Introduction: The use of virtual simulation has been validated for the acquisition and development of laparoscopic surgical skills. Accordingly, a training curriculum for basic laparoscopic skills in our residency program has been developed. This curriculum was used in the present study to evaluate the sensibility of different variables for detecting skill acquisition and the impact of hand dominance; later validated in an in-vivo porcine model.
Methods: Case-control study using the LapSIM® laparoscopic surgery virtual simulator (Surgical Science®) with the LapSIM Basic Skills 3.0 software (11 tasks, medium difficulty). A basic skills curriculum was previously developed with twenty subjects being exposed to 10 repetitions for each task, with ten hour maximum training time. Their scores improvement was analyzed, thus discriminating “easy” from “difficult” tasks (5 vs. 10 repetitions), establishing our basic training curriculum. The latter was used accordingly to compare 14 subjects from the training group vs. 8 controls, executing 3 specific tasks (fine dissection, cut and coagulation, suturing) in an in-vivo model. Sessions were recorded, and a blind evaluation of the videos was performed by two experienced laparoscopic surgeons. Time was registered and a specific score given for each of the completed tasks.
Results: In the virtual simulator, the most sensitive variable for detecting skill acquisition was “total score” followed by “total time” (p‹0.05). There was a significant difference in score and total time among controls and subjects in the in-vivo model (p‹0.05, statistical power ›85%).
The most improved skill was suturing. Furthermore, there was a positive correlation between the results obtained during the training with the simulator and the results obtained after the in vivo model evaluation. There was no difference with variable hand dominance in performance or skill development.
Conclusions: A basic laparoscopic skills curriculum has been developed and validated in our institution. The latter allows for optimal results when applying the skills developed to an in-vivo model. This could translate to better results, faster learning curves and less morbidity in the operating room. A basic skill curriculum for specific surgical techniques is being developed accordingly.
Program Number: P222