THE EFFECT OF PRACTICE ON PERFORMANCE IN A LAPAROSCOPIC SIMULATOR

Background: Laparoscopic skill was measured objectively in a simulator , Seven tasks were scored in terms of precision and speed. These tasks included transferring, cutting, clip+ divide, placement of a ligating loop, mesh placement+ fixation, and suturing with intracorporeal and extracorporeal knot. Methods: After baseline evaluation, 12 surgical r esidents were randomized to either five weekly practice sessions (Grou p A) or no practice (Group B). Each group was then retested. Performan ce scores were compared for baseline versus final test, and improvemen t (baseline to final) for Group A versus Group B, Group A residents ha d a total of seven repetitions of each task (baseline, five practices, final). Linear regression analysis was used to test for the correlati on between score and repetition number. Results: Group A showed signif icant improvement in their scores (baseline to final) for each task an d for the total score (sum of all tasks) (p < 0.05). Group B showed si gnificant improvement in four of seven tasks and for the total score. The magnitude of improvement of Group A versus Group B residents was s ignificantly greater for four of seven tasks (peg transfer, placement of ligating loop, and both suturing skills) and for the total score. T he final total score for Group A was 219 +/- 14% of baseline (p < 0.00 01), whereas Group B was only 162 +/- 35% of baseline (p = 0.07) and n ot statistically significant. For Group A residents, there was a highl y significant correlation between trial number and performance score ( p < 0.05); for each individual task and for the total score. Conclusio ns: Laparoscopic skill can be measured objectively in a simulator, and performance improves progressively with practice. These skills can be incorporated into the training and evaluation of residents in laparos copic surgery.