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Defining the key skills required to perform advanced laparoscopic procedures: a qualitative descriptive study

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Abstract

Background

Simulation is widely used to teach and assess fundamental laparoscopic skills; however, program directors have reported that current simulation programs do not meet the needs for trainees and surgeons learning advanced laparoscopic procedures (ALP). The purpose of our study was to identify the key skills required to perform ALP, to serve as the basis to establish an advanced laparoscopic skills training program.

Methods

Semi-structured interviews were conducted with attending surgeons, fellows, and senior residents in general surgery, gynaecology, and urology. The questions were developed through an iterative process using relevant literature, expert opinions, and in consultation with a qualitative researcher. Interviews were conducted in person, over the phone, or by videoconference, and inductive thematic analysis was performed.

Results

25 interviews were conducted with 16 attending surgeons and 9 fellows/residents from 9 institutions in Canada and USA. Twenty-one skills were identified to be important when performing ALP. The skills most commonly described by faculty were the following : (a) suturing, (b) dissection, (c) procedural expertise, (d) retraction and exposure, and (e) familiarity with relevant anatomy as viewed through the laparoscope. The skills most commonly described by trainees were the following: (a) suturing, (b) dissection, (c) procedural expertise, (d) trocar positioning, and (e) patient factors. There was a large difference between the importance the faculty attributed to the ‘Retraction and Exposure’ skill compared to the trainees.

Conclusion

This study identified key skills that are important when performing ALP. In order to address the current needs of trainees/surgeons learning ALP, this work provides the building blocks for the development of an advanced laparoscopic surgery simulation program.

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Acknowledgements

We would like to thank Drs Dmitry Nepomnayshy, Adnan Alseidi, and all of the other members of Advanced Training in Laparoscopic Suturing (ATLAS) subcommittee for their help throughout the study.

Funding

There was no funding or financial support for this work.

Author information

Authors and Affiliations

  1. Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, QC, Canada

    Elif Bilgic & Gerald M. Fried

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Elif Bilgic, Tomonori Hada, Sofia Valanci, Bernardo de Azevedo, Liane S. Feldman, Melina C. Vassiliou & Gerald M. Fried

  3. Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada

    Tim Dubé

  4. Department of Surgery, McGill University Health Centre, 1650 Cedar Ave, #L9.121, Montreal, QC, H3G 1A4, Canada

    Tomonori Hada, Sofia Valanci, Bernardo de Azevedo, Liane S. Feldman, Melina C. Vassiliou & Gerald M. Fried

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  1. Elif Bilgic
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  2. Tomonori Hada
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  3. Tim Dubé
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  7. Melina C. Vassiliou
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  8. Gerald M. Fried
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Correspondence to Gerald M. Fried.

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The Steinberg-Bernstein Centre receives unrestricted educational grants from Medtronic Canada. All authors report no relevant conflicts of interest or financial ties to disclose.

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Bilgic, E., Hada, T., Dubé, T. et al. Defining the key skills required to perform advanced laparoscopic procedures: a qualitative descriptive study. Surg Endosc 35, 2645–2659 (2021). https://doi.org/10.1007/s00464-020-07685-3

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