Introduction: Laparoscopic simulators are utilized as an integral part of pre-clinical OR surgical training and proficiency assessment. Currently no standard model for teaching laparoscopic colectomy exists. We hypothesized that performance on a laparoscopic colectomy simulator would correlate with key laparoscopic skills and level of clinical volume and expertise.
Methods: 15 surgeons participated in this study which was conducted in the SAGES Learning Center (2008). Laparoscopic skill level was measured by a portion of the Fundamentals of Laparoscopic Surgery (FLS) skills test. Each surgeon then performed a hand-assisted laparoscopic sigmoid colon resection on the Haptica (Hapitca, Inc, Dublin, Ireland) Laparoscopic Colectomy Simulator. Pre and post-procedure questionnaires were utilized to stratify level of training, clinical experience, and subjective impressions of the simulation experience. A blinded independent expert graded simulation trays at a time remote from the trial. Both data sets were subject to correlation analysis using 2-tailed Pearson test of the SPSS software (SPSS, Inc.). Additionally, cumulative simulator performance scores were tested for correlation with the data subsets of FLS-style suturing score and participant’s annual volume of laparoscopic basic cases, advanced cases, and separately, laparoscopic colorectal procedures.
Results: The cumulative performance score on the simulator positively correlated with the combined score of the results of the survey and FLS-style intracorporeal suturing: Pearson Correlation Coefficient of 0.533, p=0.041. The highest correlation level was achieved between the simulator scores and intracorporeal suturing: 0.723, p=0.002. There was also a strong positive correlation between the performance on the simulator and annual laparoscopic colorectal surgical volume: 0.603, p=0.017. A trend was noted in the relationship between the performance on the simulator and cumulative annual advanced laparoscopic surgical volume of advanced: 0.470, p=0.077. Finally, we elucidated no significant correlation between the simulated procedural performance and basic laparoscopic surgical volume: 0.290, p=0.295.
Conclusion: The proficiency level of the FLS-style intracorporeal suturing is a strong predictive factor for performance on the Haptica HALC surgical simulator. Moreover, experience performing laparoscopic colon surgery is also a strong predictive factor for simulation performance indicating that the current laparoscopic colon simulator is valid as a model. The correlation between level of training/experience and simulation performance indicates that the simulator is a valid tool and potentially can be effective for teaching laparoscopic colectomy skills outside the operating room.
Session: Podium Presentation
Program Number: S016