C2B - 07: ADVANCED LAPAROSCOPIC SKILLS: UNDERSTANDING THE RELATIONSHIP BETWEEN SIMULATION-BASED PRACTICE AND CLINICAL PERFORMANCE.
Dmitry Nepomnayshy, MD1, Shanley Deal2, Adnan Alseidi, MD2, Richard Birkett, MD3, James Whitledge4, Aimee Gardner, PhD5, Biba Nijaar5, Dimitrios Stephanidis, MD, PhD6, Rafia Duvra6, Shimae Fitzgibbons, MD7; 1Lahey Hospital, 2Virginia Mason, 3University of Pennsylvania, 4Tufts, 5Baylor, 6Indiana University, 7Georgetown
INTRODUCTION: The advanced laparoscopic skills (ALS) curriculum was created to address the need for improved laparoscopic training for senior surgical trainees. This study examines the impact of the curriculum on improvement in clinical laparoscopic suturing.
METHODS: All PGY level surgery residents from multiple institutions were invited to complete the ALS curriculum. Skill improvement was determined via completion of the 6 ALS tasks and performance on a porcine gastrojejunostomy (GJ) and Nissen before and after training. Video-recorded performance was de-identified and scored using time in seconds and a laparoscopic suturing assessment (29=highest score) by 3 expert laparoscopic surgeons.. Paired t-tests examined performance differences before and after the curriculum. Pearson correlations examined the relationship among performance on the porcine, and ALS tasks.
RESULTS: Twelve residents from 4 institutions ranging from PGY1-8 completed the study. Average practice time on ALS tasks was 6.25 weeks (1-14 weeks) and 254 minutes (140-600min). Combined ALS task time decreased from 2748s±603s to 1756s±281s (p<0.001). Each of the 6 task times significantly improved (p<0.05). Total errors decreased from 5.8±3.2 to 3.7±1.9 (p<0.05). Among individual tasks, errors decreased significantly only for the continuous suturing task 2.5±2.0 to 1.0±1.3 (p<0.05). Average GJ times decreased from 1043s±698s to 643s±183s (p=0.055) and scores increased from 15.4±4.1 to 16.7±2.3 (p=0.190). Average Nissen times decreased from 990s±531s to 685s±265s (p<0.05) but scores did not increase significantly 17.8±3.4 to 18.7 ±3.8.
Shorter (better) final GJ and Nissen performance times were associated with shorter initial ALS times (GJ: r=0.61,p<0.05; Nissen r=0.41, p=.181) and significantly fewer initial ALS errors (GJ r=0.619, p<0.05, Nissen r=0.62, p<0.05). Duration of practice in weeks was associated with shorter (better) final GJ and Nissen performance times but the associations were not statistically significant (GJ r=-0.457, p=.157, Nissen r=0.349, p=.292).
CONCLUSION: More time practicing the six ALS tasks resulted in significant improvement in ALS tasks, porcine GJ, and Nissen suturing performance. Initial ALS task performance and ALS errors correlated with porcine suturing performance. Further studies will be undertaken to determine the optimal application of the ALS task set in advanced laparoscopic training.