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One or two trainees per workplace for laparoscopic surgery training courses: results from a randomized controlled trial

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Abstract

Background

There are no standards for optimal utilization of workplaces in laparoscopic training. This study aimed to define whether laparoscopy training should be done alone or in pairs (known as dyad training).

Methods

This was a three-arm randomized controlled trial with laparoscopically naïve medical students (n = 100). Intervention groups participated alone (n = 40) or as dyad (n = 40) in a multimodality training curriculum with e-learning, basic, and procedural skills training using box and VR trainers. The control group (n = 20) had no training. Post-performance of a cadaveric porcine laparoscopic cholecystectomy (LC) was measured as the primary outcome by blinded raters using the objective structured assessment of technical skills (OSATS). Global operative assessment of laparoscopic skills (GOALS), time for LC, and VR performances were secondary outcomes.

Results

There were no differences between groups for performance scores [OSATS: alone (40.2 ± 9.8) vs. dyad (39.8 ± 8.6), p = 0.995; alone vs. control (37.1 ± 7.4), p = 0.548; or dyad vs. control, p = 0.590; and GOALS score: alone (10.6 ± 3.0) vs. dyad (10.0 ± 2.7), p = 0.599; alone vs. control (10.1 ± 3.0), p = 0.748; or dyad vs. control, p = 0.998]. Dyad finished LC faster than control [median = 62.5 min (CI 58.0–73.0) vs. 76.5 min (CI 72.0–80+); p = 0.042], while there were no inter-group differences between alone vs. control [median = 69.0 min (CI 62.0–76.0) vs. control; p = 0.099] or alone vs. dyad (p = 0.840). Dyad and alone showed superior performance on the VR trainer vs. control for time, number of movements, and path length, but not for complications and application of cautery.

Conclusions

The curriculum provided trainees with the laparoscopic skills needed to perform LC safely, irrespective of the number of trainees per workplace. Dyad training reduced the operation time needed for LC. Therefore, dyad training seems to be a promising alternative, especially if training time is limited and resources must be used as efficiently as possible. Trial registration German Clinical Trials Register: DRKS00004675.

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Acknowledgements

The current study was supported by the Heidelberg Surgery Foundation. The full registered trial protocol can be accessed under http://www.drks.de (Registration Number: DRKS00011040).

Funding

The present research was supported by the Heidelberg Surgery Foundation.

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Authors and Affiliations

  1. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Karl-Friedrich Kowalewski, Andreas Minassian, Jonathan David Hendrie, Anas Amin Preukschas, Hannes Götz Kenngott, Lars Fischer, Beat P. Müller-Stich & Felix Nickel

  2. Institute for Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Laura Benner

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  1. Karl-Friedrich Kowalewski
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Correspondence to Felix Nickel.

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Disclosures

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, Andreas Minsassian, Jonathan D. Hendrie, Laura Benner, Anas A. Preukschas, Hannes Kenngott, Lars Fischer, and Beat Müller-Stich have no conflicts of interest or financial ties to disclose.

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Kowalewski, KF., Minassian, A., Hendrie, J.D. et al. One or two trainees per workplace for laparoscopic surgery training courses: results from a randomized controlled trial. Surg Endosc 33, 1523–1531 (2019). https://doi.org/10.1007/s00464-018-6440-5

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