A Data-Based Self-training Guideline for Laparoscopic Surgical Skills According to the Operative Experiences

Morimasa Tomikawa, MD, PhD, FACS1, Munenori Uemura, PhD1, Tomohiko Akahoshi, MD, PhD1, Kazuo Tanoue, MD, PhD, FACS2, Makoto Hashizume, MD, PhD, FACS1. 1Kyushu Univeristy, 2Ueno Hospital

Aim: To propose a data-based self-training guideline for laparoscopic surgical skills according to the operative experiences.

Methods: The trainees of the 2-day standardized laparoscopic surgical training program were divided into three groups according to their operative experiences of laparoscopic surgery; group N (novices, n=276), group M (intermediates, n=161) and group E (experts, n=145). Their skills for laparoscopic surgery were assessed by our originally-developed skills assessment task in box trainer with suturing and knot tying. Times taken for suturing and knot tying, the number of completed sutures, and the errors during suturing were recorded. A three-dimensional electromagnetic tracking system (AURORA; Northern Digital Inc. Canada) was used to analyze the path lengths and the speeds of the hand motions. The data at the beginning of the program were compared with those at the end, and did among the 3 groups.

Results: In all 3 groups (N/M/E), suturing and knot tying times at the end of the program (121.4/111.1/99.6 seconds) were significantly shorter than those at the beginning (209.7/187.3/164.2) (all P < 0.001). The significant differences of the times among the 3 groups each other at the beginning remains even at the end (P < 0.05). While the significant differences of the times spent at the first suture and knot tying among the 3 groups at the beginning (P<0.05) remains at the end of the program, the significant differences of the times spent at the second knot tying among the 3 groups at the beginning (P<0.05) disappeared at the end. The significant differences of the number of completed sutures among the 3 groups at the beginning (2.0/2.4/3.1) remains at the end of the program (4.0/4.5/4.9) (P<0.05). Errors increased in all 3 groups at the end of the program. In group N, the path length of the left hand significantly increased at the end of the program (P < 0.05). In group M, the path length of the right hand significantly increased at the end (P < 0.05). However, in group E, the path lengths of both hands did not change.

Conclusions: The amount of surgeons’ experiences reflects the changes of the speeds and the qualities of suturing and knot tying after the short-term training. While novices should focus on non-dominant hand motion, intermediates should focus on bi-hand motions. It is feasible to propose a data-based self-training guideline for laparoscopic surgical skills according to the operative experiences.

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