Educational Role for an Advanced Suturing Task in the Pediatric Laparoscopic Surgery Simulator.
BACKGROUND
Laparoscopic models are recognized as important training tools. Lower fidelity systems are used mainly for simpler tasks; an advanced suturing task may allow for additional training of experts. The purpose of this study was to explore the educational role of an advanced suturing task using motion analysis and establish the task's construct validity.


METHODS
The pediatric laparoscopic surgery (PLS) simulator was customized with motion-tracking hardware and software. Participants were stratified by expertise, then performed an advanced task involving intracorporeal suturing in a vertical plane, with the suture passing superiorly to inferiorly. Traditional PLS scores were calculated, and motion was analyzed in the four degrees of freedom available in laparoscopic surgery (Pitch, Yaw, Roll, and Surge). Data were compared to historic results for a standard suturing task.


RESULTS
Sixty participants were recruited (8 novices, 13 intermediates, and 39 experts). Analysis of motion in all degrees of freedom allowed discrimination between participants based on expertise level. Compared with the standard task, PLS scores for the advanced task were significantly lower for intermediates and experts, and the number of extreme motion events was significantly higher, indicating that advanced task is more challenging. In addition, only 76.3% of experts, 76.9% of intermediates, and 37.5% of novices were able to successfully complete the advanced task.


CONCLUSIONS
Performance of an advanced intracorporeal suturing task allowed discrimination of expertise level. The task's increased complexity may help hone laparoscopic technical skills, particularly among advanced performers, and even allow discrimination of psychomotor expertise within the traditional cohort of experts.
1 Department of General Surgery, St. Michael's Hospital, University of Toronto , Toronto, Canada .
Maeve O'Neill
MO
Trudeau
2 Hospital for Sick Children , Toronto, Canada .
Brian
B
Carrillo
3 Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa , Ottawa, Canada .
Ahmed
A
Nasr
4 Division of General and Thoracic Surgery, Hospital for Sick Children , Toronto, Canada .
Justin T
JT
Gerstle
4 Division of General and Thoracic Surgery, Hospital for Sick Children , Toronto, Canada .
Georges
G
Azzie
D000328:Adult; D002983:Clinical Competence; D003201:Computers; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D010372:Pediatrics / Q000193:education*; D010820:Physicians; D000066908:Simulation Training / Q000379:methods*; D012984:Software; D013043:Specialties, Surgical / Q000193:education; D013536:Suture Techniques / Q000193:education*
box trainer; expertise; intracorporeal knot-tying; laparoscopy; motion analysis parameters; tracking device