Eur J Pediatr Surg 2023; 33(03): 228-233
DOI: 10.1055/a-1868-6050
Original Article

Learning of Intracorporal Knot Tying in Minimally Invasive Surgery by Video or Expert Instruction

Philipp Romero
1   Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
,
Annabelle Gerhaeuser
2   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
,
Leonie Carstensen
1   Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
,
Julia Kössler-Ebs
1   Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
,
Erica Wennberg
3   Lady Davis Institute for Medical Research, Jewish General Hospital/McGill University, Montréal, Quebec, Canada
,
Mona W. Schmidt
4   Department of Gynecology, University of Mainz, Mainz, Germany
,
Beat P. Müller-Stich
2   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
,
Patrick Günther
1   Department of Surgery, Division of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
,
Felix Nickel
2   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
› Author Affiliations

Abstract

Introduction Minimally invasive surgery skill laboratories are indispensable in training, especially for complex procedural skills such as intracorporal suturing and knot tying (ICKT). However, maintaining a laboratory is expensive, and specially trained teachers are in short supply. During the COVID-19 pandemic, in-person instruction has reduced to almost zero, while model learning via video instruction (VID) has become an integral part of medical education. The aim of this study was to compare the learning effectiveness and efficiency of ICKT by laparoscopically inexperienced medical students through video versus direct expert instruction.

Materials and Methods A secondary analysis of two randomized controlled trials was performed. We drew data from students who were trained in ICKT with expert instruction (EXP, n = 30) and from students who were trained via VID, n = 30). A laparoscopic box trainer including laparoscope was used for ICKT. Objective Structured Assessment of Technical Skills (OSATS), knot quality, and total ICKT time were the parameters for the assessment in this study. Proficiency criteria were also defined for these parameters.

Results Students in the EXP group performed significantly better in OSATS-procedure-specific checklist (PSC) and knot quality compared with students in the VID group, with no difference in task time. Of the students who reached the proficiency criteria for OSATS-PSC and knot quality, those in the EXP group required fewer attempts to do so than those in the VID group. Students in both groups improved significantly in all parameters over the first hour of evaluation.

Conclusion For the laparoscopically inexperienced, training in ICKT through expert instruction presents an advantage compared with video-based self-study in the form of faster understanding of the procedure and the associated consistent implementation of good knot quality. Both teaching methods significantly improved participants' ICKT skills.

Ethical Approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The studies were approved by the Local Ethics Committee at Heidelberg University (S-436/2018 and S-334/2011).




Publication History

Received: 19 March 2022

Accepted: 31 May 2022

Accepted Manuscript online:
03 June 2022

Article published online:
14 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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