title: Cost Comparison of Fundamentals of Laparoscopic Surgery Training Completed With Standard Fundamentals of Laparoscopic Surgery Equipment versus Low-Cost Equipment.
abstract: OBJECTIVE
  Training for the Fundamentals of Laparoscopic Surgery (FLS) skills test can be expensive. Previous work demonstrated that training on an ergonomically different, low-cost platform does not affect FLS skills test outcomes. This study compares the average training cost with standard FLS equipment and medical-grade consumables versus training on a lower cost platform with non-medical-grade consumables.
  
  
  METHODS
  Subjects were prospectively randomized to either the standard FLS training platform (n = 19) with medical-grade consumables (S-FLS), or the low-cost platform (n = 20) with training-grade products (LC-FLS). Both groups trained to proficiency using previously established mastery learning standards on the 5 FLS tasks. The fixed and consumable cost differences were compared.
  
  
  METHODS
  Training occurred in a surgical simulation center.
  
  
  METHODS
  Laparoscopic novice medical student and resident physician health care professionals who had not completed the national FLS proficiency curriculum and who had performed less than 10 laparoscopic cases.
  
  
  RESULTS
  The fixed cost of the platform was considerably higher in the S-FLS group (S-FLS, $3360; LC-FLS, $879), and the average consumable training cost was significantly higher for the S-FLS group (S-FLS, $1384.52; LC-FLS, $153.79; p < 0.001). The LC-FLS group had a statistically discernable cost reduction for each consumable (Gauze $9.24 vs. $0.39, p = 0.002; EndoLoop $540.00 vs. $40.60, p < 0.001; extracorporeal suture $216.45 vs. $25.20, p < 0.001; intracorporeal suture $618.83 vs. $87.60, p < 0.001). The annual fixed and consumable cost to train 5 residents is $10,282.60 in the S-FLS group versus $1647.95 in the LC-FLS group.
  
  
  CONCLUSIONS
  This study shows that the average cost to train a single trainee to proficiency using a lower fixed-cost platform and non-medical-grade equipment results in significant financial savings. A 5-resident program will save approximately $8500 annually. Residency programs should consider adopting this strategy to reduce the cost of FLS training.
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland. Electronic address: brentonfranklin@gmail.com.
authors.forename: Brenton R
authors.initials: BR
authors.lastname: Franklin
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Placek
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland.
authors.forename: Mercy D
authors.initials: MD
authors.lastname: Wagner
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; Weill Cornell Medical College, Cornell University, New York, New York.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Haviland
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland.
authors.forename: Mary T
authors.initials: MT
authors.lastname: O'Donnell
authors.affiliation: Division of General Surgery, USU/Walter Reed Department of Surgery, Bethesda, Maryland; National Capital Region Simulation Consortium, Bethesda, Maryland.
authors.forename: E Matthew
authors.initials: EM
authors.lastname: Ritter
mesh_terms: D000046:Academic Medical Centers; D017046:Cost Savings; D003365:Costs and Cost Analysis; D004503:Education, Medical, Graduate / Q000191:economics* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007396:Internship and Residency; D020706:Laparoscopes / Q000191:economics*; D010535:Laparoscopy / Q000191:economics* / Q000193:education; D008297:Male; D009519:New York City; D011446:Prospective Studies; D000066908:Simulation Training / Q000191:economics* / Q000379:methods; D013337:Students, Medical / Q000706:statistics & numerical data
keywords: Practice-Based Learning and Improvement; cost analysis; fundamentals of laparoscopic surgery; laparoscopy; mastery learning; proficiency-based curriculum; simulation training