title: Simulation-based training and learning curves in laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Ex vivo simulation-based technical skills training has been shown to improve operating room performance and shorten learning curves for basic laparoscopic procedures. The application of such training for laparoscopic Roux-en-Y gastric bypass (LRYGBP) has not been reviewed.
  
  
  METHODS
  Relevant studies were identified by one author from a search of MEDLINE and Embase databases from 1 January 1994 to 30 November 2010. Studies examining the learning curves and ex vivo training methods for LRYGBP were included; all other types of bariatric operations were excluded. A manual search of the references was also performed to identify additional potentially relevant papers.
  
  
  RESULTS
  Twelve studies (5 prospective and 7 retrospective case series) were selected for review. The learning curve for LRYGBP was reported to be 50-100 procedures. Bench-top laparoscopic jejunojejunostomy, anaesthetized animals and Thiel human cadavers made up the bulk of the reported models for ex vivo training. Most studies were of relatively poor quality. An evidence-based ex vivo training curriculum for LRYGBP is currently lacking.
  
  
  CONCLUSIONS
  Better quality studies are needed to define the learning curve for LRYGBP. Future studies should focus on the design and validation of training models, and a comprehensive curriculum for training and assessment of cognitive, technical and non-technical components of competency for laparoscopic bariatric surgery.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada. boris.zevin@utoronto.ca
authors.forename: B
authors.initials: B
authors.lastname: Zevin
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: T P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D000818:Animals; D002102:Cadaver; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D015390:Gastric Bypass / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D059032:Learning Curve; D007902:Length of Stay; D023421:Models, Animal; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013663:Teaching / Q000379:methods