Simulated laparoscopic sigmoidectomy training: responsiveness of surgery residents.
OBJECTIVE
This study aimed to evaluate the responsiveness of surgery residents to simulated laparoscopic sigmoidectomy training.


METHODS
Residents underwent simulated laparoscopic sigmoidectomy training for previously tattooed sigmoid cancer with use of disposable abdominal trays in a hybrid simulator to perform a seven-step standardized technique. After baseline testing and training, residents were tested with predetermined proficiency criteria. Content validity was defined as the extent to which outcome measures departed from clinical reality. Content-valid measures of trays were evaluated by two blinded raters. Simulator-generated metrics included path length and smoothness of instrument movements. Responsiveness was defined as change in performance over time and was assessed by comparing baseline testing with unmentored final testing.


RESULTS
For eight weeks, eight postgraduate year 3/4 residents performed 34 resections. Overall operating time (67 vs. 37 min; P = 0.005), flexure (10 vs. 5 min; P = 0.005), inferior mesenteric vessel (8 vs. 5 min; P = 0.04), and ureter (7 vs. 1 min; P = 0.003) times improved significantly. Content-valid measures from trays remained unchanged. Path length (27,155.2 mm) and smoothness (3,575.5 cm/s3) of instrument movement remained unchanged. There were two bowel perforations and 19 anastomotic leaks. Leak rate decreased from 87% to 12.5%. Strong correlation was found between path length and smoothness of instrument movements (r = 0.9; P < 0.001). There was no correlation between simulator-generated metrics and content-valid outcome measures. Interrater reliability was 1.0 for all measures except anastomotic leak (k = 0.56). There was a linear relationship between residents' clinical advanced laparoscopic case volume and responsiveness (r = -0.7; P = 0.04).


CONCLUSIONS
Simulated laparoscopic sigmoidectomy training affected responsiveness in surgery residents with significantly decreased operating time and anastomotic leak rate.
Essani
Rahila
R
Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York 11794-8191, USA.
Scriven
Richard J
RJ
McLarty
Allison J
AJ
Merriam
Louis T
LT
Ahn
Hongshik
H
Bergamaschi
Roberto
R
D000328:Adult; D002983:Clinical Competence; D012809:Colon, Sigmoid / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education*; D003198:Computer Simulation; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D008953:Models, Anatomic; D013664:Teaching Materials