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