Assessing laparoscopic manipulative skills.
BACKGROUND
The rapid emergence of laparoscopic surgery over the past decade has highlighted the need for teaching and assessing laparoscopic manipulative skills. Most analyses consist of a measurement of the time to complete a specified task and a subjective assessment by an observer. Objective assessments of accuracy in the performance of manipulative skills have been lacking. To quantify both speed and accuracy during laparoscopic skill performance, we have developed a skills assessment device (SAD) using a laparoscopic simulator platform and computer-based skills assessment software that precisely measures an instrument's movement during performance of timed laparoscopic manipulations.


METHODS
The SAD device measures the time necessary for an operator to complete a task, and the movements of the working end of laparoscopic instruments in three dimensions. Ten nonsurgeons performed 10 repetitions of a standardized laparoscopic manipulation. Data were captured in real time for both hands on a personal computer. Accuracy was determined by calculating the sum of all distances traveled. Duration was measured in seconds. Results are group means.


RESULTS
The time necessary to perform defined laparoscopic manipulative skills improved dramatically during the first 3 repetitions and then stabilized. However, accuracy of manipulations continued to improve over all 10 repetitions.


CONCLUSIONS
When untrained subjects are learning a laparoscopic manipulative task, measurement of time alone fails to account for the more protracted learning curve for accuracy. Therefore, devices and training programs that fail to consider objective assessments of accuracy may overestimate laparoscopic proficiency.
Smith
C D
CD
Department of Surgery, Emory University School of Medicine, H124-B, Emory University Hospital, 1364 Clifton Rd, NE, Atlanta GA 30322, USA. csmit27@emory.edu
Farrell
T M
TM
McNatt
S S
SS
Metreveli
R E
RE
D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D007858:Learning; D013997:Time Factors; D014584:User-Computer Interface