Lap mini-residency hones post-grad surgical skill

Orange, CA-A dedicated laparoscopic training program has been shown to offer an excellent start to postgraduate urologists in performing laparoscopic urologic procedures. However, participants are unlikely to sustain the skills acquired in this intensive 5-day training program unless they incorporate laparoscopic procedures into their practice. Further, being able to work with a team of urologists immediately after completing this training also bolsters the learning curve.

"All of these [laparoscopic and robotic] procedures are surgeries that are here to stay. My philosophy is to train people for the most complex procedures," senior author Elspeth McDougall, MD, who heads the training program at the Astellas Center for Urological Education at the University of California, Irvine Medical Center, said in an interview with Urology Times.

Training is held at the Astellas Center and UCI Medical Center.

Participants' performance was measured in open, laparoscopic, and robotic surgery before they entered and after they completed the training program, using the Objective Structured Assessment of Technical Skill, which is administered by an experienced observer. Scores were analyzed using the paired sample t-test and analysis of variance at a confidence level of ≤.05.

Skills improve, some significantly

Overall, Dr. McDougall noted that open skill task scores were all significantly higher, both before and after the mini-residency training, compared with the laparoscopic and robot-assisted laparoscopic skill task scores. The participants found performing robotic surgery was easier than performing laparoscopic surgery was because it "is totally intuitive and 3-dimensional."

Ring transfer skills improved significantly from day 1 to day 5 for both robotic and laparoscopic skill testing (p=.0001), and both laparoscopic and robotic ring transfer skills each improved by 10%. However, out of a maximum score of 48, ring transfer scores rose to 43.4±7.6 for robotic versus 33.2±12.3 for laparoscopic format testing (p=.0001).

The cutting skill task scores again showed the robotic scores to have a higher degree of improvement than did those for the laparoscopic format. With a maximum possible score of 72, cutting skill scores were 68.1±8.9 for open procedures, 27.8±12.8 for robotic procedures, and 20±11.2 for laparoscopic procedures (p=.001).

The suture threading skill task also proved challenging. With a maximum possible score of 44, suture threading using the robot significantly improved from 21.1±11.6 to 25.8±13.1 (p=.01). The laparoscopic suture threading scores were lower overall: 2.5±2.8 on day 1 versus 4.2±3.9 on day 5 (p=.001).