M. C. Mora1, K. E. Wong1, G. L. Fernandez1, M. V. Tirabassi2 1Baystate Medical Center,Surgery,Springfield, MA, USA 2Baystate Children’s Hospital,Pediatric Surgery,Springfield, MA, USA
Introduction:
The SAGES Fundamentals of Laparoscopic Surgery (FLS) program has shown to be a reliable marker of performance in the operating room when compared to performance in simulation. Currently no validated program exists to evaluate skills for single incision laparoscopy (SIL), thus we are unable to test proficiency in SIL. With experience, certain psychomotor skills should translate from standard laparoscopy to SIL. We proposed to compare all PGY levels and determine if experience translated to improved SIL skills.
Methods:
Surgical residents of all PGY levels at our institution were included in this study and grouped based on clinical PGY level. Baseline survey was obtained to determine resident level exposure to both SIL and standard laparoscopic cases. Participants performed the following tasks: running of the bowel, endoloop placement, extracorporeal suture tying, and intracorporeal suture tying. All tasks were performed on a commercially provided simulated organ model. Participants were given five-minutes to complete each task. All data was collected and analyzed by an impartial certified FLS proctor. Data were analyzed using chi-square test.
Results:
A total of 31 residents participated in the study (PGY5- 4, PGY4- 4, PGY3- 6, PGY2- 6, PGY1- 11). Overall, there was minimal SIL exposure among all residents; only one resident had greater than 10 assisted SIL cases. As expected, PGY level correlated with increased ability to complete the tasks within the allotted time. There was a statistically significant difference in the percentage of individuals able to complete a task based on PGY level for all given tasks (p<0.0001). With increased difficulty, the percentage of higher-level residents able to complete the task decreased. Only one individual in the PGY-3 level was able to complete the intracorporeal suture task, highlighting its difficulty in SIL.
Conclusion:
Certain psychomotor skills appear to translate to SIL skills. In our program there is no specific SIL training provided in the simulation center and exposure in the operating room is rare. With increased post-graduate training experience, SIL performance improves. However, further dedicated SIL training is required to better develop surgical skills devoted to this field, such as intracorporeal suturing.