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Sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying—a randomized controlled trial “The Shoebox Study” DRKS00008668

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Abstract

Purpose

Learning curves for minimally invasive surgery are prolonged since psychomotor skills and visuospatial orientation differ from open surgery and must be learned. This study explored potential advantages of sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying compared to simultaneous learning.

Methods

Laparoscopy-naïve medical students were randomized into a sequential learning group (SEQ) or a simultaneous learning group (SIM). SEQ (n = 28) trained on a shoebox with direct 3D view before proceeding on a box trainer with 2D laparoscopic view. SIM (n = 25) trained solely on a box trainer with 2D laparoscopic view. Training time and number of attempts needed were recorded until a clearly defined proficiency level was reached.

Results

Groups were not different in total training time (SEQ 5868.7 ± 2857.2 s; SIM 5647.1 ± 2244.8 s; p = 0.754) and number of attempts to achieve proficiency in their training (SEQ 44.0 ± 17.7; SIM 36.8 ± 15.6; p = 0.123). SEQ needed less training time on the box trainer with 2D laparoscopic view than did SIM (SEQ 4170.9 ± 2350.8 s; SIM 5647.1 ± 2244.8 s; p = 0.024), while the number of attempts here was not different (SEQ 29.9 ± 14.1; SIM 36.8 ± 15.6; p = 0.097). SEQ was faster in the first attempts on the shoebox (281.9 ± 113.1 s) and box trainer (270.4 ± 133.1 s) compared to the first attempt of SIM on the box trainer (579.4 ± 323.8 s) (p < 0.001).

Conclusion

In the present study, SEQ was faster than SIM at the beginning of the learning curve. SEQ did not reduce the total training time needed to reach an ambitious proficiency level. However, SEQ needed less training on the box trainer; thus, laparoscopic experience can be gained to a certain extent with a simple shoebox.

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Acknowledgments

We would like to thank Marion Link for her help with organizing this study.

Authors’ contributions

Study conception and design were done by Nickel, Müller-Stich, Fischer, Kenngott, Hendrie, Kowalewski, and Romero.

Acquisition of data was done by Nickel, Hendrie, Kowalewski, Mantel, and Garrow.

Analysis and interpretation of data were done by Bruckner, Nickel, Kowalewski, Kenngott, Fischer, Romero, and Müller-Stich.

Drafting of manuscript was done by Hendrie, Nickel, Kowalewski, Mantel, and Garrow.

Critical revision of manuscript was done by Müller-Stich, Romero, Bruckner, Fischer, and Kenngott.

Author information

Authors and Affiliations

  1. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Felix Nickel, Jonathan D Hendrie, Karl-Friedrich Kowalewski, Carly R Garrow, Hannes G Kenngott, Lars Fischer & Beat P Müller-Stich

  2. Institute for Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany

    Thomas Bruckner

  3. Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Maisha Mantel & Philipp Romero

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  1. Felix Nickel
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  10. Beat P Müller-Stich
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Corresponding author

Correspondence to Beat P Müller-Stich.

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Funding

This study was funded by the Heidelberg Foundation for Surgery.

Conflicts of interest

Felix Nickel received travel support by KARL STORZ and Johnson & Johnson. Jonathan D. Hendrie declares that he has no conflict of interest. Karl-Friedrich Kowalewski declares that he has no conflict of interest. Thomas Bruckner declares that he has no conflict of interest. Carly R. Garrow declares that she has no conflict of interest. Maisha Mantel declares that she has no conflict of interest. Hannes G. Kenngott declares that he has no conflict of interest. Philipp Romero declares that he has no conflict of interest. Lars Fischer declares that he has no conflict of interest. Beat P Müller-Stich declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies 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 or comparable ethical standards. The present study was approved by the local ethics committee at Heidelberg University (S-334/2011).

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Nickel, F., Hendrie, J.D., Kowalewski, KF. et al. Sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying—a randomized controlled trial “The Shoebox Study” DRKS00008668. Langenbecks Arch Surg 401, 893–901 (2016). https://doi.org/10.1007/s00423-016-1421-4

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