Laparoscopies
Development of a Model for Training and Evaluation of Laparoscopic Skills 1

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Abstract

Background: Interest in the training and evaluation of laparoscopic skills is extending beyond the realm of the operating room to the use of laparoscopic simulators. The purpose of this study was to develop a series of structured tasks to objectively measure laparoscopic skills. This model was then used to test for the effects of level of training and practice on performance.

Methods: Forty-two subjects (6 each of surgical residents PGY1 to PGY5, 6 surgeons who practice laparoscopy and 6 who do not) were evaluated. Each subject viewed a 20-minute introductory video, then was tested performing 7 laparoscopic tasks (peg transfers, pattern cutting, clip and divide, endolooping, mesh placement and fixation, suturing with intracorporeal or extracorporeal knots). Performance was measured using a scoring system rewarding precision and speed. Each candidate repeated all 7 tasks and was rescored. Data were analyzed by linear regression to assess the relationship of performance with level of residency training for each task, and by ANOVA with repeated measures to test for effects of level of training, of repetition, and of the interaction between level of training and repetition on overall performance. Student’s t test was used to evaluate differences between laparoscopic and nonlaparoscopic surgeons and between each of these groups and the PGY 5 level of surgical residents.

Results: Significant predictors of overall performance were (a) level of training (P = 0.002), (b) repetition (P < 0.0001), and (c) interaction between level of training and practice (P = 0.001). There was also a significant interaction between level of training and the specific task on performance scores (P = 0.006). When each task was evaluated individually for the 30 residents, 4 of the 7 tasks (tasks 1, 2, 6, 7) showed significant correlation between PGY level and score. A significant difference in performance scores between laparoscopic and nonlaparoscopic surgeons was seen for tasks 1, 2, and 6.

Conclusions: A model was developed to evaluate laparoscopic skills. Construct validity was demonstrated by measuring significant improvement in performance with increasing residency training, and with practice. Further validation will require correlation of performance in the model with skill in vivo.

Section snippets

Materials and Methods

The McGill Laparoscopic Simulation study involved 42 examinees (volunteers) in total. There were 6 residents from each of the 5 years of the general surgery residency program, 6 practicing laparoscopic surgeons, and 6 attending surgeons who do not practice laparoscopy. It was required that each examinee complete seven exercises in turn and then repeat them. The simulator consists of a laparoscopic trainer box measuring 40 × 30 × 19.5 cm (USSC Laptrainer, United States Surgical Corporation,

Statistics

The overall data were analyzed with analysis of variance (ANOVA) to test for the effects of level of training and repetition (and their interaction) on performance. Linear regression analysis was used to relate total performance scores and timing scores for each task to residents’ level of training. Correlation coefficients were calculated. Student’s t-test was used to test differences between laparoscopic and nonlaparoscopic attending surgeons, nonlaparoscopic surgeons versus PGY5 residents,

Results

The effect of level of training on performance was evaluated by ANOVA with repeated measures and was found to be a significant predictor of performance (P = 0.002). Linear regression analysis was used to correlate level of training with performance for each task individually. Overall four out of seven tasks (1, 2, 6, 7) showed a significant correlation (P <0.05) between PGY level and total scores. Table Isummarizes the correlation coefficients and P values for all seven exercises.

Timing score

Comments

Laparoscopic simulators have been used primarily as practicing tools. The simulator initially was constructed as a training model to assist surgeons in the development of coordination prior to application of a procedure in experimental animals.[4]Although not specifically designed to simulate a specific surgical operation, the laparoscopic trainer provides fundamental training for most laparoscopic skills used in the majority of surgical operations. In addition, many surgeons may not have

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This work was supported by an educational grant from United States Surgical Corporation (Auto Suture Canada).

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