drop drill more slowly. There was no significant difference in performance between male and female residents. Conclusion: Basic skills relevant to laparoscopic performance can be acquired with a high level of competence in a brief course unrelated to prior surgical experience, sex, or age.

Objective assessment of endoscopic surgical skills by analyzing direction-dependent dexterity using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD)

“…The time taken to perform a procedure has always been considered one of the most important measurements. 13,14 Indeed, our results showed that the time taken by the expert group to perform Task 1 and Task 2 was signifi cantly shorter than the time taken by the novice group (Fig. 4).…”

Metrics for Laparoscopic Skills Trainers: The Weakest Link!

“…The first non-computer based laparoscopic skills trainers incorporated empirical outcome metrics as an indirect way to evaluate performance and learning. Performance, however, cannot be evaluated solely on the basis of the outcome [15]. With the advent of computer simulation it became apparent that it will be possible to define specific metrics that can be used effectively and efficiently to evaluate performance [17].…”

“…A major part of the learning process, however, relies on an apprenticeship model according to which an expert surgeon qualitatively assesses the performance of the novice 1 [15]. In order to define a quantitative performance metric that is useful across a large variety of tasks, we looked at the way expert surgeons instruct and comment upon the performance of novices in the operating room.…”

“…Time to perform the task as well as outcome of the task are two other important aspects of the "success" of a task that we decided to include [15,11,16]. Finally, in order to transform these parameters into quantitative metrics, we relied on kinematics analysis theory that has been successfully used in previous work to study psychomotor skills [10].…”

“…There are various ways of evaluating z 0 and it can be either a binary measure (z 0 = 0 for success, z 0 = 1 for failure), or a more complex measure, as introduced by several authors [15,16]. Similarly, α i is the coefficient for a particular parameter P i .…”