Background/context Laparoscopic suturing is recognised as one of the most difficult laparoscopic skills to master. It is a surgical technique required to perform complex laparoscopic operations, being described as the rate limiting step in a laparoscopic skills training.1 With the use of simulation increasing in the training of future surgeons, a comprehensive literature review was conducted to evaluate the current evidence for the role of simulators in facilitating the acquisition of this particular skill.
Methodology A PubMed search was performed using the terms “laparoscopy”, “suturing”, and “simulation. The resulting 91 articles were then analysed for relevance and summarised. After the exclusion of 43 abstracts, the selected 48 papers were read in detail, and their references lists searched for further significant articles.
Results/outcomes A total of 68 relevant articles were found and evaluated; despite the relatively small sample size in most studies, simulation has been proved to provide an effective method for the tuition of trainees in laparoscopic suturing.2 Furthermore, the skills acquired through simulator training appear to be successfully transferable to the operating room environment.3 Simulators have also shown potential as valuable tools in the assessment of proficiency in trainees, with their evaluation of individuals correlating well with expert observer ratings in complex laparoscopic tasks such suturing.
Conclusion and recommendations Simulators appear to be a valuable tool in the cost-effective acquisition of complex laparoscopic skills such as intracorporeal suturing. With the ethical obligation to move basic clinical skills learning away from patients, these findings demonstrate the utility of simulators in the acquisition of complex laparoscopic techniques. While there is no doubt in their usefulness in the training of future laparoscopists, questions regarding the type of simulator, the nature of the training curriculum, and how such a curriculum can be successfully integrated into current surgical training programmes remain to be answered.
Harold KL, Matthews BD, Backus CL, et al. Prospective randomized evaluation of surgical resident proficiency with laparoscopic suturing after course instruction. Surg Endosc 2002;16:1729–31
Munz Y, Almoudaris AM, Moorthy K, et al. Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 2007;193:774–83
Stefanidis D, Acker C, Heniford BT, et al. Proficiency-based laparoscopic simulator trining leads to improved operating room skill that is resistant to decay. Surg Innov 2008;15:69–73
- Category: Course or curriculum evaluation/innovation/integration
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