Prospective, Randomized, Double-Blind Trial of Curriculum-Based Training for Intracorporeal Suturing and Knot Tying

Background: Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic suturing and knot tying. Study Design: Senior surgery residents in a university-based general surgery residency program were prospectively enrolled and randomized to receive either a simulation-based laparoscopic suturing curriculum (TR group, n = 11) or standard clinical training (NR group, n = 11). During a laparoscopic Nissen fundoplication, placement of two consecutive intracorporeally knotted sutures was video recorded for analysis. Operative performance was assessed by two reviewers blinded to subject training status using a validated, error-based system to an interrater agreement of ≥ 80%. Performance measures assessed were time, errors, and needle manipulations, and comparisons between groups were made using an unpaired t-test. Results: Compared with NR subjects, TR subjects performed significantly faster (total time, 526 ± 189 seconds versus 790 ± 171 seconds; p < 0.004), made significantly fewer errors (total errors, 25.6 ± 9.3 versus 37.1 ± 10.2; p < 0.01), and had 35% fewer excess needle manipulations (18.5 ± 10.5 versus 27.3 ± 8.6; p < 0.05). Conclusions: Subjects who receive simulation-based training demonstrate superior intraoperative performance of a highly complex surgical skill. Integration of such skills training should become standard in a surgical residency's skills curriculum.