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Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study

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Abstract

Background

Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills.

Methods

Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion.

Results

92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P < 0.0001) and precision cutting (P < 0.0001) were significantly more difficult. Males performed significantly better than females (P < 0.005). For LS, a deterioration of skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A–C) (P < 0.05).

Discussion

Our data reveal that complex laparoscopic tasks (cutting) and techniques (SILS) are more difficult to learn and acquired skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

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Acknowledgments

The authors thank the Royal Australasian College of Surgeon (RACS) for loan of the two FLS box trainers and their substantial support.

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Author notes

    Authors and Affiliations

    1. Division of Surgery, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Woodville, SA, 5011, Australia

      Scott Michael Ellis, Martin Varley, Markus Trochsler, Guy Maddern, Peter Hewett, Tina Runge & Soeren Torge Mees

    2. Data Management and Analysis Centre, University of Adelaide, Adelaide, SA, Australia

      Stuart Howell

    3. Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Dresden, Dresden, Germany

      Soeren Torge Mees

    Authors
    1. Scott Michael Ellis
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    2. Martin Varley
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    3. Stuart Howell
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    5. Guy Maddern
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    6. Peter Hewett
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    7. Tina Runge
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    8. Soeren Torge Mees
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    Correspondence to Soeren Torge Mees.

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    Disclosures

    Mr. Ellis, Dr Varley, Mr Howell, Dr Trochsler, Prof Maddern, Prof Hewett, Dr Runge and Dr Mees have no conflicts of interest or financial ties to disclose.

    Additional information

    Tina Runge and Soeren Torge Mees have contributed equally to the study.

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    Ellis, S.M., Varley, M., Howell, S. et al. Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study. Surg Endosc 30, 3386–3390 (2016). https://doi.org/10.1007/s00464-015-4619-6

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    • DOI: https://doi.org/10.1007/s00464-015-4619-6

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