SEQUENTIAL PSYCHOMOTOR-SKILLS DEVELOPMENT IN LAPAROSCOPIC COLON SURGERY

Objectives: To quantify the complexity of each of three skills used in laparoscopic colon surgery and to quantify the relative complexity of seven laparoscopic colon procedures on a graduated complexity scale. Design: Five surgeons used a scale of 1 through 6 to measure the relat ive complexity of three laparoscopic skills (intracorporeal mobilizati on, intracorporeal devascularization, and intracorporeal anastomosis) to assess the relative difficulty of seven laparoscopic procedures (ri ght colon resection, sigmoid colon resection, low anterior resection, Hartmann's procedure, left colon resection, abdominoperineal resection , and transverse colon resection) using detailed evaluation of their f irst 100 laparoscopic colon resections. Setting: Three private communi ty hospitals. Main Outcome Measures: The complexities of intracorporea l mobilization, intracorporeal devascularization, and intracorporeal a nastomosis were recorded for seven laparoscopic colon procedures. Resu lts: The least complex procedure was right colon resection, followed i n increasing complexity by sigmoid colon, Hartmann's procedure, low an terior resection, abdominoperineal resection, left colon resection, an d transverse colon resection. The addition of each laparoscopic skill increased the complexity during each procedure. All three skills were not required for every procedure. Conclusions: Since all procedures do not require all three skills, skills can be learned sequentially if p atients are chosen judiciously. A sequence of laparoscopic procedures performed by surgeons is recommended. The relative complexities for ea ch procedure suggest an outline (map) for surgeons to use during lapar oscopic colon surgery.