[Assessment of resident training in laparoscopic surgery based on a digestive system anastomosis model in the laboratory].
BACKGROUND
The complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program.


METHODS
Prospective study of surgical resident training based on anastomosis performance on an "endotrainer". The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded.


RESULTS
Twelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7 min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120 h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70 h of training the learning curve reaches a plateau zone.


CONCLUSIONS
Intestinal anastomosis (either JJA or GJA) performed in "endotrainer" is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit.
Rodríguez-Sanjuán
Juan Carlos
JC
Servicio de Cirugía General, Centro de Entrenamiento en Cirugía Endoscópica y Laparoscópica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España. cgdrsj@humv.es
Manuel-Palazuelos
Carlos
C
Fernández-Díez
María José
MJ
Gutiérrez-Cabezas
José Manuel
JM
Alonso-Martín
Joaquín
J
Redondo-Figuero
Carlos
C
Herrera-Noreña
Luis Antonio
LA
Gómez-Fleitas
Manuel
M
D000714:Anastomosis, Surgical / Q000193:education; D007396:Internship and Residency; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008953:Models, Anatomic; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*