Defining the key skills required to perform advanced laparoscopic procedures: a qualitative descriptive study

Abstract

Background Simulation is widely used to teach and assess fundamental laparoscopic skills; however, program directors have reported that current simulation programs do not meet the needs for trainees and surgeons learning advanced laparoscopic procedures (ALP). The purpose of our study was to identify the key skills required to perform ALP, to serve as the basis to establish an advanced laparoscopic skills training program. Methods Semi-structured interviews were conducted with attending surgeons, fellows, and senior residents in general surgery, gynaecology, and urology. The questions were developed through an iterative process using relevant literature, expert opinions, and in consultation with a qualitative researcher. Interviews were conducted in person, over the phone, or by videoconference, and inductive thematic analysis was performed. Results 25 interviews were conducted with 16 attending surgeons and 9 fellows/residents from 9 institutions in Canada and USA. Twenty-one skills were identified to be important when performing ALP. The skills most commonly described by faculty were the following : (a) suturing, (b) dissection, (c) procedural expertise, (d) retraction and exposure, and (e) familiarity with relevant anatomy as viewed through the laparoscope. The skills most commonly described by trainees were the following: (a) suturing, (b) dissection, (c) procedural expertise, (d) trocar positioning, and (e) patient factors. There was a large difference between the importance the faculty attributed to the 'Retraction and Exposure' skill compared to the trainees. Conclusion This study identified key skills that are important when performing ALP. In order to address the current needs of trainees/surgeons learning ALP, this work provides the building blocks for the development of an advanced laparoscopic surgery simulation program.

Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape

“…Prior work has reported on the challenges of mastering the complexities of laparoscopic surgery [ 23 , 24 ]. Before achieving proficiency, surgeons performing laparoscopic surgery experience more blood loss, higher complication rates, longer operative times, and greater patient length of hospital stay [ 25 ].…”

Pilot Evaluation of a Novel, Low-Cost, Simulation Model for Training and Assessment of Laparoscopic Intracorporeal Continuous Suturing

“…Skills in laparoscopic surgery are gained throughout residency training, however, prior observational studies have shown that significant gaps remain by the end of residency training for more complex but still essential minimally invasive skills. 3,4 Laparoscopic suturing alone has been identified as a key barrier to widespread adoption of laparoscopic surgery despite evidence of better patient outcomes with minimally invasive approaches. 5 Barriers to skills acquisition in laparoscopic suturing include complexity of tasks, lack of regular exposure, and timing differences between clinical operative opportunity and simulation training.…”