title: Learning Curve Associated With an Automated Laparoscopic Suturing Device Compared With Laparoscopic Suturing.
abstract: BACKGROUND
  Laparoscopic suturing has proved to be a challenging skill to master which may prevent surgical procedures from being started, or completed, in a minimally invasive fashion. The aim of this study is to compare the learning curves between traditional laparoscopic techniques with a novel suturing device.
  
  
  METHODS
  In this prospective single blinded nonrandomized controlled crossover study, we recruited 19 general surgery residents ranging from beginner (PGY1-2, n = 12) to advanced beginner (PGY3-5, n = 7). They were assigned to perform a knot tying and suturing task using either Endo360 or traditional laparoscopic technique (TLT) with needle holders before crossing over to the other method. The proficiency standards were developed by collecting the data for task completion time (TCT in seconds), dots on target (DoT in numbers), and total deviation (D in mm) on 5 expert attending surgeons (mean ± 2SD). The test subjects were "proficient" when they reached these standards 2 consecutive times.
  
  
  RESULTS
  Number of attempts to complete the task was collected for Endo360 and TLT. A significant difference was observed between mean number of attempts to reach proficiency for Endo360 versus TLT ( P = .0027) in both groups combined, but this was not statistically significant in the advanced beginner group. TCT was examined for both methods and demonstrated significantly less time to complete the task for Endo360 versus TLT ( P < .0001). There were significantly less DoT for Endo360 as compared with TLT ( P < .0001), which was also associated with significantly less D ( P < .0001) indicating lower accuracy with Endo360. However, no significant difference was observed between the groups for increasing number of trials for both DoT and D.
  
  
  CONCLUSIONS
  This novel suturing device showed a shorter learning curve with regard to number of attempts to complete a task for the beginner group in our study, but matched the learning curve in the advanced beginner group. With regard to time to complete the task, the device was faster in both groups.
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Leeds
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: Lizzy
authors.initials: L
authors.lastname: Wooley
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sankaranarayanan
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Daoud
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: James
authors.initials: J
authors.lastname: Fleshman
authors.affiliation: 1 Baylor University Medical Center at Dallas, Dallas, TX, USA.
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
mesh_terms: D001331:Automation / Q000295:instrumentation*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000295:instrumentation* / Q000379:methods*; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D013536:Suture Techniques / Q000193:education* / Q000295:instrumentation*; D013647:Task Performance and Analysis
keywords: knot tying; laparoscopic suturing; residency training; simulation; surgical education