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 residents were randomized to either five weekly practice sessions (Group A) or no practice (Group B). Each group was then retested. Performance scores were compared for baseline versus final test, and improvement (baseline to final) for Group A versus Group B. Group A residents had a total of seven repetitions of each task (baseline, five practices, final). Linear regression analysis was used to test for the correlation between score and repetition number.

RESULTS: Group A showed significant improvement in their scores (baseline to final) for each task and for the total score (sum of all tasks) (p < 0.05). Group B showed significant improvement in four of seven tasks and for the total score. The magnitude of improvement of Group A versus Group B residents was significantly greater for four of seven tasks (peg transfer, placement of ligating loop, and both suturing skills) and for the total score. The final total score for Group A was 219 +/- 14% of baseline (p < 0.0001), whereas Group B was only 162 +/- 35% of baseline (p = 0.07) and not statistically significant. For Group A residents, there was a highly significant correlation between trial number and performance score (p < 0.05) for each individual task and for the total score.

CONCLUSIONS: 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 laparoscopic surgery.