Prospective randomised controlled blinded study to evaluate the effect of short term focused training program in laparoscopy on operative room performance of surgery resident.

Virinder K Bansal, MS, FACS, M C Misra, Rahul Raveendran, Hemanga K Bhattacharjee, Karthik Rajan, Subodh Kumar, Asuri Krishna

Minimally Invasive Surgery Training Center, Department of Surgical Disciplines, All India Institute of Medical sciences, New Delhi,

Introduction
The role of training in laparoscopic surgery cannot be overemphasised. There are various methods of laparoscopic training ranging from inanimate box trainers to virtual reality trainers. Although there are many studies which have shown that training helps in improving the operative room performance of the trainees, but no single method of training has been evaluated which can be easily integrated into the the curriculum of residency programs. We have shown in our previous studies that training on Tuebingen Trainer with integrated porcine organs helps the trainees in effectively acquiring laparoscopic skills. This study was intended to assess the transferability of skills acquired in the trainer to real operation room.

Materials and methods
Seventeen General surgery residents were randomized into 2 groups, ie Laparoscopic Training Group (n=9) and Standard Training Group (n=8). Nine residents from Laparoscopic Training Group underwent training on the porcine phantom model in a five day short term focussed training program and performed ten laparoscopic cholecystectomies on the phantom model and eight residents in Standard Training Group did not undergo training in laparoscopic surgery. All the participants performed a laparoscopic cholecystectomy in the operation theatre with a consultant as camera man who was blinded to the training status of the participants. The performance of the residents in both groups in the operation theatre was assessed using GOALS criteria, Surgical performance assessment parameters, task specific checklists and Visual Analogue Scale (VAS) for gallbladder difficulty and overall competence.

Results
The base line skills of both groups of residents were similar on the phantom porcine model. The Laparoscopic Training Group showed statistically significant improvement in all domains of GOALS criteria with training. The participants were able to identify the plane of dissection accurately and the incidence of gallbladder perforation decreased with training. When the performance of both the groups were compared in the operation theatre the Laparoscopic Training Group had statistically significant better performance than the Standard Training Group with regards to operation time, GOALS criteria and Task specific checklists. Although the Surgical performance assessment i.e. cystic duct and artery identification scores, gallbladder perforation and liver injury scores were better in the Laparoscopic Training Groups it was not was not statistically significant. The overall difficulty of the surgery was comparable in both the groups. The Training Group exhibited significantly more overall competence levels on the visual analogue scale (VAS) scores.

Conclusion
The short term focused training program in the Tuebingen MIC trainer significantly improved the laparoscopic skills of the residents which help them to perform laparoscopic cholecystectomy better in the operating room as compared to the residents who do not undergo training. This training model is a cheap and effective method of learning laparoscopic skills which can be easily integrated into the surgical curriculum of the residency program.


Session: Poster Presentation

Program Number: P186

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