title: New models for advanced laparoscopic suturing: taking it to the next level.
abstract: BACKGROUND
  Current simulations for laparoscopic suturing do not reflect the complexity of the skills required in the operating room. The purpose of this study was to develop three novel advanced suturing tasks with assessment metrics and to collect validity evidence for their measures of suturing skill.
  
  
  METHODS
  We developed three tasks based on training gaps identified through a previous needs assessment: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). Minimally invasive surgeons (MIS) and senior surgical residents (SR) completed these tasks and a questionnaire regarding their educational value. Performance was assessed by two raters based on time and accuracy. Validity was assessed by comparing performance according to the level of training and self-reported experience. The inter-rater reliability and internal consistency of the tasks were calculated.
  
  
  RESULTS
  Thirty-one subjects (13 MIS, 18 SR) were enrolled in the study (median age 32; 77% male). Compared to the SR group, the MIS group had significantly greater scores on all tasks. While all MIS surgeons completed the three tasks within the allotted time, six (33%) residents could not complete at least one out of the three tasks. Laparoscopic suturing experience correlated positively with the scores of all tasks (NH 0.51, UT 0.70, CS 0.65. p < 0.01). Inter-rater reliability for all tasks was 0.99, and internal consistency was 0.80. The majority of participants agreed that the tasks were relevant to practice, helped improve technical competence, and adequately measured suturing ability.
  
  
  CONCLUSIONS
  This study provides validity evidence for three novel advanced laparoscopic suturing tasks. Performance on all tasks correlated significantly with training level and self-reported experience. Integrating these tasks into educational curricula may help improve residents' suturing skills and better prepare residents for the operating room.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada. ywatanabe328@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McKendy
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Elif
authors.initials: E
authors.lastname: Bilgic
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Ghada
authors.initials: G
authors.lastname: Enani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Amani
authors.initials: A
authors.lastname: Munshi
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, D6-136, Montreal, QC, H3G 1A4, Canada.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D008953:Models, Anatomic; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000193:education*
keywords: FLS; Laparoscopic suturing; Residency training; Simulation; Surgical education; Technical skills