LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy—results of a randomized controlled trial

  • K. F. Kowalewski
  • C. R. Garrow
  • T. Proctor
  • A. A. Preukschas
  • M. Friedrich
  • P. C. Müller
  • H. G. Kenngott
  • L. Fischer
  • B. P. Müller-Stich
  • F. Nickel



Multiple training modalities for laparoscopy have different advantages, but little research has been conducted on the benefit of a training program that includes multiple different training methods compared to one method only. This study aimed to evaluate benefits of a combined multi-modality training program for surgical residents.


Laparoscopic cholecystectomy (LC) was performed on a porcine liver as the pre-test. Randomization was stratified for experience to the multi-modality Training group (12 h of training on Virtual Reality (VR) and box trainer) or Control group (no training). The post-test consisted of a VR LC and porcine LC. Performance was rated with the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded experts.


Training (n = 33) and Control (n = 31) were similar in the pre-test (GOALS: 13.7 ± 3.4 vs. 14.7 ± 2.6; p = 0.198; operation time 57.0 ± 18.1 vs. 63.4 ± 17.5 min; p = 0.191). In the post-test porcine LC, Training had improved GOALS scores (+ 2.84 ± 2.85 points, p < 0.001), while Control did not (+ 0.55 ± 2.34 points, p = 0.154). Operation time in the post-test was shorter for Training vs. Control (40.0 ± 17.0 vs. 55.0 ± 22.2 min; p = 0.012). Junior residents improved GOALS scores to the level of senior residents (pre-test: 13.7 ± 2.7 vs. 18.3 ± 2.9; p = 0.010; post-test: 15.5 ± 3.4 vs. 18.8 ± 3.8; p = 0.120) but senior residents remained faster (50.1 ± 20.6 vs. 25.0 ± 1.9 min; p < 0.001). No differences were found between groups on the post-test VR trainer.


Structured multi-modality training is beneficial for novices to improve basics and overcome the initial learning curve in laparoscopy as well as to decrease operation time for LCs in different stages of experience. Future studies should evaluate multi-modality training in comparison with single modalities.

Trial registration: German Clinical Trials Register DRKS00011040


Laparoscopy Training Education Laparoscopic cholecystectomy Curriculum GOALS 



The current study was supported by the Heidelberg Surgery Foundation. The full registered trial protocol can be accessed under (Registration No. DRKS00011040).

Author contributions

Study conception and design: Kowalewski, Nickel, Müller-Stich, Fischer. Acquisition of data: Friedrich, Garrow, Preukschas, Müller. Statistical analysis: Proctor, Kowalewski, Kenngott. Analysis and interpretation of data: Kowalewski, Proctor, Nickel, Preukschas, Garrow. Drafting of manuscript: Garrow, Kowalewski, Kenngott, Nickel, Friedrich. Critical revision: Müller-Stich, Nickel, Kenngott, Fischer, Müller.

Compliance with ethical standards


Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, and Medtronic. Karl-Friedrich Kowalewski, Carly R. Garrow, Tanja Proctor, Anas A. Preukschas, Mirco Friedrich, Philip Müller, Hannes Kenngott, Lars Fischer, and Beat Müller-Stich have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • K. F. Kowalewski
    • 1
  • C. R. Garrow
    • 1
  • T. Proctor
    • 2
  • A. A. Preukschas
    • 1
  • M. Friedrich
    • 1
  • P. C. Müller
    • 1
  • H. G. Kenngott
    • 1
  • L. Fischer
    • 1
  • B. P. Müller-Stich
    • 1
  • F. Nickel
    • 1
  1. 1.Department of General, Visceral, and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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