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

• Published in: Journal of the American College of Surgeons Vol. 207; no. 4; pp. 560 - 568
• Main Authors: Van Sickle, Kent R., MD, Ritter, E. Matt, MD, FACS, Baghai, Mercedeh, MD, Goldenberg, Adam E., MD, Huang, Ih-Ping, MD, Gallagher, Anthony G., PhD, Smith, C. Daniel, MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2008; Elsevier Science
• Subjects: Biological and medical sciences; Competency-Based Education; Computer-Assisted Instruction; Curriculum; Double-Blind Method; Education, Medical, Undergraduate; Educational Measurement; Fundoplication - education; General aspects; Humans; Laparoscopy; Medical sciences; Prospective Studies; Surgery; Suture Techniques - education; minimally invasive surgical trainer–virtual reality; minimally invasive surgery; NR; MIST-VR; standard clinical training; KQS; Pictorial Surface Orientation test; PQS; PicSOr; knot quality score; MIS; performance quality score; TR; simulation-based laparoscopic suturing curriculum; Medicine; Educational program; Prospective; Randomization; Treatment; Surgery; Double blind study; Clinical trial; Teaching
• ISSN: 1072-7515; 1879-1190; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2008.05.007

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.