Intracorporeal knot tying in a box trainer: how proficient is in vitro evaluation in laparoscopic experts?
OBJECTIVE
To determine the applicability of motion analysis parameters of intracorporeal knot tying in box trainers in experts as predictors of surgical outcome.


METHODS
Consecutive series of 1534 advanced laparoscopic hysterectomies (Canadian Task Force classification II-2).


METHODS
Time, path length, and motion in depth of a standardized intracorporeal knot-tying task were compared with mean risk-adjusted primary clinical outcomes for each participant.


RESULTS
Although a large variety in proficient knot tying and surgical skills factors was observed; after correction for patient mix in 50 expert surgeons, motion analysis of intracorporeal knot tying could not significantly determine surgical outcome skills in advanced laparoscopic surgery.


CONCLUSIONS
Levels of proficiency in advanced laparoscopic surgery cannot be appropriately determined using motion analysis in box trainers. Therefore, box trainer assessments do not adequately differentiate proficient from suboptimal clinical performance.
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
A R H
AR
Twijnstra
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
E
E
Hiemstra
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
E W
EW
van Zwet
Department of Gynecology, Kennemer Gasthuis, Haarlem, The Netherlands.
E I R
EI
Balkema
Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
J
J
Dankelman
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands. Electronic address: f.w.jansen@lumc.nl.
F W
FW
Jansen
D002983:Clinical Competence; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D066298:In Vitro Techniques; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D013536:Suture Techniques
Advanced laparoscopy; Knot tying; Quality measures; Skills training