Abstract
Background
Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills.
Methods
Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion.
Results
92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P < 0.0001) and precision cutting (P < 0.0001) were significantly more difficult. Males performed significantly better than females (P < 0.005). For LS, a deterioration of skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A–C) (P < 0.05).
Discussion
Our data reveal that complex laparoscopic tasks (cutting) and techniques (SILS) are more difficult to learn and acquired skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.
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References
Santos BF, Enter D, Soper NJ, Hungness ES (2011) Single-incision laparoscopic surgery (SILS) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator. Surg Endosc 25(2):483–490
Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, Oh ST (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254(6):933–940
Pucher PH, Sodergren MH, Singh P, Darzi A, Parakseva P (2013) Have we learned from lessons of the past? A systematic review of training for single incision laparoscopic surgery. Surg Endosc 27(5):1478–1484
Alevizos L, Brinkman W, Fingerhut A, Jakimowicz J, Leandros E (2012) Novice surgeons versus experienced surgeons in laparoendoscopic single-site (LESS) surgery: a comparison of performances in a surgical simulator. World J Surg 36(5):939–944
Santos BF, Reif TJ, Soper NJ, Hungness ES (2011) Effect of training and instrument type on performance in single-incision laparoscopy: results of a randomized comparison using a surgical simulator. Surg Endosc 25(12):3798–3804
Varley M, Choi R, Kuan K, Bhardwaj N, Trochsler M, Maddern G, Hewett P, Mees ST (2015) Prospective randomized assessment of acquisition and retention of SILS skills after simulation training. Surg Endosc 29(1):113–118
Khandelwal S, Wright AS, Figueredo E, Pellegrini CA, Oelschlager BK (2011) Single-incision laparoscopy: training, techniques, and safe introduction to clinical practice. J Laparoendosc Adv Surg Tech A 21(8):687–693
Muller EM, Cavazzola LT, Grossi JVM, Mariano MB, Morales C, Brun M (2010) Training for laparoendoscopic single-site surgery (LESS). Int J Surg 8(1):64–68
Wu AS, Podolsky ER, Huneke R, Curcillo PG (2010) Initial surgeon training for single port access surgery: our first year experience. Jsls 14(2):200–204
Stroup SP, Bazzi W, Derweesh IH (2010) Training for laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery. BJU Int 106(6 Pt B):934–940
Lewis T, Aggarwal R, Kwasnicki R, Darzi A, Paraskeva P (2012) Does previous laparoscopic experience improve ability to perform single-incision laparoscopic surgery? Surg Endosc 26(5):1214–1219
Fransen SA, Mertens LS, Botden SM, Stassen LP, Bouvy ND (2012) Performance curve of basic skills in single-incision laparoscopy versus conventional laparoscopy: is it really more difficult for the novice? Surg Endosc 26(5):1231–1237
Bonrath EM, Weber BK, Fritz M, Mees ST, Wolters HH, Senninger N, Rijcken E (2012) Laparoscopic simulation training: testing for skill acquisition and retention. Surgery 152(1):12–20
Stefanidis D, Korndorffer JR Jr, Sierra R, Touchard C, Dunne JB, Scott DJ (2005) Skill retention following proficiency-based laparoscopic simulator training. Surgery 138(2):165–170
Gallagher AG, Jordan-Black JA, O’Sullivan GC (2012) Prospective, randomized assessment of the acquisition, maintenance, and loss of laparoscopic skills. Ann Surg 256(2):387–393
Stefanidis D, Walters KC, Mostafavi A, Heniford BT (2009) What is the ideal interval between training sessions during proficiency-based laparoscopic simulator training? Am J Surg 197(1):126–129
Akdemir A, Zeybek B, Ergenoglu AM, Yeniel AO, Sendag F (2014) Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills. Int J Gynaecol Obstet 127(3):309–313
Spruit EN, Band GP, Hamming JF (2015) Increasing efficiency of surgical training: effects of spacing practice on skill acquisition and retention in laparoscopy training. Surg Endosc 29(8):2235–2243
Donnon T, DesCoteaux JG, Violato C (2005) Impact of cognitive imaging and sex differences on the development of laparoscopic suturing skills. Can J Surg 48(5):387–393
Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy. Surg Endosc 17(7):1082–1085
Acknowledgments
The authors thank the Royal Australasian College of Surgeon (RACS) for loan of the two FLS box trainers and their substantial support.
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Mr. Ellis, Dr Varley, Mr Howell, Dr Trochsler, Prof Maddern, Prof Hewett, Dr Runge and Dr Mees have no conflicts of interest or financial ties to disclose.
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Tina Runge and Soeren Torge Mees have contributed equally to the study.
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Ellis, S.M., Varley, M., Howell, S. et al. Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study. Surg Endosc 30, 3386–3390 (2016). https://doi.org/10.1007/s00464-015-4619-6
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DOI: https://doi.org/10.1007/s00464-015-4619-6