title: Laparoscopic suturing skills acquisition: a comparison between laparoscopy-exposed and laparoscopy-naive surgeons.
abstract: BACKGROUND
  Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room. This study was done with the primary aim of assessing whether prior exposure to laparoscopic surgery helped trainees in acquiring laparoscopic suturing skills more quickly than trainees with no prior exposure to laparoscopic surgery.
  
  
  METHODS
  Twenty laparoscopy-exposed and 20 laparoscopy-naïve surgeons performed 5 laparoscopic gastrojejunostomies each on a phantom porcine model. The performance was evaluated for operation time, overall anastomotic score (calculated by adding scores of anastomotic leak, size of the anastomosis, suture placement, and mucosal approximation), and the level of difficulty. The performance at the beginning of training (baseline) was compared to the performance at the end of training.
  
  
  RESULTS
  All participants showed statistically significant improvement in operation time, overall anastomotic score, and difficulty level. Laparoscopy-exposed surgeons had a significantly better operation time than laparoscopynaïve surgeons at the beginning of training; however, the difference became insignificant by the end of training. The difference in overall anastomotic score was not significant between laparoscopy-exposed and naïve-surgeons. Laparoscopy-exposed surgeons showed significant improvements in anastomotic leak rate and size of the anastomosis, whereas laparoscopy naïve surgeons showed improvements in all the parameters, although these were not significant statistically.
  
  
  CONCLUSIONS
  Training improves the laparoscopic suturing skills of laparoscopy-exposed as well as laparoscopy-naïve surgeons. Prior experience in laparoscopic surgery does not seem to influence the acquisition of laparoscopic suturing skills as laparoscopic-naïve surgeons manage to catch up with the skills of the laparoscopy-exposed surgeons.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India. drvkbansal@gmail.com
authors.forename: Virinder Kumar
authors.initials: VK
authors.lastname: Bansal
authors.forename: Tseten
authors.initials: T
authors.lastname: Tamang
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
authors.forename: Pradeep
authors.initials: P
authors.lastname: Prakash
authors.forename: Karthik
authors.initials: K
authors.lastname: Rajan
authors.forename: Hemanga K
authors.initials: HK
authors.lastname: Bhattacharjee
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: Amit
authors.initials: A
authors.lastname: Goswami
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D013536:Suture Techniques / Q000193:education*; D013552:Swine; D055815:Young Adult