Prospective, Randomized, Double-Blind Trial of Curriculum-Based Training for Intracorporeal Suturing and Knot Tying

Van Sickle, Kent R.; Ritter, E. Matt; Baghai, Mercedeh; Goldenberg, Adam E.; Huang, Ih-Ping; Gallagher, Anthony G.; Smith, C. Daniel

doi:10.1016/j.jamcollsurg.2008.05.007

« Previous Next »Journal of the American College of Surgeons
Volume 207, Issue 4 , Pages 560-568, October 2008

Prospective, Randomized, Double-Blind Trial of Curriculum-Based Training for Intracorporeal Suturing and Knot Tying

Kent R. Van Sickle, MD
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
- Correspondence address: Kent R Van Sickle, MD, University of Texas Health Science Center San Antonio, Department of Surgery, 7703 Floyd Curl Dr, Mail Code 7842, San Antonio, TX 78229-3900
E. Matt Ritter, MD, FACS
- NCA Medical Simulation Center, Uniformed Services University of the Health Sciences, Bethesda, MD
Mercedeh Baghai, MD
- Emory Simulation Training and Robotics (ESTAR), Emory University School of Medicine, Atlanta, GA
Adam E. Goldenberg, MD
- Emory Simulation Training and Robotics (ESTAR), Emory University School of Medicine, Atlanta, GA
Ih-Ping Huang, MD
- Emory Simulation Training and Robotics (ESTAR), Emory University School of Medicine, Atlanta, GA
Anthony G. Gallagher, PhD
- Royal College of Surgeons Ireland, Dublin, Ireland
C. Daniel Smith, MD, FACS
- Mayo Clinic Jacksonville, Jacksonville, FL

Received 24 January 2008; received in revised form 5 May 2008; accepted 6 May 2008. published online 14 July 2008.

Background

Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic suturing and knot tying.

Study Design

Senior surgery residents in a university-based general surgery residency program were prospectively enrolled and randomized to receive either a simulation-based laparoscopic suturing curriculum (TR group, n=11) or standard clinical training (NR group, n=11). During a laparoscopic Nissen fundoplication, placement of two consecutive intracorporeally knotted sutures was video recorded for analysis. Operative performance was assessed by two reviewers blinded to subject training status using a validated, error-based system to an interrater agreement of≥80%. Performance measures assessed were time, errors, and needle manipulations, and comparisons between groups were made using an unpaired t-test.

Results

Compared with NR subjects, TR subjects performed significantly faster (total time, 526±189 seconds versus 790±171 seconds; p < 0.004), made significantly fewer errors (total errors, 25.6±9.3 versus 37.1±10.2; p < 0.01), and had 35% fewer excess needle manipulations (18.5±10.5 versus 27.3±8.6; p < 0.05).

Conclusions

Subjects who receive simulation-based training demonstrate superior intraoperative performance of a highly complex surgical skill. Integration of such skills training should become standard in a surgical residency's skills curriculum.

Abbreviations and Acronyms: KQS, knot quality score, MIS, minimally invasive surgery, MIST-VR, minimally invasive surgical trainer–virtual reality, NR, standard clinical training, PicSOr, Pictorial Surface Orientation test, PQS, performance quality score, TR, simulation-based laparoscopic suturing curriculum