Objective measurement of retention of laparoscopic skills: a prospective cohort study

Abstract

Introduction: There has been an overall growth of 462% in laparoscopic procedures performed by surgical residents between 2000 and 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. Methods: First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after, and 4 months after completing the basic laparoscopy course. Force, motion, and time were the measured variables. Results: A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force (P=0.004), motion (P≤0.001), and time (P≤0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force (P≤0.001), motion (P=0.005), and time (P≤0.001). Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force (P=0.046), max impulse (P=0.12), and time (P=0.002). For the ZigZag loop, skill decay was observed for force (P=0.021), motion (P=0.015), and time (P≤0.001) parameters. Conclusion: Acquired laparoscopic technical skills decreased 4 months after the basic laparoscopy course. Compared to baseline performance, participants showed significant improvement, however deterioration was observed compared to postcourse measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.