Basic laparoscopic suturing skills teachable in 3 hours, according to study

San Diego-Learning the skills required to execute basic laparoscopic sutures need not be a time-consuming, tedious exercise. Basic moves and skills can be acquired in as little as 3 hours, say researchers from the Ohio State University Medical Center, Columbus.

Compressing what previously had been a course spanning 2 days into a 3-hour course at the AUA annual meeting and evaluating the success of the condensed course was an idea conceived and accomplished by senior author Ronney Abaza, MD, associate professor of urology at Ohio State. Dr. Abaza learned laparoscopic suturing using a curriculum developed by James C. Rosser, Jr., MD, a bariatric surgeon and professor of clinical surgery, Morehouse School of Medicine, Atlanta, who was not involved with the study. Several years later, he 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.

“I learned laparoscopic suturing using Dr. Rosser’s validated technique more than 10 years ago. We decided to bring his training methodology to the urologic community 5 years ago by condensing his 2-day course to 3 hours. Since the first year we offered the course together, the course has been offered every year at the AUA with all urologist trainers,” Dr. Abaza told Urology Times.

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. These are the tasks that Dr. Abaza and his team presented to AUA members attending the 3-hour class.

“The learners try to suture as a baseline assessment, and then we spend the first 2 hours of the course teaching the three validated tasks (in laparoscopic suturing) and having them practice each one several times. We use the third hour to show them how to put the three tasks together,” Dr. Abaza explained. The tasks involved gripping a slender, colored string; picking up a tiny pyramid by a loop; and dropping a small bean in a cup without touching the sides.

“What we found when we evaluated their progress was beyond our expectations. In 3 hours, surgeons who had no previous experience with laparoscopic suturing were able to throw and tie sound sutures, often in 2 minutes or less,” added Dr. Abaza, who presented his findings at the AUA annual meeting in San Diego.

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. Three-fourths (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 at the beginning of the course. During the next 3 hours, they were introduced to the three tasks and at completion, their abilities were again evaluated.

82% completion rate after training

Initially, 39% of the participants completed the suture challenge in less than 4 minutes; the median time to completion was 2.6 minutes (range, 1–4 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 [p<.01]). The percentage of residents completing the suture challenge rose from 30% initially to 85% at the end of the course. The completion percentage of those who stated they were beginners or had no laparoscopic experience rose from 26% to 76%.

Dr. Abaza’s course began 5 years ago with 20 participants and has since expanded to 40, as limited by the availability of space and laparoscopic trainers. He also observed that the demographics are changing. Increasing numbers of foreign physicians are enrolling. Among the factors he thinks might be influencing this demographic shift is the growing number of robotic systems employed in the U.S. and the relative unavailability of the expensive robotic technology overseas.UT