title: Three-step model course to teach intracorporeal laparoscopic suturing.
abstract: BACKGROUND
  Laparoscopy requires a set of skills such as intracorporeal stitching and knotting. The aim of this study is to present an effective specialized training course for the laparoscopic suturing technique.
  
  
  METHODS
  We designed a specialized 5-day training course for laparoscopic suturing skills with theoretical and practical sessions on inanimate pelvic training. The "gladiator rule" was the method used to teach intracorporeal suturing using the right and left hand from a lateral and suprapubic access. Data on sense of depth, coordination, dexterity, traction power, and posture at the beginning and at the end of the course were compiled. Three practical evaluations were performed by each course participant. Follow-up on subsequent live laparoscopic application of intracorporeal suturing was obtained.
  
  
  RESULTS
  We enrolled 44 consecutive trainees: 33 men and 11 women. We found a significant statistical improvement during the course in coordination (P=.001), dexterity (P=.000), traction power (P=.002), and posture (P=.003). Men were better than women in coordination (P=.002), dexterity (P=.000), and traction power (P=.014). No significant statistical difference in suturing skill was found in relation to age, gender, previous courses, surgical training (surgeon or resident), and dominant hand. Twenty-nine of 40 (72.5%) trainees after the course began to apply intracorporeal sutures in vivo.
  
  
  CONCLUSIONS
  The present study demonstrates the utility of a 5-day suturing course in teaching laparoscopic suturing technique. The "gladiator rule" is a useful and reproducible theory to teach intracorporeal knotting. The three-step model allows the majority of the trainees to apply laparoscopic suturing in vivo.
authors.affiliation: Department of Gynecology, Fiorentino Oncology Center, Sesto Fiorentino, Italy. liliana.mereu@lacittadellasalute.it
authors.forename: Liliana
authors.initials: L
authors.lastname: Mereu
authors.forename: Giada
authors.initials: G
authors.lastname: Carri
authors.forename: Edmundo Daniel
authors.initials: ED
authors.lastname: Albis Florez
authors.forename: Vito
authors.initials: V
authors.lastname: Cofelice
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pontis
authors.forename: Armando
authors.initials: A
authors.lastname: Romeo
authors.forename: Luca
authors.initials: L
authors.lastname: Mencaglia
mesh_terms: D000328:Adult; D004501:Education, Medical / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques / Q000193:education*