Langenbeck's Archives of Surgery

, Volume 403, Issue 2, pp 271–278 | Cite as

Conception of the Lübeck Toolbox curriculum for basic minimally invasive surgery skills

  • Tilman Laubert
  • Hamed Esnaashari
  • Paul Auerswald
  • Anna Höfer
  • Michael Thomaschewski
  • Hans-Peter Bruch
  • Tobias Keck
  • Claudia Benecke



Difficulties at the beginning of the learning curve in minimally invasive surgery (MIS) can well be overcome by simulation outside the operating room. Despite a great number of available devices, standardized, structured, and validated training curricula for video simulators are scarce.


The Lübeck Toolbox (LTB) video trainer provides six training modules and online video tutorials. Proficiency levels for the tasks were defined by performance analysis of MIS experts (n = 15). Mean values of the best performed repetitions were set as benchmarks for a validation study with n = 30 MIS novices and the learning curves calculated. The novices performed a cholecystectomy on a pig organ model before and after the curriculum which were analyzed using the GOALS score.


Benchmarks defined by expert performance for the task Nos. 1 to 6 were 72 s (± 8) (Pack Your Luggage), 49 s (± 9) (Weaving), 66 s (± 10) (Chinese Jump Rope), 89 s (± 28) (Triangle Cut), 138 s (± 44) (Hammer Cut), and 98 (± 22) (Suturing). The median numbers of required repetitions by the novices to reach the proficiency level were n = 42 (7–80), n = 26 (9–55), n = 32 (14–77), n = 44 (15–59), n = 19 (6–68), and n = 26 (15–60). These values were all located at the beginning of the plateau phase of the learning curves. GOALS score improved significantly after completion of the curriculum (18.0 (± 2.6) vs. 10.9 (± 1.6), p < 0.0001).


The LTB curriculum constitutes a new highly standardized and proficiency level-based training program for basic skills in MIS. Transferability of the task content to a (sub)-realistic environment could be demonstrated. Still, future trials will have to further validate the effectiveness of the LTB curriculum.


Laparoscopy Training Simulation Lübeck Toolbox Education Minimally invasive surgery 



We thank Freya Zielke for her tedious and reliable work throughout the study.

Authors’ contributions

Study conception and design: TL, HE, AH, H-PB; acquisition of data: HE, PA, AH, MT; analysis and interpretation of data: TL, PA, AH, TK; drafting of the manuscript: TL, CB; critical revision of the manuscript: all authors

Compliance with ethical standards

Conflict of interest

Tilman Laubert and Hamed Esnaashari are co-founders of LTB Ltd.

Paul Auerswald, Anna Höfer, Hans-Peter Bruch, Tobias Keck, and Claudia Benecke declare that they have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Tilman Laubert
    • 1
  • Hamed Esnaashari
    • 1
  • Paul Auerswald
    • 1
  • Anna Höfer
    • 1
  • Michael Thomaschewski
    • 1
  • Hans-Peter Bruch
    • 1
  • Tobias Keck
    • 1
  • Claudia Benecke
    • 1
  1. 1.Department of SurgeryUniversity Medical Center Schleswig-Holstein Campus LübeckLübeckGermany

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