The impact of intense laparoscopic skills training on the operative performance of urology residents

Purpose: As laparoscopy has become more commonplace in urology, increased e mphasis has been placed on laparoscopic education. We assessed the impact o f laparoscopic skills training on the operative performance of urological s urgeons inexperienced with laparoscopy. Materials and Methods: Urology residents were prospectively randomized to u ndergo laparoscopic skills training (6) or no training (6). Baseline assess ment of operative performance (scale 0 to 35) during porcine laparoscopic n ephrectomy was completed by all subjects. Cumulative time to complete lapar oscopic tasks using an inanimate trainer was also recorded. The skills trai ning group then practiced inanimate trainer tasks for 30 minutes daily for 10 days. The 2 groups then repeated the timed inanimate trainer tasks and u nderwent repeat assessment of the ability to perform porcine laparoscopic n ephrectomy. Results: At baseline no statistical difference was noted in laparoscopic ex perience, inanimate trainer time or overall operative assessment in the 2 g roups. In the skills training group mean cumulative time to complete inanim ate trainer tasks decreased from 341 to 176 seconds (p = 0.003), while in t he control group it decreased from 365 to 301 (p = 0.15). Operative assessm ent improved from initial to repeat porcine laparoscopic nephrectomy regard less of the trained versus control randomization grouping (22.0 to 27.8, p = 0.0008 and 20.8 to 26.5, p = 0.00007, respectively). Conclusions: In vivo experience enables urological surgeons inexperienced w ith laparoscopy to improve significantly in all aspects of complex laparosc opic procedures. In this pilot study the magnitude of improvement was indep endent of additional training in laparoscopic skills. Educational curriculu m should include in vivo practice in addition to skills training.