Effectiveness of Learning Advanced Laparoscopic Skills in an Intensive Laparoscopic Training Program

Erwin Buckel, MD, Pablo Achurra, MD, Julian Varas, MD, Carla Faivovich, MD, Jorge Martinez, MD, Napoleon Salgado, MD, Nicolas Jarufe, MD, Camilo Boza, MD

Faculty of Medicine,. Pontificia Universidad Catolica de Chile, Department of Digestive Surgery.

Introduction: Nowadays most simulated advanced laparoscopic training programs exist under a curricular-based training program or in the form of short training courses. There is little evidence on how effective short courses can be for learning laparoscopic skills or on how to create a successful teaching experience.

Aim: To propose an intensive 6-session training course for improving advanced laparoscopic skills and to demonstrate if these skills are transferred into a more complex live model.

Methods and Procedures: Trainees were analyzed after the completion of a 2-week advanced laparoscopy diploma course aimed for surgeons and surgical residents with none or little advanced laparoscopic experience. Trainees underwent a 6 session advanced laparoscopy course that included an initial (IA), 4 training sessions and a final assessment (FA). Both assessments consisted in performing a stapled jejuno-jejunostomy on a live porcine model within a 40 minute time limit. Procedures were video recorded and analyzed by two blinded experts using validated global (GRS) and procedure-specific (SRS) rating scales. Operative time and procedure completion was also registered. Training sessions consisted of three 160-minute periods of simulated laparoscopy training on a validated bench model of ex-vivo bovine intestinal bowel. Simulation was completed under supervision of an expert tutor giving effective feedback for the specific tasks needed to perform a stapled jejuno-jejunostomy. Results were compared between each group. A post-hoc analysis was performed comparing performance and improvement in different age categories.

Results: 127 subjects were recruited for this study (7 courses, 2006-2012). Students improved significantly in all categories after the training course (results shown in Table 1). The 50-66 age category had significantly lower performance scores and overall skill improvement in regards to trainees under 50 (Table 2).

Table 1: Results for initial and final assessments

IA (n=127)FA (n=127)P value
GRS8 (4-14)15 (5-22)<0.001
SRS9 (5-19)12 (5-18)<0.001
Operative Time (minutes)34.7 (11.5-40)23.5 (11-40)<0.001
Completion Percentage63%89%<0.001

Table 2: Results obtained for each age category

20-35 yrs.36-50 yrs.51-66 yrs.P value
GRS16 (10-22)15 (7-21)11,5 (5-15)0,001
SRS13 (7-17)12 (6-18)9,5 (5-15)0,030
Operative Time in FA (minutes)22,3 (11,6-40)25 (14,6-40)37,9 (27,8-40)0,001
Improvement in Op. Time.9,9 (-6 -28)8 (-4-25)0,3 (-8-12)0,019

Conclusions: Trainees significantly improved their advanced laparoscopic skills at the end of the training course, showing their improvement on a more complex live model. Trainees over the age of 50 had a significantly worse performance in all categories than other age groups.

Session: Poster Presentation

Program Number: P160

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