Factors Influencing Performance in Laparoscopic Suturing and Knot Tying: A Cohort Study

Lina Armbrust; Moritz Lenz; Julia Elrod; Antonia Kiwit; Konrad Reinshagen; Johannes Boettcher; Michael Boettcher

doi:10.1055/s-0042-1742302

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2023; 33(02): 144-151
DOI: 10.1055/s-0042-1742302

Original Article

Factors Influencing Performance in Laparoscopic Suturing and Knot Tying: A Cohort Study

Lina Armbrust‡^*

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

,

Moritz Lenz‡^*

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

,

Julia Elrod

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

²Department of Pediatric Surgery, University Medical Center Mannheim, Germany

,

Antonia Kiwit

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

,

Konrad Reinshagen

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

,

Johannes Boettcher

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

³Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany

,

Michael Boettcher

¹Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany

³Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany

› Author Affiliations

Abstract

Background Laparoscopic suturing and knot tying are regarded as some of the most difficult laparoscopic skills to learn. Training is essential to reach proficiency, but available training opportunities are limited. Various techniques to improve training have been evaluated. It appears that individual-related factors affect initial performance and response to training. Thus, the current study aimed to assess factors influencing laparoscopic-suturing and knot-tying performances.

Methods All patients were trained one-on-one (teacher–student) for 3 hours. Patients were tested before training (bowel anastomosis model) and directly after training (congenital diaphragmatic hernia or esophageal atresia model) to evaluate transferability. Primary endpoints were time, knot quality, precision, knot strength, and overall laparoscopic knotting performance. Moreover, factors such as (1) age, (2) gender, (3) handedness, (4) previous training or operative experience, (5) playing an instrument, (6) sportive activities, and (7) computer gaming which may influence the primary endpoints were assessed.

Results In total, 172 medical students or novice surgical residents were included. Training significantly improved all outcome parameters assessed in the current study. More than 50% of the patients reached proficiency after 3 hours of training. Personal factors like operative experience, playing music instruments, sportive activities, and computer gaming affected some outcome parameters. Handedness and gender affected initial performance but differences partially subsided after training. Younger participants showed a much better response to training.

Conclusion In conclusion, several factors influence initial performance and response to the training of laparoscopic suturing and knot tying. Surgeons who want to improve their laparoscopic performance, should concentrate on playing a musical instrument and performing sports rather than playing videos gaming. It appears that training is a key and more practice opportunities should be incorporated into medical school and surgical curricula. Moreover, handedness may affect the outcome but only if the training concepts are not tailored to the dominant hand of the surgeon. Future training and surgical curricula should adapt to this and tailor their concepts accordingly.

Keywords

spaced learning - laparoscopy - suturing - surgery - training - halsted - peyton

Full Text

References

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