Significant transfer of surgical skills obtained with an advanced laparoscopic training program to a laparoscopic jejunojejunostomy in a live porcine model: feasibility of learning advanced laparoscopy in a general surgery residency.
BACKGROUND
Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model.


METHODS
First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after training assessments at the bench model were compared to a single performance of six expert laparoscopic surgeons. Results obtained by trainees at the porcine model assessment were compared to those of 11 general surgeons without any laparoscopic lab-simulation training and 6 expert laparoscopic surgeons. In all assessments, global and specific OSATS scores, operative time, and covered path length of hands were registered.


RESULTS
Twenty-five residents improved significantly their global and specific OSATS score median at the bench model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05 and 7 (range, 4-8) vs. 18 (range, 18-19); p < 0.05, respectively] and obtained significantly better scores on the porcine model compared with general surgeons with no lab-simulation training [21 (range, 20.5-21) vs. 8 (range, 12-14); p < 0.05]. The results were comparable to those achieved by expert certificated bariatric surgeons. Total path lengths registered for trainees were more efficient post-training and significantly lower compared with general surgeons on the porcine model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05] with no statistical difference compared with experts.


CONCLUSIONS
Trainees significantly improved their advanced laparoscopic skills to a level compared with expert surgeons. More importantly, these acquired skills were transferred to a more complex live model.
Experimental Surgery Simulation Center, Department of Digestive Surgery, Hospital Clínico, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, Chile.
Julián
J
Varas
Ricardo
R
Mejía
Arnoldo
A
Riquelme
Felipe
F
Maluenda
Erwin
E
Buckel
José
J
Salinas
Jorge
J
Martínez
Rajesh
R
Aggarwal
Nicolás
N
Jarufe
Camilo
C
Boza
D000818:Animals; D002983:Clinical Competence; D003479:Curriculum; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D007582:Jejunostomy / Q000193:education* / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D013552:Swine