The Importance of Stressing the Use of Laparoscopic Instruments in the Initial Training for Laparoscopic Surgery Using Box Trainers: A Randomized Control Study

Background. The goal of this study was to improve the efficiency of initial box training for laparoscopic surgery. Materials and Methods. The study used the following task: suturing and knot tying task under a combination of four conditions. (1) The C (use of conventional instruments)-D (direct vision); (2) the C-V (indirect vision via a video monitor); (3) the L (use of laparoscopic instruments)-D; and (4) the L-V (the standard laparoscopic suturing and knot tying). The first study assessed 11 medical students undergoing L-V training. The time to complete each of the four assessment tasks was recorded pre- and post-training. The second study was a randomized, controlled trial involving 36 students grouped according to three types of training methods: the L-D, the C-V, and the L-V group. The improvement in the time to complete the L-V task was assessed and the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD) was used for assessment as well. Results. In the first study, a significant improvement in the performance time between pre- and post-training for the L-D task was found, but not for the C-V task. The second study found that the improvement rate of the L-D trained group was significantly greater than that of the C-V and L-V groups. The HUESAD assessment also showed the similar results. Conclusions. A training program stressing the use of laparoscopic instruments and compensating for the fulcrum effect is more effective for novices using box trainers in the initial laparoscopic surgery instruction than one emphasizing performing the tasks via a video monitor. (C) 2012 Elsevier Inc. All rights reserved.