Laparoscopic training on bench models: Better and more cost effective thanoperating room experience?

Background: Developing technical skill is essential to surgical training, b ut using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determine s if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents. Study Design: Second- and third-year residents (n = 27) were prospectively randomized to receive formal laparoscopic skills training or to a control g roup. At baseline, residents had a validated global assessment of their abi lity to perform a laparoscopic cholecystectomy based on direct. observation by three evaluators who were blinded to the residents' randomization statu s. Residents were also tested on five standardized videotrainer tasks. The training group practiced the videotrainer tasks as a group for 30 minutes d aily for 10 days. The control group received no formal training. All reside nts repeated the video-trainer test and underwent a second global assessmen t by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for diff erences in baseline performance. Results: Five residents were unable to participate because of scheduling pr oblems; 9 residents in the training group and 13 residents in the control g roup completed the study. Baseline laparoscopic experience, video-trainer s cores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four o f eight criteria) over the course of the four-week curriculum, compared wit h controls. Conclusions: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training. (J Am Cell Surg 200 0;191:272-283. (C) 2000 by the American College of Surgeons).