AUA 2013: Lap suturing skills: Can they be taught in 3 hours?

Basic laparoscopic suturing moves and skills can be acquired in as little as 3 hours, say researchers from the Ohio State University Medical Center, Columbus.

Condensing what previously had been a course spanning 2 days into a 3-hour course and evaluating the success of the condensed course was an idea conceived and accomplished by senior author Ronney Abaza, MD. Dr. Abaza learned laparoscopic suturing using a curriculum developed by James C. Rosser, Jr., MD, of Morehouse School of Medicine, Atlanta, who was not involved with the current study. Several years later, Dr. Abaza learned how to teach the skill under Dr. Rosser by assisting in administering what at the time was a 2-day course that had been used to train more than 5,000 learners.

Dr. Abaza explained that Dr. Rosser developed the curriculum in the early 1990s from an initial 10 basic skills he thought would allow a surgeon to learn laparoscopic suturing. After training many surgeons with these tasks and validating the curriculum, Dr. Rosser found that only three of these hand-eye-instrument exercises were needed before trainees could be introduced to his method of suturing.

“Dr. Rosser believed that any learner, even non-surgeons, can acquire the ability to suture by learning these three tasks. He made what seemed to be a complex and difficult-to-learn skill easy and reproducible,” said Dr. Abaza.

Dr. Abaza and his colleagues evaluated the course curriculum by assessing the performance of 144 course participants, 110 (76%) of whom provided demographic information. Among those in the study were 73 practicing urologists, nine fellows, and 21 residents. Some 75% said they were beginners or had no laparoscopic experience.

The participants were given 4 minutes to throw one interrupted suture with one surgeon’s knot followed by two square knots. During the next 3 hours, they were introduced to three separate laparoscopic tasks intended to challenge and build manual dexterity, and at completion, their abilities were again evaluated.

Initially, 39% of the participants completed the suture challenge in less than 4 minutes; the median time to completion was 2.6 minutes (range, 1.0–4.0 minutes). At the completion of 3 hours of training and practice, 82% were able to complete the challenge. The median best completion time was 2.2 minutes (range, 0.8–3.9 minutes, p<.01).