Measuring laparoscopic operative skill in a video trainer.

BACKGROUND: Laparoscopic surgery requires a unique set of technical skills. More experienced laparoscopic surgeons perform certain tasks more efficiently in a video trainer than less experienced laparoscopic surgeons. The presumption is that the experienced surgeon possesses more of the skill required to complete the task. This study sought to determine the degree to which previous laparoscopic operative experience influenced the performance of selected video trainer tasks of varying complexity.

METHODS: In this study, 19 general surgery residents with varying levels of laparoscopic operative case experience (as defined by operative case logs) were timed performing five tasks in a video trainer. The tasks were rope pass, peg drop, peg exchange, needle pass, and knot tie. All the residents watched a video demonstration of each skill before testing. None of the residents had previous exposure to video trainers, and no practice was allowed before testing. A composite score for all tasks was calculated for each resident as a measure of overall performance.

RESULTS: There was a strong correlation between operative experience and time required for successful completion of each task, with the exception of the rope pass. The magnitude of correlation increased with tasks of increasing complexity. Composite scores were correlated with operative experience. Significant interval improvements in performance were observed for increasing experience up to a level of approximately 100 previous laparoscopic cases.

CONCLUSIONS: Overall composite scores and time required for the completion of each individual video trainer task (with the exception of the rope pass) may be an accurate reflection of laparoscopic surgical skill acquired in the operating room. A resident may need as many as 100 laparoscopic cases for full development of a basic skill set in the operating room. A more efficient and safe method of training, such as a validated skills curriculum conducted in a dry lab, is a desirable alternative to developing skill exclusively in the operating room.