Dry Lab Practice Leads to Improved Laparoscopic Performance in the Operating Room

Background

Research has demonstrated that practice in surgical simulators leads to improved performance in that simulator. Our hypothesis is that skills acquired in simulators are transferable to the operating room.

Materials and methods

Twenty-three laparoscopically naïve surgical interns performed two standardized tasks in a simulator: pegboard transfer and intracorporeal knot tying. Performance was measured using a validated scoring system. On the same day as this initial assessment, subjects were videotaped performing two tasks in a live porcine model: running the small bowel and intracorporeal knot tying. Performance in the porcine model was measured using a modified version of a validated skills assessment tool by two blinded experts. Following a 6-wk proficiency-based dry lab laparoscopic training course, task performance was re-evaluated. No interval live operative laparoscopic experience occurred between the first and second assessment.

Results

After training, mean pegboard transfer scores increased from 118.7 to 181.8 (theoretical maximum = 300; P < 0.01). Dry lab knot tying scores increased from 294.7 to 459.0 (theoretical maximum = 600, P < 0.01). In the porcine model, scores for the bowel running task increased from 8.5 to 13.5 (maximum score = 20 for both porcine tasks, P < 0.01). Knot tying scores increased from 7.3 to 14.3 (P < 0.01).

Conclusion

Practice in a simulator leads to improved performance in that simulator and in a live operative model. We believe that this is evidence that laparoscopic skills developed in a dry laboratory setting are transferable to the operating room.

Introduction

Since the late 1980s, the laparoscopic approach to common procedures has frequently been used. Laparoscopic procedures have gained momentum due to decreased morbidity, shorter hospital stays, and a quicker recovery compared with a more “traditional” open approach. The pressures of reduced resident work hours, increasing costs of operating room time, a focus on medical errors, and the ethics of learning basic laparoscopic skills on patients have contributed to the demand for establishing curricula to teach fundamental technical skills in the laboratory [1]. Simulator technology was first proven to be a useful teaching tool in the aviation industry, and has been effectively applied in the field of anesthesiology [2, 3]. Aviation training programs use simulators because of their low cost (relative to the cost of flying time), their effectiveness in producing expert pilots, and the potentially dangerous nature of flying. Similarly, in various publications, including a recent meta-analysis, simulators have been proven to be useful teaching tools in surgical education [4]. Specifically, surgical simulators have proven to be useful tools for laparoscopic surgical skills measurement and enhancement. A prospective randomized control trial of medical students showed statistically significant improvement on the majority of tasks after training [5].

Since implementing a laparoscopic skills training curriculum in our hospital for trainees, the subjective impression of attending surgeons who perform laparoscopic procedures is that residents are better prepared and more skilled surgeons than in years past. The aim of this study is to determine if this basic skills curriculum is indeed fostering the development of real surgical skills transferable to a live operative experience in the operating room.