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Self-directed training with e-learning using the first-person perspective for laparoscopic suturing and knot tying: a randomised controlled trial

Learning from the surgeon’s real perspective

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Abstract

Background

Laparoscopic suturing and knot tying is essential for advanced laparoscopic procedures and requires training outside of the operating room. However, personal instruction by experienced surgeons is limitedly available. To address this, the concept of combining e-learning with practical training has become of interest. This study aims to investigate the influence of the first-person perspective in instructional videos, as well as the feasibility of a completely self-directed training curriculum for laparoscopic suturing and knot tying.

Materials and methods

Ninety-one laparoscopically naïve medical students were randomised into two groups training with e-learning videos in either the first-person perspective (combining endoscopic view and view of hands/instruments/forearm motion) or the endoscopic view only. Both groups trained laparoscopic suturing and knot tying in teams of two until reaching predefined proficiency levels. Blinded, trained raters regularly assessed the participants’ performance by using validated checklists. After training, participants filled out questionnaires regarding training experience and personal characteristics.

Results

Average training time to reach proficiency did not differ between groups [first-person perspective (min): 112 ± 44; endoscopic view only (min): 109 ± 47; p = 0.746]. However, participants from both groups perceived the first-person perspective as useful for learning new laparoscopic skills. Both groups showed similar baseline performances and improved significantly after training [Objective Structured Assessment of Technical Skills (OSATS) (max. 37 points): first-person perspective: 30.3 ± 2.3; endoscopic view only: 30.8 ± 2.3]. All participants managed to reach proficiency, needing 8–43 attempts without differences between groups. Visuospatial abilities (mental rotation) seemed to enhance the learning curve.

Conclusion

Modifying instructional videos to the first-person perspective did not translate into a better performance in this setting but was welcomed by participants. Completely self-directed training with the use of e-learning can be a feasible training approach to achieve technical proficiency in laparoscopic suturing and knot tying in a training setting.

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Abbreviations

MIS:

Minimally invasive surgery

VR:

Virtual reality

MRT:

Mental rotation test

PSVT: R:

Revised purdue spatial visualisation test

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Acknowledgements

This work is part of Ms. Mona W. Schmidt’s doctoral thesis at Heidelberg University. We thank the European Social Fund of the State Baden-Wuerttemberg, from whom we received a total amount of 448.200 € for the laparoscopy training centre at the Department of Surgery at Heidelberg University to conduct laparoscopy training courses and the associated research.

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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

    Mona W. Schmidt, Karl-Friedrich Kowalewski, Sarah M. Trent, Beat P. Müller-Stich & Felix Nickel

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

    Laura Benner

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Correspondence to Felix Nickel.

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Disclosures

Mona. W. Schmidt, Karl-Friedrich Kowalewski, Sarah Trent, Laura Benner and Beat-Peter Müller-Stich have no conflict of interest or financial ties to disclose. F. Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, Intuitive and Medtronic.

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Appendix

Appendix

The first two knot of each participant, as well as their last knot after reaching proficiency were recorded on a self-developed and previously validated [21] motion-tracking system. Parameters recorded include duration, path length, angular path length and number of movements. Results can be found in Table 4 in Appendix.

Table 4 Improvement of objective motion-tracking parameters from first knot (pre-training) to last knot (post-training)
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Schmidt, M.W., Kowalewski, KF., Trent, S.M. et al. Self-directed training with e-learning using the first-person perspective for laparoscopic suturing and knot tying: a randomised controlled trial. Surg Endosc 34, 869–879 (2020). https://doi.org/10.1007/s00464-019-06842-7

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