Prospective Randomized Trial of Transfer of Training in the Development of Intracorporeal Suturing Skill in Novices

Introduction: Teaching minimally invasive surgical skills outside the operating room is a pressing need. In addition to the usual challenges of learning new skills, trainees have to contend with a loss of depth perception and movement in laparoscopy. Our study aims to help delineate what type of training is of benefit to learning intracorporeal suturing in novices.
Methods: 41 first to fourth year medical students were recruited in this study and trained initially for one hour in intracorporeal suturing. Subjects were then tested on a pig intestine enterotomy model (Pre-test) and scored for speed, accuracy, and knot quality. Mental workload was also assessed with the NASA – Task Load Index (NASA-TLX) scale, a series of questions that generates a score reflecting the cognitive demand of a task. Subjects were then randomly assigned to one of four different training arms: laparoscopic suturing (Lap Sut); laparoscopic drills (Lap Drills); open suturing (Open Sut); and virtual reality drills (VR). All groups trained for six 20-minute sessions over three weeks. At the end of the sixth session, subjects were re-tested on the enterotomy model (Post-test).
Results: After removing 2 pre-test outliers (>2 SD from mean), data from 39 subjects were compared using pre-post paired t-tests on the 4 dependent measures. All groups except VR showed statistically significant improvement in at least two measures, suggesting some transfer of training (see below). While task time was improved in all groups except VR, knot quality improved only in those who practiced suturing, either open or laparoscopic. Mental workload improved only for those practicing on a real-world laparoscopic trainer, as demonstrated by a significant lowering of the NASA-TLX score.Conclusions: In novice surgical trainees, there appears to be limitations in the efficacy of current VR training, perhaps related to limited haptics and model fidelity. In contrast, there were benefits to the other training methods for time, quality, and, importantly, perceived workload. This includes some transfer of training from open to laparoscopic suturing, an effect not seen in previous studies with more experienced subjects.


Session: Poster

Program Number: P157

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